Abstract:
BACKGROUND:In patients with postinfarction sustained ventricular tachycardia showing one or more antiarrhythmic drug failures, the question is how long to proceed with new drug trials before deciding to perform map-guided arrhythmia surgery. Although the techniques of this surgery developed rapidly in the early 1980s, this therapy may be offset by damage to residual left ventricular function. However, surgery has been shown to be very effective in selected groups of patients. METHODS:A randomized study was carried out in patients with postinfarction ventricular tachycardia and eligible for arrhythmia surgery based on residual left ventricular function. Therapy failure was defined by the occurrence of the following events: spontaneous recurrence of ventricular tachycardia or ventricular fibrillation, sudden cardiac death, inducibility of sustained ventricular tachycardia or ventricular fibrillation with programmed stimulation of the heart, symptomatic non-sustained ventricular tachycardia requiring therapy or side-effects of antiarrhythmic drugs requiring withdrawal. In the drug limb, failure of the first antiarrhythmic drug was accepted but failure of a second and different drug was regarded as true therapy failure. RESULTS:After randomization, antiarrhythmic drug therapy was administered in 33 patients, and 30 patients underwent surgery. Neither group differed in baseline characteristics, and the mean number of drug failures before randomization was 2.7. The Kaplan-Meier therapeutic failure of antiarrhythmic drugs was 39 +/- 11%, 42 +/- 11% and 51 +/- 18% at 0.5-, 1- and 4-year follow-up, respectively, whereas the therapeutic failure of cardiac surgery was 37 +/- 11%, 37 +/- 11% and 50 +/- 20% at 0.5, 1 and 4 years, respectively, showing no statistical difference. The 1- and 4-year Kaplan-Meier survival of the antiarrhythmic drug-treated group was 91 +/- 6% and 78 +/- 15%, respectively, and of the surgical group 92 +/- 6% and 59 +/- 20%, respectively, and did not differ between either group. However, the relative risk for total cardiac death was higher in the surgical limb than in the drug limb (relative risk 2.2, CI 0.68-7.48). CONCLUSION:This study demonstrated no difference between the therapeutic result of continuation of two different antiarrhythmic drugs and that of arrhythmia surgery. Despite the small number of patients studied, it is recommended that drug therapy should continue as long as this regimen is tolerated by the patient. When true drug refractoriness or side-effects of drugs arise, arrhythmia surgery offers a valuable alternative. However, when additional reasons for cardiac surgery exist, arrhythmia surgery should be undertaken earlier and may become the first choice of treatment of postinfarction ventricular tachycardia.
journal_name
Eur Heart Jjournal_title
European heart journalauthors
van Hemel NM,Kingma JH,Defauw JJ,Hoogteijling-van Dusseldorp E,Kelder JC,Beukema WP,Vermeulen FEdoi
10.1093/oxfordjournals.eurheartj.a014910subject
Has Abstractpub_date
1996-04-01 00:00:00pages
564-73issue
4eissn
0195-668Xissn
1522-9645journal_volume
17pub_type
临床试验,杂志文章,随机对照试验abstract::Physical fitness of athletes affected by mitral valve prolapse (MVP) was examined, in order to evaluate the influence of sport activity on the natural history of the disease. Maximal workload, total workload, percentage efficiency (according to Hollmann's formula), double product of maximal cycloergometric stress test...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/8.suppl_d.33
更新日期:1987-08-01 00:00:00
abstract:AIMS:Experimental and clinical studies indicate that tea exerts protection against cardiovascular diseases. However, a question of much debate is whether addition of milk modifies the biological activities of tea. We studied the vascular effects of tea, with or without milk, in humans and elucidated the impact of indiv...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehl442
更新日期:2007-01-01 00:00:00
abstract:AIMS:Magnetic resonance imaging (MRI) is well established as an important diagnostic tool in medicine. However, the presence of a cardiac pacemaker is usually regarded as a contraindication for MRI due to safety reasons. In this study, heating effects at the myocardium-pacemaker lead tip interface have been investigate...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehi009
更新日期:2005-02-01 00:00:00
abstract::Haemodynamic effects of pharmacological doses of insulin during acute ischaemic heart failure were studied in 8 dogs. Severe depression of left ventricular function was induced by the injection of 50 micron plastic microspheres into the left main coronary artery. This was demonstrated by a significant increase in left...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a061885
更新日期:1985-05-01 00:00:00
abstract:AIMS:Emerging evidence indicates that nuclear receptors play a critical regulatory role in cardiovascular physiology/pathology. Recently, farnesoid-X-receptor (FXR), a member of the metabolic nuclear receptor superfamily, has been demonstrated to be expressed in vascular cells, with important roles in vascular physiolo...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehs011
更新日期:2013-06-01 00:00:00
abstract:BACKGROUND:Recently, a new exercise test criterion diagnosing coronary artery disease was proposed, based on a composite of changes in Q-, R- and S-waves: the QRS score. We compared this new criterion with conventional ST-segment depression and other compositions of Q-, R- and S-wave changes in patients and normals and...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a014936
更新日期:1996-05-01 00:00:00
abstract::The pharmacokinetics of glyceryl trinitrate are still not completely understood. The substance disappears rapidly from plasma largely by extrahepatic mechanisms. It is converted in glyceryl dinitrates and glyceryl mononitrates. After transdermal application of a controlled delivery system, plasma concentrations of gly...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:10.1093/eurheartj/9.suppl_a.33
更新日期:1988-01-01 00:00:00
abstract::There has been considerable controversy over whether elevated levels of triglycerides, or hypertriglyceridaemia, is an independent risk factor in coronary heart disease (CHD). Discrepancies between findings of univariate and multivariate statistical analyses are likely to be due to the strong inverse correlation betwe...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:
更新日期:1998-07-01 00:00:00
abstract::Twenty-three patients who had undergone aortic valve replacement with a mechanical aortic valve prosthesis (ball-valve: 17, tilting-disc: 6) were investigated by retrograde left ventricular catheterization using a 6 F pigtail catheter. Twelve of these 23 patients also had had combined aortic and mitral valve replaceme...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/8.7.689
更新日期:1987-07-01 00:00:00
abstract::We investigated cardiovascular and coronary responses to intravenous infusions of adrenaline, which raised arterial concentrations in a stepwise fashion from basal to about 5-6 nmol.l-1, in 11 non-rejecting heart transplanted patients, and in eight intact innervated subjects. Cardiac adrenaline extraction and noradren...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/14.4.474
更新日期:1993-04-01 00:00:00
abstract:AIMS:Characteristics of sudden cardiac arrest (SCA) during sports offers a novel (and unexplored) setting to assess factors associated with disparities in outcomes across regions. METHODS AND RESULTS:From a prospective 5-year community-based French registry concerning SCA during sports in 10-75 year-olds, we evaluated...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/eht282
更新日期:2013-12-01 00:00:00
abstract:AIMS:Tissue inhibitor of metalloproteinases-1 (TIMP-1) is a key regulator of extracellular matrix degradation. We examined relations of plasma total TIMP-1 to cardiovascular risk factors and echocardiographic left ventricular (LV) structure and function in a community-based sample. METHODS AND RESULTS:We studied 1069 ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1016/j.ehj.2004.05.029
更新日期:2004-09-01 00:00:00
abstract::Cardiac hypertrophy was induced in rats either by isoprenaline treatment or by experimental abdominal aortic stenosis. In both models, the UTP content increased in the hypertrophying heart, while the ATP level remained depressed. The rate of net synthesis of uracil nucleotides, estimated by phosphate incorporation int...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/5.suppl_f.155
更新日期:1984-12-01 00:00:00
abstract:AIMS:In patients with sick sinus syndrome, bradycardia can be treated with a single-lead pacemaker or a dual-chamber pacemaker. Previous trials have revealed that pacing modes preserving atrio-ventricular synchrony are superior to single-lead ventricular pacing, but it remains unclear if there is any difference between...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1093/eurheartj/ehr022
更新日期:2011-03-01 00:00:00
abstract:AIMS:Valve compliance might determine the onset of symptoms better than resting measures of aortic stenosis. This study compared valve compliance measured by dobutamine stress echocardiography with resting haemodynamic variables against the end-point of symptoms at low workload during exercise testing. METHODS AND RES...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1016/s0195-668x(03)00235-5
更新日期:2003-07-01 00:00:00
abstract::From a clinicopharmacological standpoint, the urinary excretory potency of diuretics should be assessed comparatively, on the basis of placebo-controlled changes in 24 h natriuresis, following single oral doses administered to healthy adult subjects who are in steady-state habitual external sodium balance. The potency...
journal_title:European heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/eurheartj/13.suppl_g.15
更新日期:1992-12-01 00:00:00
abstract::Left ventricular performance at rest and during supine symptom-limited exercise was determined by radionuclide ventriculography (RNV) in 65 subjects of the age of 65 years or older. Eleven subjects had no evidence of coronary artery disease (CAD) by history or submaximal stress ECG. In this control group left ventricu...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/5.suppl_e.55
更新日期:1984-11-01 00:00:00
abstract:AIMS:Targeting interleukin-1 (IL-1) represents a novel therapeutic approach to atherosclerosis. CANTOS demonstrated the benefits of IL-1β neutralization in patients post-myocardial infarction with residual inflammatory risk. Yet, some mouse data have shown a prominent role of IL-1α rather than IL-1β in atherosclerosis,...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehz008
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1053/euhj.2001.3115
更新日期:2002-06-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章,多中心研究
doi:10.1093/eurheartj/ehn210
更新日期:2008-08-01 00:00:00
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journal_title:European heart journal
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更新日期:2018-06-21 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1016/j.ehj.2004.09.003
更新日期:2004-11-01 00:00:00
abstract:Aims:The ESC-EHRA Atrial Fibrillation Ablation Long-Term registry is a prospective, multinational study that aims at providing an accurate picture of contemporary real-world ablation for atrial fibrillation (AFib) and its outcome. Methods and results:A total of 104 centres in 27 European countries participated and wer...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究
doi:10.1093/eurheartj/ehw564
更新日期:2017-05-01 00:00:00
abstract::In a pilot study, a computerized precordial mapping system monitored ischaemia on-line in 50 patients (40 with acute myocardial infarction and 10 with unstable angina, class IV (Canadian Cardiovascular Society). All had ST-segment depression or elevation greater than or equal to 0.2 mV in one or more precordial leads ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a061637
更新日期:1984-03-01 00:00:00
abstract::Measurement of the pre-ejection period (PEP) can give valuable information on myocardial function in rats. Depressed cardiac function is accompanied by prolongation of PEP, which shortens when cardiac function improves. Left ventricular ejection time (LVET) may be shortened with ageing in spontaneously hypertensive ra...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/11.suppl_i.114
更新日期:1990-12-01 00:00:00
abstract::An exercise test was performed in 455 patients in the third week after acute myocardial infarction (AMI). One hundred and seventeen (26%) of them were considered as having a complicated AMI. During a follow-up of 4.5 years their mortality was 49% vs 23% in the remaining patients with uncomplicated AMI. The survival of...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a062329
更新日期:1987-06-01 00:00:00
abstract:AIM:Little is known about the prognostic significance of silent versus symptomatic coronary artery disease (CAD) in diabetic patients. We therefore assessed the incidence of scintigraphic evidence of CAD in diabetic patients without known CAD and the impact of symptoms and scintigraphic findings on prognosis. METHODS ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1016/j.ehj.2004.02.013
更新日期:2004-04-01 00:00:00
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journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/9.suppl_l.54
更新日期:1988-11-01 00:00:00
abstract:AIMS:Although regular physical activity has beneficial cardiovascular effects, exercise can trigger an acute cardiac event. We aimed to determine the incidence and prognosis of exercise-related out-of-hospital cardiac arrest (OHCA) in the general population. METHODS AND RESULTS:We prospectively collected all OHCAs in ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/eht401
更新日期:2013-12-01 00:00:00
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journal_title:European heart journal
pub_type: 新闻
doi:
更新日期:2014-04-01 00:00:00