Heart Disease

CORONARY HEART DISEASE

Alirocumab has been approved by the FDA for secondary prevention of cardiovascular events.

DISORDERS OF RATE & RHYTHM

Possible arrhythmia can be identified by optic sensors on wearable devices, such as smartwatches, with a positive predictive value for detection of atrial fibrillation of approximately 70%.

SINUS ARRHYTHMIA, BRADYCARDIA, & TACHYCARDIA

In patients without evidence of atrioventricular nodal or bundle branch conduction abnormality, a single chamber atrial pacemaker is reasonable.

ATRIOVENTRICULAR BLOCK

For patients in permanent atrial fibrillation who require pacing for symptomatic bradycardia or pauses, catheter-based implantation of a leadless pacemaker directly to the right ventricular endocardium may be considered.

ATRIAL FIBRILLATION

For regular, moderate drinkers, total abstinence from alcohol reduces but does not usually eliminate atrial fibrillation recurrences.

Up to two-thirds of patients experiencing acute onset (shorter than 36 hours) of atrial fibrillation will spontaneously revert to sinus rhythm without the need for cardioversion. If atrial fibrillation has been present for more than a week, spontaneous conversion is unlikely and cardioversion may be considered for symptomatic patients.

Patients with atrial fibrillation who had stable coronary disease or who were at least 1 year from most recent coronary stent or coronary bypass surgery appeared to have greater risk than benefit from the combination therapy of rivaroxaban and an antiplatelet agent.

An effective treatment strategy in select patients with symptomatic but rare (a few times a year) episodes of atrial fibrillation is on-demand pharmacologic cardioversion. In patients without coronary or structural heart disease, flecainide (200–300 mg) or propafenone (450–600 mg) in addition to a beta-blocker or nondihydropyridine calcium channel blocker is taken as a single dose at the onset of symptoms.

The primary benefit of catheter ablation in patients with atrial fibrillation is an improvement in quality of life. In the CABANA trial, there was no difference in the primary endpoint of death, disabling stroke, serious bleeding, or cardiac arrest in patients randomized to catheter ablation versus medical therapy as first treatment for symptomatic atrial fibrillation.

HEART FAILURE

In patients with heart failure and preserved left ventricular ejection fraction (45% or greater), sacubatril/valsartan did not significantly improve the outcome of total heart failure hospitalizations and cardiovascular death in the PARAGONHF trial.