Circulation. 2005;111:1093
(Circulation. 2005;111:1093.)
© 2005 American Heart Association, Inc.
Issue Highlights
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WORLDWIDE SURVEY ON THE METHODS, EFFICACY, AND SAFETY OF CATHETER ABLATION FOR HUMAN ATRIAL FIBRILLATION, by Cappato et al.
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Catheter ablation of atrial fibrillation is evolving rapidly.
This survey from 181 responding centers provides an indication
of the dramatic growth of the procedure between the mid-1990s,
when fewer than 100 patients were treated, and 2002, when >5000
patients received ablation annually at these centers alone.
Methods, criteria for patient selection, and outcomes varied
among centers. A beneficial effect on symptoms was reported
for more than half of patients without antiarrhythmic drug therapy,
and more received benefit with continued drug therapy. Approximately
one quarter of patients required two procedures. Major complications,
including cardiac tamponade and stroke, occurred in 6%. Although
these data are subject to the reporting bias inherent in a survey,
they provide a useful look at the outcomes and problems with
this procedure during the initial period of its rapid growth.
See p
1100.
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COST-EFFECTIVENESS OF EPLERENONE COMPARED WITH PLACEBO IN PATIENTS WITH MYOCARDIAL INFARCTION COMPLICATED BY LEFT VENTRICULAR DYSFUNCTION AND HEART FAILURE, by Weintraub et al.
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As costs of health care increase and expensive new therapies
are shown to have benefit, it is important to question whether
the intervention is economically attractive from a societal
perspective. The Eplerenone Post–Acute Myocardial Infarction
Heart Failure Efficacy and Survival Study (EPHESUS) demonstrated
that selective aldosterone blockade with eplerenone reduced
mortality and morbidity in patients with left ventricular systolic
dysfunction and heart failure after an acute myocardial infarction.
Over 16 months, eplerenone reduced the risk of death by 17%
and the risk of death from cardiovascular causes or hospitalization
for cardiovascular events by 13%. The risk of serious hyperkalemia
increased. Weintraub and colleagues have used the EPHESUS trial
results in an economic analysis to determine the how well the
benefits associated with the therapy balance the costs. They
compare the cost-effectiveness of eplerenone therapy with many
other commonly used interventions in cardiology. See p
1106.
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PLAQUE INSTABILITY FREQUENTLY OCCURS DAYS OR WEEKS BEFORE OCCLUSIVE CORONARY THROMBOSIS: A PATHOLOGICAL THROMBECTOMY STUDY IN PRIMARY PERCUTANEOUS CORONARY INTERVENTION, by Rittersma et al.
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Unstable coronary syndromes are caused primarily by plaque disruption
leading to platelet activation, stimulation of coagulation,
and occlusion of the vessel. When patients have a myocardial
infarction, however, the amount of time between initiation of
this process and clinical presentation is unknown. In this issue
of
Circulation, Rittersma and colleagues examine this question
by studying aspirated material from intracoronary thrombectomy
samples obtained during angioplasty. They found that at least
half of the patients had coronary thrombi that were days to
weeks old. The observation that patients presenting with acute
myocardial infarction have a high likelihood of having established
clot could have therapeutic implications and might explain the
lack of efficacy of antithrombotics in certain patients. See
p
1160.
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Visit www.circ.ahajournals.org:
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Images in Cardiovascular Medicine
Unexpected Profound Transient Anterior ST Elevation After Occlusion
of the Conus Branch of the Right Coronary Artery During Angioplasty.
See p
e113.
Visualization of Endomyocardial Fibrosis by Delayed-Enhancement Magnetic Resonance Imaging. See p e115.
Correspondence
Letter Regarding Article by Martinelli et al, "Risk Factors and Recurrence Rate of Primary Deep Vein Thrombosis of the Upper Extremities. " See p e118.
Letter Regarding Article by Korshunov and Berk, "Strain-Dependent Vascular Remodeling: The ‘Glagov Phenomenon’ Is Genetically Determined. " See p e119.
Related Articles:
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Plaque Instability Frequently Occurs Days or Weeks Before Occlusive Coronary Thrombosis: A Pathological Thrombectomy Study in Primary Percutaneous Coronary Intervention
- Saskia Z.H. Rittersma, Allard C. van der Wal, Karel T. Koch, Jan J. Piek, José P.S. Henriques, Karla J. Mulder, Johanna P.H.M. Ploegmakers, Martin Meesterman, and Robbert J. de Winter
Circulation 2005 111: 1160-1165.
[Abstract]
[Full Text]
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Cost-Effectiveness of Eplerenone Compared With Placebo in Patients With Myocardial Infarction Complicated by Left Ventricular Dysfunction and Heart Failure
- William S. Weintraub, Zefeng Zhang, Elizabeth M. Mahoney, Paul Kolm, John A. Spertus, Jaime Caro, Jack Ishak, Robert Goldberg, Joseph Tooley, Richard Willke, and Bertram Pitt
Circulation 2005 111: 1106-1113.
[Abstract]
[Full Text]
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Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation
- Riccardo Cappato, Hugh Calkins, Shih-Ann Chen, Wyn Davies, Yoshito Iesaka, Jonathan Kalman, You-Ho Kim, George Klein, Douglas Packer, and Allan Skanes
Circulation 2005 111: 1100-1105.
[Abstract]
[Full Text]
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Unexpected Profound Transient Anterior ST Elevation After Occlusion of the Conus Branch of the Right Coronary Artery During Angioplasty
- J. Eichhöfer and N. Curzen
Circulation 2005 111: e113-e114.
[Extract]
[Full Text]
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Visualization of Endomyocardial Fibrosis by Delayed-Enhancement Magnetic Resonance Imaging
- Ricardo C. Cury, Suhny Abbara, Larry J-Diaz Sandoval, Stuart Houser, Thomas J. Brady, and Igor F. Palacios
Circulation 2005 111: e115-e117.
[Extract]
[Full Text]
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Letter Regarding Article by Martinelli et al, "Risk Factors and Recurrence Rate of Primary Deep Vein Thrombosis of the Upper Extremities" • Response
- J. Ernesto Molina, Ida Martinelli, Tullia Battaglioli, Paolo Bucciarelli, Serena Maria Passamonti, and Pier Mannuccio Mannucci
Circulation 2005 111: e118.
[Extract]
[Full Text]
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Letter Regarding Article by Korshunov and Berk, "Strain-Dependent Vascular Remodeling: The ‘Glagov Phenomenon’ Is Genetically Determined" • Response
- Jolanda J. Wentzel, Rob Krams, Cornelis J. Slager, Vyacheslav A. Korshunov, and Bradford C. Berk
Circulation 2005 111: e119.
[Extract]
[Full Text]
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