Physician-led cardioversion of atrial arrhythmias using intravenous sedation is effective and well tolerated. Sedation with diazepam was associated with fewer minor adverse events and a quicker recovery time than midazolam.

A 64-year-old woman with a mechanical mitral valve prosthesis developed late-onset Candida endocarditis. Blood cultures grew Candida glabrata and Candida krusei. Transesophageal echocardiography demonstrated vegetations on the valve. The patient was not medically fit for valve replacement, but her condition was successfully treated with 6 weeks of intravenous caspofungin therapy.

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With an ageing population, atrial fibrillation has become an increasing cause of hospital admission and morbidity. Pacemaker implantation may prevent atrial tachyarrhythmias by preventing bradycardia and pauses. Implantable devices are now available with specific atrial pacing algorithms designed to prevent atrial arrhythmias. These algorithms work by increasing the atrial pacing rate to achieve continuous overdrive pacing or by responding to triggers such as premature atrial complexes. This article examines how the algorithms work by describing the functions of one of the new generation of pacemakers in detail. Early studies have indicated that the use of preventative pacing can reduce atrial arrhythmia burden and symptomatic atrial fibrillation in selected patients. There are clearly some patients who benefit from implantation of these devices but what remains unclear is how to identify this patient group.

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