Omega-3 and Risk of atrial fibrillation: Vagally-mediated double-edged sword.

Objective: Studies regarding effects of omega-3 fatty acids, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on risk of atrial fibrillation (AF) have reported discordant results. The aim of this review is to clarify effects of marine omega-3 intake on risk of AF.

Patients And Methods: A PubMed search was performed using terms: atrial fibrillation, omega-3, EPA, DHA, vagal tone.

Hidden in Plain Sight-An Unusual Case of Acute-onset Persistent Dyspnea.

Pacemaker (PM) syndrome is an uncommon complication after PM or defibrillator implant in patients with long-standing persistent atrial fibrillation. We present a case where an unexpected and unrecognized improvement in a comorbid condition paradoxically led to worsened symptoms, ie, acute-onset persistent dyspnea, in a patient with a single-chamber implantable cardiac defibrillator. A careful review of clinical data led to diagnosis and successful treatment.

How to Perform a Completely Fluoroless Ablation.

Radiation exposure related to electrophysiology catheter ablation procedures carries small but non-negligible stochastic and deterministic effects on health. Lead aprons can also place considerable pressure on the spinal column, resulting in potentially detrimental consequences. Fortunately, however, advancements in tools used for arrhythmia mapping and ablation have made it feasible to reduce or essentially eliminate the need for fluoroscopy, with no impact on the efficacy or safety of such procedures, as demonstrated by several long-term outcome studies.

Wearable Devices for Remote Monitoring of Heart Rate and Heart Rate Variability-What We Know and What Is Coming.

Heart rate at rest and exercise may predict cardiovascular risk. Heart rate variability is a measure of variation in time between each heartbeat, representing the balance between the parasympathetic and sympathetic nervous system and may predict adverse cardiovascular events. With advances in technology and increasing commercial interest, the scope of remote monitoring health systems has expanded.

Left Atrial Appendage Closure in a Patient With a Patent Foramen Ovale Septal Occluder Device.

Left atrial appendage closure (LAAC) has evolved as a safe alternative to oral anticoagulation therapy for stroke prophylaxis. However, the presence of a patent foramen ovale (PFO) occluder device is considered a relative contraindication. Here we report a successful case of LAAC in the presence of a PFO occluder device.

Spontaneous Pothole Cardioversion of a Wide Complex Tachycardia.

External mechanical forces, if properly timed and of sufficient energy, have rarely been reported to convert tachyarrhythmias to sinus rhythm. We report a case of a patient with a wide-complex tachycardia that spontaneously converted to sinus rhythm after an ambulance ran over a pothole during emergency transport to the hospital. ().

Causes and Predictors of 30-Day Readmission in Patients With Syncope/Collapse: A Nationwide Cohort Study.

Background Syncope accounts for 0.6% to 1.5% of hospitalizations in the United States.

Meta-analysis of randomized controlled trials on atrial fibrillation ablation in patients with heart failure with reduced ejection fraction.

Background: The role of catheter ablation (CA) is increasingly recognized as a reasonable therapeutic option in patients with atrial fibrillation (AF) and heart failure (HF).

Hypothesis: We aimed to compare CA to medical therapy in AF patients with HF with reduced ejection fraction (HFrEF).

Methods: We searched the literature for randomized clinical trials comparing CA to medical therapy in this population.

Meta-analysis of Risk of Ventricular Arrhythmias After Improvement in Left Ventricular Ejection Fraction During Follow-Up in Patients With Primary Prevention Implantable Cardioverter Defibrillators.

Implantable cardioverter defibrillators (ICDs) reduce the risk of sudden cardiac death in patients with impaired left ventricular ejection fraction (LVEF). However, there are limited data on the long-term benefit of ICD therapy in patients whose LVEF subsequently improves. We conducted a meta-analysis to evaluate the effect of LVEF improvement on ICD therapy during follow-up.

Premature ventricular contraction-induced cardiomyopathy.

Premature ventricular contractions are of common occurrence in routine clinical practice. Though generally perceived as of benign consequence in healthy people in the absence of heart disease, their presence can be a harbinger of fatal ventricular tachyarrhythmia in individuals with structural heart disease. With some of the latest insights into the treatment of ventricular tachyarrhythmia, especially with the advent of catheter ablation, there has been renewed interest in premature ventricular contractions, not only as a predictor of arrhythmia, but also for their potential etiological association with cardiomyopathy.

Prolonged QTc interval and torsades de pointes induced by citalopram.

Citalopram is a selective serotonin reuptake inhibitor with a favorable cardiac-safety profile. Corrected QT interval (QTc) prolongation and cardiac arrhythmias have not been previously reported in association with citalopram use except in the presence of overdose, abnormal electrolyte values, or renal or liver failure. Herein, we report the case of a 40-year-old woman with mental depression who presented with a prolonged QTc interval and torsades de pointes after the initiation of citalopram at therapeutic doses.

Use of the Impella microaxial blood pump for ablation of hemodynamically unstable ventricular tachycardia.

Ablation for ventricular tachycardia remains a challenge with suboptimal procedural success rates. One of the major causes of difficulty is precipitous hypotension when ventricular tachycardia is induced precluding even rapid mapping of the arrhythmia. We report the successful use of the Impella microcirculatory axial blood flow pump in 3 patients with hemodynamically unstable ventricular tachycardia that allowed successful completion of the procedure.

Statins as antiarrhythmics: a systematic review part I: effects on risk of atrial fibrillation.

Background: Recent studies have demonstrated that statins may possess antiarrhythmic properties in addition to their lipid-lowering effects.

Methods: Studies which reported the association of statins with the incidence of atrial arrhythmias were identified through a systematic review of published literature.

Results: One randomized, placebo-controlled trial of 200 patients undergoing cardiac surgery showed that atorvastatin decreased the incidence of postoperative atrial fibrillation by 61%.

Statins as anti-arrhythmics: a systematic review part II: effects on risk of ventricular arrhythmias.

Background: Recent studies have demonstrated that statins may possess anti-arrhythmic properties in addition to their lipid-lowering effects.

Methods: Studies which reported the association of statins with the incidence of ventricular arrhythmias were identified through a systematic review of the published literature.

Results: Statins have been associated with a significant reductions in ventricular arrhythmia in cardiomyopathy patients with an implantable cardioverter defibrillator, although randomized trials have not been completed.

The role of renin-angiotensin-aldosterone system-based therapy in diabetes prevention and cardiovascular and renal protection.

Hypertension increases the risk of type 2 diabetes mellitus (T2DM) and cardiovascular disease. In addition to lowering blood pressure, blockade of the renin-angiotensin-aldosterone system (RAAS) reduces the risk of new-onset T2DM and offers renal protection. Using a MEDLINE search, we identified multiple trials that reported the incidence of T2DM in patients taking inhibitors of RAAS.

Rapid bioprosthetic valve degeneration resulting in severe mitral stenosis.

A 61-year-old man presented 9 months after bioprosthetic mitral valve implantation with progressive exertional dyspnea. Transesophageal echocardiography revealed severe mitral stenosis with diffuse leaflet thickening but no calcification. Subsequent pathologic examination of the valve demonstrated infiltrating fibroconnective tissue and chronic inflammation.

Coronary artery disease prognosis and C-reactive protein levels improve in proportion to percent lowering of low-density lipoprotein.

This editorial outlines the data supporting aggressive lipid goals and options for treating low-density lipoprotein (LDL) cholesterol to a range of approximately 30 to 70 mg/dl. The physiologically normal cholesterol range is approximately 30 to 70 mg/dl for native hunter-gatherers, healthy human neonates, free-living primates, and virtually all wild mammals. Randomized statin trials in patients with recent acute coronary syndromes and stable coronary artery disease have demonstrated that cardiovascular events are reduced and cardiovascular survival optimized when LDL cholesterol is reduced to <70 mg/dl.

Effects of omega-3 fatty acids on resting heart rate, heart rate recovery after exercise, and heart rate variability in men with healed myocardial infarctions and depressed ejection fractions.

We explored possible mechanisms by which recommended intakes of omega-3 fatty acids may decrease the risk for sudden cardiac death in patients with documented coronary heart disease. The cardioprotective effects of omega-3 fatty acids have been documented in epidemiologic and randomized controlled trials. These fatty acids are presumed to decrease susceptibility to fatal arrhythmias, but whether this is mediated by classic risk factors or direct cardiac mechanisms is not known.

Personal health habits of American cardiologists.

This study surveyed all cardiologists in a large coalition of cardiology groups. A 1-page, 25-item anonymous questionnaire containing 3 sections (demographics, medical history, and current medications and supplements) was used. Data from returned questionnaires were analyzed and compared with those in national databases.

Low rates of exercise in patients with metabolic syndrome after an acute coronary syndrome.

Background: Metabolic syndrome (MetSyn) has reached epidemic proportions; however, regular exercise can prevent its progression to type 2 diabetes.

Hypothesis: The study was undertaken to determine both the rate and predictors of routine exercise 1 year after an acute coronary syndrome (ACS) in patients with MetSyn.

Methods: In a registry of 1,199 patients presenting with ACS, those with MetSyn were identified using the modified NCEP-ATP III criteria.

Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for prevention of type 2 diabetes: a meta-analysis of randomized clinical trials.

Objectives: We sought to investigate the role of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in preventing the new onset of type 2 diabetes mellitus.

Background: Diabetes is a public health problem of epidemic proportions and its prevalence is on the rise. The typical American born today has a one in three chance of developing type 2 diabetes.

Strategies to prevent type 2 diabetes.

Type 2 diabetes mellitus is a public health problem of epidemic proportions and its prevalence is on the rise. The typical American born today has a one in three chance of developing type 2 diabetes. This diagnosis is associated with an adverse cardiovascular prognosis and is considered the risk equivalent of established coronary disease.