Unilateral transvenous phrenic nerve stimulation significantly reduces episodes of CSA and restores a more natural breathing pattern in patients with heart failure. This approach may represent a novel therapy for CSA and warrants further study.

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Renin production, an index of renal ischemia, was markedly greater at hyperemia than at rest, suggesting that RAS, with either an HSG of 21 mm Hg or a renal FFR of 0.90, can be considered a hemodynamically significant stenosis. Intrarenal papaverine neither prolonged the QT interval nor induced ventricular arrhythmias and the safety of which will need to be corroborated in a large study. © 2010 Wiley-Liss, Inc.

While the evidence is not incontrovertible, the 3 s pause threshold does not adequately discriminate between potentially asymptomatic and symptomatic competitive athletes, and alone should not be used to exclude potential competitors.

Objective Methadone is associated with prolongation of the electrocardiographic QTc interval. QTc prolongation may be linked to cardiac dysrhythmia and sudden cardiac death. The rate of these events is unknown in methadone-maintained patients. Methods This retrospective cohort study of 749 patients with opioid use disorder receiving methadone maintenance therapy through a single safety-net hospital, queried the electronic health record for electrocardiogram results, demographics, methadone dose, and diagnostic codes consistent with cardiac conduction disorder (ICD-9 426) and cardiac dysrhythmia (ICD-9 427). Factors associated with QTc interval were explored; Cox-proportional hazards regression models were used to analyze time to an event that may predispose to sudden cardiac death. Results One hundred thirty four patients had an electrocardiogram while on methadone, 404 while off methadone, and 211 both while on and off methadone. Mean QTc interval while on methadone (436 msec, SD 36) was significantly greater than while off (423 msec, SD 33). Age and methadone dose were weakly associated with increased QTc interval (p<0.01 and p<0.0005, respectively, adjusted R2=0.05). There were 44 ICD-9 426 and 427 events over 7,064 patient years (6.3 events/1,000 patient years). Having a QTc greater than gender specific cut-off values was significantly associated with time to event (hazard ratio 3.32; 95% CI 1.25-8.81) but being on methadone was not. Conclusions Methadone is associated with QTc prolongation in a non-clinically significant dose-related manner. Cardiac events were rare and the sudden cardiac death rate was below that of the general population. Current recommendations for cardiac risk assessment in methadone maintained patients should be reconsidered.

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Summary What is known and objective Patients with non‐valvular atrial fibrillation (NVAF) are at risk for stroke and systemic embolism (SSE), and this risk can be decreased with adjusted‐dose warfarin. Warfarin, however, is cumbersome to use and requires at least monthly laboratory monitoring. Three new oral anticoagulants (NOACs) that are less cumbersome have been approved as alternatives to warfarin for SSE prevention in NVAF. Selecting a patient‐specific alternative to warfarin can be confusing for pharmacists and clinicians. This review details clinical parameters to consider when choosing an alternative to warfarin for a specific patient and summarizes them in a Comparison Table. Methods Using available clinical evidence from pivotal trials, US FDA‐ and Health Canada‐approved prescribing information and post‐marketing observations, this review provides a summary of important clinical variables for clinicians to consider when choosing patient‐centred anticoagulant alternatives to warfarin for prevention of SSE in NVAF. Results and discussion Dabigatran, rivaroxaban and apixaban are approved alternatives to warfarin for primary and secondary prevention of SSE in patients with NVAF. Additionally, apixaban has also been compared to aspirin in patients with NVAF that were considered unsuitable for vitamin K antagonist therapy. Prospective consideration of age, weight, hepatic function, renal function and drug interactions are important clinical parameters to consider when selecting patient‐centred alternatives to adjusted‐dose warfarin. What is new and conclusion Several NOACs are now alternatives to warfarin for SSE prevention in NVAF but require providers to make a shift in strategy from tailoring anticoagulant dose based on anticoagulant effect to selection of the anticoagulant based on clinical variables that affect anticoagulant exposure. These variables and their interactions should be considered in choosing an alternative to warfarin and are summarized in a simple table comparing the new anticoagulants.

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