Nikos Mezilis - Academia.edu (original) (raw)
Papers by Nikos Mezilis
European Heart Journal - Cardiovascular Imaging, 2002
Cardiac involvement occurs in up to 50% of patients with primary amyloidosis. Diffuse amyloid dep... more Cardiac involvement occurs in up to 50% of patients with primary amyloidosis. Diffuse amyloid deposits lead to impairment of myocardial systolic and diastolic function. Due to the severe left ventricular diastolic abnormality, left atrial contribution to left ventricular stroke volume remains critical. We report a case of primary amyloidosis where we assessed non-invasively left atrial systolic function.
European Journal of Radiology, 1998
Objecti6e: A double-blind randomised study was conducted in two British centres, to evaluate the ... more Objecti6e: A double-blind randomised study was conducted in two British centres, to evaluate the safety, tolerance and efficacy of the new dimeric non-ionic contrast medium Iotrolan 320 in comparison with the monomeric non-ionic compound Iohexol 350 in coronary angiography. Methods and Material: 120 patients were randomised to receive either Iotrolan at a concentration of 320 mgI/ml or Iohexol at a concentration of 350 mgI/ml, during selective coronary angiography and left ventriculography. The variables measured were: maximum increase of the left ventricular end-diastolic pressure up to 6 min after ventriculography, haemodynamic and electrocardiographic variables, arrhythmogenicity, clinical laboratory parameters, tolerance, adverse events and efficacy. Results: Iotrolan resulted in a smaller change of left ventricular end-diastolic pressure compared to Iohexol, but the difference was not statistically significant. Transient changes in left ventricular systolic pressure, intra-arterial systolic pressure, intra-arterial diastolic pressure, and in electrocardiographic parameters, occurred after the injections, but they were not clinically significant. Changes in the clinical laboratory markers from baseline values were comparable between the two groups and confirmed good renal and hepatic tolerance. During the left ventriculogram, Iotrolan resulted in less symptoms compared to Iohexol (P=0.002). Adverse events, which were mild or moderate in most cases, were observed with no statistical difference between the two agents. The contrast quality of both agents was good with no statistical difference. Conclusion: This study did not show a significant difference between Iotrolan 320 and Iohexol 350 with regard to cardiovascular safety or patient tolerance, except for a minor difference in the intensity of heat/warmth sensation.
Pacing and Clinical Electrophysiology, 1997
Two patients with metastatic pacemaker infections, one caused by Pseudomonas aeruginosa, 5 months... more Two patients with metastatic pacemaker infections, one caused by Pseudomonas aeruginosa, 5 months after implantation, and the second by Streptococcus pneumoniae, 8 years after implantation, were treated successfully by removal of the pacemaker systems. Infection reoccurred in the patient with Pseudomonas aeruginosa, who initially underwent partial pacing system removal allowing the atrial lead to remain. Repeat partial atrial lead removal and contralateral pacemaker implantation was followed by clinical infection, which was resolved when both the implanted atrial lead fragment and the recently implanted pacemaker were both removed. Removal of all hardware is required for cure of pacemaker infection.
Journal of Cardiology Cases, 2020
Μελέτη των μεταβολών της αιμάτωσης και λειτουργικότητας της αριστεράς κοιλίας κατά την οξεία φάση του εμφράγματος του μυοκαρδίου με Tc-99m sestamibi gated spect και με δυμαμική ηχοκαρδιογραφία δοβουταμίνης
602 Effect of left ventricular filling pattern on cardiopulmonary exercise response in patients with left ventricular systolic dysfunction
European Journal of Echocardiography, 1999
327 Assessment of Doppler derived left ventricular myocardial performance index in congestive heart failure; effects of dobutamine
European Journal of Echocardiography, 1999
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē, 2012
We present the case of a patient who underwent a percutaneous secundum atrial septal defect (ASD ... more We present the case of a patient who underwent a percutaneous secundum atrial septal defect (ASD II) closure with an undersized septal occluder device. One week and one month later she experienced two transient ischemic attacks. Three-dimensional transesophageal echocardiography (TEE) revealed a residual patent foramen ovale (PFO) with a positive Valsalva bubble test. She underwent a second procedure under the 3D TEE guidance and the PFO was successfully closed percutaneously using a PFO occluder device that was attached to the ASD device. Accurate ASD and PFO morphology assessment and appropriate device selection are the key factors in the success of percutaneous closure. 3D TEE is an innovative diagnostic technique, providing a complete description of the cardiac defect and improving spatial orientation. Real-time 3D TEE is the appropriate guidance for successful and accurate positioning of the device.
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē
The treatment of calcified coronary artery lesions is a challenge for percutaneous angioplasty. R... more The treatment of calcified coronary artery lesions is a challenge for percutaneous angioplasty. Rotational atherectomy is an established technique for the effective modification of these lesions prior to conventional angioplasty and stent implantation. Drug-eluting stents (DES) have shown encouraging results in complex lesions and high-risk patients. This retrospective study investigated the immediate and long-term prognosis after treatment with rotational atherectomy (RotA) and DES implantation in 184 patients with calcified coronary artery lesions. During follow up (mean 49 months), 7 patients died (1 from a non-cardiac cause) and the incidence of major adverse cardiac events was 14.85%. Only 4.15% of patients underwent a new angioplasty procedure. The combination of RotA and DES in calcified coronary artery lesions has a very good angiographic result and a satisfactory clinical outcome.
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē
Rescue angioplasty is used in patients in whom thrombolysis has been unsuccessful, in order to ac... more Rescue angioplasty is used in patients in whom thrombolysis has been unsuccessful, in order to achieve a better restoration of flow and to improve left ventricular function and the long term prognosis. However, patients who undergo rescue angioplasty have a higher rate of reocclusion of the vessel or distal embolism, resulting in increased mortality. Rheolytic thrombectomy, which reduces the quantity of thrombus and improves flow in the vessel, has been used successfully in such cases. We describe a case in which rheolytic thrombectomy was applied during late rescue angioplasty in order to achieve immediate restoration of flow in the vessel.
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē
Papillary fibroelastomas are rare, primary, benign cardiac tumours most frequently located in the... more Papillary fibroelastomas are rare, primary, benign cardiac tumours most frequently located in the heart valves. They are a potential cause of systemic emboli, stroke, myocardial infarction and sudden death. We present two cases of papillary fibroelastomas located in the mitral and aortic valves of patients who had suffered multiple strokes. The fibroelastomas were diagnosed using transoesophageal echocardiography and the patients were treated surgically, with broad excision of the tumours and preservation of the valves. The echocardiographic and microscopic characteristics of the fibroelastomas are analysed and methods for their differential diagnosis from other cardiac tumours are discussed in the context of the available literature.
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē
The aim of this study was to evaluate the medium-term clinical and angiographic results, as well ... more The aim of this study was to evaluate the medium-term clinical and angiographic results, as well as the occurrence and treatment of restenosis, following the implantation of sirolimus-eluting stents (SES) in patients undergoing coronary angioplasty. All patients who have an SES implanted in our department are entered into a database, with a view to evaluating the use of such stents in everyday clinical practice. This study included patients who consented to repeat angiography 8+/-2.4 months after stent implantation. The study population consisted of 91 patients (63 men, mean age 58+/-8.1 years) with 116 stenoses in all. This represented 17.4% of all patients who had an SES implanted during the study period. All the angiographic examinations were analysed independently using quantitative coronary analysis in order to determine the relationship between clinical and angiographic data and restenosis and late lumen loss. The mean vessel diameter was 2.5+/-0.48 mm and the mean lesion leng...
Left atrial volumes, function and work before and after mitral valve repair in chronic mitral regurgitation
The Journal of heart valve disease, 2004
Despite the effect of mitral valve repair in left ventricular (LV) function having been extensive... more Despite the effect of mitral valve repair in left ventricular (LV) function having been extensively studied, investigations of left atrial (LA) performance indices are minimal. This prospective study was undertaken to analyze LA volumes, function and work in patients with chronic mitral valve regurgitation (MR) who underwent mitral valve repair; the analyses were conducted both before and six months after surgery. Twenty patients (15 males, five females; mean age 51.4 +/- 12.5 years) with severe MR (grade IV) due to floppy mitral valve/mitral valve prolapse (FMV/MVP; anterior, posterior or both) underwent mitral valve repair. LA volumes, maximal at mitral valve opening (LAmax); minimal at valve closure (LAmin); and at onset of atrial systole (P-wave on ECG, LAP); and transmitral Doppler A-wave velocity were measured before and six months after surgery. LA stroke volume (LASV) = LAP - LAmin; LA ejection fraction (LAEF) = LASV/LAP; LA kinetic energy (LAKE) = 1/2 x LASV x 1.06 (specifi...
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē
Surgical treatment of heart failure is emerging as one of the most challenging clinical dilemmas ... more Surgical treatment of heart failure is emerging as one of the most challenging clinical dilemmas for patients with end-stage cardiac failure not amenable to medical treatment. One of the most intriguing techniques is the use of implantable left ventricular assist devices (LVADs) as a bridge to recovery. The early experience from our centre has shown that even short term post-cardiotomy mechanical assistance, after heart failure surgery, improves patient outcome; thus, a clinical feasibility study was designed. The hypothesis of the study is that reparative heart failure surgery combined with postoperative mechanical support, ventricular resynchronisation where indicated, and pharmacological treatment can maximise myocardial recovery. In the study a new, implantable, magnetically levitated, rotary pump will be used as a bridge to recovery. In this manuscript the first worldwide human implantation of a new, continuous-flow LVAD, the WorldHeart Rotary Pump (Levacor, WorldHeart Inc., Oa...
73 TandemHeart percutaneous ventricular assist device in cardiac surgery of patients with advanced and acute heart failure
European Journal of Heart Failure Supplements, 2006
436 Left atrial function and work after surgical ventricular restoration in the treatment of advanced heart failure due to post-infarction ventricular dilatation
European Journal of Heart Failure Supplements, 2006
484 Isometric exercise as a provocative test for mitral regurgitation in patients with mitral valve prolapse
European Journal of Echocardiography, 1999
344 Dobutamine- vs. exercise-induced ST-segment elevation early after Q-wave myocardial infarction; prediction of recovery of function following revascularisation
European Journal of Echocardiography, 1999
Pacing and Clinical Electrophysiology, 1998
KOCHIADIKIS, G.E., ET AL.: Intravenous Propafenone Versus Intravenous Amiodarone in the Managemen... more KOCHIADIKIS, G.E., ET AL.: Intravenous Propafenone Versus Intravenous Amiodarone in the Management of Atrial Fibrillation of Recent Onset: A Placebo-controlled Study. The efficacy and safety of intravenous propafenone, amiodarone, or placebo were compared in the treatment of atrial fibrillation (AF) of recent onset (duration <• 48 hours). Methods: 143 patients (77 men, mean age 63 ± 12 years) were studied, of whom 46 received propafenone (2 mg/kg over 15 minutes followed by 10 mg/kg over the next 24 hours), 48 received amiodarone (300 mg intravenously over 1 hour, followed by 20 mg/kg over the next 24 hours, plus 1,800 mg/day orally, in 3 divided doses), and 49 received placebo (the equivalent amount of saline /V over 24 hours). Digoxin was administered to all patients who had not previously received it. Results: Conversion to normal sinus rhythm occurred in 36 of 46 patients (78.2%) receiving propafenone, in 40 of 48 patients (83.3%) receiving amiodarone, and in 27 of the 49 (55.10%) controls (P < 0.02, drug vs placebo, between drugs NS). The mean time to conversion was 2 ± 3 hours for propafenone, 7 ± 5 hours for amiodarone, and 13 ± 9 for placebo (P < 0.05). Patients who converted had smaller atria than those who did not (diameter: 42.7 ± 5 vs 47.2 ± 7 mm, P < 0.001 for all). Treatment was discontinued in one patient in the amiodarone group because of an allergic reaction and in two patients in the propafenone group because of excessive QRS widening. No side effects were observed in the placebo group. Conclusions: Both drugs tested intravenously were equally effective and safe for the rapid conversion of recentonset atrial fibrillation to sinus rhythm. However, propafenone offered the advantage of more rapid conversion than amiodarone.
Left Atrial Function and Work After Surgical Ventricular Restoration in Postmyocardial Infarction Heart Failure
Journal of the American Society of Echocardiography, 2008
The purpose of the current study was to examine the effect of surgical ventricular restoration in... more The purpose of the current study was to examine the effect of surgical ventricular restoration in left atrial (LA) performance and left ventricular (LV) diastolic function in patients with congestive heart failure after extensive anterior myocardial infarction. Seventeen consecutive patients (age 63 +/- 9 years, 14 male, 4 with diabetes) were studied prospectively. All patients underwent surgical ventricular restoration and concomitant coronary artery bypass surgery. LA volumes were calculated, as were peak LA kinetic energy (LAKE) and LA ejection fraction (LAEF). LV diastolic filling patterns were also assessed. Follow-up period was 1 year. LA size and volumes did not change significantly during the follow-up period. Two distinct groups of patients were identified: group A, in which LAEF and peak LAKE increased, and group B, in which LAEF and peak LAKE decreased. In both groups, the LAEF and peak LAKE appeared to increase or decrease simultaneously and this became evident from the first month after the surgery. However, 1 year after the operation, diastolic filling pattern was significantly different between the two groups. LA function showed improvement only in patients who demonstrated an improvement in indices of diastolic filling pattern. Despite improvement in clinical status and indices of LV systolic function in all patients who underwent surgical ventricular restoration for treatment of congestive heart failure as a result of LV dilatation secondary to large myocardial infarction, improvement of LA function occurs in patients with improved LV diastolic function.
European Heart Journal - Cardiovascular Imaging, 2002
Cardiac involvement occurs in up to 50% of patients with primary amyloidosis. Diffuse amyloid dep... more Cardiac involvement occurs in up to 50% of patients with primary amyloidosis. Diffuse amyloid deposits lead to impairment of myocardial systolic and diastolic function. Due to the severe left ventricular diastolic abnormality, left atrial contribution to left ventricular stroke volume remains critical. We report a case of primary amyloidosis where we assessed non-invasively left atrial systolic function.
European Journal of Radiology, 1998
Objecti6e: A double-blind randomised study was conducted in two British centres, to evaluate the ... more Objecti6e: A double-blind randomised study was conducted in two British centres, to evaluate the safety, tolerance and efficacy of the new dimeric non-ionic contrast medium Iotrolan 320 in comparison with the monomeric non-ionic compound Iohexol 350 in coronary angiography. Methods and Material: 120 patients were randomised to receive either Iotrolan at a concentration of 320 mgI/ml or Iohexol at a concentration of 350 mgI/ml, during selective coronary angiography and left ventriculography. The variables measured were: maximum increase of the left ventricular end-diastolic pressure up to 6 min after ventriculography, haemodynamic and electrocardiographic variables, arrhythmogenicity, clinical laboratory parameters, tolerance, adverse events and efficacy. Results: Iotrolan resulted in a smaller change of left ventricular end-diastolic pressure compared to Iohexol, but the difference was not statistically significant. Transient changes in left ventricular systolic pressure, intra-arterial systolic pressure, intra-arterial diastolic pressure, and in electrocardiographic parameters, occurred after the injections, but they were not clinically significant. Changes in the clinical laboratory markers from baseline values were comparable between the two groups and confirmed good renal and hepatic tolerance. During the left ventriculogram, Iotrolan resulted in less symptoms compared to Iohexol (P=0.002). Adverse events, which were mild or moderate in most cases, were observed with no statistical difference between the two agents. The contrast quality of both agents was good with no statistical difference. Conclusion: This study did not show a significant difference between Iotrolan 320 and Iohexol 350 with regard to cardiovascular safety or patient tolerance, except for a minor difference in the intensity of heat/warmth sensation.
Pacing and Clinical Electrophysiology, 1997
Two patients with metastatic pacemaker infections, one caused by Pseudomonas aeruginosa, 5 months... more Two patients with metastatic pacemaker infections, one caused by Pseudomonas aeruginosa, 5 months after implantation, and the second by Streptococcus pneumoniae, 8 years after implantation, were treated successfully by removal of the pacemaker systems. Infection reoccurred in the patient with Pseudomonas aeruginosa, who initially underwent partial pacing system removal allowing the atrial lead to remain. Repeat partial atrial lead removal and contralateral pacemaker implantation was followed by clinical infection, which was resolved when both the implanted atrial lead fragment and the recently implanted pacemaker were both removed. Removal of all hardware is required for cure of pacemaker infection.
Journal of Cardiology Cases, 2020
Μελέτη των μεταβολών της αιμάτωσης και λειτουργικότητας της αριστεράς κοιλίας κατά την οξεία φάση του εμφράγματος του μυοκαρδίου με Tc-99m sestamibi gated spect και με δυμαμική ηχοκαρδιογραφία δοβουταμίνης
602 Effect of left ventricular filling pattern on cardiopulmonary exercise response in patients with left ventricular systolic dysfunction
European Journal of Echocardiography, 1999
327 Assessment of Doppler derived left ventricular myocardial performance index in congestive heart failure; effects of dobutamine
European Journal of Echocardiography, 1999
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē, 2012
We present the case of a patient who underwent a percutaneous secundum atrial septal defect (ASD ... more We present the case of a patient who underwent a percutaneous secundum atrial septal defect (ASD II) closure with an undersized septal occluder device. One week and one month later she experienced two transient ischemic attacks. Three-dimensional transesophageal echocardiography (TEE) revealed a residual patent foramen ovale (PFO) with a positive Valsalva bubble test. She underwent a second procedure under the 3D TEE guidance and the PFO was successfully closed percutaneously using a PFO occluder device that was attached to the ASD device. Accurate ASD and PFO morphology assessment and appropriate device selection are the key factors in the success of percutaneous closure. 3D TEE is an innovative diagnostic technique, providing a complete description of the cardiac defect and improving spatial orientation. Real-time 3D TEE is the appropriate guidance for successful and accurate positioning of the device.
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē
The treatment of calcified coronary artery lesions is a challenge for percutaneous angioplasty. R... more The treatment of calcified coronary artery lesions is a challenge for percutaneous angioplasty. Rotational atherectomy is an established technique for the effective modification of these lesions prior to conventional angioplasty and stent implantation. Drug-eluting stents (DES) have shown encouraging results in complex lesions and high-risk patients. This retrospective study investigated the immediate and long-term prognosis after treatment with rotational atherectomy (RotA) and DES implantation in 184 patients with calcified coronary artery lesions. During follow up (mean 49 months), 7 patients died (1 from a non-cardiac cause) and the incidence of major adverse cardiac events was 14.85%. Only 4.15% of patients underwent a new angioplasty procedure. The combination of RotA and DES in calcified coronary artery lesions has a very good angiographic result and a satisfactory clinical outcome.
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē
Rescue angioplasty is used in patients in whom thrombolysis has been unsuccessful, in order to ac... more Rescue angioplasty is used in patients in whom thrombolysis has been unsuccessful, in order to achieve a better restoration of flow and to improve left ventricular function and the long term prognosis. However, patients who undergo rescue angioplasty have a higher rate of reocclusion of the vessel or distal embolism, resulting in increased mortality. Rheolytic thrombectomy, which reduces the quantity of thrombus and improves flow in the vessel, has been used successfully in such cases. We describe a case in which rheolytic thrombectomy was applied during late rescue angioplasty in order to achieve immediate restoration of flow in the vessel.
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē
Papillary fibroelastomas are rare, primary, benign cardiac tumours most frequently located in the... more Papillary fibroelastomas are rare, primary, benign cardiac tumours most frequently located in the heart valves. They are a potential cause of systemic emboli, stroke, myocardial infarction and sudden death. We present two cases of papillary fibroelastomas located in the mitral and aortic valves of patients who had suffered multiple strokes. The fibroelastomas were diagnosed using transoesophageal echocardiography and the patients were treated surgically, with broad excision of the tumours and preservation of the valves. The echocardiographic and microscopic characteristics of the fibroelastomas are analysed and methods for their differential diagnosis from other cardiac tumours are discussed in the context of the available literature.
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē
The aim of this study was to evaluate the medium-term clinical and angiographic results, as well ... more The aim of this study was to evaluate the medium-term clinical and angiographic results, as well as the occurrence and treatment of restenosis, following the implantation of sirolimus-eluting stents (SES) in patients undergoing coronary angioplasty. All patients who have an SES implanted in our department are entered into a database, with a view to evaluating the use of such stents in everyday clinical practice. This study included patients who consented to repeat angiography 8+/-2.4 months after stent implantation. The study population consisted of 91 patients (63 men, mean age 58+/-8.1 years) with 116 stenoses in all. This represented 17.4% of all patients who had an SES implanted during the study period. All the angiographic examinations were analysed independently using quantitative coronary analysis in order to determine the relationship between clinical and angiographic data and restenosis and late lumen loss. The mean vessel diameter was 2.5+/-0.48 mm and the mean lesion leng...
Left atrial volumes, function and work before and after mitral valve repair in chronic mitral regurgitation
The Journal of heart valve disease, 2004
Despite the effect of mitral valve repair in left ventricular (LV) function having been extensive... more Despite the effect of mitral valve repair in left ventricular (LV) function having been extensively studied, investigations of left atrial (LA) performance indices are minimal. This prospective study was undertaken to analyze LA volumes, function and work in patients with chronic mitral valve regurgitation (MR) who underwent mitral valve repair; the analyses were conducted both before and six months after surgery. Twenty patients (15 males, five females; mean age 51.4 +/- 12.5 years) with severe MR (grade IV) due to floppy mitral valve/mitral valve prolapse (FMV/MVP; anterior, posterior or both) underwent mitral valve repair. LA volumes, maximal at mitral valve opening (LAmax); minimal at valve closure (LAmin); and at onset of atrial systole (P-wave on ECG, LAP); and transmitral Doppler A-wave velocity were measured before and six months after surgery. LA stroke volume (LASV) = LAP - LAmin; LA ejection fraction (LAEF) = LASV/LAP; LA kinetic energy (LAKE) = 1/2 x LASV x 1.06 (specifi...
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē
Surgical treatment of heart failure is emerging as one of the most challenging clinical dilemmas ... more Surgical treatment of heart failure is emerging as one of the most challenging clinical dilemmas for patients with end-stage cardiac failure not amenable to medical treatment. One of the most intriguing techniques is the use of implantable left ventricular assist devices (LVADs) as a bridge to recovery. The early experience from our centre has shown that even short term post-cardiotomy mechanical assistance, after heart failure surgery, improves patient outcome; thus, a clinical feasibility study was designed. The hypothesis of the study is that reparative heart failure surgery combined with postoperative mechanical support, ventricular resynchronisation where indicated, and pharmacological treatment can maximise myocardial recovery. In the study a new, implantable, magnetically levitated, rotary pump will be used as a bridge to recovery. In this manuscript the first worldwide human implantation of a new, continuous-flow LVAD, the WorldHeart Rotary Pump (Levacor, WorldHeart Inc., Oa...
73 TandemHeart percutaneous ventricular assist device in cardiac surgery of patients with advanced and acute heart failure
European Journal of Heart Failure Supplements, 2006
436 Left atrial function and work after surgical ventricular restoration in the treatment of advanced heart failure due to post-infarction ventricular dilatation
European Journal of Heart Failure Supplements, 2006
484 Isometric exercise as a provocative test for mitral regurgitation in patients with mitral valve prolapse
European Journal of Echocardiography, 1999
344 Dobutamine- vs. exercise-induced ST-segment elevation early after Q-wave myocardial infarction; prediction of recovery of function following revascularisation
European Journal of Echocardiography, 1999
Pacing and Clinical Electrophysiology, 1998
KOCHIADIKIS, G.E., ET AL.: Intravenous Propafenone Versus Intravenous Amiodarone in the Managemen... more KOCHIADIKIS, G.E., ET AL.: Intravenous Propafenone Versus Intravenous Amiodarone in the Management of Atrial Fibrillation of Recent Onset: A Placebo-controlled Study. The efficacy and safety of intravenous propafenone, amiodarone, or placebo were compared in the treatment of atrial fibrillation (AF) of recent onset (duration <• 48 hours). Methods: 143 patients (77 men, mean age 63 ± 12 years) were studied, of whom 46 received propafenone (2 mg/kg over 15 minutes followed by 10 mg/kg over the next 24 hours), 48 received amiodarone (300 mg intravenously over 1 hour, followed by 20 mg/kg over the next 24 hours, plus 1,800 mg/day orally, in 3 divided doses), and 49 received placebo (the equivalent amount of saline /V over 24 hours). Digoxin was administered to all patients who had not previously received it. Results: Conversion to normal sinus rhythm occurred in 36 of 46 patients (78.2%) receiving propafenone, in 40 of 48 patients (83.3%) receiving amiodarone, and in 27 of the 49 (55.10%) controls (P < 0.02, drug vs placebo, between drugs NS). The mean time to conversion was 2 ± 3 hours for propafenone, 7 ± 5 hours for amiodarone, and 13 ± 9 for placebo (P < 0.05). Patients who converted had smaller atria than those who did not (diameter: 42.7 ± 5 vs 47.2 ± 7 mm, P < 0.001 for all). Treatment was discontinued in one patient in the amiodarone group because of an allergic reaction and in two patients in the propafenone group because of excessive QRS widening. No side effects were observed in the placebo group. Conclusions: Both drugs tested intravenously were equally effective and safe for the rapid conversion of recentonset atrial fibrillation to sinus rhythm. However, propafenone offered the advantage of more rapid conversion than amiodarone.
Left Atrial Function and Work After Surgical Ventricular Restoration in Postmyocardial Infarction Heart Failure
Journal of the American Society of Echocardiography, 2008
The purpose of the current study was to examine the effect of surgical ventricular restoration in... more The purpose of the current study was to examine the effect of surgical ventricular restoration in left atrial (LA) performance and left ventricular (LV) diastolic function in patients with congestive heart failure after extensive anterior myocardial infarction. Seventeen consecutive patients (age 63 +/- 9 years, 14 male, 4 with diabetes) were studied prospectively. All patients underwent surgical ventricular restoration and concomitant coronary artery bypass surgery. LA volumes were calculated, as were peak LA kinetic energy (LAKE) and LA ejection fraction (LAEF). LV diastolic filling patterns were also assessed. Follow-up period was 1 year. LA size and volumes did not change significantly during the follow-up period. Two distinct groups of patients were identified: group A, in which LAEF and peak LAKE increased, and group B, in which LAEF and peak LAKE decreased. In both groups, the LAEF and peak LAKE appeared to increase or decrease simultaneously and this became evident from the first month after the surgery. However, 1 year after the operation, diastolic filling pattern was significantly different between the two groups. LA function showed improvement only in patients who demonstrated an improvement in indices of diastolic filling pattern. Despite improvement in clinical status and indices of LV systolic function in all patients who underwent surgical ventricular restoration for treatment of congestive heart failure as a result of LV dilatation secondary to large myocardial infarction, improvement of LA function occurs in patients with improved LV diastolic function.