Atrial Fibrillation

SAN DIEGO -- With PET-guided lead placement, cardiac resynchronization therapy (CRT) can achieve significant clinical improvement in patients with severe ischemic heart failure, even in the presence of extensive scarring, investigators reported here.

Congestive heart failure and cirrhosis are the most common causes of transudative pleural effusions, while pneumonia and malignancy are responsible for the majority of exudative effusions. Plain chest films are valuable in confirming the presence of an effusion, providing clues to the cause, and directing the method of pleural fluid sampling. Thoracentesis is safe and simple, and it is diagnostic in about 75% of cases. Pleural biopsy is indicated for unexplained exudative effusions, most of which are found to result from malignancy or tuberculosis. Medical thoracoscopy, if available, is the procedure of choice for patients with these effusions. Thoracoscopy permits visually directed pleural biopsies and allows for therapeutic intervention at the time of diagnosis, obviating the need for subsequent invasive procedures.

Ischemic infarcts of the brain are usually caused by vascular disease, but 1 in 5 results from emboli that arise in the heart. The largest contributor to cardioembolic stroke is non-valvular atrial fibrillation, which is associated with a 5-fold increased risk of cerebral infarction.

SAN DIEGO -- Positron emission tomography (PET) can identify patients with ischemic heart failure who are most likely to benefit from cardiac resynchronization therapy, investigators reported here.

PHILADELPHIA -- The beta-blocker carvedilol (Coreg) does not appear to benefit children or adolescents with symptomatic systolic heart failure, suggest preliminary trial results.

CLEVELAND -- Meta-analyses of the two FDA-approved thiazolinediones for diabetes -- rosiglitazone (Avandia) and pioglitazone (Actos) -- left neither drug unscathed.

SAN FRANCISCO -- Neoadjuvant trastuzumab (Herceptin) may improve breast cancer chemotherapy response rates, but at what some oncologists called an unacceptable price in cardiac toxicity.

LOS ANGELES -- Dronedarone, an investigational drug, proved significantly more effective than placebo in maintaining sinus rhythm and in reducing the ventricular rate during recurrent atrial fibrillation.

NEW YORK -- Experiments in mice suggest that the type 2 diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) increase uptake of both glucose and triglycerides in cardiac tissue, causing or exacerbating heart failure.

VIENNA -- The anti-anginal drug ranolazine (Ranexa) may reduce episodes of ventricular tachycardia and supraventricular tachycardia, researchers here reported.

PHILADELPHIA -- Limiting the working hours of residents did not increase patients' death rates, as some had feared, nor did it save lives significantly, as others had hoped, according to two large national studies.

DALLAS -- A fatty heart, cardiac steatosis, can occur in patients on the road to type 2 diabetes and in the presence of normal left ventricular dysfunction, investigators here have determined.

Heparin-induced thrombocytopenia (HIT) is a common and serious complication of heparin therapy, occurring in about 1% to 5% of patients.1 It occurs more often with unfractionated heparin than with low molecular weight heparin. Complications of HIT include venous thromboembolism, arterial thrombosis, skin necrosis, and limb gangrene.2,3 Before the introduction of the direct thrombin inhibitors, the mortality rate associated with HIT was 20% to 25%.4-6

A 68-year-old woman with hypertension complains of intermittent dyspnea and light-headedness. She is asymptomatic during the evaluation. Vital signs are normal, but an irregularly irregular pulse is noted on examination as well as on the telemetry monitor. The 12-lead ECG is shown here; the ECG machine printout reads "atrial fibrillation." The patient has no history of this arrhythmia.

HOUSTON -- For older patients on dialysis, the phosphate binder sevelamer (Renagel) may be associated with a lower death rate compared with calcium-based phosphate binders, investigators reported.

WASHINGTON -- A left-ventricular assist device that provides a steady rather than pulsed blood flow may serve as an effective bridge to transplant, found a multicenter team.

BOSTON -- Childhood hypertension is there, if only pediatricians would look for it. Most of the time, they don't, investigators here reported.

EAST HANOVER, N.J. -- The FDA has approved a once-yearly intravenous formulation of zoledronic acid (Reclast) for osteoporosis in postmenopausal women, Novartis announced.

ROCKVILLE, Md. -- The FDA today changed the label for warfarin (Coumadin) to make clinicians aware of two tests for gene variants that may affect the risk of bleeding after initial dosing.

ROCKVILLE, Md. -- The makers of rosglitazone (Avandia) and pioglitazone (Actos), have agreed to add a black box warning to the type 2 diabetes drugs' labels about an increased risk of heart failure, the FDA said today.

LONDON -- Headache patients receiving prophylactic high-dose verapamil face a risk of heart rhythm disturbances that warrants EKG monitoring of all patients on the therapy, investigators here concluded.

BIRMINGHAM, England -- Warfarin's stroke prevention benefits extend to the elderly -- without increasing the risk of major bleeds.

NEW HAVEN, Conn. -- Older patients with advanced chronic diseases may reject medical or surgical interventions unless clinicians provide a cogent rationale for them.

ROCKVILLE, Md. -- After nine weeks of internal worry about the cardiovascular safety of two prescription proton-pump inhibitors, Prilosec and Nexium, the FDA has issued a limited all clear.

BIRMINGHAM, England -- When seeking to reduce the risk of stroke in older patients by screening for atrial fibrillation, a pulse-based system is an effective approach, found researchers here.

WINSTON-SALEM, N.C. -- One-time percutaneous radiofrequency ablation proved completely successful in eradicating small renal cell carcinomas, found researchers here.

ABSTRACT: Angiotensin-converting enzyme inhibitors and ß-blockers are the cornerstone of heart failure medical therapy; unless contraindicated, start these agents as soon as possible after volume status has been optimized. Aldosterone receptor antagonists, angiotensin-receptor blockers, and a fixed-dose combination of hydralazine and isosorbide dinitrate (the last recommended especially for African Americans) can be used as add-on therapy. Prophylactic implantable cardioverter defibrillators reduce long-term mortality in symptomatic patients with a left ventricular ejection fraction (LVEF) of 35% or less. Cardiac resynchronization therapy improves symptoms and ventricular remodeling in some patients; indications include wide (more than 20 milliseconds) QRS complex on ECG, impaired LVEF (35% or less), and advanced heart failure symptoms (NYHA classes III and IV) despite optimal drug therapy. Measurement of natriuretic peptides and impedance cardiography both show promise for monitoring patients with heart failure and for guiding therapy, but definitive data to justify their routine use are still lacking.

GAITHERSBURG, Md. -- Patients with severe type 2 diabetes who use insulin or those with established heart disease are probably not good candidates for rosiglitazone (Avandia).

LOS ANGELES -- An initiative to integrate evidence-based care into the hospital treatment of heart failure patients met with a modicum of success, found investigators here.

GAITHERSBURG, Md. -- Documents prepared by the FDA for Monday's review of the cardiovascular safety of rosiglitazone (Avandia) support published reports of a significant rise in the risk of myocardial infarction for the diabetes drug.