Circulation. 2006;113:2373
(Circulation. 2006;113:2373.)
© 2006 American Heart Association, Inc.
Issue Highlights
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FOCAL PHARMACOLOGICAL MODULATION OF ATRIOVENTRICULAR NODAL CONDUCTION VIA IMPLANTABLE CATHETER: A NOVEL THERAPY FOR ATRIAL FIBRILLATION? by Sigg et al.
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Medical treatment of atrial fibrillation using antiarrhythmic
agents or ventricular rate control is challenging because of
variable success and systemic side effects. In this issue of
Circulation, Sigg and colleagues describe a local catheter-based
delivery system for administration of drugs to alter atrioventricular
nodal conduction. They implanted a catheter at the atrioventricular
nodal region for local infusion of acetylcholine and demonstrated
proof-of-principle in an acute canine model. Regulation of atrioventricular
nodal refractoriness and conduction properties was achieved
using low-dose local drug delivery without systemic actions.
It is conceivable that focal drug therapy may eventually be
combined with an implantable pacemaker-type device using a closed-loop
feedback system to chronically modulate ventricular rate control
during atrial arrhythmias. See p
2383.
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IMPLEMENTATION OF GUIDELINES IMPROVES STANDARD OF CARE: THE VIENNESE REGISTRY ON REPERFUSION STRATEGIES IN ST-ELEVATION MYOCARDIAL INFARCTION (VIENNA STEMI REGISTRY), by Kalla et al.
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For the past 25 years, various guidelines for the treatment
of acute ST-segment–elevation myocardial infarction (STEMI)
have consistently emphasized the importance of time to reperfusion
over the importance of the reperfusion method itself. Once emergency
departments had successfully optimized speed to diagnosis and
reperfusion, ie achieving a door-to-needle or door-to-balloon
time of cutaneous coronary intervention (PPCI) became the preferred
therapy over intravenous thrombolysis because of its lower stroke
rate, value of coronary anatomy definition, and more definitive
treatment of the culprit lesion. However, application of a PPCI
solution for STEMI in most communities is strategically difficult,
and the prioritization of a PPCI strategy over a time-to-reperfusion
strategy has resulted in substantial delays with important clinical
consequences. Kalla and colleagues describe the implementation
of an ambulance triage system that coordinated the management
of STEMI at 5 hospital emergency systems servicing Vienna, Austria.
An algorithm was deployed that utilized changing diurnal and
geographic PPCI resources to achieve AHA/ACC guideline reperfusion
goals within 2 hours as the first priority and PPCI, whenever
possible, as the second priority. Other subalgorithms were also
employed. The study describes the execution of the algorithms
for the study cohort and the breakdown of results by timing,
reperfusion therapy, patient characteristics, and mortality
outcomes. The study’s main value is the health service
perspective of this city’s imaginative implementation
of society guideline goals in a realistic environment in which
limited resources exist. Although there is an uncontrolled comparison
of results after policy implementation, with earlier benchmarks
suggesting lower mortality and higher rates of reperfusion therapy,
the citizens of Vienna are clearly the beneficiaries of this
program, which aims for guideline-driven quality improvement.
See p
2398.
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SUPPRESSION OF ATHEROSCLEROTIC PLAQUE PROGRESSION AND INSTABILITY BY TISSUE INHIBITOR OF METALLOPROTEINASE-2: INVOLVEMENT OF MACROPHAGE MIGRATION AND APOPTOSIS, by Johnson et al.
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Although extracellular matrix degradation by vascular cell proteases
has been hypothesized as a mechanism of atherosclerotic plaque
progression and rupture, direct experimental evidence is scant.
In this issue of
Circulation, Johnson et al investigate whether
adenoviral overexpression of tissue inhibitors of metalloproteinase
(TIMP)-1 and TIMP-2 would attenuate plaque growth and instability
in brachiocephalic artery plaques of apolipoprotein E–deficient
mice. Over-expression of TIMP-2, but not of TIMP-1, inhibited
plaque development and destabilization. Modification of adenoviral
vectors was required to maintain these favorable effects longer
term. This study provides a proof-of-principle approach to modulate
features of plaque stability. See p
2435.
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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A Swelling of the Right Neck and Sudden Death. See p
e768.
Methemoglobinemia as a Rare Complication During a Transesophageal Echocardiogram. See p e770.
Multimodality Imaging of Cardiac Sarcoidosis Before and After Steroid Therapy. See p e771.
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Book Review
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Cardiac Remodeling: Mechanism and Treatment. See p
e774.
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Correspondence
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See p
e775.
Related Articles:
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A Swelling of the Right Neck and Sudden Death
- Thomas Neumann, Anja Bornkessel, Stefan O.R. Pfleiderer, Gert Hein, Stefan Isenmann, Gunter Wolf, and Christoph Terborg
Circulation 2006 113: e768-e769.
[Extract]
[Full Text]
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Methemoglobinemia as a Rare Complication During a Transesophageal Echocardiogram
- Rami N. Khouzam
Circulation 2006 113: e770.
[Extract]
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Multimodality Imaging of Cardiac Sarcoidosis Before and After Steroid Therapy
- Eiji Tadamura, Masaki Yamamuro, Shigeto Kubo, Shotaro Kanao, Ryohei Hosokawa, Takeshi Kimura, Toru Kita, and Kaori Togashi
Circulation 2006 113: e771-e773.
[Extract]
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Cardiac Remodeling: Mechanism and Treatment
- Sidney Goldstein
Circulation 2006 113: e774.
[Extract]
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Letter Regarding Article by Khan et al, "Prognostic Value of Troponin T and I Among Asymptomatic Patients With End-Stage Renal Disease: A Meta-Analysis"
- Fred S. Apple, Allan S. Jaffe, and Charles A. Herzog
Circulation 2006 113: e775.
[Extract]
[Full Text]
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Implementation of Guidelines Improves the Standard of Care: The Viennese Registry on Reperfusion Strategies in ST-Elevation Myocardial Infarction (Vienna STEMI Registry)
- Karim Kalla, Günter Christ, Ronald Karnik, Reinhard Malzer, Georg Norman, Herbert Prachar, Wolfgang Schreiber, Gerhard Unger, Helmut D. Glogar, Alfred Kaff, Anton N. Laggner, Gerald Maurer, Johannes Mlczoch, Joerg Slany, Heinrich S. Weber, Kurt Huber for the Vienna STEMI Registry Group
Circulation 2006 113: 2398-2405.
[Abstract]
[Full Text]
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Focal Pharmacological Modulation of Atrioventricular Nodal Conduction via Implantable Catheter: A Novel Therapy for Atrial Fibrillation?
- Daniel C. Sigg, Prasanga Hiniduma-Lokuge, James A. Coles, Jr, Phillip Falkner, Rebecca Rose, Jon F. Urban, and Michael R. Ujhelyi
Circulation 2006 113: 2383-2390.
[Abstract]
[Full Text]
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Suppression of Atherosclerotic Plaque Progression and Instability by Tissue Inhibitor of Metalloproteinase-2: Involvement of Macrophage Migration and Apoptosis
- Jason L. Johnson, Andrew H. Baker, Kazuhiro Oka, Lawrence Chan, Andrew C. Newby, Christopher L. Jackson, and Sarah J. George
Circulation 2006 113: 2435-2444.
[Abstract]
[Full Text]
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