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Objectives: This study sought to examine the efficacy of ranolazine versus placebo on weekly angina frequency and sublingual nitroglycerin use in subjects with type 2 diabetes mellitus, coronary ar...

Objectives We investigated clinical correlates of atrial fibrillation (AF) progression and evaluated the prognosis of patients demonstrating AF progression in a large population. Background Progression of paroxysmal AF to more sustained forms is frequently seen. However, not all patients will progress to persistent AF. Methods We included 1,219 patients with paroxysmal AF who participated in the Euro Heart Survey on AF and had a known rhythm status at follow-up. Patients who experienced AF progression after 1 year of follow-up were identified. Results Progression of AF occurred in 178 (15%) patients. Multivariate analysis showed that heart failure, age, previous transient ischemic attack or stroke, chronic obstructive pulmonary disease, and hypertension were the only independent predictors of AF progression. Using the regression coefficient as a benchmark, we calculated the HATCH score. Nearly 50% of the patients with a HATCH score >5 progressed to persistent AF compared with only 6% of the patients with a HATCH score of 0. During follow-up, patients with AF progression were more often admitted to the hospital and had more major adverse cardiovascular events. Conclusions A substantial number of patients progress to sustained AF within 1 year. The clinical outcome of these patients regarding hospital admissions and major adverse cardiovascular events was worse compared with patients demonstrating no AF progression. Factors known to cause atrial structural remodeling (age and underlying heart disease) were independent predictors of AF progression. The HATCH score may help to identify patients who are likely to progress to sustained forms of AF in the near future.

Objectives The purpose of this study was to determine whether J-point elevation is a marker of arrhythmic risk. Background J-point elevation has been considered an innocent finding among healthy young individuals (the “early repolarization” pattern). However, this electrocardiogram (ECG) finding is increasingly being associated with idiopathic ventricular fibrillation (VF). Methods In a case-control study, the ECG of 45 patients with idiopathic VF were compared with those of 124 age- and gender-matched control subjects and with those of 121 young athletes. We measured the height of J-point and ST-segment elevation and counted the presence of slurring in the terminal portion of the R-wave. Results J-point elevation was more common among patients with idiopathic VF than among matched control subjects (42% vs. 13%, p 0.001). This was true for J-point elevation in the inferior leads (27% vs. 8%, p 0.006) and for J-point elevation in leads I to aVL (13% vs. 1%, p 0.009). J-point elevation in V4 to V6 occurred with equal frequency among patients and matched control subjects (6.7% vs. 7.3%, p 0.86). Male subjects had J-point elevation more often than female subjects and young athletes had J-point elevation more often than healthy adults but less often than patients with idiopathic VF. The presence of ST-segment elevation or QRS slurring did not add diagnostic value to the presence of J-point elevation. Conclusions J-point elevation is found more frequently among patients with idiopathic VF than among healthy control subjects. The frequency of J-point elevation among young athletes is intermediate (higher than among healthy adults but lower than among patients with idiopathic VF). (J Am Coll Cardiol 2008;52:1231‐8) © 2008 by the American College of Cardiology Foundation

Objectives This study sought to investigate gender-related differences in patients with atrial fibrillation (AF) in Europe. Background Gender-related differences may play a significant role in AF. Methods We analyzed the data of 5,333 patients (42% female) enrolled in the Euro Heart Survey on Atrial Fibrillation. Results Compared with men, the women were older, had a lower quality of life (QoL), had more comorbidities, more often had heart failure (HF) with preserved left ventricular systolic function (18% vs. 7%, p Conclusions Women with AF had more comorbidities, more HF with preserved systolic function, and a lower QoL than men. In the large group with atypical or no symptoms, women were treated appropriately more conservatively with less rhythm control than men. Women had a higher chance for stroke. Long-term QoL changes and other morbidities and mortality were similar.

The purpose of this study was to determine whether J-point elevation is a marker of arrhythmic risk.J-point elevation has been considered an innocent finding among healthy young individuals (the "early repolarization" pattern). However, this electrocardiogram (ECG) finding is increasingly being associated with idiopathic ventricular fibrillation (VF).In a case-control study, the ECG of 45 patients with idiopathic VF were compared with those of 124 age- and gender-matched control subjects and with those of 121 young athletes. We measured the height of J-point and ST-segment elevation and counted the presence of slurring in the terminal portion of the R-wave.J-point elevation was more common among patients with idiopathic VF than among matched control subjects (42% vs. 13%, p = 0.001). This was true for J-point elevation in the inferior leads (27% vs. 8%, p = 0.006) and for J-point elevation in leads I to aVL (13% vs. 1%, p = 0.009). J-point elevation in V(4) to V(6) occurred with equal frequency among patients and matched control subjects (6.7% vs. 7.3%, p = 0.86). Male subjects had J-point elevation more often than female subjects and young athletes had J-point elevation more often than healthy adults but less often than patients with idiopathic VF. The presence of ST-segment elevation or QRS slurring did not add diagnostic value to the presence of J-point elevation.J-point elevation is found more frequently among patients with idiopathic VF than among healthy control subjects. The frequency of J-point elevation among young athletes is intermediate (higher than among healthy adults but lower than among patients with idiopathic VF).

Objectives. The purpose of this study was to evaluate the ability of impedance cardiography to determine the change in cardiac output caused by modifications in the atrioventricular (AV) delay in DDD (dual-chamber) pacing mode while pacing the atrium and ventricle at different programmed rates.Background. Impedance cardiography permits continuous noninvasive monitoring of hemodynamic variables on a beat to beat basis.Methods. Eleven patients with a DDD pacemaker were evaluated by impedance cardiography. Stroke volume, cardiac output and total peripheral resistance were assessed in the supine rest position during both DDD and ventricular (VVI) pacing. Hemodynamic variables were measured during DDD pacing at rates ranging from 60 to 110 beats/min in 10-beats/min increments with programmed AV delay varying from 50 to 250 ms in 50-ms increments. When the pacemaker was reprogrammed to the VVI pacing mode, these measurements were repeated at the same pacing rates.Results. Cardiac output measurements during programmed conditions were found to be highly reproducible. The mean coefficient of variation was 3% during DDD pacing; it was 6% in the VVI pacing mode. A large decrease in cardiac output (≈30%) was found when i pacemaker was reprogrammed from the DDD to the VVI pacing mode. At DDD pacing rates between 70 to 110 beats/min, the highest cardiac output occurred at an average AV delay of < 120 ms from atrial stimulus to ventricular stimulus. At an average AV delay of ≥200 ms, the cardiac output in the DDD and VVI pacing modes was similar.Conclusions. 1) Impedance cardiography allows highly reproducible noninvasive assessments of cardiac output in pacemaker patients; 2) inappropriate programming of the AV interval in patients with atrial and ventricular pacing can decrease cardiac output significantly, and the extent of the decrease is similar to or less than that observed in ventricular pacing; 3) hemodynamic measurements obtained with impedance cardiography can facilitate optimal programming of pacemaker variables.