Urgent Catheter Ablation for Sustained Ventricular Tachyarrhythmias in Patients With Acute Heart Failure Decompensation.
Urgent catheter ablation for sustained ventricular tachyarrhythmias in patients with acute heart failure decompensation.
Europace. 2013 Jul 14;
Hayashi M, Miyauchi Y, Murata H, Takahashi K, Tsuboi I, Uetake S, Hayashi H, Horie T, Yodogawa K, Iwasaki YK, Mizuno K
Ventricular tachycardia (VT) and ventricular fibrillation (VF) are not uncommon in patients hospitalized with acute heart failure (AHF). We sought to evaluate the efficacy of urgent radiofrequency catheter ablation (RFCA) for recurrent VT/VF during AHF decompensations.METHODS AND RESULTS: The present study retrospectively analysed the data of 15 consecutive patients (69 ± 9 years, ischaemic heart disease in 10), who underwent urgent RFCA for frequent drug-refractory VT/VF episodes during an AHF decompensation with pulmonary congestion. The target arrhythmias were clinically documented monomorphic VTs in 10 patients, frequent premature ventricular contractions (PVCs) triggering VF in 4, and both in 1. The mean left ventricular ejection fraction was 26 ± 8%. The maximum number of arrhythmia episodes over 24 h was 9.1 ± 11.7. All RFCA sessions were completed without any major complications except for a temporary deterioration of pulmonary congestion in three patients (20%). Elimination and non-inducibility of the target arrhythmias were achieved in 13 patients (87%). Successful ablation site electrograms showed Purkinje potentials for all 5 PVCs triggering VF and 4 of 14 clinically documented monomorphic VTs (29%). Five patients (33%) underwent second sessions 10 ± 4 days after the first session for acute recurrences. Sustained VT/VF was completely suppressed during admission in 12 patients (80%), and the AHF ameliorated in 13 patients (93%). Twelve patients (80%) were discharged alive.CONCLUSION: Urgent RFCA for drug-resistant sustained ventricular tachyarrhythmias during AHF decompensations would be an appropriate therapeutic option. Purkinje fibres can be ablation targets not only in those with PVCs triggering VF, but also in those with monomorphic VT. HubMed – drug
Cancer complicating systemic lupus erythematosus – a dichotomy emerging from a nested case-control study.
Lupus. 2013 Jul 15;
Dey D, Kenu E, Isenberg D
ObjectivesWe determined whether any individual cancers are increased or decreased in a cohort of 595 patients with systemic lupus erythematosus (SLE) followed for up to 32 years at the University College London Hospitals Lupus Clinic, looking for any associated clinical or serological factors and the prognosis after cancer diagnosis.MethodsWe undertook a careful retrospective review of the medical records and identified all individuals diagnosed with cancer. For controls, we selected three other patients in the cohort who had not developed cancer, carefully matched for age, sex, ethnicity and disease duration, to determine if any obvious differences emerged in a nested case-control design.ResultsThirty-three patients developed cancer after being diagnosed with SLE. There was a statistically insignificant small increase in overall cancer risk, standardized incidence ratios (SIRs) 1.05 (95% CI 0.52-1.58) and increased SIRs for cervical, prostate, anal and pancreatic cancers and reduction in breast cancer SIRs.Haematological and musculoskeletal manifestations, anticardiolipin and antithyroid globulin antibodies were found to be positively associated with cancer risk in multivariate analysis. There was no drug, dose or duration was associated with cancer risk. There was a reduction in survival with a cancer fatality rate of 84.2% (p?HubMed – drug
Acute Lung Injury With Alveolar Hemorrhage As Adverse Drug Reaction Related to Crizotinib.
J Clin Oncol. 2013 Jul 15;
Ono A, Takahashi T, Oishi T, Sugino T, Akamatsu H, Shukuya T, Taira T, Kenmotsu H, Naito T, Murakami H, Nakajima T, Endo M, Yamamoto N