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(Circulation. 2004;110:893.)
© 2004 American Heart Association, Inc.
Issue Highlights |
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 prognosis with standard care than patients who did not require inotropic support, but with LVADs, both groups obtained a similar survival rate. As a result, the incremental survival benefit with LVAD was greater in patients who required inotropic support, thus identifying a subpopulation that may particularly benefit from LVAD therapy. See p 975.
RELATIONSHIP BETWEEN ACTIVATED CLOTTING TIME AND ISCHEMIC OR HEMORRHAGIC COMPLICATIONS: ANALYSIS OF 4 RECENT RANDOMIZED CLINICAL TRIALS OF PERCUTANEOUS CORONARY INTERVENTION, by Brener et al.
In patients undergoing coronary interventions, unfractionated heparin is monitored by the activated clotting time (ACT). The ACT that predicts both hemorrhagic complications and coronary ischemia is not known, particularly in the era of multiple platelet inhibitor use. Brener and colleagues pooled the results from 4 large studies comprising >8000 patients and found that the ACT did not correlate with ischemic complications and had a minimal association with bleeding. Increased weight-adjusted heparin dose was associated with a modest increase in rate of bleeding. Although the results would need to be validated in a prospective trial, this study suggests that the ACT provides little helpful information beyond the heparin dose. See p 994.
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Images in Cardiovascular Medicine
Leriche Syndrome Visualized by 3-Dimensional Multislice Computed Tomography Angiography. See p e77.
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Related Articles:
Circulation 2004 110: 897-903.
Circulation 2004 110: 975-981.
Circulation 2004 110: 994-998.
Circulation 2004 110: e77-e78.
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