Circulation. 2006;113:1817
(Circulation. 2006;113:1817.)
© 2006 American Heart Association, Inc.
Issue Highlights
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A TAILORED APPROACH TO CATHETER ABLATION OF PAROXYSMAL ATRIAL FIBRILLATION, by Oral et al.
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Paroxysmal atrial fibrillation is a complex arrhythmia initiated
by rapid "triggering" foci and likely perpetuated by the triggers
and abnormal conduction in regions outside the triggering sites.
Although the location of this arrhythmogenic substrate varies
among patients, a simple anatomic ablation approach encircling
the pulmonary venous regions is often effective, but not always
easy to achieve. Oral and colleagues evaluated a tailored approach
to ablation, sequentially targeting areas identified as potentially
arrhythmogenic on the basis of rapid electrical activity, seeking
to achieve an electrophysiological end point of noninducibility
of atrial fibrillation. The results are comparable to those
of some studies utilizing purely anatomic approaches and show
that a tailored approach can achieve efficacy without extensive
anatomic ablation. Such an approach can avoid ablation in the
high-risk area adjacent to the esophagus. The study illustrates
the heterogeneity of this arrhythmia and supports continued
evaluation of ablation strategies. See p
1824.
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ß2-ADRENERGIC RECEPTOR GENETIC VARIANTS AND RISK OF SUDDEN CARDIAC DEATH, by Sotoodehnia et al.
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Sudden cardiac death is a major cause of death in developed
countries and results in almost one half million deaths per
year in the United States. Both experimental and clinical observations
suggest that ß2 adrenergic receptors partially mediate
sympathetic activation. Hence the ß2 adrenergic receptor
gene (B2AR) represents an attractive candidate gene for susceptibility
to sudden cardiac death. Sotoodehnia and colleagues examined
the association of two polymorphisms in the B2AR gene (Gly16Arg
and Gln27Glu) with sudden cardiac death in the community-based
Cardiovascular Health Study. They report that Gln27 homozygotes
had a 58% increased risk of sudden cardiac death (nominal
P=0.002).
They tested both polymorphisms in a second small case-control
study, the Cardiac Arrest Blood Study, and replicated the association
of Gln27 for sudden cardiac death. Further testing in other
samples is required to verify the findings and test for potential
modification by sex, ethnicity, medications, risk factors, and
preexisting cardiovascular disease. However, this study suggests
that genetic polymorphisms may eventually provide information
to identify individuals at increased risk of sudden cardiac
death. See p
1842.
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RETROSPECTIVE DETERMINATION OF THE AREA AT RISK FOR REPERFUSED ACUTE MYOCARDIAL INFARCTION WITH T2-WEIGHTED CARDIAC MAGNETIC RESONANCE IMAGING: HISTOPATHOLOGICAL AND DISPLACEMENT ENCODING WITH STIMULATED ECHOES (DENSE) FUNCTIONAL VALIDATIONS, by Aletras et al.
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In trials of reperfusion strategies for acute myocardial infarction,
noninvasive assessment of the area-at-risk and final infarct
size (and the difference between them—salvage) has been
accomplished by the use of serial single-photon emission computed
tomography (SPECT) perfusion imaging studies. Incorporating
the initial SPECT area-at-risk study is challenging, as isotope
must be given prior to intervention, with imaging performed
within several hours after acute intervention. Thus, many trials
have evolved to using only final infarct size as the surrogate
end point, although an index of salvage would be more desirable.
In this issue of
Circulation, Aletras and colleagues use cardiac
magnetic resonance imaging in an animal model of reperfused
myocardial infarction to demonstrate that 2 days after the infarct,
T2-weighted cardiac magnetic resonance imaging can provide a
retrospective "snapshot" of the area at risk from the acute
occlusion, followed by late-enhancement gadolinium imaging to
assess final infarct size. Thus, one imaging modality, temporally
remote from the acute infarct, can potentially provide information
on area at risk, final infarct size, and thus salvage from an
intervention. Should this result be confirmed in human studies,
it would greatly facilitate the study of therapeutic reperfusion
strategies, as discussed by Pennell in an accompanying editorial.
See p
1865.
Visit http://circ.ahajournals.org
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Clinician Update
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Anticoagulants and Transaminase Elevation. See p
e698.
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Images in Cardiovascular Medicine
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Unclassified Type of Aortopulmonary Window. See p
e703.
Dynamic Myocardial Ischemia Caused by Circumflex Artery Stenosis Detected by a New Implantable Left Atrial Pressure Monitoring Device. See p e705.
From Bad to Worse: Complete Heart Block Leading to Ventricular Fibrillation. See p e707.
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Correspondence
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See p
e709.
Related Articles:
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ß2-Adrenergic Receptor Genetic Variants and Risk of Sudden Cardiac Death
- Nona Sotoodehnia, David S. Siscovick, Matteo Vatta, Bruce M. Psaty, Russell P. Tracy, Jeffrey A. Towbin, Rozenn N. Lemaitre, Thomas D. Rea, J. Peter Durda, Joel M. Chang, Thomas S. Lumley, Lewis H. Kuller, Gregory L. Burke, and Susan R. Heckbert
Circulation 2006 113: 1842-1848.
[Abstract]
[Full Text]
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Anticoagulants and Transaminase Elevation
- Nipun Arora and Samuel Z. Goldhaber
Circulation 2006 113: e698-e702.
[Full Text]
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Unclassified Type of Aortopulmonary Window
- Ming-Ren Chen and Shyr-Jao Wu
Circulation 2006 113: e703-e704.
[Full Text]
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Dynamic Myocardial Ischemia Caused by Circumflex Artery Stenosis Detected by a New Implantable Left Atrial Pressure Monitoring Device
- Jay L.T. Ritzema-Carter, David Smyth, Richard W. Troughton, Ian G. Crozier, Iain C. Melton, A. Mark Richards, Neal Eigler, James Whiting, Saibal Kar, Henry Krum, and William T. Abraham
Circulation 2006 113: e705-e706.
[Full Text]
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From Bad to Worse: Complete Heart Block Leading to Ventricular Fibrillation
- Wendel Moreira, David Perez, Carl Timmermans, and Luz-Maria Rodriguez
Circulation 2006 113: e707-e708.
[Full Text]
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Letter Regarding Article by Burke et al, "Role of SCN5A Y1102 Polymorphism in Sudden Cardiac Death in Blacks"
- Dörte Etzrodt, Eric Schulze-Bahr, Allen Burke, Wendy Creighton, Erik Mont, Ling Li, Susan Hogan, Robert Kutys, David Fowler, and Renu Virmani
Circulation 2006 113: e709.
[Full Text]
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Retrospective Determination of the Area at Risk for Reperfused Acute Myocardial Infarction With T2-Weighted Cardiac Magnetic Resonance Imaging: Histopathological and Displacement Encoding With Stimulated Echoes (DENSE) Functional Validations
- Anthony H. Aletras, Gauri S. Tilak, Alex Natanzon, Li-Yueh Hsu, Felix M. Gonzalez, Robert F. Hoyt, Jr, and Andrew E. Arai
Circulation 2006 113: 1865-1870.
[Abstract]
[Full Text]
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A Tailored Approach to Catheter Ablation of Paroxysmal Atrial Fibrillation
- Hakan Oral, Aman Chugh, Eric Good, Sundar Sankaran, Stephen S. Reich, Petar Igic, Darryl Elmouchi, David Tschopp, Thomas Crawford, Sujoya Dey, Alan Wimmer, Kristina Lemola, Krit Jongnarangsin, Frank Bogun, Frank Pelosi, Jr, and Fred Morady
Circulation 2006 113: 1824-1831.
[Abstract]
[Full Text]
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