Flecainide: Current status and perspectives in arrhythmia management.

Flecainide acetate is a class IC antiarrhythmic agent and its clinical efficacy has been confirmed by the results of several clinical trials. Nowadays, flecainide is recommended as one of the first line therapies for pharmacological conversion as well as maintenance of sinus rhythm in patients with atrial fibrillation and/or supraventricular tachycardias. Based on the Cardiac Arrhythmia Suppression Trial study results, flecainide is not recommended in patients with structural heart disease due to high proarrhythmic risk.

Economic evaluation of dabigatran etexilate in the management of atrial fibrillation in Greece.

Introduction: The objective of the present study was to evaluate, from an economic perspective, dabigatran etexilate in comparison to existing pharmaceutical therapeutic options available for the protection of moderate-to-high risk patients with non-valvular atrial fibrillation from cardioembolic risk.

Methods: An existing Markov model was adapted to the Greek setting to reflect the natural course of the disease and the management of patients with different therapies. The model predicts health and economic outcomes and the implications for the social security system during the course of a patient's lifetime.

Correlation of mechanical dyssynchrony with QRS duration measured by signal-averaged electrocardiography.

Background: Preimplantation left ventricular dyssynchrony is considered a prerequisite for a beneficial response to cardiac resynchronization therapy (CRT). However, electrical dyssynchrony estimated by QRS duration (QRSd) on ECG has not been proven to be an optimal surrogate of mechanical dyssynchrony. We evaluated the correlation of mechanical dyssynchrony with QRSd as measured by signal-averaged electrocardiography (SAECG) in comparison with measurements based on conventional surface ECG and with onscreen measurements based on digital ECG.

Duration of treadmill exercise testing combined with QRS score predicts adverse cardiac outcome at long-term follow-up.

Objective: Total exercise duration and abnormal QRS score values are treadmill exercise testing (TET) prognostic parameters that have been shown to be significantly and independently associated with cardiac mortality. We evaluated the prognostic value of a new index (M score, Michaelides score) incorporating TET duration and QRS score values in a simple index.

Methods: In this study, we included 626 patients, who underwent TET and coronary arteriography.

Intracardiac echocardiography-facilitated ablation of a left-lateral bypass tract in a patient with atrial septal aneurysm.

Intracardiac echocardiography (ICE) has been used as an adjunctive tool during electrophysiological procedures, mainly to increase the safety of transseptal puncture. We present the case of a young patient with a left-lateral bypass tract and atrial septal aneurysm, in whom ICE delineated the underlying anatomy, excluded the presence of thrombus and facilitated access to the left atrium through a small atrial septal defect, avoiding the risk of needle puncture for interatrial septal crossing.

Correlation of modification of heart rate recovery with adaptation to myocardial ischemia in a model of sequential exercise testings.

Background: Heart rate recovery (HRR) has been identified as a reliable predictor of cardiac mortality, correlated with autonomic tone. In a model of sequential exercise testings, we investigated the reproducibility of HRR and the association between HRR modification and myocardial adaptation to ischemia.

Methods: We studied 128 patients (mean age 62 +/- 9 years, 83% males) with angiographically documented coronary artery disease (CAD) and a first positive exercise testing, who agreed to undergo a second exercise testing after 24 hours.

Modification of cardiometabolic risk through cannabinoid type-1 receptor antagonism.

Large-scale epidemiological studies show that hypertension, diabetes, and dyslipidaemia are highly prevalent among obese individuals. Regrettably, preventive efforts have failed to abolish the increasing prevalence of obesity worldwide. The endocannabinoid system is implicated in the regulation of appetite, food intake, lipids, and glucose metabolism.

Alternate site pacing in patients at risk for heart failure.

Cardiac pacing from the right ventricular apex is the most common site of cardiac pacing. During the last decade, several studies demonstrated the harmful effects of the iatrogenic left bundle branch block, which is observed in cardiac pacing from the right ventricular apex. These observations led to an interest in alternative right ventricular pacing sites aiming to achieve a more "physiological" pattern of ventricular activation.

Association of the 894G>T polymorphism in the endothelial nitric oxide synthase gene with risk of acute myocardial infarction.

Background: This study was designed to investigate the association of the 894G>T polymorphism in the eNOS gene with risk of acute myocardial infarction (AMI), extent of coronary artery disease (CAD) on coronary angiography, and in-hospital mortality after AMI.

Methods: We studied 1602 consecutive patients who were enrolled in the GEMIG study. The control group was comprised by 727 individuals, who were randomly selected from the general adult population.

QRS score improves diagnostic ability of treadmill exercise testing in women.

Objective: The accuracy of treadmill exercise testing to detect coronary artery disease is limited in women. This study was undertaken to evaluate whether QRS score can improve the accuracy of treadmill exercise testing in women.

Methods: The study population consisted of 114 women with angina-like symptoms, who underwent both treadmill exercise testing and coronary angiography.

Multiple cardiac metastases from a malignant melanoma.

Metastatic tumors in the pericardium or the heart are more common than primary tumors and their incidence has increased during the last decades due to the prolonged survival of patients with cancer and the increased prevalence of the disease in the general population. We present the case of a 36-year-old patient admitted to our hospital due to fatigue, dyspnea, and episodes of dizziness and fainting during the last month. He had a history of a malignant skin melanoma surgically removed 4 years ago.

Hypertensive patients with false-positive thallium-201 scintigraphic results in the infero-posterior wall are in high risk for coronary artery disease development.

Background: It has been previously postulated that Thallium-201 (Tl201) scintigraphy is characterized by relatively low specificity in hypertensive patients. This study was undertaken to assess any possible influence of false-positive scintigraphic results on the prognosis of hypertensive patients.

Methods: The study group comprised 179 consecutive hypertensive patients (128 men and 51 women), aged 50+/-7 years, who underwent exercise Tl(201) scintigraphy and coronary angiography (patients with normal scintigraphic results underwent coronary angiography due to persistent angina-like symptoms).

Significance of QRS duration changes in the evaluation of ST-segment depression presenting exclusively during the postexercise recovery period.

Background: The aim of this study was to evaluate the contribution of QRS prolongation in the diagnosis of coronary artery disease (CAD) in patients with exercise-induced ST-segment depression exclusively during the recovery period.

Methods: The study population consisted of 107 patients (90 males and 17 females) aged 39-70 (mean 59 +/- 7) years who underwent a treadmill exercise test using Bruce protocol and presented ST-segment depression limited to the recovery period. Angiographic data were available for all studied patients.

The aortic distensibility alteration is an index of influence of ischemic preconditioning to myocardial performance.

Background: Ischemic preconditioning (IP) is a cardioprotective phenomenon, induced by brief episodes of myocardial ischemia, which is supposed to affect not only the myocardium, but also the entire cardiovascular system. Considering that patients with coronary artery disease (CAD) have also been described to present impaired aortic mechanical properties, we tried to investigate the possible influence of the late phase of IP on aortic distensibility in patients with CAD.

Methods: Fifty patients, aged 48 to 72 (mean, 57+/-6 years), with angiographically confirmed CAD and exercise-induced myocardial ischemia, underwent two treadmill exercise testings (ETs).

Role of right-sided chest leads in the detection of multivessel coronary artery disease in patients with extended Q-wave anterior myocardial infarction.

Objective: To evaluate the improvement of diagnostic ability of exercise testing to detect multivessel coronary artery disease in patients with extended Q-wave anterior myocardial infarction, using additional right-sided chest leads.

Methods: Fifty-two consecutive patients with Q-wave anterior myocardial infarction underwent exercise testing, using the standard 12 and the additional right-sided (V3R, V4R, V5R) chest leads, thallium-201 scintigraphy and coronary arteriography.

Results: Twenty-one (40%) patients had one-vessel disease, 18 (35%) had two-vessel disease and 13 (25%) had three-vessel disease.

Wide-QRS-complex tachycardia with a negative concordance pattern in the precordial leads: Are the ECG criteria always reliable?

We present a case of wide-complex tachycardia with negative concordance in the precordial leads and a qR pattern in V6, in a 42-year-old man with risk factors for coronary artery disease, in whom the electrocardiogram criteria were apparently fallible. This case highlights the key contribution of the electrophysiological study in rendering correct diagnosis.

The prognostic value of a QRS score during exercise testing.

Background: Values of a QRS score have been positively related to the number of narrowed coronary arteries and to the extent of myocardial ischemia in radionuclide imaging techniques.

Hypothesis: This study was conducted to evaluate the potential prognostic information of abnormal values of this QRS score during treadmill exercise testing in patients with established coronary artery disease (CAD).

Methods: In all, 309 patients (258 men, 51 women, mean age 56.

Ocular trauma in a Greek population: review of 899 cases resulting in hospitalization.

Purpose: To determine the annual hospitalization rate and risk factors of eye injuries requiring hospitalization in an area of Greece.

Methods: Retrospective case analysis of 899 consecutive patients with ocular injury admitted at the Department of Ophthalmology, University Hospital at Patras Medical School, Greece, over a 9-year period.

Results: The average annual rate of hospitalized ocular injuries was 71.