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Rhythm vs rate control in atrial fibrillation after surgery
Calkins H. Is Less More for the Treatment of Atrial Fibrillation after Cardiac Surgery? N Engl J Med. 2016 May 19;374(20):1977-8. doi: 10.1056/NEJMe1604311. PubMed PMID: 27192676.
Among patients who developed atrial fibrillation following coronary artery bypass grafting (CABG) surgery, the use of rate control was not inferior to rhythm control (amiodarone followed by cardioversion within 24 to 48 hours), with 94% of patients in the rate-control group versus 98% in the rhythm-control group with a stable rhythm without atrial fibrillation for at least 30 days at day 60. This clinical scenario occurs in about 30% of all patients after CABG surgery.
Authors interpret their results as showing no advantage of either strategy.
Treatment, no treatment, or placebo for unprovoked seizures
Following first unprovoked seizures, immediate treatment (rather than no treatment, placebo, or deferred treatment) is associated with fewer recurrent seizures after 1 year (19% vs 39%) and 5 years (37% vs 47%) as well as a higher probability of events classified as adverse (30% vs 20% over a period of time ranging from months to several years).
These results will inform decisions of patients and clinicians facing this reasonably frequent management dilemma.
Intravenous magnesium in children with acute asthma
Intravenous magnesium (25-75 mg/kg) used as an adjunct to steroids and bronchodilators has decreased the need for hospital admissions in children presenting with acute asthma exacerbation to the emergency department.
These results add to the similar evidence in adults, although authors point out the relative heterogeneity of findings between studies and the overall small number of involved children (<200).
