Abstract:
OBJECTIVE:To review the literature systematically to determine whether noninvasive or invasive risk stratification, such as with an electrophysiological study of patients with asymptomatic pre-excitation, reduces the risk of arrhythmic events and improves patient outcomes. METHODS:PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (all January 1, 1970, through August 31, 2014) were searched for randomized controlled trials and cohort studies examining noninvasive or invasive risk stratification in patients with asymptomatic pre-excitation. Studies were rejected for low-quality design or the lack of an outcome, population, intervention, or comparator of interest or if they were written in a language other than English. RESULTS:Of 778 citations found, 9 studies met all the eligibility criteria and were included in this paper. Of the 9 studies, 1 had a dual design-a randomized controlled trial of ablation versus no ablation in 76 patients and an uncontrolled prospective cohort of 148 additional patients-and 8 were uncontrolled prospective cohort studies (n=1,594). In studies reporting a mean age, the range was 32 to 50 years, and in studies reporting a median age, the range was 19 to 36 years. The majority of patients were male (range, 50% to 74%), and <10% had structural heart disease. In the randomized controlled trial component of the dual-design study, the 5-year Kaplan-Meier estimates of the incidence of arrhythmic events were 7% among patients who underwent ablation and 77% among patients who did not undergo ablation (relative risk reduction: 0.08; 95% confidence interval: 0.02 to 0.33; p<0.001). In the observational cohorts of asymptomatic patients who did not undergo catheter ablation (n=883, with follow-up ranging from 8 to 96 months), regular supraventricular tachycardia or benign atrial fibrillation (shortest RR interval >250 ms) developed in 0% to 16%, malignant atrial fibrillation (shortest RR interval ≤250 ms) in 0% to 9%, and ventricular fibrillation in 0% to 2%, most of whom were children in the last case. CONCLUSIONS:The existing evidence suggests risk stratification with an electrophysiological study of patients with asymptomatic pre-excitation may be beneficial, along with consideration of accessory-pathway ablation in those deemed to be at high risk of future arrhythmias. Given the limitations of the existing data, well-designed and well-conducted studies are needed.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Al-Khatib SM,Arshad A,Balk EM,Das SR,Hsu JC,Joglar JA,Page RLdoi
10.1016/j.jacc.2015.09.018subject
Has Abstractpub_date
2016-04-05 00:00:00pages
1624-1638issue
13eissn
0735-1097issn
1558-3597pii
S0735-1097(15)06202-6journal_volume
67pub_type
杂志文章,评审abstract:OBJECTIVES:The purpose of this study was to determine quality of life (QOL) and exercise performance (EP) in patients with persistent atrial fibrillation (AF) converted to sinus rhythm (SR) compared with those remaining in or reverting to AF. BACKGROUND:Restoration of SR in patients with AF improving QOL and EP remain...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jacc.2006.03.051
更新日期:2006-08-15 00:00:00
abstract::Forty-seven patients with primary pulmonary hypertension were evaluated with a dose titration protocol utilizing nifedipine (20 mg orally) or diltiazem (60 mg orally) given every hour until maximal effectiveness was achieved. Of the patients tested, 15 (32%) had a greater than 20% reduction in pulmonary artery pressur...
journal_title:Journal of the American College of Cardiology
pub_type: 指南,杂志文章
doi:10.1016/0735-1097(91)90556-o
更新日期:1991-11-01 00:00:00
abstract:OBJECTIVES:This study sought to determine the long-term outcome of adult patients undergoing percutaneous balloon aortic valvuloplasty. BACKGROUND:Percutaneous balloon aortic valvuloplasty has been offered as an alternative to aortic valve replacement for selected patients with valvular aortic stenosis. Although ballo...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(95)00363-0
更新日期:1995-11-15 00:00:00
abstract:OBJECTIVES:To determine the effect of angiotensin-converting enzyme (ACE) inhibition on brachial flow-mediated vasodilation. BACKGROUND:Quinapril, an ACE inhibitor with high affinity, has been shown to improve coronary endothelial dysfunction in patients with coronary artery disease. The effectiveness of different vas...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0735-1097(99)00537-9
更新日期:2000-01-01 00:00:00
abstract::A technique was developed for the simultaneous recording of 30 endocardial electrograms during cardiac surgery in patients undergoing aneurysmectomy or endocardial resection, or both, for medically intractable ventricular tachycardia. An inflatable balloon covered with 30 terminals at distances of 1.5 to 2 cm was used...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(83)80244-7
更新日期:1983-11-01 00:00:00
abstract:OBJECTIVES:This study evaluated the value of noninvasive testing to predict cardiac events in patients with stable coronary disease after hospital admission (and risk stratification) for an acute coronary event. BACKGROUND:Exercise testing with thallium perfusion imaging identifies patients with obstructive coronary a...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1016/0735-1097(94)90109-0
更新日期:1994-11-01 00:00:00
abstract::Sixteen patients with double-outlet right ventricle, aged 1 week to 29 years (median 5 months), were studied with a 1.5 tesla nuclear magnetic resonance (NMR) imaging scanner. Two-dimensional echocardiography was performed in all patients. Thirteen patients underwent angiography, including nine who underwent subsequen...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(10)80237-2
更新日期:1991-07-01 00:00:00
abstract::Left ventricular function during percutaneous transluminal coronary angioplasty was studied in 16 patients undergoing the procedure. All measurements were performed before and during the first episode of balloon coronary occlusion. In 16 patients (Group A), data were recorded before and 30 or 50 s after balloon inflat...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(88)90403-2
更新日期:1988-08-01 00:00:00
abstract::Doppler echocardiographic determination of the pulmonary to systemic blood flow (Qp/Qs) ratio requires calculation of pulmonary artery and aortic luminal areas and integrals of the Doppler systolic velocity curves. To simplify the Doppler calculation of the Qp/Qs ratio, the square of the ratio of pulmonary to aortic l...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(88)90218-5
更新日期:1988-04-01 00:00:00
abstract:OBJECTIVES:This study sought to establish and maintain patency of the ductus arteriosus by a new method of transvascular formalin infiltration of the ductus arteriosus wall. BACKGROUND:Maintaining patency of the ductus arteriosus postnatally is necessary with many forms of congenital heart disease to ensure survival u...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(96)00128-3
更新日期:1996-07-01 00:00:00
abstract::Many Blalock-Taussig shunts (subclavian to pulmonary artery anastomoses) have been created and a significant number are still being done. Two cases of aneurysmal degeneration of a Blalock-Taussig shunt and their management are described. Development of this rare complication may be related to large shunt flow and long...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(84)80188-6
更新日期:1984-05-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to evaluate the survival of patients with hypertrophic cardiomyopathy (HCM) after resuscitated ventricular fibrillation or syncopal sustained ventricular tachycardia (VT/VF) when treated with low dose amiodarone or implantable cardioverter defibrillators (ICDs). BACKGROUND:Prospect...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(99)00056-x
更新日期:1999-05-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to investigate whether therapy with nitroglycerin (GTN) would lead to abnormal coronary artery responses to the endothelium-dependent vasodilator acetylcholine. BACKGROUND:Nitroglycerin therapy is associated with specific biochemical changes in the vasculature that may lead to ...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0735-1097(98)00456-2
更新日期:1998-12-01 00:00:00
abstract:OBJECTIVES:We examined the prognostic significance of concentric remodeling of the left ventricle in patients with essential hypertension and normal left ventricular mass on echocardiography. BACKGROUND:An echocardiographic pattern of concentric remodeling of the left ventricle has been associated with clinical featur...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(94)00424-O
更新日期:1995-03-15 00:00:00
abstract:OBJECTIVES:The present study was designed to establish possible predictors of unfavorable outcome in infants with pulmonary valve stenosis. BACKGROUND:Balloon pulmonary valvuloplasty is the treatment of choice for typical pulmonary valve stenosis. Patients with dysplastic valves may be less suitable candidates for thi...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(92)90100-2
更新日期:1992-08-01 00:00:00
abstract:OBJECTIVES:This study investigated the combination of maximal and low-intensity exercise testing in predicting prognosis in chronic heart failure (CHF), using one single exercise test (two-step protocol). BACKGROUND:Risk assessment based on any single factor has limited accuracy and reproducibility. METHODS:Treadmill...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(03)00502-3
更新日期:2003-07-02 00:00:00
abstract::Frequency analysis with fast Fourier transform and time domain analysis after signal averaging of the electrocardiogram (ECG) have given contradictory results in patients with sustained ventricular tachycardia after myocardial infarction. Therefore, the same orthogonal ECGs were analyzed in the frequency domain (Black...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(88)90368-3
更新日期:1988-07-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to evaluate the safety of implanting a cardiac resynchronization therapy (CRT) system. BACKGROUND:Clinicians and patients require data on the safety of the CRT implant procedure to estimate procedural risk. METHODS:We evaluated outcomes of transvenous CRT system implantation i...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2005.08.031
更新日期:2005-12-20 00:00:00
abstract:OBJECTIVES:The goal of this study was to investigate the nature of the association between silent ischemia and postoperative myocardial infarction (PMI). BACKGROUND:Silent ischemia predicts cardiac morbidity and mortality in both ambulatory and postoperative patients. Whether silent stress-induced ischemia is merely a...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(01)01265-7
更新日期:2001-06-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to examine the two-year clinical outcomes in patients enrolled in the Sirolimus-Eluting Stent in De Novo Native Coronary Lesions (SIRIUS) study. BACKGROUND:The SIRIUS study was a double-blinded randomized study which demonstrated that sirolimus-eluting stents (SES) significantl...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2005.11.077
更新日期:2006-04-04 00:00:00
abstract:BACKGROUND:Clinical practice guidelines recommend post-operative dual antiplatelet therapy (DAPT) in patients who undergo coronary artery bypass grafting (CABG) following acute coronary syndromes (ACS). OBJECTIVES:The authors have evaluated DAPT utilization rates and associated outcomes among post-CABG patients with d...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2016.10.043
更新日期:2017-01-17 00:00:00
abstract::Four hundred sixty-two patients, all with either documented spontaneous sustained ventricular tachycardia or cardiac arrest unresponsive to other antiarrhythmic drugs (2.6/patient), were treated with amiodarone. Thirty-five patients (7.6%) failed to respond or died during the initial oral or intravenous loading phase....
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(89)90525-1
更新日期:1989-02-01 00:00:00
abstract:OBJECTIVES:Percutaneous balloon valvotomy was studied retrospectively in newborns with critical pulmonary valve stenosis or atresia to assess its potential role as an alternative therapy to operation. BACKGROUND:Severe right ventricular outflow tract obstructions are life-threatening conditions requiring prostaglandin...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(95)00369-X
更新日期:1995-12-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to examine mortality and liver disease among patients exposed to dronedarone. BACKGROUND:There has been concern about the safety of dronedarone, especially for patients with heart failure and permanent atrial fibrillation (AF). There have also been suspicions about liver toxicity. ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2014.02.601
更新日期:2014-06-10 00:00:00
abstract:BACKGROUND:In patients with resistant hypertension (RH) and obstructive sleep apnea (OSA), the blood pressure response to continuous positive airway pressure (CPAP) treatment is highly variable and could be associated with differential micro-ribonucleic acid (miRNA) profiles. Currently, no available methods exist to id...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jacc.2015.06.1315
更新日期:2015-09-01 00:00:00
abstract::Congestive heart failure is a potentially debilitating disorder that affects a significant number of patients. The age-adjusted death rate has doubled over the past decade. Patients live an average of 4 to 5 years, and nearly all suffer from fatigue and breathlessness, which limits exercise capacity and produces a poo...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/0735-1097(94)00428-S
更新日期:1995-03-01 00:00:00
abstract::To determine whether two-dimensional echocardiography can identify patients with left ventricular thrombus after myocardial infarction who are prone to embolism, clinical and echocardiographic variables in 541 patients with a first infarction between 1979 and 1983 were studied prospectively. The first echocardiogram s...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(89)90592-5
更新日期:1989-03-01 00:00:00
abstract:OBJECTIVES:We assessed the incremental value of baseline Q waves over time from symptom onset as a marker of clinical outcome in ST-segment elevation myocardial infarction (STEMI). BACKGROUND:Time from symptom onset is a central focus in STEMI patients. The presence of Q waves on the baseline electrocardiogram (ECG) h...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jacc.2009.01.046
更新日期:2009-04-28 00:00:00
abstract::To evaluate the effectiveness and cost of low osmolarity, nonionic contrast agents for cardiac angiography, 443 patients were randomized to receive either iopamidol or diatrizoate. All adverse events that occurred within 24 h of the procedure were recorded prospectively by study personnel and classified according to p...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0735-1097(10)80335-3
更新日期:1990-10-01 00:00:00
abstract:OBJECTIVES:This study sought to evaluate regional myocardial flow reserve in long-term survivors of repair of anomalous left coronary artery from pulmonary artery (ALCAPA) and to relate the flow abnormalities to the patients' exercise performance. BACKGROUND:Patients with ALCAPA usually present during infancy with sev...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(97)00488-9
更新日期:1998-02-01 00:00:00