In order to evaluate atrial function after the restoration of normal sinus rhythm in patients with atrial fibrillation, an echocardiographic study was performed in 60 patients hospitalized for atrial fibrillation that was subsequently converted to sinus rhythm. The study population consisted of 60 patients, 41 males and 19 females, with a mean age of 67 ± 8 years. In etiological terms, 20 patients had atrial fibrillation with no associated pathology, 20 had an underlying ischemic cardiopathy an 20 had hypertension. The duration of atrial fibrillation varied from 24 h to 6 months. The restoration of sinus rhythm was spontaneous in 20 patients and drug induced in 40. Patients were divided into groups on the basis of the duration of the atrial fibrillation, the etiology of the atrial fibrillation and the size of the atrium. Transmitral Doppler inflow patterns at rest were assessed within 24 h after conversion to sinus rhythm, and 1 week, 1 month and 3 months later. The statistical significance of serial changes in peak A velocity and A wave integral was determined by analysis of variance. Using the peak A wave for atrial filling and the velocity-time integral as the index of atrial mechanical function, the following results were obtained: restoration of atrial mechanical function occurred earlier in hypertensive patients and in patients with atrial fibrillation only than in patients with associated ischemic cardiopathy. Restoration also occurred earlier in the group of patients that had atrial fibrillation for < 24 h and in patients whose left atrium was of normal size. Since the mechanical activity of the left atrium, evaluated as the peak A wave, does not necessarily return immediately after the restoration of sinus rhythm, a follow-up assessment of the contraction of the left atrium is appropriate.

SummaryBackground: Several reports suggest that the incidence of stroke and atrial fibrillation is reduced in patients receiving physiologic pacemakers, compared with patients receiving a venhicular pacemaker.Hvpothesis: The study was undertaken to address the impact of different pacing modalities on the incidence of stroke and atrial fibrillation.Methods: We prospectively analyzed 2 10 consecutive patients. Those with previous episodes of cerebral ischemia a n d or atrial fibrillation were excluded from the study. The study population included 100 patients paced for total atrioventricu-

Patients with sick sinus syndrome have a high prevalence of cerebral ischemia. The present study was designed to establish the prevalence of stroke in patients with sick sinus syndrome and the role of atrial size and function. This prospective study analyzed 100 consecutive patients with sick sinus syndrome without atrial fibrillation who received either dual chamber or ventricular pacemakers. Patients underwent a cranial CT scan at the time of enrollment and again at the end of the study 24 months later. Endpoint of the study was cerebral ischemia. Clinical and echocardiographic features were assessed at the beginning of the study. A multivariate regression analysis was applied to all variables that had at least a marginal univariate predictive value. Cerebral ischemia occurred in 18 patients. Univariate predictors for embolism were age >65 years (p < 0.001), low atrial ejection force (p < 0.01) and a dilated left atrium with spontaneous echo contrast (p < 0.05). These findings identified patients at high risk for the development of peripheral embolism among the group of patients paced for sick sinus syndrome.

The short-term clinical efficacies of furosemide, 25 mg/day, and torasemide, 10 mg/day, have been compared in 2 groups of 12 patients with severe heart failure. In each group there were similar numbers of patients in whom heart failure was due to coronary heart disease, high blood pressure, or idio-pathic dilated cardiac myopathy. The design of the study was open and the diuretics were added to baseline treatment with digoxin. Treatment for 8 days with the 2 loop diuretics resulted in similar substantial and significant improvements in symptoms and exercise tolerance as judged by the increase in total body oxygen consumption, and reductions in radio-graphic evidence of pulmonary congestion and in right heart filling pressure as judged from the jugular venous pressure wave. The results of this short-term comparative study confirm that furosemide and torasemide are equally efficacious in inducing substantial improvements in the clinical status of patients in severe heart failure.

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