Circulation. 2005;112:619
(Circulation. 2005;112:619.)
© 2005 American Heart Association, Inc.
Issue Highlights
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RESPONSE OF ATRIAL FIBRILLATION TO PULMONARY VEIN ANTRUM ISOLATION IS DIRECTLY RELATED TO RESUMPTION AND DELAY OF PULMONARY VEIN CONDUCTION, by Verma et al.
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The atrial myocardium in and around the pulmonary veins often
supports atrial fibrillation, but whether complete electrical
isolation is required for successful ablation of atrial fibrillation
is debated. After ablation targeting complete isolation, repeat
electrophysiological evaluation was performed in a cohort of
patients with recurrent atrial arrhythmias and also in a cohort
without recurrent arrhythmia. Recurrent arrhythmias were associated
with reconnection of one or more venous regions. When the arrhythmia
was controlled despite recovery of conduction into the pulmonary
veins, conduction was often slowed and incapable of supporting
high rates. These findings further support the importance of
the pulmonary vein regions in the genesis of atrial fibrillation.
Recovery from acute conduction block is not uncommon but does
not preclude success if conduction remains impaired. See p
643.
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PLASMA OXIDIZED LOW-DENSITY LIPOPROTEIN, A STRONG PREDICTOR FOR ACUTE CORONARY HEART DISEASE EVENTS IN APPARENTLY HEALTHY, MIDDLE-AGED MEN FROM THE GENERAL POPULATION, by Meisinger et al.
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It is increasingly appreciated that atherosclerosis is a chronic
inflammatory process and that local oxidative mechanisms contribute
to the development and progression of atherosclerosis. In experimental
and clinical studies, investigators have demonstrated that oxidized
LDL (oxLDL) may contribute to the initiation and progression
of atherosclerotic lesions. However, there have been few prospective
studies examining the relation of circulating oxLDL to outcome.
Meisinger and colleagues examined the relation of oxLDL to future
coronary heart disease events in a nested case-control study
of middle-aged men from the MONICA/KORA Augsburg surveys. They
report that adjusting for cardiovascular risk factors including
total/HDL cholesterol and C-reactive protein, the highest tertile
(compared with the lowest) was associated with an almost tripling
in the risk of coronary heart disease in follow-up. The authors
acknowledge that the use of oxLDL as a screening test awaits
the development of more standardized assays and additional investigation
into the findings’ generalizability and the tests’
cost-effectiveness. The study does emphasize that the complex
interrelations between lipids, oxidation, and inflammation in
the development of cardiovascular disease merit further research.
See p
651.
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PILOT STUDY OF RAPID INFUSION OF 2 L OF 4°C NORMAL SALINE FOR INDUCTION OF MILD HYPOTHERMIA IN HOSPITALIZED, COMATOSE SURVIVORS OF OUT-OF-HOSPITAL CARDIAC ARREST, by Kim et al.
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The American Heart Association, as part of the International
Liaison Committee on Resuscitation (ILCOR), recommends that
unconscious adult patients with spontaneous circulation after
out-of-hospital cardiac arrest be cooled to 32°C to 34°C
for 12 to 24 hours when the initial rhythm was ventricular fibrillation.
There are currently several methods for inducing hypothermia;
however, most are logistically cumbersome and are slow to attain
the targeted amount of temperature reduction. In this issue
of
Circulation, Kim et al present pilot results with regard
to the effects of a rapid infusion of 2 L of 4°C normal
saline over 20 to 30 minutes using a peripheral intravenous
line attached to a high-pressure bag to 17 survivors of out-of-hospital
cardiac arrest. The authors evaluated time to cooling, metabolic
effects, left ventricular systolic function, and intracardiac
filling pressures. Although further clinical outcome studies
are needed, these preliminary results offer great promise in
delivering this potentially life-saving treatment in the field.
See p
715.
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Images in Cardiovascular Medicine
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Dense Right-Sided Hemiparesis in a 36-Year-Old Woman. See p
e67.
Magnetocardiography in a Fetus With Long-QT Syndrome. See p e68.
Polytetrafluoroethylene Stent Deployment for a Left Anterior Descending Coronary Aneurysm Complicated by Late Acute Anterior Myocardial Infarction. See p e70.
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Correspondence
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See p
e72.
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PLASMA OXIDIZED LOW-DENSITY...