Left atrial radiofrequency ablation during mitral valve surgery: a prospective randomized multicentre study (SAFIR).

Background: Randomized studies evaluating left atrial radiofrequency ablation (RFA) in patients with persistent atrial fibrillation undergoing mitral valve surgery are scarce and monocentric.

Aim: To evaluate the efficacy of left atrial RFA concomitant with mitral valve surgery to restore and maintain sinus rhythm.

Methods: The SAFIR is a multicentre, double-blinded, centrally randomized study involving four university hospitals.

[Patients' and physicians' perceptions on participation in a clinical trial: results on a survey in a French hospital].

Objectives: We report the first survey on French physicians and patients participating to assess motivations prior enrolment and benefits and constraints perceived after participation.

Method: Twenty physicians were interviewed and 37 patients completed a questionnaire during clinical study participation.

Results: If the main patient's motivation is altruistic, physician wish their own patient feel better.

[Perceptions of patients and physicians involved in clinical trials: an overview of the literature].

Unlabelled: OBJECTIVE - METHOD: The purpose of this review is to explore the expectations of patients and physicians prior to participate to a clinical trial and their positive or negative experiences after participating. A systematic review of Medline database from 1966 to 2005 identified 79 papers reported patients and physicians perceptions of clinical trials (only 3 in French), whom 27 English surveys conducted on patients and physicians.

Results: If primary patients' motivation for enrolment was altruistic, physicians wish to help their patient.

Beat-to-beat variations of the electrocardiogram in survivors of sudden death without structural heart disease.

Aim: We sought to determine whether survivors of sudden death without structural heart disease have beat-to-beat electrocardiographic (ECG) characteristics at the microvolt and at the millisecond level that differ from normal subjects.

Methods: We studied patients at our implantable cardioverter defibrillator clinic who had been resuscitated from ventricular fibrillation with no evidence of underlying structural heart disease. Continuous 10-minute high-resolution unfiltered digital surface ECGs at 1000-Hz sampling rate were acquired in these subjects and in a group of healthy volunteers.

Wavelet transform for analysis of heart rate variability preceding ventricular arrhythmias in patients with ischemic heart disease.

Introduction: Studies evaluating changes in HRV preceding the onset of ventricular arrhythmias using conventional techniques have shown inconsistent results. Time-frequency analysis of HRV is traditionally performed using short-term Fourier transform (STFT). Wavelet transform (WT) may however be better suited for analyzing non-stationary signals such as heart rate recordings.

Significance of serum troponin I elevation in patients with acute aortic dissection of the ascending aorta.

Objective: This study evaluated the prevalence of increased cardiac troponin I (cTnI) in patients with acute aortic dissection of the ascending aorta (type A).

Methods And Results: In 119 consecutive patients with type A acute aortic dissection, serum cardiac troponin I was measured along with clinical, haemodynamic, electrocardiographic and echocardiographic variables obtained on admission. Cardiac troponin I was positive in 28 patients (23.

Is primary angioplasty more effective than prehospital fibrinolysis in diabetics with acute myocardial infarction? Data from the CAPTIM randomized clinical trial.

Aims: The CAPTIM study randomized patients managed within 6 h of acute ST-segment elevation myocardial infarction to primary angioplasty or prehospital fibrinolysis (rt-PA), with immediate transfer to a centre with interventional facilities. It found a similar incidence of the primary endpoint of death, recurrent MI, or stroke at 30 days with both strategies. We report here the outcome in the diabetic subgroup.

Primary angioplasty is cost-minimizing compared with pre-hospital thrombolysis for patients within 60 min of a percutaneous coronary intervention center: the Comparison of Angioplasty and Pre-hospital Thrombolysis in Acute Myocardial Infarction (CAPTIM) cost-efficacy sub-study.

Objectives: This ancillary study of the Comparison of Angioplasty and Pre-hospital Thrombolysis in Acute Myocardial Infarction (CAPTIM) trial sought to assess the cost-efficacy ratio of primary coronary angioplasty (PCA) and pre-hospital thrombolysis (PHT) in patients suffering from an acute myocardial infarction (AMI) (<6 h) close to (<60 min journey) a percutaneous coronary intervention (PCI) center.

Background: In the CAPTIM study, at 30 days follow-up PCA was as equally effective as PHT with rescue angioplasty if needed. The cost efficacy of these two strategies has not yet been compared.

Perioperative outcome and long-term survival of surgery for acute post-infarction mitral regurgitation.

Objective: To determine factors predictive of mortality in patients undergoing emergency mitral valve surgery in the setting of severe post-infarction regurgitation.

Methods: Patients admitted for an acute myocardial infarction who required urgent mitral valve surgery for severe regurgitation were studied. Factors predictive of outcome were analysed.

Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty: data from the CAPTIM randomized clinical trial.

Background: CAPTIM was a randomized trial comparing prehospital thrombolysis with transfer to an interventional facility (and, if needed, percutaneous intervention) with primary percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction (STEMI). Because the benefit of thrombolysis is maximal during the first 2 hours after symptom onset, and because prehospital thrombolysis can be implemented earlier than PCI, this analysis studied the relationship between the effect of assigned treatment and the time elapsed from symptom onset.

Methods And Results: Randomization within 2 hours (n=460) or > or =2 hours (n=374) after symptom onset had no impact on the effect of treatment on the 30-day combined primary end point of death, nonfatal reinfarction, and disabling stroke.

Dronedarone for prevention of atrial fibrillation: a dose-ranging study.

Aims: Dronedarone, a benzofurane derivative without iodine substituents, shares the electrophysiologic properties of amiodarone. This study was designed to determine the most appropriate dose of dronedarone for prevention of atrial fibrillation (AF) after cardioversion.

Methods And Results: Patients with persistent AF were randomly allocated to 800, 1200, 1600 mg daily doses of dronedarone or placebo.

QT dynamicity and sudden death after myocardial infarction: results of a long-term follow-up study.

Introduction: The aim of this study was to determine whether impaired adaptation of the QT interval to changes in heart rate predicts sudden death after an acute myocardial infarction.

Methods And Results: The Groupe d'Etude du Pronostic de l'Infarctus du Myocarde (GREPI) trial was a prospective multicenter study designed to evaluate the long-term outcome of myocardial infarction. QT dynamicity was evaluated in 265 patients by analyzing 24-hour Holter recordings obtained 9 to 14 days after myocardial infarction.

Amiodarone versus placebo and class Ic drugs for cardioversion of recent-onset atrial fibrillation: a meta-analysis.

Objectives: This meta-analysis compared amiodarone with placebo and class Ic drugs for the cardioversion of recent-onset atrial fibrillation (AF), defined as lasting less than seven days.

Background: Despite the lack of trials that support its efficacy convincingly, amiodarone is widely used for conversion of recent-onset AF.

Methods: We searched Medline and EMBASE databases, as well as the Cochrane Controlled Trials Register for randomized trials on recent-onset AF comparing amiodarone to placebo or class Ic drugs.

Cardiac phantom measurement validating the methodology for a cardiac multi-centre trial with positron emission tomography.

In an ongoing international multi-centre trial, positron emission tomography (PET) is being used to evaluate the effect of a new P-selectin antagonist on the infarct size in patients with acute myocardial infarction, treated with thrombolysis. Although it is possible to correct for site-dependent factors, it is desirable to reduce these factors to a minimum. Therefore, acquisition and reconstruction protocols have been defined that can be closely followed by all participating centres.

Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomised study.

Background: Although both prehospital fibrinolysis and primary angioplasty provide a clinical benefit over in-hospital fibrinolysis in acute myocardial infarction, they have not been directly compared. Our aim was to find out whether primary angioplasty was better than prehospital fibrinolysis.

Methods: We did a randomised multicentre trial of 840 patients (of 1200 planned) who presented within 6 h of acute myocardial infarction with ST-segment elevation, initially managed by mobile emergency-care units.