sildenafil-citrate and Atrial-Fibrillation

Atrial fibrillation (AF) is common among patients with heart failure and preserved ejection fraction (HFpEF), but its clinical profile and impact on exercise capacity remain unclear. RELAX (Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in HFpEF) was a multicenter randomized trial testing the impact of sildenafil on peak VO2 in stable outpatients with chronic HFpEF. We sought to compare clinical features and exercise capacity among patients with HFpEF who were in sinus rhythm (SR) or AF.. RELAX enrolled 216 patients with HFpEF, of whom 79 (37%) were in AF, 124 (57%) in SR, and 13 in other rhythms. Participants underwent baseline cardiopulmonary exercise testing, echocardiogram, biomarker assessment, and rhythm status assessment before randomization. Patients with AF were older than those in SR but had similar symptom severity, comorbidities, and renal function. β-blocker use and chronotropic indices were also similar. Despite comparable left ventricular size and mass, AF was associated with worse systolic (lower EF, stroke volume, and cardiac index) and diastolic (shorter deceleration time and larger left atria) function compared with SR. Pulmonary artery systolic pressure was higher in AF. Patients with AF had higher N-terminal pro-B-type natriuretic peptide, aldosterone, endothelin-1, troponin I, and C-telopeptide for type I collagen levels, suggesting more severe neurohumoral activation, myocyte necrosis, and fibrosis. Peak VO2 was lower in AF, even after adjustment for age, sex, and chronotropic response, and VE/VCO2 was higher.. AF identifies an HFpEF cohort with more advanced disease and significantly reduced exercise capacity. These data suggest that evaluation of the impact of different rate or rhythm control strategies on exercise tolerance in patients with HFpEF and AF is warranted.. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00763867.

Topics: Age Factors; Aged; Atrial Fibrillation; Blood Pressure; Cohort Studies; Comorbidity; Exercise Tolerance; Female; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Oxygen Consumption; Phosphodiesterase 5 Inhibitors; Piperazines; Purines; Sildenafil Citrate; Stroke Volume; Sulfones; Treatment Outcome

The surgical treatment of permanent atrial fibrillation (AF) continues to be a clinical challenge. Increased left atrial (LA) wall tension affected by LA wall thickness and volume has been associated with poor restoration of sinus rhythm after the Maze procedure. This study was designed to investigate the impact of conversion rates to sinus rhythm using LA wall tension reduction techniques in conjunction with aggressive postoperative pharmacological therapy in comparison to a modified Maze procedure alone.. From 1999 to 2008, 322 patients with permanent AF and biatrial enlargement, who required mitral valve ± tricuspid valve surgery were exactly randomized into two groups: The study group used biatrial reduction with reef-imbricate suture technique concomitant with the Maze procedure and aggressive postoperative pharmacological therapy; the control group was treated with the Maze procedure alone. LA dimension was measured by transesophageal echocardiogram (TEE) or transthoracic echocardiography (TTE); LA wall thickness was measured by TEE and manually during surgery. Pulmonary artery (PA) pressures were measured by PA catheter or TTE, BNP test and clinical follow-up at discharge, 3 months, 6 months and 1 year. There were 187 woman (58%) and 135 men (42%). Their mean age was 45 ± 9.5 years.. Overall restoration of sinus rhythm was significantly improved in the group with aggressive reduction of LA wall tension during 1-year clinical follow-up (89.3% vs 67.2%, p < 0.001). Calculated LA wall tension was significantly reduced at discharge in the study group versus control group (4.012 ± 1.650 dyn cm(-1) vs 20 384 ± 3313 dyn cm(-1) (p < 0.001)) and at 1-year follow-up (1059 ± 1161 dyn cm(-1) vs 17 139 ± 3170 dyn cm(-1) (p < 0.001)), respectively. Significant differences in changes in LA dimension were detected at discharge and 1-year follow-up in the study group versus control group (43 ± 7 vs 61 ± 11, p < 0.001). LA wall (3.9 ± 1.3 vs 2.3 ± 0.9) thickness also significantly differed at the 1-year follow-up.. An aggressive approach to reduce LA wall tension significantly improves restoration of sinus rhythm after the Maze procedure. LA wall tension directly affects sinus conversion. Further studies using pharmacologic intervention to reduce LA wall tension for maintenance of sinus rhythm need to be evaluated.

Topics: Adult; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Combined Modality Therapy; Drug Administration Schedule; Drug Therapy, Combination; Echocardiography, Transesophageal; Female; Follow-Up Studies; Heart Atria; Humans; Male; Middle Aged; Mitral Valve; Piperazines; Postoperative Care; Purines; Sildenafil Citrate; Sulfones; Suture Techniques; Treatment Outcome; Tricuspid Valve; Vasodilator Agents

Topics: Aged; Atrial Fibrillation; Biological Availability; Catheter Ablation; Echocardiography; Female; Heart Atria; Humans; Hypertension, Pulmonary; Pulmonary Wedge Pressure; Sildenafil Citrate; Treatment Outcome; Vasodilator Agents

Topics: Atrial Fibrillation; Carbolines; Humans; Hypertension; Male; Middle Aged; Migraine with Aura; Phosphodiesterase Inhibitors; Piperazines; Purines; Sildenafil Citrate; Sulfones; Tadalafil

A 61-year-old man with atrial fibrillation receiving Coumadin brand warfarin was switched to Barr brand warfarin without his knowledge as a result of a retail pharmacy dispensing error. The patient took the same dosage for 6-7 days and experienced severe epistaxis that required two visits to the emergency room. Previously, his coagulation values were within therapeutic range, but when tested at the emergency room the international normalized ratio was elevated. The patient denied changes in therapy compliance, diet, alcohol ingestion, or use of other drugs. His only other drug, taken periodically, was sildenafil for erectile dysfunction. Clinicians should be aware of differences between branded and generic compounds.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Anticoagulants; Atrial Fibrillation; Drugs, Generic; Epistaxis; Humans; International Normalized Ratio; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Purines; Sildenafil Citrate; Sulfones; Warfarin

This case report describes a patient with hypertrophic cardiomyopathy who developed symptomatic atrial fibrillation on two occasions after ingesting sildenafil citrate (Viagra). Sildenafil citrate should be withheld or used with extreme caution in persons with hypertrophic obstructive cardiomyopathy.

Topics: Acute Disease; Atrial Fibrillation; Cardiomyopathy, Hypertrophic; Humans; Male; Middle Aged; Piperazines; Purines; Sildenafil Citrate; Sulfones

Topics: Adult; Atrial Fibrillation; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Sildenafil Citrate; Sulfones

A 55-year-old Japanese man was hospitalized for palpitations and severe chest oppression one hour after he ingested about 1500 ml of beer and sildenafil (Viagra) 50 mg. At 43 years of age, he had been diagnosed with intermittent WPW syndrome following a paroxysmal supraventricular tachycardia (PSVT) attack. He took a 1 mg tablet of doxazosin daily for mild hypertension. On admission, his blood pressure was 90/54 mmHg and his heart beat was weak and irregular with a rate of about 220/min. Since atrial fibrillation (Af) was diagnosed on an electrocardiogram (minimum RR interval; 0.22 seconds), direct current shock was performed with 100 joules and 150 joules but conversion to sinus rhythm failed. Sinus rhythm returned spontaneously from Af four hours after taking sildenafil. Since blood pressure was 50/17 mmHg despite the return to sinus rhythm, blood pressure was maintained by dopamine for twelve hours after sinus rhythm returned. The patient underwent catheter ablation for curative therapy and thereafter has not had any further episodes of tachycardia.

Topics: Atrial Fibrillation; Electrocardiography; Humans; Hypotension; Male; Middle Aged; Phosphodiesterase Inhibitors; Piperazines; Purines; Sildenafil Citrate; Sulfones; Wolff-Parkinson-White Syndrome