Circulation. 2007;116:2235
doi: 10.1161/CIRCULATIONAHA.107.187244
(Circulation. 2007;116:2235.)
© 2007 American Heart Association, Inc.
Issue Highlights
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CATHETER ABLATION OF VENTRICULAR TACHYCARDIA AFTER REPAIR OF CONGENITAL HEART DISEASE: ELECTROANATOMIC IDENTIFICATION OF THE CRITICAL RIGHT VENTRICULAR ISTHMUS, by Zeppenfeld et al.
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Ventricular tachycardia (VT) is an important source of morbidity
and mortality after repair of congenital heart disease, particularly
tetralogy of Fallot. VT is often inducible and attributed to
reentry. Zeppenfeld and coworkers characterized VT during catheter
ablation procedures in 11 patients and related the findings
to detailed anatomic study of autopsy specimens. Surgical incisions
and scars created isthmuses for conduction that defined portions
of reentry circuits that are consistent with anatomic studies.
Isthmuses can be identified during catheter mapping and can
be transected with ablation. In this selected series, ablation
through 1 of these isthmuses was frequently effective in controlling
VT. The findings provide guidance for catheter ablation in this
patient population and suggest surgical procedures that might
reduce the risk of late VT. See p 2241. (editorial p
2236).
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ACUTE MYOCARDIAL INFARCTION AND CONGESTIVE HEART FAILURE OUTCOMES AT SPECIALTY CARDIAC HOSPITALS, by Nallamothu et al.
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Specialty cardiac hospitals have arisen over the past few years
purportedly to homogenize processes of care and improve outcomes
by focusing on specific disease states and procedures. Controversy
has followed, as accusations have been leveled that these hospitals
focus on lower-risk patients and profitable procedures, as well
as that they shift the burden of sicker, higher-risk patients
to more general hospitals. The controversy resulted in a 2003
moratorium on federal payments to new specialty facilities while
these issues were assessed. To date, studies of outcomes in
specialty versus general hospitals have focused only on procedural
outcomes. In this issue of
Circulation, Nallamothu and colleagues
advance the debate substantially by assessing disease-based
outcomes for acute myocardial infarction and heart failure at
specialty cardiac versus general hospitals. They find that the
risk profile of patients with these conditions seen at the specialty
hospitals is lower, and that even after adjustment for these
differences, outcomes at the specialty hospitals were slightly
more favorable. An important finding was the wide variability
of outcomes at both specialty and general hospitals. In an accompanying
editorial, Brindis and Spertus call for specialty hospitals
to participate in national outcomes registries, so that substantial
data can be accrued to truly understand the issues at hand.
See p 2280 (editorial p
2238).
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METABOLIC PROFILING OF ARGININE AND NITRIC OXIDE PATHWAYS PREDICTS HEMODYNAMIC ABNORMALITIES AND MORTALITY IN PATIENTS WITH CARDIOGENIC SHOCK AFTER ACUTE MYOCARDIAL INFARCTION, by Nicholls et al.
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Acute myocardial infarction complicated by cardiogenic shock
is associated with an extremely poor prognosis even when an
early reperfusion strategy is adopted. Early studies have suggested
that excess nitric oxide production contributes to the pathogenesis
of cardiogenic shock. Increased systemic concentrations of nitric
oxide may facilitate the hypotension and decreased cardiac output
seen in cardiogenic shock by depressing myocardial contractility,
increasing vasodilation, and limiting responsiveness to endogenous
catecholamines. Despite these observations, it remains unknown
whether abnormalities in arginine, a substrate for the synthesis
of nitric oxide, and nitric oxide metabolism are related to
the hemodynamic instability in patients with cardiogenic shock.
In this issue of
Circulation, Nicholls et al present data obtained
using mass spectrometry to analyze these plasma metabolites
in patients who presented with acute myocardial infarction and
cardiogenic shock and identify new targets for therapeutic intervention.
See p
2315.
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Images in Cardiovascular Medicine
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Magnetic Resonance Imaging Characteristics in Carvajal Syndrome
(Variant of Naxos Disease). See p
e524.
Numerous Small Vegetations Revealing Libman-Sacks Endocarditis in Catastrophic Antiphospholipid Syndrome. See p e531.
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Correspondence
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See p
e536.
Related Articles:
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Substrate Mapping and Catheter Ablation of Ventricular Tachycardia after Right Ventriculotomy
- George F. Van Hare
Circulation 2007 116: 2236-2237.
[Extract]
[Full Text]
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Specialty Cardiac Hospitals: How Special Are They?
- Ralph G. Brindis and John A. Spertus
Circulation 2007 116: 2238-2240.
[Extract]
[Full Text]
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Magnetic Resonance Imaging Characteristics in Carvajal Syndrome (Variant of Naxos Disease)
- Maria Prompona, Rainer Kozlik-Feldmann, Josef Mueller-Hoecker, Maximilian Reiser, and Armin Huber
Circulation 2007 116: e524-e530.
[Extract]
[Full Text]
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Numerous Small Vegetations Revealing Libman-Sacks Endocarditis in Catastrophic Antiphospholipid Syndrome
- Hideo Yamamoto, Tamaki Iwade, Ryuji Nakano, Masahiro Mohri, Yoshifumi Amari, and Mitsuru Noma
Circulation 2007 116: e531-e535.
[Extract]
[Full Text]
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Letter Regarding Article by Schmidt et al, "Infarct Tissue Heterogeneity by Magnetic Resonance Imaging Identifies Enhanced Cardiac Arrhythmia Susceptibility in Patients With Left Ventricular Dysfunction"
- Jeffrey J. Goldberger
Circulation 2007 116: e536.
[Extract]
[Full Text]
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Metabolic Profiling of Arginine and Nitric Oxide Pathways Predicts Hemodynamic Abnormalities and Mortality in Patients With Cardiogenic Shock After Acute Myocardial Infarction
- Stephen J. Nicholls, Zeneng Wang, Robert Koeth, Bruce Levison, Brian DelFraino, Vladimir Dzavik, Owen W. Griffith, David Hathaway, Julio A. Panza, Steven E. Nissen, Judith S. Hochman, and Stanley L. Hazen
Circulation 2007 116: 2315-2324.
[Abstract]
[Full Text]
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CATHETER ABLATION OF VENTRICULAR...
ACUTE MYOCARDIAL INFARCTION AND...