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289

Treatment failure of low molecular weight heparin bridging therapy in atrial fibrillation after acute coronary syndrome E. Imbalzano a,⁎, R. Ceravolo b, R. Di Stefano c, M. Vatrano b, A. Saitta a a b c

Department of Internal Medicine, University of Messina, Italy Department of Cardiology, Hospital “Pugliese-Ciaccio” of Catanzaro, Italy Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa, Italy

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Article history: Received 28 August 2013 Accepted 23 November 2013 Available online 4 December 2013 Keywords: Atrial fibrillation Thrombosis prevention Low-molecular-weight heparin Oral anticoagulant therapy Ischemic stroke

Thrombosis prevention in atrial fibrillation [1–21] is a very common problem for cardiologists. Low molecular weight heparin bridging therapy (LMWH-BT) has been considered in patients at high risk of thromboembolism during the start or temporary interruption of oral anticoagulation therapy [22–24]. Several cases of treatment failure of LMWH-BT have been reported [25–27]. A 70-year-old man, with a history of arterial hypertension, recurrent atrial fibrillation and mild aortic valve stenosis in oral anticoagulant therapy [1–33], came to our observation for inferior STEMI (Fig.1A) complicated by total BAV (Fig.1B). In urgency was inserted PM temporary and revascularized with double DES for thrombotic occlusion of the proximal right coronary artery. The current therapy with LMWH was standardized according to body weight, beta-blockers, ACE inhibitors, diuretics, aspirin and clopidogrel [34–36]. After 3 days the ECG showed atrial fibrillation (Fig. 1C). After 6 days the patient has sudden expressive aphasia and hemi-facial-brachial left. Echocardiographic assessment did not detect the presence of thrombus in the cardiac chambers. A computed tomography [37,38] performed in emergency and after 24 h showed cerebral ischemic injury (Fig. 2). Also this case focuses on the failure of treatment with LMWH-BT. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.

References [1] Hendriks JM, Crijns HJ, Tieleman RG, Vrijhoef HJ. The atrial fibrillation knowledge scale: development, validation and results. Int J Cardiol Sep 2013;168(2):1422–8. [2] Chao TF, Liu CJ, Chen SJ, et al. CHADS(2) score and risk of new-onset atrial fibrillation: a nationwide cohort study in Taiwan. Int J Cardiol Sep 2013;168(2):1360–3. [3] John S, Salmas J, Kornej J, et al. Effects of dronedarone and amiodarone on atrial fibrillatory rate in patients with persistent atrial fibrillation. Int J Cardiol Sep 2013;167(5):2354–6. [4] Patanè S, Marte F, Sturiale M, Dattilo G. Changing axis deviation and acute myocardial infarction. Int J Cardiol Aug 18 2011;151(1):e1–3. [5] Patanè S, Marte F, Dattilo G, Sturiale M. Changing axis deviation during atrial fibrillation. Int J Cardiol Jan 12 2012;154(1):e1–3. [6] Yoshino S, Yoshikawa A, Hamasaki S, et al. Atrial fibrillation-induced endothelial dysfunction improves after restoration of sinus rhythm. Int J Cardiol Dec Sep 2013;168(2):1280–5. [7] Yu HI, Sheu WH, Lai CJ, Lee WJ, Chen YT. Endothelial dysfunction in type 2 diabetes mellitus subjects with peripheral artery disease. Int J Cardiol Mar 2001;78(1):19–25. ⁎ Corresponding author at: Unità Operativa Complessa di Medicina Interna, Azienda Ospedaliera Universitaria “Policlinico G. Martino” Via Consolare Valeria n.1, 98125 Messina, Italy. Tel.: + 39 3392894665. E-mail address: [email protected] (E. Imbalzano).

[8] Dattilo G, Lamari A, Crosca S, et al. Correlation between insulin resistance and endothelial dysfunction assessed by flow-mediated dilation. Recenti Prog Med Sep 2012;103(9):328–32. [9] Saitta A, Sardo A, Bonaiuto M, et al. Effects of picotamide on release of endothelin1, thromboxane and prostacycline after treadmill stress in patients with peripheral artery disease. Angiology Nov 1998;49(11):879–84. [10] Mandraffino G, Sardo MA, Riggio S, et al. Smoke exposure and circulating progenitor cells: evidence for modulation of antioxidant enzymes and cell count. Clin Biochem Dec 2010;43(18):1436–42. [11] Patanè S, Marte F, Dattilo G, Sturiale M. Acute myocardial infarction and left bundle branch block with changing axis deviation. Int J Cardiol Feb 9 2012;154(3):e47–9. [12] Patanè S, Marte F, Sturiale M, Dattilo G, Luzza F. Atrial flutter, ventricular tachycardia and changing axis deviation associated with scleroderma. Int J Cardiol Dec 1 2011;153(2):e25–8. [13] Casado-Arroyo R, Chierchia GB, Rodriguez-Mañero M, et al. Atrial fibrillation outcomes: changing the paradigm. Int J Cardiol Jun 20 2013;166(2):545–7. [14] Wu J, Wang J, Jiang S, et al. The efficacy and safety of lowintensitywarfarin therapy in Chinese elderly atrial fibrillation patientswith high CHADS(2) risk score. Int J Cardiol Sep 2013;167(6):3067–8. [15] Dattilo G, Tulino V, Tulino D, Lamari A, Marte F, Patanè S. Interatrial defect, ventricular septal defect and patent ductus arteriosus in a 2-day-old newborn infant. Int J Cardiol May 15 2009;134(2):e82–3. [16] Camm AJ, Lip GY, De Caterina R, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation—developed with the special contribution of the European Heart Rhythm Association. Europace Oct 2012;14(10):1385–413. [17] Dattilo G, Lamari A, Messina F, et al. The chance finding at multislice computed tomography coronary angiography of an ectopic origin of the left circumflex coronary artery from the right sinus of Valsalva. Int J Cardiol Jun 2 2011;149(2): e43–6. [18] Saitta A, Saitta MN, Messina A, et al. Effects of adrenergic stimulation on transmembrane transport of Na + in patients with essential hypertension. Minerva Med Jul–Aug 1997;88(7–8):275–82 [Italian]. [19] Dattilo G, Carerj S, Lamari A, et al. The chance finding at multislice computed tomography coronary angiography of myocardial bridging. Int J Cardiol Jan 26 2012;154(2):e21–3. [20] Zannad F, Stough WG, Regnault V, et al. Is thrombosis a contributor to heart failure pathophysiology? Possible mechanisms, therapeutic opportunities, and clinical investigation challenges. Int J Cardiol Sep 2013;167(5):1772–82. [21] Gooshah Gir AA, Namdar H, Emaratkar E, et al. Avicenna's view on the prevention of thrombosis. Int J Cardiol Jun 5 2013;166(1):274–5. [22] Task Force for Preoperative Cardiac Risk Assessment, Perioperative Cardiac Management in Non-cardiac Surgery, European Society of Cardiology (ESC), Poldermans D, et al. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur Heart J Nov 2009;30(22):2769–812. [23] European Heart Rhythm Association, European Association for Cardio-Thoracic Surgery, Camm AJ, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace Oct 2010;12(10):1360–420 [No abstract available. Erratum in: Europace. 2011 Jul;13(7):1058. Dosage error in article text]. [24] European Heart Rhythm Association, European Association for Cardio-Thoracic Surgery, Camm AJ, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J Oct 2010;31(19):2369–429 [Erratum in: Eur Heart J. 2011 May;32(9):1172]. [25] Tulino D, Imbalzano E, Casale M, et al. Treatment failure of low molecular weight heparin in diabetic patient. Int J Cardiol Sep 2013;168(2):e63–4. [26] Dattilo G, Tulino D, Lamari A, Tulino V, Marte F, Patanè S. Treatment failure of low molecular weight heparin in a patient with an aortic mechanical prosthesis. Int J Cardiol Jan 21 2011;146(2):e30–2. [27] Patanè S, Marte F, Risica G, et al. Treatment failure of low molecular weight heparin bridging therapy before a cardiac surgery intervention in a patient with atrial fibrillation. Int J Cardiol Nov 12 2009;137(3):e59–60. [28] Mandraffino G, Sardo MA, Riggio S, et al. Circulating progenitor cells are increased in newly diagnosed untreated hypertensive patients with arterial stiffening but normal carotid intima-media thickness. Hypertens Res Jul 2011;34(7):876–83. [29] Sardo MA, Mandraffino G, Campo S, et al. Biglycan expression in hypertensive subjects with normal or increased carotid intima-media wall thickness. Clin Chim Acta Aug 2009;406(1–2):89–93. [30] Sardo MA, Mandraffino G, Riggio S, et al. Effects of the angiotensin II receptor blocker losartan on the monocyte expression of biglycan in hypertensive patients. Clin Exp Pharmacol Physiol Sep 2010;37(9):933–8.

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Fig. 1. Panel A: ECG showed inferior STEMI. Panel B: ECG with total BAV. Panel C: ECG shows atrial fibrillation.

Letters to the Editor

291

[32] Tulino V, Cacace C, Tulino D, Imbalzano E, Dattilo G. Clinical variants in Ebstein's anomaly, Int J Cardiol 168 (5). Oct 2013;12:4969–70. [33] Zhang DY, Lozier J, Chang R, et al. Case study and review: treatment of tricuspid prosthetic valve thrombosis. Int J Cardiol Dec 15 2012;162(1):14–9. [34] Denardo SJ, Davis KE, Tcheng JE. Effectiveness and safety of reduced-dose enoxaparin in non-ST-segment elevation acute coronary syndrome followed by antiplatelet therapy alone for percutaneous coronary intervention. Am J Cardiol Nov 1 2007;100(9):1376–82. [35] Patanè S, Marte F, Sturiale M, Dattilo G. ST-segment elevation and diminution of prostate-specific antigen in a patient with coronary spasm and without significant coronary stenoses. Int J Cardiol Apr 14 2011;148(2):e31–3. [36] Reed GW, Cannon CP. Triple oral antithrombotic therapy in atrial fibrillation and coronary artery stenting. Clin Cardiol Sep 2013;36(10):585–94. [37] Arboix A, García-Eroles L, Massons JB, Oliveres M, Pujades R, Targa C. Atrial fibrillation and stroke: clinical presentation of cardioembolic versus atherothrombotic infarction. Int J Cardiol Mar 31 2000;73(1):33–42. [38] Guo Y, Pisters R, Apostolakis S, et al. Guo Y, Pisters R, Apostolakis S. Stroke risk and suboptimal thromboprophylaxis in Chinese patients with atrial fibrillation: would the novel oral anticoagulants have an impact? Int J Cardiol Sep 2013;168(1):515–22.

Fig. 2. CT image showing the presence of a large area of cortical–subcortical hypodense in the distribution of the right middle cerebral.

[31] Dattilo G, Lamari A, Tulino V, et al. Congenital valvular heart disease with high familial penetrance. Recenti Prog Med Dec 2012;103(12):581–3.

0167-5273/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijcard.2013.11.079

Type 2 short QT syndrome and vestibular dysfunction: Mirror of the Jervell and Lange- Nielsen syndrome? Alice Maltret a,⁎, Sylvette Wiener-Vacher b, Charlotte Denis c, Fabrice Extramiana d, Marie Paule Morisseau-Durand e, Veronique Fressart f, Damien Bonnet a, Christian Chabbert g a

Department of Pediatric Cardiology, Hospital Necker, AP-HP, Paris, France Department of Vestibulometry, Hospital Robert Debré, AP-HP, Paris, France Department of Pediatric Cardiology, Château des Côtes, Les loges en Josas, France d University Paris Diderot, Hospital Bichat, AP-HP, Paris, France e Department of Oto-Rhino-Laryngology, Hospital Necker, AP-HP, Paris, France f Department of Biochemistry, Hospital Pitie-Salpetriere, AP-HP, Paris, France g INSERM U1051, Institute for Neurosciences of Montpellier, France b c

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Article history: Received 30 August 2013 Accepted 25 November 2013 Available online 4 December 2013 Keywords: Short QT syndrome Inner ear Imbalance Canalar dysfunction Pediatric KCNQ1

In cardiac myocytes the role of potassium is central for resting membrane potential as well as for the action potential course [1,2]. ⁎ Corresponding author. Tel.: +33 1 44 49 43 42; fax: +33 1 44 49 43 40. E-mail address: [email protected] (A. Maltret).

Accordingly mutations in KCNQ1 resulting in a loss of function in IKs are associated with ventricular repolarization prolongation leading to ventricular arrhythmias (long QT syndromes) and also with congenital bilateral deafness in its homozygous presentation (Jervell and Lange-Nielsen syndrome) [3,4]. Mutations leading to a gain of function in KCNQ1 gene have also been described and are associated with the type 2 short QT syndrome (SQTS) characterized by ventricular repolarization shortening and life threatening ventricular arrhythmias [5]. We here report a case of inner ear dysfunction in a patient with type 2 short QT syndrome. The baby girl was born preterm at 32 weeks by cesarean section that was prompted by fetal bradycardia. The postnatal basal twelvelead surface electrocardiogram (ECG) (Fig. 1) showed a slow sinus rhythm (HR = 69 bpm) with an extremely short QT interval duration (QT = 260 ms, QTc Bazett = 279 ms, QTc Fridericia = 272 ms). The ECG-Holter monitoring has repeatedly recorded both slow sinus and junctional rhythms (24-hour mean heart rate at 50 bpm)

Treatment failure of low molecular weight heparin bridging therapy in atrial fibrillation after acute coronary syndrome.

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