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(Circulation. 2004;110:893.)
© 2004 American Heart Association, Inc.

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An extract of the first 250 words of the full text is provided, because this article has no abstract.

REMODELING OF SINUS NODE FUNCTION IN PATIENTS WITH CONGESTIVE HEART FAILURE: REDUCTION IN SINUS NODE RESERVE, by Sanders et al.

Electrophysiological and anatomic remodeling of the ventricles and atrium has been observed previously in patients with congestive heart failure, with atrial remodeling being particularly prominent in those patients with prior atrial fibrillation. The present study by Sanders et al has further defined right atrial abnormalities in patients with congestive heart failure and no prior history of atrial arrhythmias. These investigators found abnormalities both in innervated and pharmacologically denervated sinus node function in marked conduction abnormalities along the crista terminalis. These latter abnormalities were predominately related to markedly abnormal conduction that is consistent with the development of nonuniform anisotropy secondary to fibrosis in that region. These findings provide insight into the increased instance of atrial tachyarrhythmias and, in particular, atrial flutter in patients with heart failure. The anatomic and electrophysiological "barrier" of the crista terminalis is a requisite component of isthmus-dependent flutter. On the basis of the present study, the incidence of atrial fibrillation, as well as the brady-tachy syndrome in patients with congestive heart failure, can be more appropriately understood. See p 897.

LEFT VENTRICULAR ASSIST DEVICE AS DESTINATION FOR PATIENTS UNDERGOING INTRAVENOUS INOTROPIC THERAPY: A SUBSET ANALYSIS FROM REMATCH (RANDOMIZED EVALUATION OF MECHANICAL ASSISTANCE IN TREATMENT OF CHRONIC HEART FAILURE), by Stevenson et al.

There has been intense interest in the use of left ventricular assist devices (LVADs) as long-term destination therapy for patients with end-stage heart failure. Although the Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure (REMATCH) trial found that the use of LVADs extended survival, the absolute increment was modest. In a subset analysis of the REMATCH trial, Stevenson et al report that patients who required intravenous inotropic support at baseline had a worse . . . [Full Text of this Article]

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