CardioExchange Archive

CardioExchange is pleased to reprint selections from Dr. Richard Lehman’s weekly journal review blog at BMJ.com. Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.

JAMA  8 May 2013  Vol 309

Effect of Long-Detection Interval vs. Standard-Detection Interval for ICDs on Antitachycardia Pacing and Shock Delivery (pg. 1903): When an implanted cardioverter defibrillator goes off inside you, you are sure to feel deeply shocked: whereas, for others, watching you drop dead might be even more shocking. One needs to strike a balance. That was the purpose of the ADVANCE III (Avoid Delivering Therapies for Nonsustained Arrhythmias in ICD Patients III) trial. Essentially this was a gamble on how many ventricular tachycardia beats are allowed to happen before the device fired: with current devices it is usually 18-24, whereas in this trial half the patients got a newly programmed device which counts to 30-40. They stayed alive as much, didn’t have more syncopal episodes, and had a third fewer shocks in the first year.

NEJM  9 May 2013  Vol 368

n–3 Fatty Acids in Patients with Multiple CV Risk Factors (pg. 1800): They’re at it again! Crunching up thousands of tons of lovely oily fish and turning them into capsules of n-3 fatty acids. These were then fed to Italian “men and women with multiple cardiovascular risk factors or atherosclerotic vascular disease but not myocardial infarction. Patients were randomly assigned to n−3 fatty acids (1 g daily) or placebo (olive oil).” Maybe 1G of olive oil is just a placebo: certainly for an Italian. Anyway, there was no difference at 5 years. To derive any protection, you have to eat the fish as well as the oils. Turbot is the best fish for n-3 fatty acids, I’m told: excellent as steaks or fillets fried in butter and served with a sauce of reduced cream, white wine and morels (or since you probably lack morels, some fresh chopped sorrel at the last minute); or just a simple hollandaise. The point of all fish is the butter that goes with them. There are those who assert that the quantity of butter should equal the quantity of fish, but I think that this should be left to the conscience of the individual believer.

Ann Intern Med  7 May 2013  Vol 158

Management Strategies for Asymptomatic Carotid Stenosis (pg. 676): Courtesy of the Annals, you can read the whole of a big systematic review of management strategies for asymptomatic carotid stenosis. Golly, what a mess. “Studies defined asymptomatic status heterogeneously. Participants in RCTs did not receive best available medical therapy… Future RCTs of asymptomatic carotid artery stenosis should explore whether revascularization interventions provide benefit to patients treated by best-available medical therapy.” Correct me if I’m wrong, but doesn’t that prove that all the 47 studies analysed here were actually unethical, because they tell us nothing about how to manage asymptomatic carotid stenosis and did not give patients an adequate control intervention?