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Introduction: Tecadenoson, a selective A1 adenosine derivative,prolongs AV nodal conduction without A2 -mediated reductions in BP or A2B/ A3 -mediated bronchospasm. The primary study objective was to assess the rate of therapeutic conversion of PSVT without high degree AV block. Methods: This randomized, double-blind, placebo-controlled study enrolled PSVT patients in need of electrophysiologic study. PSVT was induced, sustained for ≥2 minutes and first IV bolus of study drug administered. If PSVT persisted after 1 minute, a second bolus was administered. The five tecadenoson regimens were 75μg/150μg (A), 150μg/300μg (B), 300μg/600μg (C), 450μg/900μg (D), 900μg/900μg (E) vs placebo. Results: Therapeutic conversion rate of each tecadenoson regimen was statistically significant versus placebo (ITT; n = 181; p < 0.0005). Higher regimens converted PSVT after the first dose in most patients (p < 0.001). Median time to conversion was ≤1 minute. No apparent dose-dependent increase in AE frequency was observed. Conclusion: Each tecadenoson regimen rapidly converted PSVT to sinus rhythm in a dose-dependent manner. In TEMPEST, tecadenoson regimens were identified that rapidly converted 90% of patients without significant adverse symptoms or hemodynamic effects. [ABSTRACT FROM AUTHOR]

Background: Expectations that reestablishing and maintaining sinus rhythm in patients with atrial fibrillation might improve survival were disproved in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. This report describes the cause-specific modes of death in the AFFIRM treatment groups., Methods and Results: All deaths in patients enrolled in AFFIRM underwent blinded review by the AFFIRM Events Committee, and a mode of death was assigned. In AFFIRM, 2033 patients were randomized to a rhythm-control strategy and 2027 patients to a rate-control strategy. During a mean follow-up of 3.5 years, there were 356 deaths in the rhythm-control patients and 310 deaths in the rate-control patients (P=0.07). In the rhythm-control group, 129 patients (9%) died of a cardiac cause, and in the rate-control group, 130 patients (10%) died (P=0.95). Both groups had similar rates of arrhythmic and nonarrhythmic cardiac deaths. The numbers of vascular deaths were similar in the 2 groups: 35 (3%) in the rhythm-control group and 37 (3%) in the rate-control group (P=0.82). There were no differences in the rates of ischemic stroke and central nervous system hemorrhage. In the rhythm-control group, there were 169 noncardiovascular deaths (47.5% of the total number of deaths), whereas in the rate-control arm, there were 113 noncardiovascular deaths (36.5% of the total number of deaths) (P=0.0008). Differences in noncardiovascular death rates were due to pulmonary and cancer-related deaths., Conclusions: Management of atrial fibrillation with a rhythm-control strategy conferred no advantage over a rate-control strategy in cardiac or vascular mortality and may be associated with an increased noncardiovascular death rate.