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At least 253 records · Page 14Linked to original sources
PubMed2005

Surgical treatment of atrial fibrillation.

Surgery aims to eliminate atrial fibrillation (AF) through direct modification of the arrhythmogenic substratum. The Maze procedure, developed two decades ago, has proven to be clearly effective in restoring sinus rhythm in AF patients with or without associated organic cardiac disorders. Indications for surgery may be tailored to the clinical situation involved. In patients with continuous AF associated with structural heart disease (eg, valvular, congenital or coronary artery disease), the performance of a concomitant AF ablation procedure proven to add minimal morbidity to the operation may be highly beneficial to patient outcome. It is likely, although not entirely proven, that the restoration and maintenance of sinus rhythm after mitral valve surgery promotes survival by preventing tachycardia-induced cardiomyopathy and stroke. Novel strategies for AF surgery involve the use of alternate energy sources to create the lines of block in the atria and the simplification of the lesion pattern compared with the earlier Cox-Maze procedure. Published clinical data support the contention that left atrial ablation techniques performed concomitantly with valvular and/or coronary artery bypass surgery are likely to result in a 70% to 90% cure rate of AF in patients with preoperatively documented AF. Despite the lack of evidence for long-term outcome benefit, intraoperative pulmonary vein ablation, feasible with minimal morbidity, clearly appears to be an improvement over simply ignoring AF in patients undergoing cardiac surgery. Left atrial appendectomy appears warranted in patients with chronic persistent AF.

Atrial Fibrillation↗
PubMed2005

Pacing for the prevention of atrial fibrillation.

Multiple randomized clinical trials have demonstrated that atrial or dual-chamber pacing prevents paroxysmal and permanent atrial fibrillation (AF) in patients with symptomatic bradycardia as the primary indication for cardiac pacing. The benefit of atrial pacing for the prevention of AF is observed predominantly in patients with sinus node dysfunction. Emerging evidence also suggests that the risk of AF is directly linked to the proportion of time that ventricular pacing occurs. Consequently, pacemakers should be programmed to minimize the amount of ventricular pacing in patients with intrinsic atrioventricular conduction. Temporary atrial pacing following heart surgery may be of benefit for the prevention of perioperative AF. Atrial pacing has not been shown to prevent AF in patients without symptomatic bradycardia. In addition, selective pacing algorithms designed to prevent AF have minimal or no incremental benefits for the prevention of AF. At present, the role of selective atrial lead site(s) for the prevention of AF remains uncertain.

Algorithms↗
PubMed2005

Atrial arrhythmias and special circumstances.

The present paper discusses the general principles of management of atrial fibrillation and atrial flutter under special circumstances. Management recommendations, which encompass initial assessment, initial arrhythmia management and chronic pharmacological therapy, are outlined for patients with hypertrophic cardiomyopathy, Wolff-Parkinson-White syndrome and congenital heart disease. Recommendations are also made for pregnant patients and pediatric patients without congenital heart disease. Discrepancies between the authors' recommendations and those from the American College of Cardiology/American Heart Association/European Society of Cardiology are discussed.

Atrial Fibrillation↗
PubMed2005

Management of atrial fibrillation in the emergency department and following acute myocardial infarction.

Atrial fibrillation (AF) is the most common arrhythmia managed by emergency physicians and there is increasing evidence that selected patients with acute AF can be safely managed in the emergency department without the need for hospital admission. The principles of management are identification and treatment of precipitating or underlying causes, hemodynamic stabilization/rate control, reduction of thromboembolism risk and the conversion/maintenance of sinus rhythm. A strategy of rate or rhythm control should be chosen based on the patient's clinical status, the duration of AF, the experience of the treating physician and the status of anticoagulation. Before either electric or pharmacological cardioversion, anticoagulation should be considered. Most patients should be given heparin or low molecular weight heparin while preparing for cardioversion. All patients should be considered for long-term anticoagulation based on their thromboembolic risk and bleeding risk from antithrombotic therapy. Following restoration of sinus rhythm, a decision regarding the use of antiarrhyhmic drugs should be made based on the estimated frequency of recurrence and degree of symptoms. In the setting of acute myocardial infarction, beta-blockers should be administered whenever possible. If beta-blockers are contraindicated, the rate can be slowed with digoxin or amiodarone. Cardioversion should be performed if the patient is hemodynamically unstable. Class IC antiarrhythmic drugs should not be administered in this setting.

Atrial Fibrillation↗
PubMed2005

An evidence-based approach to prescribing nonsteroidal antiinflammatory drugs. Third Canadian Consensus Conference.

OBJECTIVE: To revisit our previous evidence-based recommendations on the appropriate prescription of nonsteroidal antiinflammatory drugs (NSAID) with particular emphasis on cyclooxygenase-2 selective inhibitors (coxibs). METHODS: Needs assessments were conducted among Canadian physicians to determine their educational needs surrounding NSAID/coxibs. A survey of patients with arthritis was also conducted. Consensus participants reviewed articles relating to NSAID/coxibs in peer-reviewed journals between January 2000 and December 2004. At the consensus meeting, held January 21-23, 2005, participants discussed selected topics, after which recommendations were formulated and debated. Results. At the time of the meeting, it was agreed that emerging cardiovascular data were not clear enough to decide whether unanticipated cardiovascular events associated with coxibs represent a class effect or an effect of an individual drug. However, publications that appeared shortly after the meeting, as well as data presented at both the Joint Meeting of the Arthritis Advisory Committee and the Drug Safety and Risk Management Advisory Committee of the US Food and Drug Administration, February 16-18, 2005, and Health Canada's Expert Advisory Panel on the Safety of Cox-2 Selective NSAID, June 9-10, 2005, clarified that all available coxibs do carry some degree of cardiovascular risk, denoting a class effect. Our consensus group made the following specific recommendations: (1) Patients should be fully informed about treatment options, including the need to balance between cardiovascular risks and gastrointestinal (GI) benefits of NSAID/coxibs. (2) Coxibs are as effective as nonselective NSAID and superior to acetaminophen for the symptoms of arthritis. Topical NSAID may also be beneficial. (3) Coxibs are associated with fewer severe GI complications than nonselective NSAID. A proton pump inhibitor (PPI) should be prescribed if an NSAID must be used in a patient at increased GI risk. (4) The renal/blood pressure (BP) impact of coxibs is similar to that of NSAID. (5) In individuals at risk, creatinine clearance and BP should be determined at baseline and shortly after treatment begins. (6) In the geriatric population, use of nonpharmacological therapies should be maximized, and special caution is required before prescribing oral NSAID/coxibs. (7) Patients taking rofecoxib have been shown to have an increased risk of cardiovascular events. Current data suggest that this increased cardiovascular risk may be an effect of the NSAID/coxib class. (8) Although the data are limited, coxibs may be more cost-effective for patients at high GI risk than nonselective NSAID plus proprietary PPI. CONCLUSION: Coxibs continue to be an option in the treatment armamentarium. Given the evolving cardiovascular information, physicians and patients should weigh the benefits and risks of NSAID/coxib treatment. This concern emphasizes the need to routinely reassess patients' risks. These recommendations, which were formulated according to the Appraisal of Guidelines for Research and Evaluation, are intended to be used as guidelines to supplement, but not replace, the physician's judgment in clinical decision-making.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2006

Canadian guidelines for the management of adult growth hormone deficiency.

PURPOSE: To develop guidelines for the management of growth hormone (GH) deficiency in Canadian adults to facilitate rational use of GH in appropriate indications. METHODS: The guidelines were developed by group of endocrinologists and an endocrine specialist nurse with an interest in neuroendocrine disorders, representing all regions of Canada and practicing in a variety of settings. A steering committee with broad expertise undertook a systematic review of the evidence relating to adult GHD and GH replacement. This evidence was reviewed by the whole group, and guidelines were developed using a consensus approach. RESULTS: The document addresses the causes and clinical characteristics of GHD in adults and reviews the evidence in support of GH replacement in this group. The authors provide recommendations for the identification of adult GHD, and guidelines for GH replacement in appropriate patients. Also, access to GH therapy across Canada is reviewed.

Adult↗
PubMed2005

[Current status of hormone therapy during the menopausal transition and post-menopause].

Starting from prospective clinical studies that have evaluated its benefits and risks, hormone replacement therapy in menopause women has been reassessed in its indications in the last four years. In October, 2004 a Latinamerican Experts Consensus was carried out, such report with some modifications is presented in this publication. The conclusions the experts reached were the following: 1) Hormone Therapy is the gold standard for the control of moderate to severe vasomotor symptoms; 2) this therapy must be indicated in an individual manner and only in symptomatic women in which the benefit is greater than the risk; 3) the least effective dose must be used; 4) it must be used neither for cardiovascular prevention, osteoporosis, colon cancer nor for mental disorder; 5) the patient must be informed about the benefits and risks.

Female↗
PubMed1990

Canadian Consensus Conference on Nonpharmacological Approaches to the Management of High Blood Pressure: postconference initiatives.

Following the Canadian Consensus Conference on Nonpharmacological Approaches to the Management of High Blood Pressure. March 1989, the Coalition through its member organizations, launched a number of initiatives stemming from the conference. The Coalition achieved a unified document acceptable to all levels of the health profession for nonpharmacological approaches to hypertension, which will be the very first approach prior to treatment with drugs. The information dissemination was successfully carried out. With the cooperation of all member organizations the Coalition is hopeful of executing its future planned strategies for successful intervention of nonpharmacological approaches to the treatment of high blood pressure.

Education, Medical, Continuing↗
PubMed1991

Is there a need for more precise definitions of bioavailability? Conclusions of a consensus workshop, Munich, September 9, 1989; under the patronage of the F.I.P.

After evaluation of the present definitions in a set of particular cases, it was agreed that there was no need for "more precise" definitions and that the current ones were adequate in the majority of cases. However, it was felt that the present definitions might be improved, in particular in view of the existence of non-systemically acting drugs and future "targeted drugs". Thus, the FDA definition might be modified as follows: "Bioavailability means the rate and extent to which the active drug ingredient or therapeutic moiety from a drug product becomes available at the site of drug action or in a biological medium believed to reflect accessibility to a site of action".

Biological Availability↗
PubMed1990

Standardization of definitions and criteria of causality assessment of adverse drug reactions. Drug-induced liver disorders: report of an international consensus meeting.

International reporting of adverse drug reactions by pharmaceutical manufacturers to national drug regulatory authorities requires internationally accepted standard definitions of reactions and criteria for assessment of causality. The Council for International Organizations of Medical Sciences (CIOMS) undertook a pilot project to prepare such definitions and criteria, and proposed to use as its model a series of expert consensus meetings organized in France by the pharmaceutical company, Roussel Uclaf, with the participation of the official French network of pharmacovigilance. Under CIOMS auspices, an international meeting was organized to test the feasibility of adapting for international use the outcome of the French consensus meetings on drug-induced liver disorders. The meeting resulted in a series of proposed standard designations of drug-induced liver disorders and criteria of causality assessment.

Chemical and Drug Induced Liver Injury↗