Circulation. 2005;112:1375
(Circulation. 2005;112:1375.)
© 2005 American Heart Association, Inc.
Issue Highlights
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ANATOMIC RELATIONS BETWEEN THE ESOPHAGUS AND LEFT ATRIUM AND RELEVANCE FOR ABLATION OF ATRIAL FIBRILLATION, by Sánchez-Quintana et al.
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Development of a fistula between the left atrium and esophagus
is a feared and usually fatal complication of left atrial catheter
or surgical ablation for atrial fibrillation that does not typically
emerge until days after the procedure. Although it is rare,
an increasing number of ablation procedures that put patients
at risk are being performed. Better understanding the anatomic
features that may put patients at risk is important. In detailed
studies of cadavers, Sánchez-Quintana and coworkers show
that the esophagus frequently courses within 5 mm of the atrial
endocardium at some point in its path. The variable amount of
fibrofatty tissue interposed between the atrium and esophagus
can contain vagal nerves and esophageal arteries exposing these
structures to potential injury from ablation. These anatomic
findings suggest explanations for the infrequent occurrence
of atrio-esophageal fistula and its delayed presentation, and
they suggest that injury to the vagal nerves may also occur.
See p
1400.
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PROGNOSTIC VALUE OF DOBUTAMINE STRESS MYOCARDIAL CONTRAST PERFUSION ECHOCARDIOGRAPHY, by Tsutsui et al.
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The prognostic value of stress echocardiography has been demonstrated
in several studies. Negative exercise and dobutamine stress
echocardiography is associated with a good prognosis. The addition
of intravenous ultrasound contrast to stress echocardiography
improves the sensitivity for detecting coronary artery disease,
but the prognostic value of the additional perfusion information
has not been demonstrated. As reported in this issue of
Circulation,
Tsutsui et al studied 788 patients with dobutamine echocardiography
and demonstrated that myocardial perfusion with real-time contrast
echocardiography is a predictor of outcome and appears to provide
incremental prognostic information over wall-motion abnormalities.
The 3-year event-free survival rate decreases progressively
from 95% in patients with normal wall motion and normal perfusion,
to 82% for those with normal wall motion and abnormal perfusion,
and finally to 68% in those with abnormal wall motion and abnormal
myocardial perfusion. See p
1444.
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RANDOMIZED EVALUATION OF THE EFFECTS OF FILTER-BASED DISTAL PROTECTION ON MYOCARDIAL PERFUSION AND INFARCT SIZE AFTER PRIMARY PERCUTANEOUS CATHETER INTERVENTION IN MYOCARDIAL INFARCTION WITH AND WITHOUT ST-SEGMENT ELEVATION, by Gick et al.
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In patients with non-ST-segment- or ST-segment-elevation myocardial
infarction, unstable coronary artery atherosclerotic plaques
may be friable and overlaid with thrombus. Percutaneous coronary
interventional procedures may unintentionally dislodge components
of these lesions, resulting in downstream embolization of plaque
material and occlusion of the microvasculature. Angiographically,
this is recognized as the no-reflow phenomenon and is often
associated with symptomatic chest pain and increased indices
of myocardial necrosis. Owing to the success of distal protection
devices in preventing no-reflow during percutaneous interventional
treatment of diseased saphenous vein grafts, investigators have
attempted to apply this strategy to the treatment of native
coronary arteries. In this issue of
Circulation, Gick et al
report the results of a randomized trial of 200 patients using
distal protection with a filter wire and evaluate the effects
of this strategy on coronary flow in the recanalized infarct
artery and infarct size. See p
1462.
Visit http://www.circ.ahajournals.org:
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Clinician Update
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Diuretics for Hypertension. See p
e127.
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Images in Cardiovascular Medicine
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Left Atrial Thrombus on Atrial Septal Defect Closure Device
as a Source of Cerebral Emboli 3 Years After Implantation. See
p
e130.
Diaphragmatic Motion During Cheyne-Stokes Respiration by Navigator Magnetic Resonance Imaging. See p e132.
A Case of Effusive Constrictive Pericarditis. See p e133.
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Correspondence
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See p
e135.
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Diuretics for Hypertension
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Circulation 2005 112: e127-e129.
[Full Text]
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Left Atrial Thrombus on Atrial Septal Defect Closure Device as a Source of Cerebral Emboli 3 Years After Implantation
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Circulation 2005 112: e130-e131.
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Diaphragmatic Motion During Cheyne-Stokes Respiration by Navigator Magnetic Resonance Imaging
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Circulation 2005 112: e132.
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A Case of Effusive Constrictive Pericarditis
- Jeffrey S. Kunz, James King, and Joseph Miller
Circulation 2005 112: e133-e134.
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Letter Regarding Article by Lyseggen et al, "Myocardial Acceleration During Isovolumic Contraction: Relationship to Contractility" • Response
- Michael M.H. Cheung, Andrew N. Redington, Michael R. Schmidt, Keld E. Sorensen, Michael Vogel, Erik Lyseggen, Stein Inge Rabben, Helge Skulstad, Stig Urheim, Cecilie Risøe, and Otto A. Smiseth
Circulation 2005 112: e135-e136.
[Full Text]
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Prognostic Value of Dobutamine Stress Myocardial Contrast Perfusion Echocardiography
- Jeane M. Tsutsui, Abdou Elhendy, James R. Anderson, Feng Xie, Anna C. McGrain, and Thomas R. Porter
Circulation 2005 112: 1444-1450.
[Abstract]
[Full Text]
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Randomized Evaluation of the Effects of Filter-Based Distal Protection on Myocardial Perfusion and Infarct Size After Primary Percutaneous Catheter Intervention in Myocardial Infarction With and Without ST-Segment Elevation
- Michael Gick, Nikolaus Jander, Hans-Peter Bestehorn, Rolf-Peter Kienzle, Miroslaw Ferenc, Klaus Werner, Thomas Comberg, Kristhild Peitz, Dietlind Zohlnhöfer, Valerio Bassignana, Heinz Joachim Buettner, and Franz-Josef Neumann
Circulation 2005 112: 1462-1469.
[Abstract]
[Full Text]
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Anatomic Relations Between the Esophagus and Left Atrium and Relevance for Ablation of Atrial Fibrillation
- Damian Sánchez-Quintana, José Angel Cabrera, Vicente Climent, Jerónimo Farré, Maria Cristina de Mendonça, and Siew Yen Ho
Circulation 2005 112: 1400-1405.
[Abstract]
[Full Text]
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