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2. Out-of-hospital administration of pharmacological agents for cardioversion of first-detected, paroxysmal, or persistent AF in patients without heart disease or when the safety of the drug in the particular patient has been verified. Level of Evidence: C ; See Table 12. ; Class III 1. Electrical cardioversion in patients who display spontaneous alternation between AF and sinus rhythm over short periods of time. Level of Evidence: C.
Causes of syncope, could not give informed consent, had important noncardiovascular or cardiovascular diseases, had a permanent pacemaker, had a pressing need for or contraindication to -blockers, had a diagnosis of carotid sinus hypersensitivity, or had previously used -blockers at a dose greater than the equivalent of metoprolol 25 mg BID for the purpose of suppressing the symptoms of vasovagal presyncope or syncope. In the isoproterenol substudy, 151 patients in 9 participating centers underwent a prespecified, uniform tilt-test protocol that involved a 30-minute head-up tilt at an angle of 80, followed if necessary by an infusion of isoproterenol 30 ng kg min 1 for 10 minutes at 80. This substudy was initially planned to include all study centers, but due to local practices, several centers were unable to participate in it. Centers that participated in this substudy enrolled all their study subjects in it.
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Coeruleus of patients with major depression Klimek et al., 1997 ; . The degeneration of the locus coeruleus occurring in Parkinson's disease Paulus and Jellinger, 1991 ; might play a role in mood changes in these patients Zweig et al., 1993 ; . This is supported here by the lower [11C]RTI-32 binding found in the locus coeruleus of depressed compared with nondepressed patients. In addition, the negative correlation found between locus coeruleus [11C]RTI-32 binding and severity of anxiety in Parkinson's disease supports a direct role for noradrenaline in the pathophysiology of anxiety in Parkinson's disease. It is striking that the reduction of catecholaminergic innervation in depressed Parkinson's disease patients occurs in regions thought to comprise the emotional circuits of the brain. Indeed, the amygdala, mediodorsal thalamus, ventral striatum and CingA belong to the limbic system and have been implicated as dysfunctional regions in mood disorders Drevets, 1998 ; . The amygdala is a key structure for emotional processing in humans LeDoux, 2000 ; . Functional abnormalities in the amygdala correlate with severity of endogenous depression Drevets, 1998 ; , and the amygdala mediates fear processing and anxiety LeDoux, 2000 ; . The amygdala connects with locus coeruleus and receives a noradrenergic and dopaminergic innervation Fallon et al., 1978; Fudge and Emiliano, 2003 ; which is reduced in Parkinson's disease Moore, 2003 ; . In addition, it has been reported in a post-mortem study that Parkinson's disease patients have up to a 20% reduction of amygdala volume and that this structure contains Lewy bodies Harding et al., 2002 ; . In our study, [11C]RTI-32 binding was significantly reduced in the right amygdala of depressed Parkinson's disease patients and the anxiety score was negatively correlated with bilateral amygdala [11C]RTI-32 binding. The loss of noradrenaline and dopamine in the and mazindol.
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