Circulation. 2006;114:869
(Circulation. 2006;114:869.)
© 2006 American Heart Association, Inc.
Issue Highlights
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SELECTIVE ATRIAL VAGAL DENERVATION GUIDED BY EVOKED VAGAL REFLEX TO TREAT PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION, by Scanavacca et al.
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Atrial fibrillation is a complex, multifaceted arrhythmia. Autonomic
factors are involved in the initiation of some paroxysmal atrial
fibrillation. Cardiac ganglionated plexuses containing sympathetic
and parasympathetic nerves are clustered in epicardial fat pads
where their injury has been suggested to contribute to the success
of wide-area encircling pulmonary vein ablation. Using electrical
stimulation during endocardial and percutaneous epicardial catheter
mapping, Scanavacca and colleagues selectively targeted ganglionated
plexuses for ablation in 10 selected patients who had clinical
features of "vagally-mediated" atrial fibrillation. This approach
was effective in 2 patients. The present study shows that ablation
targeted to achieve autonomic modulation is feasible, and it
provides perspective on the challenges involved. Further investigation
and technological improvements will determine whether ablation
will become an option for some types of atrial fibrillation.
See p
876.
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THE ECONOMIC BURDEN OF ANGINA IN WOMEN WITH SUSPECTED ISCHEMIC HEART DISEASE: RESULTS FROM THE NATIONAL INSTITUTES OF HEALTH–NATIONAL HEART, LUNG, AND BLOOD INSTITUTE–SPONSORED WOMEN’S ISCHEMIA SYNDROME EVALUATION, by Shaw et al.
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With spiraling health care costs, there is increasing interest
in characterizing resource consumption of various groups as
a means of directing policy-based interventions to improve care.
Until recently, women with heart disease were a generally overlooked
group, and recent studies are indicating that women with coronary
artery disease frequently require repetitive care and have a
substantial risk of adverse outcomes. To provide perspective
on the resource consumption of this group, investigators from
the National Institutes of Health–National Heart, Lung,
and Blood Institute–sponsored Women’s Ischemia Syndrome
Evaluation (WISE) study estimated the societal economic burden
for coronary artery disease care for women enrolled in their
study. They also examined the importance of the absence of obstructive
coronary disease in predicting future healthcare costs. Their
findings have importance for healthcare planning and reveal
that a group that was previously thought to be at low risk of
major events may impose major costs on the health care system.
See p
894.
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PRIMARY STENTING OF TOTALLY OCCLUDED NATIVE CORONARY ARTERIES II (PRISON II): A RANDOMIZED COMPARISON OF BARE METAL STENT IMPLANTATION WITH SIROLIMUS-ELUTING STENT IMPLANTATION FOR THE TREATMENT OF TOTAL CORONARY OCCLUSIONS, by Suttorp et al.
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Drug-eluting stents have been shown in randomized trials to
reduce restenosis in selected groups of patients. However, efficacy
in patients with totally occluded coronary arteries is lacking.
In this issue of
Circulation, Suttorp and colleagues report
the results of a prospective, single blind, 2-center trial in
which 200 patients with total occlusions were randomized to
a bare metal stent or a sirolimus-eluting Cypher stent (SES).
The primary endpoint was in-segment restenosis at 6 months,
with major adverse cardiac events, target vessel failure and
other angiographic parameters as secondary events. The authors
found significantly lower in-segment binary restenosis in those
receiving the SES stent as compared with those receiving a bare
metal stent (11% versus 41%). The other end points were, likewise,
significantly lower in the SES group. These findings confirm
the benefit of SES in another subgroup of patents that are at
higher risk of restenosis and support the use of SES as the
first choice for patients with chronic total occlusions. See
p
921.
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Images in Cardiovascular Medicine
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Demonstration of Multislice Computed Tomography of Graft Destruction
and Rupture to the Pericardium After Replacement of Ascending
Aorta for Stanford Type-A Dissection. See p
e366.
Rapid Progression of Left Ventricular Hypertrophy. See p e368.
Neurogenic T Waves Preceding Acute Ischemic Stroke. See p e369.
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Correspondence
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See p
e371.
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