In selected patients, atrial fibrillation (AF) converts to atrial flutter (AFl) due to treatment with class IC antiarrhythmic drugs. In this study, we prospectively investigated the effects of AFl ...ablation and continuation of drug therapy in patients with AF who developed AFl due to long-term administration of class IC antiarrhythmic drugs. The study population consisted of 187 patients from an AF registry with paroxysmal AF who were orally treated with flecainide (n = 96) or propafenone (n = 91). Twenty-four patients (12.8%) developed AFl during the course of treatment. In 20 of these patients (10.7%), electrophysiologic study revealed typical AFl. These patients underwent radiofrequency ablation of AFl. Ablation failed in 1 patient. All patients continued preexisting drug treatment. Recurrence of AF was assessed by ambulatory Holter monitoring and serial questionnaires. During a mean follow-up of 11 ± 4 months, the incidence of AF episodes was significantly lower in patients with a combined therapy (2.7 ± 3.6 per year) than in control subjects with a sole drug treatment (7.8 ± 9.2 per year, p <0.05) and than before therapy (10.2 ± 5.4 per year, p <0.001). Subgroup analysis revealed that 7 patients (36.8%) remained symptom free with no evidence of atrial tachyarrhythmia. Eight additional patients (42.1%) had ongoing paroxysmal AF, however, with a significantly lower incidence of AF episodes than before therapy (2.3 ± 1.6 per year vs 11.5 ± 5.0 per year, p <0.001). In the remaining 4 patients (14.7%), no beneficial effect of AFl ablation was found. It is concluded that in patients with AF who develop typical AFl due to administration of class IC antiarrhythmic agents, a combined therapy with catheter ablation of AFl and continuation of drug treatment is highly effective in reducing occurrence and duration of atrial tachyarrhythmias.
Background: Atherosclerotic plaques prone to cause thrombotic complications and plaque rupture account for the majority of fatal myocardial infarctions (MI), which may be complicated by ventricular ...fibrillation (VF). Matrix-degrading metalloproteinases (MMPs) and their inhibitors (TIMPs) are expressed in atherosclerotic lesions and contribute to plaque vulnerability. Interleukin-8 (IL-8) is one of the predominant chemokines interacting with MMPs and TIMPs and the coagulation system. The aim of the present study was to assess potential differences of levels of MMP-9, TIMP-1 and IL-8 in postmyocardial infarction patients with or without VF complicating acute MI. Methods: Blood samples were taken from 45 patients with VF complicating acute MI and from 88 patients without VF. All samples were collected during a symptom-free interval remote from the acute ischemic event with a median of 556 days. The markers of interest were TIMP-1, MMP-9 and IL-8. Results: IL-8 and TIMP-1 levels were significantly higher among patients with VF than among patients without VF (p<0.001). In a logistic regression approach IL-8 was an independent indicator of patients prone to VF during MI (p=0.03). High levels of TIMP-1 (p=0.05), MMP-9 (p=0.03), the MMP-9/TIMP-1 ratio (p=0.049) and hypertension (p=0.02) were found to be indicators in patients with reinfarction or unstable angina pectoris during follow-up. Hypertension (p=0.02) and MMP-9 (p=0.03) were the only significant indicators characterizing patients undergoing coronary reinterventions, such as percutaneous coronary interventions and coronary bypass surgery. Conclusions: Higher TIMP-1 and IL-8 levels are present in patients with VF complicating MI. High TIMP-levels may be related to the degree of fibrosis which is a substrate for electrical instability and may contribute to the occurrence of VF. Patients prone to develop VF during MI seem to have an increased proinflammatory condition compared to patients without VF. Clin Chem Lab Med 2007;45:1360–5.
PDF
