MIODARONE, CONSIDERED THE most effective antiarrhythmic drug, was originally developed in the 1960s as an antianginal agent. It was widely prescribed in Europe for angina but serendipitously found to suppress arrhythmias. Argentinian physicians began using amiodarone to treat resistant arrhythmias in the 1970s. 1,2 United States physicians initially obtained amiodarone from Canada and Europe. Under threat of nonshipment from Europe, the US Food and Drug Administration approved amiodarone in 1985 for use in lifethreatening ventricular tachyarrythmias when other drugs are ineffective or poorly tolerated. 3,4 Despite limited indications, amiodarone is one of the most frequently prescribed specific antiarrhythmic drugs in the United States. 5 In this article, we review amiodarone's clinical pharmacology and evaluate evidence supporting amiodarone for treatment and prevention of various arrhythmias, with the goal of motivating clinicians to rigorously evaluate how they prescribe amiodarone. EVIDENCE ACQUISITION We performed a systematic review of peer-reviewed literature using MEDLINE. We searched amiodarone using the terms adverse effects, atrial fibrillation, atrial flutter, congestive heart failure, electrical storm, hypertrophic cardiomyopathy, implantable cardioverterdefibrillator, surgery, ventricular arrhythmia, ventricular fibrillation, and Wolff-Parkinson-White. Studies included all clinical trials, randomized controlled trials, meta-analyses, and other studies with clinical pertinence. Relevant studies compared amiodarone with placebo, other contemporary antiarrhythmic drugs, or nonpharmacological therapies. We limited our search to human-participant, English-language reports published between 1970 and 2007. Bibliographies of identified articles and guidelines from official societies were reviewed for additional references. The search identified 856 articles; of these, CME available online at www.jama.com

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LAA elimination is often incomplete and goes undetected. If the LAA is eliminated at the time of surgery, then TEE should be used intraoperatively to assess effectiveness and reintervention performed if warranted. Late assessment for completeness of closure should be considered before cessation of anticoagulation until more effective LAA techniques can be developed.

AAIM is the largest academically focused specialty organization representing departments of internal medicine at medical schools and teaching hospitals in the United States and Canada. As a consortium of five organizations, AAIM represents department chairs and chiefs; clerkship, residency, and fellowship program directors; division chiefs; and academic and business administrators as well as other faculty and staff in departments of internal medicine and their divisions.

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Ophthalmic complications may occur after nasal and sinus surgery, even using an endoscopic procedure. Successful handling of these complications could be reached by on their early recognition and treatment.

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Background Valve‐sparing aortic root replacement (VSARR) is an alternative to valve‐replacing aortic root replacement (VRARR) with valved‐conduits based on recent guidelines for clinical practice. This study investigated outcomes of these two procedures in patients with nonstenotic valves. Methods Between January 7, 2007 and June 30, 2019, 475 patients with aortic root aneurysm without aortic stenosis underwent VSARR (151) or VRARR (324) techniques. Propensity score‐matching (PSM) was used to alleviate confounding. Endpoints were 30‐day mortality, 8‐year survival and reoperation, aortic regurgitation, and valve gradients. Results PSM created 69 pairs of patients with a mean age 52 ± 13 years (10.1% Marfan syndrome, 34.8% bicuspid aortic valve). There was no statistically significant difference in major perioperative morbidity or 30‐day mortality (0% VSARR vs. 1.4% VRARR; p = 0.316). Overall survival was significantly higher (p = 0.025) in the VSARR group versus the VRARR group (8‐year estimates 100% vs. 88.9%, respectively), while freedom from valve reoperation was similar (p = 0.97, 8‐year estimates 90.9% vs. 96.7%, respectively). Freedom from > moderate‐severe AR was not significantly different (p = 0.08, 8‐year estimates 90.0% VSARR group vs. 100% VRARR), but mean valve gradients at last follow‐up were better in the VSARR group (5.9 vs. 13.2 mmHg, p < 0.001). Conclusions VSARR is a safe operation in patients with aortic root aneurysm and nonstenotic aortic valves in the hands of experienced surgeons. Freedom from reoperation is similar and the mode of aortic valve failure differs between the two groups.