S-66
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A new clinical approach in the
treatment of cardiac arrhythmias
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Annibale Sandro Montenero,
Anselma Intini, Maria Grazia Bendini, Gemma Pelargonio, Katia Martini, Paolo Zecchi.
Istituto di Cardiologia, Universita Cattolica del Sacro Cuore, Rome, Italy
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Introduction
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The aim of this article is to define the state of the
art, as well as to give information about recent and future developments on the treatment
of cardiac arrhythmias. Syncope and ventricular tachycardia in people with anatomically
normal hearts ask for a totally different approach than in people with ischemic heart
disease. Molecular biology changed perspective for diagnosis and treatment of the long QT
syndrome patients. Radiofrequency catheter ablation will soon make Wolff-Parkinson-White
syndrome and other supraventricular tachycardias syndrome of young people only. Even
patients that after surgery for congenital heart disease develop atrial arrhythmias can
actually receive a more appropriate and definitive therapy.
The role of arrhythmogenic foci as a trigger of paroxysmal atrial fibrillation is
going to suggest a new entity, the so called "focal atrial fibrillation" that
might require a new therapeutic approach.
Primary prevention against sudden death has long been a therapeutic goal principally
in patients with coronary artery disease and prior myocardial infarction. Clinical trials
using beta-blockers in the latter population showed a favorable effect on all cause of
mortality and sudden death1. Therefore, subsequent
studies with antiarrhythmic drugs, showed a neutral or unfavorable effect on all-cause
mortality and sudden cardiac death2,3.
It is in this context that the importance of the outcome of the Multicenter Automatic
Defibrillator Implantation Trial (MADIT) must be viewed4.
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Key Words
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Treatment of arrhythmias – mechanisms
supraventricular arrhythmias, atrial fibrillation, ventricular tachiarrhythmias, MADIT trial,
EMIAT trial, Sicilian Gambit, ICD, R
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