Circulation. 2007;115:1177
(Circulation. 2007;115:1177.)
© 2007 American Heart Association, Inc.
Issue Highlights
 |
REMOTE MAGNETIC NAVIGATION TO GUIDE ENDOCARDIAL AND EPICARDIAL CATHETER MAPPING OF SCAR-RELATED VENTRICULAR TACHYCARDIA, by Aryana et al.
|
|---|
Catheter mapping of ventricular tachycardia is challenging because
of tissue heterogeneity in diverse scar-related disease substrates
as well as limitations in maneuverability and accessibility
to critical regions of the ventricular endocardium and epicardium.
In this issue of
Circulation, Aryana and colleagues report their
clinical results obtained by using a remote magnetic navigation
system combined with electroanatomic mapping to identify areas
of interest related to ventricular tachycardia, while using
a limited amount of fluoroscopy exposure. Although the majority
of epicardial and endocardial ventricular sites could be safely
and effectively mapped remotely, because of current limitations
of the magnetic navigation catheter, most patients required
additional manual ablation using an irrigated catheter to ablate
fully the ventricular tachycardia substrates. See p
1191.
|
RENAL INSUFFICIENCY FOLLOWING CONTRAST MEDIA ADMINISTRATION TRIAL (REMEDIAL): A RANDOMIZED COMPARISON OF 3 PREVENTIVE STRATEGIES, by Briguori et al.
|
|---|
Exposure to radiocontrast media can lead to transient and permanent
renal failure in high-risk patients such as those with preexisting
moderate or severe renal failure. Current methods to prevent
contrast-induced nephrotoxicity include volume expansion with
saline and limitation of contrast volume. Other strategies have
been proposed, including N-acetylcysteine (NAC), sodium bicarbonate
infusion, and ascorbic acid. The study by Briguori et al was
a 2-center, randomized, double-blind study of 3 strategies to
prevent contrast-induced nephrotoxicity in 326 patients with
moderate chronic renal disease undergoing coronary or peripheral
angiography. Moderate renal failure was defined as a creatinine
concentration of 2 to 8 mg/dL. Patients were randomized to saline
plus NAC, sodium bicarbonate infusion plus NAC, or saline plus
ascorbic acid plus NAC. Contrast-induced nephropathy defined
as an increase in creatinine concentration by 25% occurred in
9.9%, 1.9%, and 10.3%, respectively. The sodium bicarbonate
infusion plus NAC produced significantly better results than
the other regimens (
P=0.019). Other measures of contrast-induced
nephrotoxicity showed similar results. In addition, similar
results were seen in high-risk subgroups such as those with
diabetes. These findings support the use of volume expansion
with sodium bicarbonate plus NAC as a more effective strategy
in preventing contrast-induced nephrotoxicity than saline plus
NAC or saline plus ascorbic acid and NAC. See p
1211.
|
USE OF A CONSTITUTIVELY ACTIVE HYPOXIA-INDUCIBLE FACTOR-1 TRANSGENE AS A THERAPEUTIC STRATEGY IN NO-OPTION CRITICAL LIMB ISCHEMIA PATIENTS: PHASE I DOSE-ESCALATION EXPERIENCE, by Rajagopalan et al.
|
|---|
Critical limb ischemia is a serious manifestation of peripheral
atherosclerosis associated with limb loss in a considerable
number of patients. Although surgery and percutaneous transluminal
angioplasty may provide improvement in some patients, in others,
amputation is the only option. Several systems in the body sense
hypoxia, among them the hypoxia-inducible factor-1
. Such ischemia-sensing
systems activate protective pathways in the body to limit tissue
damage. In the study by Rajagolpalan et al, therefore, the authors
tested whether a constitutively active transcription factor
of hypoxia-inducible factor-1
transfected with an adenovirus
would be safe and potentially ameliorate symptoms and improve
outcome in patients with critical limb ischemia and no other
options. No serious adverse events of this treatment were noted,
but peripheral edema disease progression and ischemia were still
common. In approximately half of the hypoxia-inducible factor-1
treated patients, however, complete pain resolution was noted
at 1 year and ulcer healing in almost one third. Although very
preliminary, this study suggests that this novel gene therapy
approach in critical limb ischemia should be pursued further
and may, if confirmed in larger studies, offer a treatment for
those patients with no other options. See p
1234.
Visit http://circ.ahajournals.org:
|
Images in Cardiovascular Medicine
|
|---|
Huge Pericardial Hemangioma Imaging. See p
e315.
Cardiovocal Syndrome Associated With Huge Left Atrium. See p e318.
Infarction-Like Electrocardiographic Changes Due to a Myocardial Metastasis From a Primary Lung Cancer. See p e320.
|
Correspondence
|
|---|
See p
e322.
Related Articles:
-
Huge Pericardial Hemangioma Imaging
- Abdel-Rauf Zeina, Ghassan Zaid, Dawod Sharif, Uri Rosenschein, and Elisha Barmeir
Circulation 2007 115: e315-e317.
[Full Text]
-
Cardiovocal Syndrome Associated With Huge Left Atrium
- Okan Gulel, Diyar Koprulu, Zafer Kucuksu, Mustafa Yazici, and Senem Cengel
Circulation 2007 115: e318-e319.
[Full Text]
-
Infarction-Like Electrocardiographic Changes Due to a Myocardial Metastasis From a Primary Lung Cancer
- Panagiotis Samaras, Frank Stenner-Liewen, Stefan Bauer, Gerhard W. Goerres, Lotta von Boehmer, Nina Kotrubczik, Rolf Jenni, Christoph Renner, and Alexander Knuth
Circulation 2007 115: e320-e321.
[Full Text]
-
Letter by Pischon et al Regarding Article, "Adiponectin and Coronary Heart Disease: A Prospective Study and Meta-Analysis"
- Tobias Pischon, Matthias B. Schulze, and Eric B. Rimm
Circulation 2007 115: e322.
[Full Text]
-
Use of a Constitutively Active Hypoxia-Inducible Factor-1 Transgene as a Therapeutic Strategy in No-Option Critical Limb Ischemia Patients: Phase I Dose-Escalation Experience
- Sanjay Rajagopalan, Jeffrey Olin, Steven Deitcher, Ann Pieczek, John Laird, P. Michael Grossman, Corey K. Goldman, Kevin McEllin, Ralph Kelly, and Nicolas Chronos
Circulation 2007 115: 1234-1243.
[Abstract]
[Full Text]
-
Remote Magnetic Navigation to Guide Endocardial and Epicardial Catheter Mapping of Scar-Related Ventricular Tachycardia
- Arash Aryana, Andre d’Avila, E. Kevin Heist, Theofanie Mela, Jagmeet P. Singh, Jeremy N. Ruskin, and Vivek Y. Reddy
Circulation 2007 115: 1191-1200.
[Abstract]
[Full Text]
-
Renal Insufficiency Following Contrast Media Administration Trial (REMEDIAL): A Randomized Comparison of 3 Preventive Strategies
- Carlo Briguori, Flavio Airoldi, Davide D’Andrea, Erminio Bonizzoni, Nuccia Morici, Amelia Focaccio, Iassen Michev, Matteo Montorfano, Mauro Carlino, John Cosgrave, Bruno Ricciardelli, and Antonio Colombo
Circulation 2007 115: 1211-1217.
[Abstract]
[Full Text]
Top
REMOTE MAGNETIC NAVIGATION TO...
RENAL INSUFFICIENCY FOLLOWING...