NEJM â Collection Updates for Arrhythmias

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2010 â A 47-Year-Old Man with Abdominal and Flank Pain

Thu, 21Â JanÂ 2010 00:00:00 -05:00

Dr. Rima A. Arnaout (Medicine): A 47-year-old man was admitted to this hospital because of abdominal pain.

The patient was in his usual state of health until 5 weeks before admission,...

ORIGINAL ARTICLE: Long-Term Outcome Associated with Early Repolarization on Electrocardiography

Thu, 24Â DecÂ 2009 00:00:00 -05:00

Background: Early repolarization, which is characterized by an elevation of the QRSâST junction (J point) in leads other than V1 through V3 on 12-lead electrocardiography, has been associated with vulnerability...

EDITORIAL: Deleterious Effects of Right Ventricular Pacing

Bruce D. Lindsay, M.D. — Thu, 26Â NovÂ 2009 00:00:00 -05:00

In this issue of the Journal, Yu et al. report results of the Pacing to Avoid Cardiac Enlargement (PACE) study, a prospective, double-blind, multicenter trial designed to determine whether biventricular...

ORIGINAL ARTICLE: Biventricular Pacing in Patients with Bradycardia and Normal Ejection Fraction

Thu, 26Â NovÂ 2009 00:00:00 -05:00

Background: Observational studies suggest that conventional right ventricular apical pacing may have a deleterious effect on left ventricular function. In this study, we examined whether biventricular pacing is superior to...

EDITORIAL: The Confirmatory Trial in Comparative-Effectiveness Research

Alan M. Garber, M.D., Ph.D., and Mark A. Hlatky, M.D. — Thu, 08Â OctÂ 2009 00:00:00 -05:00

Despite the infusion of more than $1 billion through the American Recovery and Reinvestment Act of 2009 and the potential commitment of much more money, there will never be enough...

ORIGINAL ARTICLE: Defibrillator Implantation Early after Myocardial Infarction

Thu, 08Â OctÂ 2009 00:00:00 -05:00

Background: The rate of death, including sudden cardiac death, is highest early after a myocardial infarction. Yet current guidelines do not recommend the use of an implantable cardioverterâdefibrillator (ICD) within...

PERSPECTIVE: Left Atrial Appendage Occlusion â Closure or Just the Beginning?

Thu, 18Â JunÂ 2009 00:00:00 -05:00

More than 3 million Americans have atrial fibrillation, which increases their risk of stroke by a factor of 5.12 Patients with atrial fibrillation account for one of every six strokes,...

EDITORIAL: The ACTIVE Pursuit of Stroke Prevention in Patients with Atrial Fibrillation

Alan S. Go, M.D. — Thu, 14Â MayÂ 2009 00:00:00 -05:00

Approximately 1% of Americans have atrial fibrillation, and the prevalence of this arrhythmia increases sharply with older age (being approximately 10% among persons 80 years of age or older).1 Worldwide...

ORIGINAL ARTICLE: Effect of Clopidogrel Added to Aspirin in Patients with Atrial Fibrillation

The ACTIVE Investigators — Thu, 14Â MayÂ 2009 00:00:00 -05:00

Background: Vitamin K antagonists reduce the risk of stroke in patients with atrial fibrillation but are considered unsuitable in many patients, who usually receive aspirin instead. We investigated the hypothesis...

PERSPECTIVE: Dronedarone for Atrial Fibrillation â An Odyssey

Thu, 30Â AprÂ 2009 00:00:00 -05:00

On March 18, 2009, the Cardiovascular and Renal Drugs Advisory Committee of the Food and Drug Administration (FDA) convened to determine whether the antiarrhythmic drug dronedarone should be approved for...

EDITORIAL: Angiotensin-Receptor Blockers for Prevention of Atrial Fibrillation â A Matter of Timing or Target?

Anne M. Gillis, M.D., F.R.C.P.C. — Thu, 16Â AprÂ 2009 00:00:00 -05:00

Atrial fibrillation is the most common sustained arrhythmia and is associated with substantial morbidity and mortality.1 Antiarrhythmic drug therapy is often ineffective and may cause serious adverse effects, including ventricular...

ORIGINAL ARTICLE: Valsartan for Prevention of Recurrent Atrial Fibrillation

The GISSI-AF Investigators — Thu, 16Â AprÂ 2009 00:00:00 -05:00

Background: Atrial fibrillation is the most common cardiac arrhythmia, and no current therapy is ideal for control of this condition. Experimental studies suggest that angiotensin IIâreceptor blockers (ARBs) can influence...

CORRESPONDENCE: Inappropriate ICD Shocks Caused by External Electrical Noise

Thu, 26Â MarÂ 2009 00:00:00 -05:00

To the Editor: Because of the growing number of patients worldwide who are receiving implantable cardioverterâdefibrillators (ICDs)1 and the increasing number of indications for their use, physicians and patients need...

ORIGINAL ARTICLE: A New Diagnostic Test for Arrhythmogenic Right Ventricular Cardiomyopathy

Thu, 12Â MarÂ 2009 00:00:00 -05:00

Background: The diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) can be challenging because the clinical presentation is highly variable and genetic penetrance is often low.

Methods: To determine whether a change...

ORIGINAL ARTICLE: Effect of Dronedarone on Cardiovascular Events in Atrial Fibrillation

Thu, 12Â FebÂ 2009 00:00:00 -05:00

Background: Dronedarone is a new antiarrhythmic drug that is being developed for the treatment of patients with atrial fibrillation.

Methods: We conducted a multicenter trial to evaluate the use of dronedarone...

CORRESPONDENCE: Long-QT Syndrome Induced by the Antiaddiction Drug Ibogaine

Thu, 15Â JanÂ 2009 00:00:00 -05:00

To the Editor: Anecdotal evidence suggests that ibogaine alleviates drug craving and relapse of drug use in humans, as has been confirmed for animals.1 Ibogaine is currently used as an...

CORRESPONDENCE: Persistent Fainting after Implantation of a âCurativeâ Pacemaker

Sazzli Kasim, M.R.C.P.I., Michael Hennessy, M.D., and James Crowley, M.D. — Thu, 01Â JanÂ 2009 00:00:00 -05:00

To the Editor: Syncope is a common and disabling problem, and its cause may be difficult to elucidate. A 64-year-old right-handed male taxi driver was referred to us for the...

REVIEW ARTICLE: Implantable CardioverterâDefibrillators after Myocardial Infarction

Robert J. Myerburg, M.D. — Thu, 20Â NovÂ 2008 00:00:00 -05:00

Persons who survive a myocardial infarction are at increased risk for sudden death from cardiac causes, owing largely to ventricular tachyarrhythmias.12 The risk of sudden death after a myocardial infarction...

IMAGES IN CLINICAL MEDICINE: What Lies Beneath?

Darren M. Mylotte, M.B. and Anthony O'Regan, M.D. — Thu, 23Â OctÂ 2008 00:00:00 -05:00

A 74-year-old male smoker was hospitalized for a transurethral resection of the prostate. His medical history was notable for the insertion of a dual-chamber pacemaker to treat symptomatic bradycardia 10...

BOOK REVIEW:

Thu, 11Â SepÂ 2008 00:00:00 -05:00

Atrial fibrillation has become the focus of intense investigation over the past several years, owing to its clinical importance, an increased understanding of its pathophysiology, and the development of new...

ORIGINAL ARTICLE: Atrial Natriuretic Peptide Frameshift Mutation in Familial Atrial Fibrillation

Thu, 10Â JulÂ 2008 00:00:00 -05:00

Atrial fibrillation is a common arrhythmia that is hereditary in a small subgroup of patients. In a family with 11 clinically affected members, we mapped an atrial fibrillation locus to...

BOOK REVIEW:

Thu, 03Â JulÂ 2008 00:00:00 -05:00

It must have been a daunting task to produce a comprehensive account of the extraordinary advances in the genetics, molecular mechanisms, diagnosis, and treatment of cardiac arrhythmias. Ihor Gussak and...

EDITORIAL: Rhythm Control in Atrial Fibrillation â One Setback after Another

Michael E. Cain, M.D., and Anne B. Curtis, M.D. — Thu, 19Â JunÂ 2008 00:00:00 -05:00

Atrial fibrillation, the most common sustained arrhythmia observed in hospitalized patients, is associated with substantial morbidity, and its occurrence approximately doubles the rate of death as compared with that of...

ORIGINAL ARTICLE: Electrocardiographic Abnormalities and Sudden Death in Myotonic Dystrophy Type 1

Thu, 19Â JunÂ 2008 00:00:00 -05:00

Background: Sudden death can occur as a consequence of cardiac-conduction abnormalities in the neuromuscular disease myotonic dystrophy type 1. The determinants of the risk of sudden death remain imprecise.

Methods: We...

ORIGINAL ARTICLE: Rhythm Control versus Rate Control for Atrial Fibrillation and Heart Failure

Thu, 19Â JunÂ 2008 00:00:00 -05:00

Background: It is common practice to restore and maintain sinus rhythm in patients with atrial fibrillation and heart failure. This approach is based in part on data indicating that atrial...

EDITORIAL: Early Repolarization Revisited

Hein J. Wellens, M.D. — Thu, 08Â MayÂ 2008 00:00:00 -05:00

For more than 60 years, physicians have been fascinated by a peculiar electrocardiographic pattern called âearly repolarization.â1 When Google is queried, more than 1 million hits turn up on this...

IMAGES IN CLINICAL MEDICINE: Giant Left Atrium

Garrick C. Stewart, M.D. and Anju Nohria, M.D. — Thu, 08Â MayÂ 2008 00:00:00 -05:00

An 83-year-old woman with long-standing atrial fibrillation who had previously undergone atrioventricular nodal ablation and pacemaker placement presented with symptoms of progressive heart failure. Physical examination was notable for elevated...

ORIGINAL ARTICLE: Left Cardiac Sympathetic Denervation for Catecholaminergic Polymorphic Ventricular Tachycardia

Thu, 08Â MayÂ 2008 00:00:00 -05:00

Catecholaminergic polymorphic ventricular tachycardia is a potentially lethal disease characterized by adrenergically mediated ventricular arrhythmias manifested especially in children and teenagers. Beta-blockers are the cornerstone of therapy, but some patients...

ORIGINAL ARTICLE: Sudden Cardiac Arrest Associated with Early Repolarization

Thu, 08Â MayÂ 2008 00:00:00 -05:00

Background: Early repolarization is a common electrocardiographic finding that is generally considered to be benign. Its potential to cause cardiac arrhythmias has been hypothesized from experimental studies, but it is...

EDITORIAL: Can Home AEDs Improve Survival?

David J. Callans, M.D. — Thu, 24Â AprÂ 2008 00:00:00 -05:00

Although it is difficult to study or even quantify, out-of-hospital cardiac arrest contributes greatly to total mortality in industrialized countries. Often such an event is the first manifestation of cardiovascular...

ORIGINAL ARTICLE: Home Use of Automated External Defibrillators for Sudden Cardiac Arrest

Thu, 24Â AprÂ 2008 00:00:00 -05:00

Background: The most common location of out-of-hospital sudden cardiac arrest is the home, a situation in which emergency medical services are challenged to provide timely care. Consequently, home use of...

CLINICAL PRACTICE: Long-QT Syndrome

Dan M. Roden, M.D. — Thu, 10Â JanÂ 2008 00:00:00 -05:00

After the sudden death of a 13-year-old girl while she was playing basketball, her family comes to the clinic for medical evaluation (Figure 1). Her parents' resting electrocardiograms (ECGs) are...

ORIGINAL ARTICLE: Delayed Time to Defibrillation after In-Hospital Cardiac Arrest

Thu, 03Â JanÂ 2008 00:00:00 -05:00

Background: Expert guidelines advocate defibrillation within 2 minutes after an in-hospital cardiac arrest caused by ventricular arrhythmia. However, empirical data on the prevalence of delayed defibrillation in the United States...

EDITORIAL: Survival after Tachyarrhythmic Arrest â What Are We Waiting For?

Leslie A. Saxon, M.D. — Thu, 03Â JanÂ 2008 00:00:00 -05:00

Approximately 225,000 out-of-hospital cardiac arrests occur annually in the United States. It is a little-known fact that at least double that number of cardiac arrests occur in hospitalized patients.1 Survival...

EDITORIAL: Ablation after ICD Implantation â Bridging the Gap between Promise and Practice

N.A. Mark Estes III, M.D. — Thu, 27Â DecÂ 2007 00:00:00 -05:00

Sudden cardiac arrest due to acute ventricular tachyarrhythmia remains the most common cause of death in developed nations and accounts for more than 450,000 deaths annually in the United States.12...

ORIGINAL ARTICLE: Prophylactic Catheter Ablation for the Prevention of Defibrillator Therapy

Thu, 27Â DecÂ 2007 00:00:00 -05:00

Background: For patients who have a ventricular tachyarrhythmic event, implantable cardioverterâdefibrillators (ICDs) are a mainstay of therapy to prevent sudden death. However, ICD shocks are painful, can result in clinical...

IMAGES IN CLINICAL MEDICINE: Occlusion and Reperfusion of the Middle Cerebral Artery

Ronan Ryan, A.F.R.C.S.I. and David P. Brophy, F.F.R.R.C.S.I. — Thu, 13Â DecÂ 2007 00:00:00 -05:00

A 65-year-old woman with chronic atrial fibrillation was admitted for an elective exchange of an implanted defibrillator for idiopathic dilated cardiomyopathy. To facilitate this procedure, warfarin was withheld for 5...

ORIGINAL ARTICLE: Cardiac-Resynchronization Therapy in Heart Failure with Narrow QRS Complexes

Thu, 13Â DecÂ 2007 00:00:00 -05:00

Background: Indications for cardiac-resynchronization therapy (CRT) in patients with heart failure include a prolonged QRS interval (â¥120 msec), in addition to other functional criteria. Some patients with narrow QRS complexes...

ORIGINAL ARTICLE: Dronedarone for Maintenance of Sinus Rhythm in Atrial Fibrillation or Flutter

Thu, 06Â SepÂ 2007 00:00:00 -05:00

Background: Amiodarone is effective in maintaining sinus rhythm in atrial fibrillation but is associated with potentially serious toxic effects. Dronedarone is a new antiarrhythmic agent pharmacologically related to amiodarone but...

EDITORIAL: Maintaining Sinus Rhythm â Making Treatment Better Than the Disease

Michael D. Ezekowitz, M.B., Ch.B., D.Phil., F.R.C.P. — Thu, 06Â SepÂ 2007 00:00:00 -05:00

Atrial fibrillation affects patients by increasing their risk of stroke and decreasing their quality of life. Unfortunately, even if restoration of sinus rhythm is possible, most patients remain at risk...

ORIGINAL ARTICLE: Minimizing Ventricular Pacing to Reduce Atrial Fibrillation in Sinus-Node Disease

Thu, 06Â SepÂ 2007 00:00:00 -05:00

Background: Conventional dual-chamber pacing maintains atrioventricular synchrony but results in high percentages of ventricular pacing, which causes ventricular desynchronization and has been linked to an increased risk of atrial fibrillation...

CLINICAL THERAPEUTICS: Amiodarone for Atrial Fibrillation

Peter Zimetbaum, M.D. — Thu, 01Â MarÂ 2007 00:00:00 -05:00

A 73-year-old man with stable coronary artery disease, hypertension, and chronic renal insufficiency presents with recurrent atrial fibrillation at 80 to 90 beats per minute. His symptoms include shortness of...

ORIGINAL ARTICLE: Female Predominance and Transmission Distortion in the Long-QT Syndrome

Thu, 28Â DecÂ 2006 00:00:00 -05:00

Background: Congenital long-QT syndrome is a disorder resulting in ventricular arrhythmias and sudden death. The most common forms of the long-QT syndrome, types 1 and 2, are caused by mutations...

PERSPECTIVE: Tracing Atrial Fibrillation â 100 Years

Thu, 05Â OctÂ 2006 00:00:00 -05:00

Today, there is talk about an epidemic of atrial fibrillation, and physicians caring for patients with this common arrhythmia face a bewildering array of treatment options. Contrast this situation with...

EDITORIAL: Connexins, Conduction, and Atrial Fibrillation

Jeffrey E. Saffitz, M.D., Ph.D. — Thu, 22Â JunÂ 2006 00:00:00 -05:00

Atrial fibrillation has always been the little sister to its ventricular counterpart â but during the past decade, it has captured our attention, mainly because it is so common. Atrial...

ORIGINAL ARTICLE: Somatic Mutations in the Connexin 40 Gene () in Atrial Fibrillation

Thu, 22Â JunÂ 2006 00:00:00 -05:00

Background: Atrial fibrillation is the most common type of cardiac arrhythmia and a leading cause of cardiovascular morbidity, particularly stroke. The cardiac gap-junction protein connexin 40 is expressed selectively in...

ORIGINAL ARTICLE: Outcomes of In-Hospital Ventricular Fibrillation in Children

Thu, 01Â JunÂ 2006 00:00:00 -05:00

Background: Ventricular fibrillation and ventricular tachycardia are less common causes of cardiac arrest in children than in adults. These tachyarrhythmias can also begin during cardiopulmonary resuscitation (CPR), presumably as reperfusion...

CLINICAL PRACTICE: Supraventricular Tachycardia

Etienne DelacrÃ©taz, M.D. — Thu, 09Â MarÂ 2006 00:00:00 -05:00

A 28-year-old woman suddenly has rapid palpitations accompanied by chest pain and dizziness while playing her cello. She is brought to an emergency department. She has a faint regular pulse...

EDITORIAL: Catheter Ablation of Chronic Atrial Fibrillation â The Gap between Promise and Practice

Mark A. Wood, M.D., and Kenneth A. Ellenbogen, M.D. — Thu, 02Â MarÂ 2006 00:00:00 -05:00

Atrial fibrillation remains the most common heart-rhythm abnormality seen in general clinical practice, and its incidence is increasing. Atrial fibrillation is an enormous health concern because it increases the risk...

CLINICAL PROBLEM-SOLVING: Search for the Complication

Thu, 02Â MarÂ 2006 00:00:00 -05:00

A 58-year-old woman was hospitalized for the evaluation of prolonged fever and hemoptysis. She reported an eight-month history of intermittent fevers, a productive cough, shortness of breath, and hemoptysis, which...

IMAGES IN CLINICAL MEDICINE: The Twiddler Syndrome

W.A.L. Tonino, M.D. and J.B. Winter, M.D., Ph.D. — Thu, 02Â MarÂ 2006 00:00:00 -05:00

A 55-year-old woman received a diagnosis of the sick sinus syndrome. A dual-chamber pacemaker was implanted with one lead in the right atrium and the other lead in the right...

ORIGINAL ARTICLE: Circumferential Pulmonary-Vein Ablation for Chronic Atrial Fibrillation

Thu, 02Â MarÂ 2006 00:00:00 -05:00

Background: We conducted a randomized, controlled trial of circumferential pulmonary-vein ablation for the treatment of chronic atrial fibrillation.

Methods: A total of 146 patients with a mean (Â±SD) age of 57Â±9...

ORIGINAL ARTICLE: Familial Sinus Bradycardia Associated with a Mutation in the Cardiac Pacemaker Channel

Thu, 12Â JanÂ 2006 00:00:00 -05:00

We found that sinus bradycardia in members of a large family was associated with a mutation in the gene coding for the pacemaker HCN4 ion channel. Pacemaker channels of the...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2005 â A 35-Year-Old Man with Cardiac Arrest while Sleeping

Keith A. Marill, M.D., and Patrick T. Ellinor, M.D., Ph.D. — Thu, 08Â DecÂ 2005 00:00:00 -05:00

Dr. Alex Manini (Emergency Medicine): A 35-year-old man was brought to the emergency department of this hospital by ambulance after a cardiac arrest while sleeping.

According to his partner and his...

IMAGES IN CLINICAL MEDICINE: Ebstein's Anomaly

Aiden J. O'Loughlin, M.B., B.S. and Chris Hayward, F.R.A.C.P. — Thu, 22Â SepÂ 2005 00:00:00 -05:00

A 44-year-old woman presented with increasing dyspnea. The patient had Ebstein's anomaly, which had first been diagnosed when she was in her early 20s. She had declined heart transplantation three...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2005 â A 48-Year-Old Man with Sudden Loss of Consciousness while Jogging

Thu, 25Â AugÂ 2005 00:00:00 -05:00

An unidentified black man who appeared to be approximately 40 years of age was brought to the emergency department of this hospital after suddenly losing consciousness. Witnesses had seen the...

EDITORIAL: Pacemaker Selection â The Changing Definition of Physiologic Pacing

Kenneth A. Ellenbogen, M.D., and Mark A. Wood, M.D. — Thu, 14Â JulÂ 2005 00:00:00 -05:00

Almost 50 years after the first report of the use of cardiac pacing, in the Journal,1 pacing is playing an increasingly important role in the management of cardiac disease. Cardiologists...

ORIGINAL ARTICLE: Single-Chamber versus Dual-Chamber Pacing for High-Grade Atrioventricular Block

Thu, 14Â JulÂ 2005 00:00:00 -05:00

Background: In the treatment of atrioventricular block, dual-chamber cardiac pacing is thought to confer a clinical benefit as compared with single-chamber ventricular pacing, but the supporting evidence is mainly from...

ORIGINAL ARTICLE: Heart-Rate Profile during Exercise as a Predictor of Sudden Death

Thu, 12Â MayÂ 2005 00:00:00 -05:00

Background: Changes in heart rate during exercise and recovery from exercise are mediated by the balance between sympathetic and vagal activity. Since alterations in the neural control of cardiac function...

ORIGINAL ARTICLE: Amiodarone versus Sotalol for Atrial Fibrillation

Thu, 05Â MayÂ 2005 00:00:00 -05:00

Background: The optimal pharmacologic means to restore and maintain sinus rhythm in patients with atrial fibrillation remains controversial.

Methods: In this double-blind, placebo-controlled trial, we randomly assigned 665 patients who were...

EDITORIAL: Resynchronizing Ventricular Contraction in Heart Failure

John A. Jarcho, M.D. — Thu, 14Â AprÂ 2005 00:00:00 -05:00

One quarter to one third of patients with congestive heart failure have some form of intraventricular conduction abnormality that is manifested as an increased QRS duration on the electrocardiogram.12 The...

ORIGINAL ARTICLE: The Effect of Cardiac Resynchronization on Morbidity and Mortality in Heart Failure

Thu, 14Â AprÂ 2005 00:00:00 -05:00

Background: Cardiac resynchronization reduces symptoms and improves left ventricular function in many patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. We evaluated its effects on...

CLINICAL PRACTICE: Neurocardiogenic Syncope

Blair P. Grubb, M.D. — Thu, 10Â MarÂ 2005 00:00:00 -05:00

A 23-year-old nurse presents for evaluation after having had five episodes of syncope at work during the previous three months. All the episodes occurred while she was standing and were...

IMAGES IN CLINICAL MEDICINE: Giant Osborn Waves in Hypothermia

Mori J. Krantz, M.D. and Christopher M. Lowery, M.D. — Thu, 13Â JanÂ 2005 00:00:00 -05:00

A 47-year-old man with chronic schizophrenia was hospitalized after prolonged hypothermia. The initial electrocardiogram revealed Osborn waves (arrowheads) similar in amplitude to the R waves. Characteristic sinus bradycardia and prolongation...

EDITORIAL: The Economics of ICDs

Sandeep Jauhar, M.D., Ph.D., and David J. Slotwiner, M.D. — Thu, 09Â DecÂ 2004 00:00:00 -05:00

On September 28, 2004, the Centers for Medicare and Medicaid Services (CMS) proposed new reimbursement guidelines for implantable cardioverterâdefibrillators (ICDs) used for the prevention of sudden death from cardiac causes....

EDITORIAL: Prophylactic Implantable CardioverterâDefibrillators after Myocardial Infarction â Not for Everyone

Anne M. Gillis, M.D. — Thu, 09Â DecÂ 2004 00:00:00 -05:00

A number of clinical trials have been reported to show that the implantable cardioverterâdefibrillator (ICD) prevents sudden death from cardiac causes and significantly reduces overall mortality among patients with left...

ORIGINAL ARTICLE: Prophylactic Use of an Implantable CardioverterâDefibrillator after Acute Myocardial Infarction

Thu, 09Â DecÂ 2004 00:00:00 -05:00

Background: Implantable cardioverterâdefibrillator (ICD) therapy has been shown to improve survival in patients with various heart conditions who are at high risk for ventricular arrhythmias. Whether benefit occurs in patients...

EDITORIAL: Atrial Fibrillation and Heart Failure â Five More Years

William G. Stevenson, M.D., and Lynne W. Stevenson, M.D. — Thu, 02Â DecÂ 2004 00:00:00 -05:00

Heart failure is often complicated by atrial fibrillation, and atrial fibrillation can exacerbate and in some cases cause heart failure. Adverse effects of atrial fibrillation include a loss of atrial...

CLINICAL PRACTICE: Newly Diagnosed Atrial Fibrillation

Richard L. Page, M.D. — Thu, 02Â DecÂ 2004 00:00:00 -05:00

A 77-year-old woman with a history of hypertension treated with metoprolol presents for her annual examination. She reports no new symptoms. The examination is remarkable only for the finding of...

ORIGINAL ARTICLE: Outpatient Treatment of Recent-Onset Atrial Fibrillation with the âPill-in-the-Pocketâ Approach

Thu, 02Â DecÂ 2004 00:00:00 -05:00

Background: In-hospital administration of flecainide and propafenone in a single oral loading dose has been shown to be effective and superior to placebo in terminating atrial fibrillation. We evaluated the...

ORIGINAL ARTICLE: Catheter Ablation for Atrial Fibrillation in Congestive Heart Failure

Thu, 02Â DecÂ 2004 00:00:00 -05:00

Background: Congestive heart failure and atrial fibrillation often coexist, and each adversely affects the other with respect to management and prognosis. We prospectively evaluated the effect of catheter ablation for...

ORIGINAL ARTICLE: Radiofrequency Ablation in Children with Asymptomatic WolffâParkinsonâWhite Syndrome

Thu, 16Â SepÂ 2004 00:00:00 -05:00

Background: Ventricular fibrillation can be the presenting arrhythmia in children with asymptomatic WolffâParkinsonâWhite syndrome. Deaths due to this arrhythmia are potentially preventable.

Methods: We performed a randomized study in which prophylactic...

PERSPECTIVE: Catheter Ablation for Cardiac Arrhythmias

Hein J.J. Wellens, M.D. — Thu, 16Â SepÂ 2004 00:00:00 -05:00

Cardiac arrhythmias are common; some are life-threatening, others merely a nuisance. They are caused by abnormalities in impulse formation or conduction that lead to slow or fast, regular or irregular...

PERSPECTIVE: Drugs and the QT Interval â Caveat Doctor

Barbara A. Liu, M.D., and David N. Juurlink, M.D., Ph.D. — Thu, 09Â SepÂ 2004 00:00:00 -05:00

All drugs have the potential to cause adverse effects. Occasionally, serious adverse effects are not identified in preclinical studies and become apparent only when a drug is in widespread clinical...

CLINICAL PROBLEM-SOLVING: A Bitter Tale

Lori S. Newman, M.D., Ph.D., Mark W. Feinberg, M.D., and Howard E. LeWine, M.D. — Thu, 05Â AugÂ 2004 00:00:00 -05:00

A 53-year-old woman presented to an outpatient urgent care clinic with persistent nausea and vomiting. On the previous evening, she had had an acute onset of nausea that was followed...

IMAGES IN CLINICAL MEDICINE: âPseudoinfarctionâ Pattern Due to Hyperkalemia

Kyuhyun Wang, M.D. — Thu, 05Â AugÂ 2004 00:00:00 -05:00

A 38-year-old man presented to the emergency department with nausea, vomiting, and epigastric pain. The patient had type 1 diabetes mellitus and was being treated with insulin. He was also...

IMAGES IN CLINICAL MEDICINE: Electrocardiographic Changes in Extreme Hypothermia

Haval Saadlla, M.D. — Thu, 29Â JulÂ 2004 00:00:00 -05:00

A 39-year-old man was brought to the emergency department with altered mental status and a core temperature of 27.6Â°C. The patient appeared to have had exposure to cold temperatures. He...

IMAGES IN CLINICAL MEDICINE: Radiation Injury from a Fluoroscopic Procedure

Lesley Wong, M.D. and Jason Rehm, M.D. — Thu, 17Â JunÂ 2004 00:00:00 -05:00

A 52-year-old man underwent an ablative procedure for supraventricular arrhythmias, and a painful ulceration developed on the posterior surface of his right arm four months later. His arm had accidentally...

EDITORIAL: Electromechanical Associations

Joseph G. Rogers, M.D., and Michael E. Cain, M.D. — Thu, 20Â MayÂ 2004 00:00:00 -05:00

The left ventricle strives valiantly with each cardiac cycle to maximize contractility and provide protection against lethal ventricular arrhythmias. Heart failure can make this coordination difficult. Heart-rhythm and heart-failure specialists...

ORIGINAL ARTICLE: Prophylactic Defibrillator Implantation in Patients with Nonischemic Dilated Cardiomyopathy

Thu, 20Â MayÂ 2004 00:00:00 -05:00

Background: Patients with nonischemic dilated cardiomyopathy are at substantial risk for sudden death from cardiac causes. However, the value of prophylactic implantation of an implantable cardioverterâdefibrillator (ICD) to prevent sudden...

ORIGINAL ARTICLE: Cardiac-Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure

Thu, 20Â MayÂ 2004 00:00:00 -05:00

Background: We tested the hypothesis that prophylactic cardiac-resynchronization therapy in the form of biventricular stimulation with a pacemaker with or without a defibrillator would reduce the risk of death and...

IMAGES IN CLINICAL MEDICINE: Cor Triatriatum

Daniel B. Reese, M.D. — Thu, 06Â MayÂ 2004 00:00:00 -05:00

A 29-year-old man presented with severe dyspnea and hemoptysis. He said he had always had a reduced capacity for exercise as compared with his peers. He had an elevated jugular...

REVIEW ARTICLE: Drug-Induced Prolongation of the QT Interval

Dan M. Roden, M.D. — Thu, 04Â MarÂ 2004 00:00:00 -05:00

04030426.xml In the past decade, the single most common cause of the withdrawal or restriction of the use of drugs that have already been marketed has been the prolongation...

IMAGES IN CLINICAL MEDICINE: Hypokalemia

Adam Nosworthy, M.B., B.Ch. — Thu, 27Â NovÂ 2003 00:00:00 -05:00

A 42-year-old man was hospitalized because he had had confusion, weakness, and lethargy for approximately a week. Hypertension had recently been diagnosed, and the patient had begun therapy with a...

ORIGINAL ARTICLE: A Randomized Study of Prophylactic Catheter Ablation in Asymptomatic Patients with the WolffâParkinsonâWhite Syndrome

Thu, 06Â NovÂ 2003 00:00:00 -05:00

Background: Young age and inducibility of atrioventricular reciprocating tachycardia or atrial fibrillation during invasive electrophysiological testing identify asymptomatic patients with a WolffâParkinsonâWhite pattern on the electrocardiogram as being at high...

PERSPECTIVE: High-Risk Patients with Ventricular Preexcitation â A Pendulum in Motion

Bruce B. Lerman, M.D., and Craig T. Basson, M.D., Ph.D. — Thu, 06Â NovÂ 2003 00:00:00 -05:00

Since they were first described, preexcitation syndromes have intrigued physicians. The interest derives in part from the myriad bizarre electrocardiographic abnormalities associated with these syndromes and from the variety of...

IMAGES IN CLINICAL MEDICINE: âT-U-Pâ Syndrome, or Pseudoatrial Flutter

Gregory M. Marcus, M.D. and J. Edwin Atwood, M.D. — Thu, 16Â OctÂ 2003 00:00:00 -05:00

A 77-year-old man with a remote history of atrial fibrillation presented to the emergency department reporting fatigue and weakness. The patient said he had not made any recent changes in...

ORIGINAL ARTICLE: Effect of Intensity of Oral Anticoagulation on Stroke Severity and Mortality in Atrial Fibrillation

Thu, 11Â SepÂ 2003 00:00:00 -05:00

Background: The incidence of stroke in patients with atrial fibrillation is greatly reduced by oral anticoagulation, with the full effect seen at international normalized ratio (INR) values of 2.0 or...

PERSPECTIVE: Atrial Fibrillation and Stroke Prevention

Robert G. Hart, M.D. — Thu, 11Â SepÂ 2003 00:00:00 -05:00

Atrial fibrillation is a common cardiac arrhythmia whose most serious clinical consequence is stroke. Described in pathological studies in the 1940s, uncoordinated atrial contractions result in sluggish blood flow and...

ORIGINAL ARTICLE: Long-Term Outcomes of Out-of-Hospital Cardiac Arrest after Successful Early Defibrillation

Thu, 26Â JunÂ 2003 00:00:00 -05:00

Background: Mortality after out-of-hospital cardiac arrest from ventricular fibrillation is high. Programs focusing on early defibrillation have improved the rate of survival to hospital discharge. We conducted a population-based analysis...

ORIGINAL ARTICLE: Risk Stratification in the Long-QT Syndrome

Thu, 08Â MayÂ 2003 00:00:00 -05:00

Background: Mutations in potassium-channel genes KCNQ1 (LQT1 locus) and KCNH2 (LQT2 locus) and the sodium-channel gene SCN5A (LQT3 locus) are the most common causes of the long-QT syndrome. We stratified...

PERSPECTIVE: The Long-QT Syndrome â Bedside to Bench to Bedside

G. Michael Vincent, M.D. — Thu, 08Â MayÂ 2003 00:00:00 -05:00

Thomas Carlyle's statement âOur main business is not to see what lies dimly at a distance, but to do what lies clearly at handâ was an integral part of William...

REVIEW ARTICLE: Use of the Electrocardiogram in Acute Myocardial Infarction

Peter J. Zimetbaum, M.D., and Mark E. Josephson, M.D. — Thu, 06Â MarÂ 2003 00:00:00 -05:00

The electrocardiogram remains a crucial tool in the identification and management of acute myocardial infarction. A detailed analysis of patterns of ST-segment elevation may influence decisions regarding the use of...

ORIGINAL ARTICLE: Frequent Ventricular Ectopy after Exercise as a Predictor of Death

Thu, 27Â FebÂ 2003 00:00:00 -05:00

Background: Exercise-induced ventricular ectopy predicts an increased risk of death in population-based cohorts. We sought to examine in a clinical cohort the prognostic importance of ventricular ectopy immediately after exercise,...

PERSPECTIVE: A New Look at Cardiac Exercise Testing

Gregory D. Curfman, M.D., and L. David Hillis, M.D. — Thu, 27Â FebÂ 2003 00:00:00 -05:00

Since the introduction of treadmill exercise testing by Robert Bruce five decades ago, graded exercise testing has been a cornerstone of diagnostic procedures for coronary artery disease. An article in...

EDITORIAL: Management of Atrial Fibrillation â Radical Reform or Modest Modification?

Thu, 05Â DecÂ 2002 00:00:00 -05:00

The concept that the restoration of sinus rhythm in patients with atrial fibrillation is always an important goal has been largely uncontested for many years. Now, in this issue of...

ORIGINAL ARTICLE: A Comparison of Rate Control and Rhythm Control in Patients with Recurrent Persistent Atrial Fibrillation

Thu, 05Â DecÂ 2002 00:00:00 -05:00

Background: Maintenance of sinus rhythm is the main therapeutic goal in patients with atrial fibrillation. However, recurrences of atrial fibrillation and side effects of antiarrhythmic drugs offset the benefits of...

ORIGINAL ARTICLE: A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation

Thu, 05Â DecÂ 2002 00:00:00 -05:00

Background: There are two approaches to the treatment of atrial fibrillation: one is cardioversion and treatment with antiarrhythmic drugs to maintain sinus rhythm, and the other is the use of...

PERSPECTIVE: Atrial Fibrillation â Rhythm or Rate Control

Thu, 05Â DecÂ 2002 00:00:00 -05:00

The human heart has a complex electrical system that ensures coordinated propulsion of blood under a variety of physiologic conditions. Remarkable effort is expended with each heartbeat to maintain sinus...

IMAGES IN CLINICAL MEDICINE: Commotio Cordis

Janette F. Strasburger, M.D. and Barry J. Maron, M.D. — Thu, 17Â OctÂ 2002 00:00:00 -05:00

Figure 1. A 13-year-old boy in good health was a batter in a Little League baseball game. He pivoted his body toward the field to avoid an inside pitch, was...

ORIGINAL ARTICLE: Public Use of Automated External Defibrillators

Thu, 17Â OctÂ 2002 00:00:00 -05:00

Background: Automated external defibrillators save lives when they are used by designated personnel in certain public settings. We performed a two-year prospective study at three Chicago airports to assess whether...

PERSPECTIVE: Defibrillators in Public Places â One Step Closer to Home

Thu, 17Â OctÂ 2002 00:00:00 -05:00

At least 450,000 cases of unexpected cardiac arrest occur annually in the United States (Figure 1). The majority occur in places other than hospitals in people with recognized heart disease....

REVIEW ARTICLE: Implantable Devices for the Treatment of Atrial Fibrillation

Thu, 27Â JunÂ 2002 00:00:00 -05:00

Atrial fibrillation is a common arrhythmia that causes symptoms such as palpitations and dyspnea but is also associated with stroke, heart failure, and an increased risk of hospitalization and death.12...

EDITORIAL: Cardiac-Resynchronization Therapy for Heart Failure

Thu, 13Â JunÂ 2002 00:00:00 -05:00

The syndrome of congestive heart failure is responsible for substantial morbidity and mortality.1 Patients with heart failure have shortness of breath and a limited capacity for exercise, have high rates...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery

J. Warren Harthorne, M.D. and Igor Palacios, M.D. — Thu, 13Â JunÂ 2002 00:00:00 -05:00

Figure 1. A 76-year-old man with sinus node disease who was evaluated after an episode of syncope received a single-chamber pacemaker through the left subclavian approach. A chest film (Panel...

ORIGINAL ARTICLE: Ventricular Pacing or Dual-Chamber Pacing for Sinus-Node Dysfunction

Thu, 13Â JunÂ 2002 00:00:00 -05:00

Background: Dual-chamber (atrioventricular) and single-chamber (ventricular) pacing are alternative treatment approaches for sinus-node dysfunction that causes clinically significant bradycardia. However, it is unknown which type of pacing results in the...

ORIGINAL ARTICLE: Cardiac Resynchronization in Chronic Heart Failure

Thu, 13Â JunÂ 2002 00:00:00 -05:00

Background: Previous studies have suggested that cardiac resynchronization achieved through atrial-synchronized biventricular pacing produces clinical benefits in patients with heart failure who have an intraventricular conduction delay. We conducted a...

EDITORIAL: Expanding Indications for Implantable Cardiac Defibrillators

Thu, 21Â MarÂ 2002 00:00:00 -05:00

Almost 250,000 out-of-hospital cardiac arrests occur annually in the United States; the majority are attributed to coronary artery disease. About half of these episodes appear to be caused by ventricular...

ORIGINAL ARTICLE: Amiodarone as Compared with Lidocaine for Shock-Resistant Ventricular Fibrillation

Thu, 21Â MarÂ 2002 00:00:00 -05:00

Background: Lidocaine has been the initial antiarrhythmic drug treatment recommended for patients with ventricular fibrillation that is resistant to conversion by defibrillator shocks. We performed a randomized trial comparing intravenous...

ORIGINAL ARTICLE: Prophylactic Implantation of a Defibrillator in Patients with Myocardial Infarction and Reduced Ejection Fraction

Thu, 21Â MarÂ 2002 00:00:00 -05:00

Background: 02032124.xml Patients with reduced left ventricular function after myocardial infarction are at risk for life-threatening ventricular arrhythmias. This randomized trial was designed to evaluate the effect of an implantable...

REVIEW ARTICLE: Sudden Death Due to Cardiac Arrhythmias

Heikki V. Huikuri, M.D., Agustin Castellanos, M.D., and Robert J. Myerburg, M.D. — Thu, 15Â NovÂ 2001 00:00:00 -05:00

Despite a substantial reduction in age-adjusted rates of death from cardiovascular causes during the past 40 to 50 years, cardiovascular disease remains the single most common cause of natural death...

IMAGES IN CLINICAL MEDICINE: Pigmentation Related to Amiodarone

Whitney A. High, M.D. and Steven D. Weiss, M.D. — Thu, 15Â NovÂ 2001 00:00:00 -05:00

Figure 1. A 55-year-old man had blue-gray discoloration of the auricular and periauricular areas of his ears. In 1985, he had had a large anterior myocardial infarction during aortic-valve replacement....

EDITORIAL: Driving after Ventricular Arrhythmias

Thu, 09Â AugÂ 2001 00:00:00 -05:00

Many Americans consider driving a basic necessity for everyday life. Yet driving is an activity that is inherently dangerous both to the driver and to others. Society must therefore restrict...

ORIGINAL ARTICLE: Resumption of Driving after Life-Threatening Ventricular Tachyarrhythmia

Thu, 09Â AugÂ 2001 00:00:00 -05:00

Background: Although the privilege of driving must be respected, it may be necessary to restrict driving when it poses a threat to others. The risks associated with allowing patients with...

EDITORIAL: A Molecular Basis for WolffâParkinsonâWhite Syndrome

Thu, 14Â JunÂ 2001 00:00:00 -05:00

Since its initial description1 seven decades ago, the WolffâParkinsonâWhite syndrome has attracted cardiologists' attention not only because of its clinical importance but also because of the opportunity it provides to...

ORIGINAL ARTICLE: Identification of a Gene Responsible for Familial WolffâParkinsonâWhite Syndrome

Thu, 14Â JunÂ 2001 00:00:00 -05:00

Background: The WolffâParkinsonâWhite syndrome, with a prevalence in Western countries of 1.5 to 3.1 per 1000 persons, causes considerable morbidity and may cause sudden death. We identified two families in...

IMAGES IN CLINICAL MEDICINE: Atrial Parasystole after Heart Transplantation

Viviane Conraads, M.D. and Marnix Goethals, M.D., Ph.D. — Thu, 17Â MayÂ 2001 00:00:00 -05:00

Figure 1. Three years after undergoing heart transplantation, a 44-year-old man presented with very frequent supraventricular extrasystoles (asterisks). Myocardial rejection and clinically significant hemodynamic alterations were excluded as causes. During...

EDITORIAL: Strategies for Cardioversion of Atrial Fibrillation â Time for a Change?

Thu, 10Â MayÂ 2001 00:00:00 -05:00

Dating back to the 17th-century observation that cinchona bark could correct an irregular heartbeat in patients with malaria,1 cardioversion of atrial fibrillation is one of the oldest therapies in cardiovascular...

ORIGINAL ARTICLE: Use of Transesophageal Echocardiography to Guide Cardioversion in Patients with Atrial Fibrillation

Thu, 10Â MayÂ 2001 00:00:00 -05:00

Background: The conventional treatment strategy for patients with atrial fibrillation who are to undergo electrical cardioversion is to prescribe warfarin for anticoagulation for three weeks before cardioversion. It has been...

REVIEW ARTICLE: Cardiac Resuscitation

Mickey S. Eisenberg, M.D., Ph.D., and Terry J. Mengert, M.D. — Thu, 26Â AprÂ 2001 00:00:00 -05:00

At least 225,000 people in the United States will die suddenly this year from coronary heart disease before they reach a hospital.12 In addition, an estimated 370,000 to 750,000 patients...

REVIEW ARTICLE: Atrial Fibrillation

Rodney H. Falk, M.D. — Thu, 05Â AprÂ 2001 00:00:00 -05:00

Electrocardiographically, atrial fibrillation is characterized by the presence of rapid, irregular, fibrillatory waves that vary in size, shape, and timing. This set of findings is usually associated with an irregular...

ORIGINAL ARTICLE: Long-Term Survival after Ablation of the Atrioventricular Node and Implantation of a Permanent Pacemaker in Patients with Atrial Fibrillation

Thu, 05Â AprÂ 2001 00:00:00 -05:00

Background: In patients with atrial fibrillation that is refractory to drug therapy, radio-frequency ablation of the atrioventricular node and implantation of a permanent pacemaker are an alternative therapeutic approach. The...

EDITORIAL: Sudden Death from Cardiac Arrest â Improving the Odds

Thu, 26Â OctÂ 2000 00:00:00 -05:00

Each year cardiovascular disease claims the lives of more than 950,000 people in the United States. Of these deaths, a substantial proportion are due to out-of-hospital cardiac arrest, and only...

ORIGINAL ARTICLE: Use of Automated External Defibrillators by a U.S. Airline

Thu, 26Â OctÂ 2000 00:00:00 -05:00

Background: Passengers who have ventricular fibrillation aboard commercial aircraft rarely survive, owing to the delay in obtaining emergency care and defibrillation.

Methods: In 1997, a major U.S. airline began equipping its...

ORIGINAL ARTICLE: Outcomes of Rapid Defibrillation by Security Officers after Cardiac Arrest in Casinos

Thu, 26Â OctÂ 2000 00:00:00 -05:00

Background: The use of automated external defibrillators by persons other than paramedics and emergency medical technicians is advocated by the American Heart Association and other organizations. However, there are few...

EDITORIAL: Premature Ventricular Depolarizations during Exercise

Thu, 21Â SepÂ 2000 00:00:00 -05:00

Exercise stress testing is a well-established procedure that has been in widespread clinical use for more than 30 years.1 The great majority of exercise stress tests are performed in patients...

ORIGINAL ARTICLE: Long-Term Outcome in Asymptomatic Men with Exercise-Induced Premature Ventricular Depolarizations

Thu, 21Â SepÂ 2000 00:00:00 -05:00

Background: Exercise testing is widely used in the diagnosis of coronary artery disease, but the long-term outcome for asymptomatic persons with exercise-induced premature ventricular depolarizations remains unclear. We used data...

ORIGINAL ARTICLE: A Molecular Link between the Sudden Infant Death Syndrome and the Long-QT Syndrome

Thu, 27Â JulÂ 2000 00:00:00 -05:00

The sudden infant death syndrome (SIDS) remains the leading cause of death in the first year of life and has a devastating impact on the affected families.1234 Despite the fact...

ORIGINAL ARTICLE: Electrophysiologic Testing to Identify Patients with Coronary Artery Disease Who Are at Risk for Sudden Death

Thu, 29Â JunÂ 2000 00:00:00 -05:00

Background: The mortality rate among patients with coronary artery disease, abnormal ventricular function, and unsustained ventricular tachycardia is high. The usefulness of electrophysiologic testing for risk stratification in these patients...

EDITORIAL: Cardiopulmonary Resuscitation â Strengthening the Links in the Chain of Survival

Thu, 25Â MayÂ 2000 00:00:00 -05:00

The major determinants of survival after witnessed out-of-hospital cardiac arrest due to ventricular fibrillation include whether a bystander initiates cardiopulmonary resuscitation (CPR) and how quickly defibrillation is accomplished.

The now-classic observations...

ORIGINAL ARTICLE: Effects of Physiologic Pacing versus Ventricular Pacing on the Risk of Stroke and Death Due to Cardiovascular Causes

Thu, 11Â MayÂ 2000 00:00:00 -05:00

Background: Evidence suggests that physiologic pacing (dual-chamber or atrial) may be superior to single-chamber (ventricular) pacing because it is associated with lower risks of atrial fibrillation, stroke, and death. These...

ORIGINAL ARTICLE: Amiodarone to Prevent Recurrence of Atrial Fibrillation

Thu, 30Â MarÂ 2000 00:00:00 -05:00

Background: The restoration and maintenance of sinus rhythm is a desirable goal in patients with atrial fibrillation, because the prevention of recurrences can improve cardiac function and relieve symptoms. Uncontrolled...

REVIEW ARTICLE: The Evaluation and Management of Bradycardia

J. Michael Mangrum, M.D., and John P. DiMarco, M.D., Ph.D. — Thu, 09Â MarÂ 2000 00:00:00 -05:00

Bradycardia is a common finding during the clinical evaluation of both healthy patients and those who are ill. Bradycardia may be caused either by intrinsic dysfunction of or damage to...

IMAGES IN CLINICAL MEDICINE: Internal Ventricular Defibrillation

Arthur J. Moss, M.D. and James P. Daubert, M.D. — Thu, 10Â FebÂ 2000 00:00:00 -05:00

Figure 1. A 12-year-old boy with the familial long-QT syndrome had an automatic cardioverterâdefibrillator implanted after resuscitation from cardiac arrest. The device was programmed to wait 7.5 seconds before discharging...

ORIGINAL ARTICLE: Efficacy of Implantable CardioverterâDefibrillators for the Prevention of Sudden Death in Patients with Hypertrophic Cardiomyopathy

Thu, 10Â FebÂ 2000 00:00:00 -05:00

Background: Hypertrophic cardiomyopathy is a genetic disease associated with a risk of ventricular tachyarrhythmias and sudden death, especially in young patients.

Methods: We conducted a retrospective multicenter study of the efficacy...

ORIGINAL ARTICLE: Clinical Consequences of Electrocardiographic Artifact Mimicking Ventricular Tachycardia

Thu, 21Â OctÂ 1999 00:00:00 -05:00

Electrocardiographic artifact can simulate ventricular tachycardia. The literature regarding electrocardiographic artifact is limited to case reports,1234567 proposed classifications,89 and diagnostic criteria.10 There is little information regarding the clinical implications of...

ORIGINAL ARTICLE: Molecular Diagnosis of the Inherited Long-QT Syndrome in a Woman Who Died after Near-Drowning

Thu, 07Â OctÂ 1999 00:00:00 -05:00

Drowning accounts for more accidental deaths in children and adolescents than all other causes except motor vehicle accidents.123 Many of these fatalities are attributed to lack of supervision, trauma, alcohol...

IMAGES IN CLINICAL MEDICINE: Pulsus Alternans

David P. McLaughlin, M.D. — Thu, 23Â SepÂ 1999 00:00:00 -05:00

Figure 1. A 51-year-old woman presented with dyspnea on exertion and cardiomegaly. She had a long-standing history of poorly controlled hypertension. Physical examination revealed an elevated jugular venous pressure, clear...

EDITORIAL: Atrial Fibrillation in Heart Failure

Thu, 16Â SepÂ 1999 00:00:00 -05:00

In 1920 Sir James Mackenzie reported that atrial fibrillation was present in 80 to 90 percent of patients who had congestive heart failure, which at that time was called âdropsy.â1...

ORIGINAL ARTICLE: Amiodarone for Resuscitation after Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation

Thu, 16Â SepÂ 1999 00:00:00 -05:00

Background: Whether antiarrhythmic drugs improve the rate of successful resuscitation after out-of-hospital cardiac arrest has not been determined in randomized clinical trials.

Methods: We conducted a randomized, double-blind, placebo-controlled study of...

ORIGINAL ARTICLE: Dofetilide in Patients with Congestive Heart Failure and Left Ventricular Dysfunction

Thu, 16Â SepÂ 1999 00:00:00 -05:00

Background: Atrial fibrillation occurs frequently in patients with congestive heart failure and commonly results in clinical deterioration and hospitalization. Sinus rhythm may be maintained with antiarrhythmic drugs, but some of...

EDITORIAL: Redefining the Role of Antiarrhythmic Drugs

Thu, 17Â JunÂ 1999 00:00:00 -05:00

The growing recognition of the potentially harmful effects of antiarrhythmic drugs1 and the subsequent proof from controlled trials that some of these drugs can increase the risk of death in...

ORIGINAL ARTICLE: Prevention of Implantable-Defibrillator Shocks by Treatment with Sotalol

Thu, 17Â JunÂ 1999 00:00:00 -05:00

Background: Patients with implantable cardioverterâdefibrillators often receive adjunctive antiarrhythmic therapy to prevent frequent shocks. We tested the efficacy and safety of sotalol, a beta-blocker with class III antiarrhythmic effects, for...

ORIGINAL ARTICLE: Facilitating Transthoracic Cardioversion of Atrial Fibrillation with Ibutilide Pretreatment

Thu, 17Â JunÂ 1999 00:00:00 -05:00

Background: Atrial fibrillation cannot always be converted to sinus rhythm by transthoracic electrical cardioversion. We examined the effect of ibutilide, a class III antiarrhythmic agent, on the energy requirement for...

ORIGINAL ARTICLE: Atrial Arrhythmia after Surgical Closure of Atrial Septal Defects in Adults

Thu, 18Â MarÂ 1999 00:00:00 -05:00

Background: Atrial flutter and atrial fibrillation are causes of morbidity in adults with an atrial septal defect. In this study, we attempted to identify risk factors for atrial flutter and...

REVIEW ARTICLE: Radio-Frequency Ablation as Treatment for Cardiac Arrhythmias

Fred Morady, M.D. — Thu, 18Â FebÂ 1999 00:00:00 -05:00

Radio-frequency catheter ablation has replaced antiarrhythmic-drug therapy for the treatment of many types of cardiac arrhythmia. This article reviews the biophysics and results of radio-frequency catheter ablation and the clinical...

ORIGINAL ARTICLE: Interference with an Implantable Defibrillator by an Electronic Antitheft-Surveillance Device

Thu, 05Â NovÂ 1998 00:00:00 -05:00

Implantable cardioverterâdefibrillators have an important role in the treatment of patients with ventricular arrhythmias. Electromagnetic interference with permanent pacemakers and implantable defibrillators may have deleterious effects.1234567891011 Electronic antitheft-surveillance devices, which...

ORIGINAL ARTICLE: Influence of the Genotype on the Clinical Course of the Long-QT Syndrome

Thu, 01Â OctÂ 1998 00:00:00 -05:00

Background: The congenital long-QT syndrome, caused by mutations in cardiac potassium-channel genes (KVLQT1 at the LQT1 locus and HERG at the LQT2 locus) and the sodium-channel gene (SCN5A at the...

ORIGINAL ARTICLE: Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary Veins

Thu, 03Â SepÂ 1998 00:00:00 -05:00

Background: Atrial fibrillation, the most common sustained cardiac arrhythmia and a major cause of stroke, results from simultaneous reentrant wavelets. Its spontaneous initiation has not been studied.

Methods: We studied 45...

EDITORIAL: Fatal Impact â Concussion of the Heart

Thu, 18Â JunÂ 1998 00:00:00 -05:00

When he died on a winter evening in 1995, Matthew Messing was only 16 years old. It happened while he was playing in a high-school ice-hockey game in Quincy, Massachusetts....

IMAGES IN CLINICAL MEDICINE: âR-on-Tâ Phenomenon

Paul Oupadia, M.D. and Krishnaswamy Ramaswamy, M.D. — Thu, 18Â JunÂ 1998 00:00:00 -05:00

Figure 1. Ventricular fibrillation in an 83-year-old man after coronary angiography was caused by the âR-on-Tâ phenomenon, due to a sensing failure on the part of a temporary pacemaker with...

ORIGINAL ARTICLE: An Experimental Model of Sudden Death Due to Low-Energy Chest-Wall Impact (Commotio Cordis)

Thu, 18Â JunÂ 1998 00:00:00 -05:00

Background: The syndrome of sudden death due to low-energy trauma to the chest wall (commotio cordis) has been described in young sports participants, but the mechanism is unknown.

Methods: We developed...

EDITORIAL: Prolongation of the QT Interval and the Sudden Infant Death Syndrome

Thu, 11Â JunÂ 1998 00:00:00 -05:00

The unexpected and unexplained death of an infant is a tragic occurrence. When the infant is less than one year of age and the cause remains unknown despite a thorough...

ORIGINAL ARTICLE: Prolongation of the QT Interval and the Sudden Infant Death Syndrome

Thu, 11Â JunÂ 1998 00:00:00 -05:00

Background: The sudden infant death syndrome (SIDS) is multifactorial in origin, but its causes remain unknown. We previously proposed that prolongation of the QT interval on the electrocardiogram, possibly resulting...

EDITORIAL: Do Patients Prefer Physiologic Pacing?

Thu, 16Â AprÂ 1998 00:00:00 -05:00

Cardiac pacemakers have become increasingly sophisticated during their half-century of clinical use. Each new component has been designed to simulate normal physiology more precisely. Is such complexity necessary? In this...

ORIGINAL ARTICLE: Quality of Life and Clinical Outcomes in Elderly Patients Treated with Ventricular Pacing as Compared with Dual-Chamber Pacing

Thu, 16Â AprÂ 1998 00:00:00 -05:00

Background: Standard clinical practice permits the use of either single-chamber ventricular pacemakers or dual-chamber pacemakers for most patients who require cardiac pacing. Ventricular pacemakers are less expensive, but dual-chamber pacemakers...

REVIEW ARTICLE: Quinidine

Andrew A. Grace, Ph.D., and A. John Camm, M.D. — Thu, 01Â JanÂ 1998 00:00:00 -05:00

Quinidine is the most frequently prescribed antiarrhythmic drug,1 despite unease about its possible proarrhythmic actions. That caution is required with the use of quinidine was, however, recognized early. Although the...

ORIGINAL ARTICLE: Preoperative Amiodarone as Prophylaxis against Atrial Fibrillation after Heart Surgery

Thu, 18Â DecÂ 1997 00:00:00 -05:00

Background: Atrial fibrillation occurs commonly after open-heart surgery and may delay hospital discharge. The purpose of this study was to assess the use of preoperative amiodarone as prophylaxis against atrial...

EDITORIAL: Clinical Trials of Implantable Defibrillators

Thu, 27Â NovÂ 1997 00:00:00 -05:00

Implantable cardioverterâdefibrillators met with much uncertainty when first applied in clinical practice, as zealots and skeptics debated their value. Two points in their favor were clear from the beginning: the...

ORIGINAL ARTICLE: A Comparison of Antiarrhythmic-Drug Therapy with Implantable Defibrillators in Patients Resuscitated from Near-Fatal Ventricular Arrhythmias

The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators — Thu, 27Â NovÂ 1997 00:00:00 -05:00

Background: Patients who survive life-threatening ventricular arrhythmias are at risk for recurrent arrhythmias. They can be treated with either an implantable cardioverterâdefibrillator or antiarrhythmic drugs, but the relative efficacy of...

ORIGINAL ARTICLE: Prophylactic Use of Implanted Cardiac Defibrillators in Patients at High Risk for Ventricular Arrhythmias after Coronary-Artery Bypass Graft Surgery

Thu, 27Â NovÂ 1997 00:00:00 -05:00

Background: Patients with coronary heart disease, left ventricular dysfunction, and abnormalities on signal-averaged electrocardiograms have an increased risk of sudden death. We evaluated the effect on survival of the prophylactic...

IMAGES IN CLINICAL MEDICINE: Congenital Long-QT Syndrome

Jesaia Benhorin, M.D. and Aharon Medina, M.D. — Thu, 29Â MayÂ 1997 00:00:00 -05:00

Figure 1. A 25-year-old woman who had had a single syncopal episode two years earlier was hospitalized after a two-minute episode of syncope during an argument with a police officer...

ORIGINAL ARTICLE: Molecular Basis of the Long-QT Syndrome Associated with Deafness

Thu, 29Â MayÂ 1997 00:00:00 -05:00

In 1957, Jervell and Lange-Nielsen reported a syndrome of congenital sensory deafness associated with a prolonged QT interval in four children of a Norwegian family.1 The affected children had multiple...

ORIGINAL ARTICLE: Interference with Cardiac Pacemakers by Cellular Telephones

Thu, 22Â MayÂ 1997 00:00:00 -05:00

Background: A growing body of evidence suggests that electromagnetic interference may occur between cardiac pacemakers and wireless hand-held (cellular) telephones, posing a potential public health problem. Electromagnetic interference may occur...

REVIEW ARTICLE: Atrial Arrhythmias after Cardiothoracic Surgery

Steve R. Ommen, M.D., John A. Odell, M.D., and Marshall S. Stanton, M.D. — Thu, 15Â MayÂ 1997 00:00:00 -05:00

Atrial tachyarrhythmias early in the recovery period after cardiothoracic surgery are common; they develop in 11 to 40 percent of patients after coronary-artery bypass grafting123 and in over 50 percent...

EDITORIAL: Is Atrial Fibrillation Sometimes a Genetic Disease?

Thu, 27Â MarÂ 1997 00:00:00 -05:00

In their article in this issue of the Journal, Brugada and coworkers1 describe three families, all from the same region in northern Spain, in which 21 of 49 family members...

ORIGINAL ARTICLE: Identification of a Genetic Locus for Familial Atrial Fibrillation

Thu, 27Â MarÂ 1997 00:00:00 -05:00

Background: Atrial fibrillation, the most common sustained cardiac-rhythm disturbance, affects over 2 million Americans and accounts for one third of all strokes in patients over 65 years of age. The...

IMAGES IN CLINICAL MEDICINE: Digoxin-Induced Bidirectional Ventricular Tachycardia

Scott Valent, M.D. and Patricia Kelly, M.D. — Thu, 20Â FebÂ 1997 00:00:00 -05:00

Figure 1. A 71-year-old woman had recently undergone mitral-valve replacement after being treated with digoxin for 12 years for atrial fibrillation. After the operation, the same dose of digoxin was...

EDITORIAL: Unsustained Ventricular Tachycardia â To Treat or Not to Treat

Thu, 26Â DecÂ 1996 00:00:00 -05:00

Physicians have long struggled with the vexing problem of how best to treat patients with myocardial infarction, reduced left ventricular function, and asymptomatic unsustained ventricular tachycardia who may be at...

ORIGINAL ARTICLE: Improved Survival with an Implanted Defibrillator in Patients with Coronary Disease at High Risk for Ventricular Arrhythmia

Thu, 26Â DecÂ 1996 00:00:00 -05:00

Background: Unsustained ventricular tachycardia in patients with previous myocardial infarction and left ventricular dysfunction is associated with a two-year mortality rate of about 30 percent. We studied whether prophylactic therapy...

ORIGINAL ARTICLE: An Analysis of the Lowest Effective Intensity of Prophylactic Anticoagulation for Patients with Nonrheumatic Atrial Fibrillation

Thu, 22Â AugÂ 1996 00:00:00 -05:00

Background: To avert major hemorrhage, physicians need to know the lowest intensity of anticoagulation that is effective in preventing stroke in patients with atrial fibrillation. Since the low rate of...

EDITORIAL: Acute Myocardial Infarction and Left Bundle-Branch Block â Can We Lift the Veil?

Thu, 22Â FebÂ 1996 00:00:00 -05:00

When a patient presents to the emergency room with an acute episode of cardiac ischemia, the challenges for the physician are to determine whether the patient is having a myocardial...

ORIGINAL ARTICLE: Electrocardiographic Diagnosis of Evolving Acute Myocardial Infarction in the Presence of Left Bundle-Branch Block

Thu, 22Â FebÂ 1996 00:00:00 -05:00

Background: The presence of left bundle-branch block on the electrocardiogram may conceal the changes of acute myocardial infarction, which can delay both its recognition and treatment. We tested electrocardiographic criteria...

NEJM â Collection Updates for Arrhythmias

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2010 â A 47-Year-Old Man with Abdominal and Flank Pain

ORIGINAL ARTICLE: Long-Term Outcome Associated with Early Repolarization on Electrocardiography

EDITORIAL: Deleterious Effects of Right Ventricular Pacing

ORIGINAL ARTICLE: Biventricular Pacing in Patients with Bradycardia and Normal Ejection Fraction

EDITORIAL: The Confirmatory Trial in Comparative-Effectiveness Research

ORIGINAL ARTICLE: Defibrillator Implantation Early after Myocardial Infarction

PERSPECTIVE: Left Atrial Appendage Occlusion â Closure or Just the Beginning?

EDITORIAL: The ACTIVE Pursuit of Stroke Prevention in Patients with Atrial Fibrillation

ORIGINAL ARTICLE: Effect of Clopidogrel Added to Aspirin in Patients with Atrial Fibrillation

PERSPECTIVE: Dronedarone for Atrial Fibrillation â An Odyssey

EDITORIAL: Angiotensin-Receptor Blockers for Prevention of Atrial Fibrillation â A Matter of Timing or Target?

ORIGINAL ARTICLE: Valsartan for Prevention of Recurrent Atrial Fibrillation

CORRESPONDENCE: Inappropriate ICD Shocks Caused by External Electrical Noise

ORIGINAL ARTICLE: A New Diagnostic Test for Arrhythmogenic Right Ventricular Cardiomyopathy

ORIGINAL ARTICLE: Effect of Dronedarone on Cardiovascular Events in Atrial Fibrillation

CORRESPONDENCE: Long-QT Syndrome Induced by the Antiaddiction Drug Ibogaine

CORRESPONDENCE: Persistent Fainting after Implantation of a âCurativeâ Pacemaker

REVIEW ARTICLE: Implantable CardioverterâDefibrillators after Myocardial Infarction

IMAGES IN CLINICAL MEDICINE: What Lies Beneath?

BOOK REVIEW:

ORIGINAL ARTICLE: Atrial Natriuretic Peptide Frameshift Mutation in Familial Atrial Fibrillation

BOOK REVIEW:

EDITORIAL: Rhythm Control in Atrial Fibrillation â One Setback after Another

ORIGINAL ARTICLE: Electrocardiographic Abnormalities and Sudden Death in Myotonic Dystrophy Type 1

ORIGINAL ARTICLE: Rhythm Control versus Rate Control for Atrial Fibrillation and Heart Failure

EDITORIAL: Early Repolarization Revisited

IMAGES IN CLINICAL MEDICINE: Giant Left Atrium

ORIGINAL ARTICLE: Left Cardiac Sympathetic Denervation for Catecholaminergic Polymorphic Ventricular Tachycardia

ORIGINAL ARTICLE: Sudden Cardiac Arrest Associated with Early Repolarization

EDITORIAL: Can Home AEDs Improve Survival?

ORIGINAL ARTICLE: Home Use of Automated External Defibrillators for Sudden Cardiac Arrest

CLINICAL PRACTICE: Long-QT Syndrome

ORIGINAL ARTICLE: Delayed Time to Defibrillation after In-Hospital Cardiac Arrest

EDITORIAL: Survival after Tachyarrhythmic Arrest â What Are We Waiting For?

EDITORIAL: Ablation after ICD Implantation â Bridging the Gap between Promise and Practice

ORIGINAL ARTICLE: Prophylactic Catheter Ablation for the Prevention of Defibrillator Therapy

IMAGES IN CLINICAL MEDICINE: Occlusion and Reperfusion of the Middle Cerebral Artery

ORIGINAL ARTICLE: Cardiac-Resynchronization Therapy in Heart Failure with Narrow QRS Complexes

ORIGINAL ARTICLE: Dronedarone for Maintenance of Sinus Rhythm in Atrial Fibrillation or Flutter

EDITORIAL: Maintaining Sinus Rhythm â Making Treatment Better Than the Disease

ORIGINAL ARTICLE: Minimizing Ventricular Pacing to Reduce Atrial Fibrillation in Sinus-Node Disease

CLINICAL THERAPEUTICS: Amiodarone for Atrial Fibrillation

ORIGINAL ARTICLE: Female Predominance and Transmission Distortion in the Long-QT Syndrome

PERSPECTIVE: Tracing Atrial Fibrillation â 100 Years

EDITORIAL: Connexins, Conduction, and Atrial Fibrillation

ORIGINAL ARTICLE: Somatic Mutations in the Connexin 40 Gene () in Atrial Fibrillation

ORIGINAL ARTICLE: Outcomes of In-Hospital Ventricular Fibrillation in Children

CLINICAL PRACTICE: Supraventricular Tachycardia

EDITORIAL: Catheter Ablation of Chronic Atrial Fibrillation â The Gap between Promise and Practice

CLINICAL PROBLEM-SOLVING: Search for the Complication

IMAGES IN CLINICAL MEDICINE: The Twiddler Syndrome

ORIGINAL ARTICLE: Circumferential Pulmonary-Vein Ablation for Chronic Atrial Fibrillation

ORIGINAL ARTICLE: Familial Sinus Bradycardia Associated with a Mutation in the Cardiac Pacemaker Channel

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2005 â A 35-Year-Old Man with Cardiac Arrest while Sleeping

IMAGES IN CLINICAL MEDICINE: Ebstein's Anomaly

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2005 â A 48-Year-Old Man with Sudden Loss of Consciousness while Jogging

EDITORIAL: Pacemaker Selection â The Changing Definition of Physiologic Pacing

ORIGINAL ARTICLE: Single-Chamber versus Dual-Chamber Pacing for High-Grade Atrioventricular Block

ORIGINAL ARTICLE: Heart-Rate Profile during Exercise as a Predictor of Sudden Death

ORIGINAL ARTICLE: Amiodarone versus Sotalol for Atrial Fibrillation

EDITORIAL: Resynchronizing Ventricular Contraction in Heart Failure

ORIGINAL ARTICLE: The Effect of Cardiac Resynchronization on Morbidity and Mortality in Heart Failure

CLINICAL PRACTICE: Neurocardiogenic Syncope

IMAGES IN CLINICAL MEDICINE: Giant Osborn Waves in Hypothermia

EDITORIAL: The Economics of ICDs

EDITORIAL: Prophylactic Implantable CardioverterâDefibrillators after Myocardial Infarction â Not for Everyone

ORIGINAL ARTICLE: Prophylactic Use of an Implantable CardioverterâDefibrillator after Acute Myocardial Infarction

EDITORIAL: Atrial Fibrillation and Heart Failure â Five More Years

CLINICAL PRACTICE: Newly Diagnosed Atrial Fibrillation

ORIGINAL ARTICLE: Outpatient Treatment of Recent-Onset Atrial Fibrillation with the âPill-in-the-Pocketâ Approach

ORIGINAL ARTICLE: Catheter Ablation for Atrial Fibrillation in Congestive Heart Failure

ORIGINAL ARTICLE: Radiofrequency Ablation in Children with Asymptomatic WolffâParkinsonâWhite Syndrome

PERSPECTIVE: Catheter Ablation for Cardiac Arrhythmias

PERSPECTIVE: Drugs and the QT Interval â Caveat Doctor

CLINICAL PROBLEM-SOLVING: A Bitter Tale

IMAGES IN CLINICAL MEDICINE: âPseudoinfarctionâ Pattern Due to Hyperkalemia

IMAGES IN CLINICAL MEDICINE: Electrocardiographic Changes in Extreme Hypothermia

IMAGES IN CLINICAL MEDICINE: Radiation Injury from a Fluoroscopic Procedure

EDITORIAL: Electromechanical Associations

NEJM â Collection Updates for Arrhythmias

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2010 â A 47-Year-Old Man with Abdominal and Flank Pain

PERSPECTIVE: Left Atrial Appendage Occlusion â Closure or Just the Beginning?

PERSPECTIVE: Dronedarone for Atrial Fibrillation â An Odyssey

EDITORIAL: Angiotensin-Receptor Blockers for Prevention of Atrial Fibrillation â A Matter of Timing or Target?

CORRESPONDENCE: Persistent Fainting after Implantation of a âCurativeâ Pacemaker

REVIEW ARTICLE: Implantable CardioverterâDefibrillators after Myocardial Infarction

EDITORIAL: Rhythm Control in Atrial Fibrillation â One Setback after Another

EDITORIAL: Survival after Tachyarrhythmic Arrest â What Are We Waiting For?

EDITORIAL: Ablation after ICD Implantation â Bridging the Gap between Promise and Practice

EDITORIAL: Maintaining Sinus Rhythm â Making Treatment Better Than the Disease

PERSPECTIVE: Tracing Atrial Fibrillation â 100 Years

EDITORIAL: Catheter Ablation of Chronic Atrial Fibrillation â The Gap between Promise and Practice

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2005 â A 35-Year-Old Man with Cardiac Arrest while Sleeping

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2005 â A 48-Year-Old Man with Sudden Loss of Consciousness while Jogging

EDITORIAL: Pacemaker Selection â The Changing Definition of Physiologic Pacing

EDITORIAL: Prophylactic Implantable CardioverterâDefibrillators after Myocardial Infarction â Not for Everyone

ORIGINAL ARTICLE: Prophylactic Use of an Implantable CardioverterâDefibrillator after Acute Myocardial Infarction

EDITORIAL: Atrial Fibrillation and Heart Failure â Five More Years

ORIGINAL ARTICLE: Outpatient Treatment of Recent-Onset Atrial Fibrillation with the âPill-in-the-Pocketâ Approach

ORIGINAL ARTICLE: Radiofrequency Ablation in Children with Asymptomatic WolffâParkinsonâWhite Syndrome

PERSPECTIVE: Drugs and the QT Interval â Caveat Doctor

IMAGES IN CLINICAL MEDICINE: âPseudoinfarctionâ Pattern Due to Hyperkalemia

ORIGINAL ARTICLE: A Randomized Study of Prophylactic Catheter Ablation in Asymptomatic Patients with the WolffâParkinsonâWhite Syndrome

PERSPECTIVE: High-Risk Patients with Ventricular Preexcitation â A Pendulum in Motion

IMAGES IN CLINICAL MEDICINE: âT-U-Pâ Syndrome, or Pseudoatrial Flutter

PERSPECTIVE: The Long-QT Syndrome â Bedside to Bench to Bedside

EDITORIAL: Management of Atrial Fibrillation â Radical Reform or Modest Modification?

PERSPECTIVE: Atrial Fibrillation â Rhythm or Rate Control

PERSPECTIVE: Defibrillators in Public Places â One Step Closer to Home

EDITORIAL: A Molecular Basis for WolffâParkinsonâWhite Syndrome

ORIGINAL ARTICLE: Identification of a Gene Responsible for Familial WolffâParkinsonâWhite Syndrome

EDITORIAL: Strategies for Cardioversion of Atrial Fibrillation â Time for a Change?

EDITORIAL: Sudden Death from Cardiac Arrest â Improving the Odds

EDITORIAL: Cardiopulmonary Resuscitation â Strengthening the Links in the Chain of Survival

ORIGINAL ARTICLE: Efficacy of Implantable CardioverterâDefibrillators for the Prevention of Sudden Death in Patients with Hypertrophic Cardiomyopathy