779 e-Letters

  • IV and oral flecainide for the cardioversion of acute AF
    Benjamin Mazouz

    Dear Editor

    I read, with great interest the article by Alp et al comparing intravenous and oral flecainide for the cardioversion of acute atrial fibrillation.[1] However, the article concludes that if a patient converts, there is no difference in the percentage of cardioversion by either route (even though the numbers presented tend to favour the oral route). But it fails to mention if there was any differences...

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  • Diagnostic role of BNP not yet established in heart failure
    Martin J Landray
    Dear Editor

    Cowie's editorial envisages a clinical role for measurement of brain natriuretic peptide (BNP) in the near future.[1] However, while the potential for risk stratification and monitoring of treatment in patients with heart failure is encouraging, we would urge caution regarding the diagnostic utility of plasma BNP concentration.

    There is little doubt that the diagnosis of heart failure is difficult -...

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  • A 'Persistent' Problem with Pulmonary Atresia and Intact Ventricular Septum
    Pradeep Vaideeswar

    Dear Editor

    We read with interest the case report by Codispoti et al, depicting an association of pulmonary atresia and intact inter-ventricular septum (PAIS) with persistent pulmonary hypertension of the newborn. In our study of 24 autopsied cases of PAIS, we found four cases (16.7%) with persistence of fetal circulation. All were a few days old with varying degrees of ventricular hypoplasia and tricuspid steno...

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  • Discussion of worldwide perspective of valve disease should include mitral valve prolapse
    Tsung O Cheng
    Dear Editor:

    I enjoyed reading the recent article on the worldwide perspective of valve disease by Soler-Soler and Galve from Barcelona, Spain.[1] But I was surprised that no mention was made of mitral valve prolapse (MVP) anywhere in their article.

    MVP is the commonest valve disorder in the United States as well as in many parts of the world.[2] It also has a prevalence of 4.3% in Spain (see table).

    Prevalence (%...

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  • Coronary Endothelial Dysfunction after Kawasaki Disease
    Yoshihide Mitani
    Dear Editor

    Iemura et al's hypothesis that endothelial dysfunction is associated with coronary aneurysms which have regressed after Kawasaki disease (KD) is interesting[1]; however, there are two issues with respect to their study design that need to be considered, in addition to the issues reported before.[2, 3]

    (1) Is endothelial dysfunction associated with regressed coronary aneurysms per se late after KD?

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  • Pacing for vasovagal syncope
    Adrian Morley-Davies

    Dear Editor

    Kurbaan and Sutton provide a balanced view of the role of pacing in vasovagal syncope[1] - a common but complex and challenging medical condition.

    However, we feel that attention should be drawn to the methodological problems that bedevil interpretation of the North American Vasovagal Pacemaker Study (VPS).[2] This was not a randomised study of cardiac pacing, but rather a randomised trial...

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  • Re: Pacing for vasovagal syncope
    AS Kurbaan

    Dear Editor,

    We share many of the reservations that Morley-Davies and Byrne have regarding the North American Vasovagal Pacemaker Study (VPS).[1] However, this study should be considered in the context of the other available data supporting the role of pacing in selected patients. We also are interested in the study by Di Girolamo et al[2] suggesting a benefit for orthostatic training in those with neurocardio...

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  • Management of cardiocutaneous fistulae
    Peter G Danias

    Dear Editor,

    We thank Dr. Pocar and his colleagues for contributing their experience with another case of cardiocutaneous fistula [1], which confirms several points that we and others have previously discussed [2] [3] [4]. The clinical presentation of cardiocutaneous fistula is usually slow and indolent but may rapidly deteriorate. Therefore, when this diagnosis is established elective operation should be perfo...

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  • A further case of left ventricular opacification with intracoronary echo contrast during PTSMA
    RAP Skyrme-Jones

    We read the case report by Elliott et al (1) with great interest and would like to add to their findings. In three of five consecutive patients undergoing percutaneous septal ablation (PTSMA) for hypertrophic cardiomyopathy (HCM) they observed left ventricular cavity opacification during selective injection of the first septal perforator with the contrast agent Optison.

    We treated a 61 year old man with a long hist...

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  • Pseudo Brugada or true Brugada revealed by tricyclic agents?
    De Roy

    Dear Editor

    We have read with great interest the short case in cardiology reported by E Zakynthinos et al (1) in the March 2000 edition of Heart. The ECG recordings after acute ingestion of amitriptyline are remarkable, especially the ST segment elevation in the precordial leads V1 - V3, 6 to 100 hours after admission in the intensive care unit.

    The ECG pattern resembles markedly the ones described in...

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