Studies of RFA for treatment of atrial fibrillation report higher efficacy rates than do studies of AAD therapy and a lower rate of complications
BACKGROUND Although radiofrequency catheter ablation ( RFA ) has evolved from an experimental procedure to an important treatment option for atrial fibrillation , the relative safety and efficacy of catheter ablation relative to that of antiarrhythmic drug ( AAD ) therapy has not been established .
Outcomes of early risk stratification and targeted implantable cardioverter-defibrillator implantation after ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.
BACKGROUND Methods to identify high-risk patients and timing of implantable cardioverter-defibrillator ( ICD ) therapy after ST-elevation myocardial infa rct ion need further optimization . METHODS AND RESULTS We evaluated outcomes of early ICD implantation in patients with inducible ventricular tachycardia . Consecutive patients treated with primary percutaneous coronary intervention for acute ST-elevation myocardial infa rct ion underwent early left ventricular ejection fraction ( LVEF ) assessment . Patients with LVEF > 40 % were discharged ( group 1 ) ; patients with LVEF < or = 40 % underwent risk stratification with electrophysiological study . If no ventricular tachycardia was induced , patients were discharged without an ICD ( group 2 ) . If sustained monomorphic ventricular tachycardia ( > or = 200-ms cycle length ) was induced , an ICD was implanted before discharge ( group 3 ) . Follow-up was obtained up to 30 months in all patients and up to 48 months in a subgroup of patients with LVEF < or = 30 % without an ICD . The primary end point was total mortality .  Group 1 ( n=574 ) had a mean LVEF of 54+/-8 % ; group 2 ( n=83 ) , 32+/-6 % ; and group 3 ( n=32 ) , 29+/-7 % . At a median follow-up of 12 months , there was no significant difference in survival between the 3 groups ( P=0.879 ) , with mortality rates of 3 % , 3 % , and 6 % for groups 1 through 3 , respectively . In the subgroup of group 2 patients with LVEF < or = 30 % and no ICD ( n=25 ) , there was 9 % mortality at a median follow-up of 25 months . In group 3 , 19 % had spontaneous ICD activation result ing from ventricular tachycardia . CONCLUSIONS Early ICD implantation limited to patients with inducible ventricular tachycardia enables a low overall mortality in patients with impaired LVEF after primary percutaneous coronary intervention for ST-elevation myocardial infa rct ion
Studies of RFA for treatment of atrial fibrillation report higher efficacy rates than do studies of AAD therapy and a lower rate of complications
BACKGROUND Although radiofrequency catheter ablation ( RFA ) has evolved from an experimental procedure to an important treatment option for atrial fibrillation , the relative safety and efficacy of catheter ablation relative to that of antiarrhythmic drug ( AAD ) therapy has not been established .