Circulation. 2007;116:1643
doi: 10.1161/CIRCULATIONAHA.107.185634
(Circulation. 2007;116:1643.)
© 2007 American Heart Association, Inc.
Issue Highlights
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EFFECT OF RANOLAZINE, AN ANTIANGINAL AGENT WITH NOVEL ELECTROPHYSIOLOGICAL PROPERTIES, ON THE INCIDENCE OF ARRHYTHMIAS IN PATIENTS WITH NON–ST-SEGMENT–ELEVATION ACUTE CORONARY SYNDROME: RESULTS FROM THE METABOLIC EFFICIENCY WITH RANOLAZINE FOR LESS ISCHEMIA IN NON–ST-ELEVATION ACUTE CORONARY SYNDROME–THROMBOLYSIS IN MYOCARDIAL INFARCTION 36 (MERLIN-TIMI 36) RANDOMIZED CONTROLLED TRIAL, by Scirica et al.
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Ranolazine is an inhibitor of the late phase of the inward sodium
current during cardiac repolarization. It has been shown to
reduce myocardial ischemia. However, ranolazine prolongs the
QTc by 2 to 6 ms. This has raised concerns about the possibility
that this may reflect increased susceptibility to arrhythmias.
However, this QTc prolongation is not associated with other
changes, and in animal studies, ranolazine has been shown to
suppress arrhythmic activity. In the MERLIN-TIMI 36 trial, ranolazine
was associated with a decrease in arrhythmias. In this issue
of
Circulation, Scirica et al report the findings of a substudy
of the MERLIN-TIMI 36 trial in 97% of randomized patients (n=6351)
who had continuous ECG recordings. Treatment with ranolazine
resulted in fewer patients having ventricular tachycardia, regardless
of whether ischemia was present (5.3% versus 8.3%;
P<0.001).
Supraventricular tachycardia and ventricular pauses were also
less frequent. These findings are exploratory but indicate that
ranolazine has direct antiarrhythmic effects. See p
1647.
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USE OF CARDIAC REHABILITATION BY MEDICARE BENEFICIARIES AFTER MYOCARDIAL INFARCTION OR CORONARY BYPASS SURGERY, by Suaya et al.
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Outpatient cardiac rehabilitation is an efficient and important
venue where secondary prevention interventions are implemented
and reinforced. Cardiac rehabilitation has been shown to improve
exercise capacity, risk factor profile, and quality of life
and appears to confer a lower risk of total and cardiovascular
mortality among participants. Accordingly, the American College
of Cardiology and the American Heart Association strongly recommend
cardiac rehabilitation for those patients who are capable of
participating after acute myocardial infarction, acute coronary
syndromes, and coronary artery bypass surgery. In this issue
of
Circulation, Suaya et al provide the largest and most comprehensive
evaluation to date regarding utilization of cardiac rehabilitation
in their assessment of more than 270 000 Medicare beneficiaries
after hospitalization for myocardial infarction or coronary
artery bypass surgery across the United States. They further
analyze predictors of use relative to several clinical and demographic
variables. In an accompanying editorial, Thomas highlights the
importance of this report and provides insightful recommendations
to foster referral and enrollment of patients into cardiac rehabilitation.
See p 1653 (editorial p
1644).
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EXTRACORPOREAL MEMBRANE OXYGENATION TO AID CARDIOPULMONARY RESUSCITATION IN INFANTS AND CHILDREN, by Thiagarajan et al.
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Consideration of extracorporeal membrane oxygenation support
(ECMO) is recommended for children with continued cardiac arrest
despite conventional resuscitation, provided that irreversible
causes are absent or cardiac transplantation is an option. Outcome
data are limited, however, and the practice is not universally
accepted. From a multicenter registry, Thiagarajan and coworkers
report the largest series to date of ECMO instituted for rescue
therapy of failed cardiopulmonary resuscitation. Despite likely
imminent death in 682 patients, ECMO was followed by survival
to hospital discharge in 38% of children. Thiagarajan et al
also examined factors associated with prognosis. Although long-term
outcomes and neurological outcomes were not available and the
availability and decision to use ECMO create unavoidable selection
bias, the results provide support for its use and guidance for
patient selection. See p
1693.
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Intramyocardial Spontaneous Hematoma Mimicking an Acute Myocardial
Infarction. See p
e371.
Partially Unroofed Coronary Sinus. See p e373.
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Correspondence.
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See p
e374.
Related Articles:
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Cardiac Rehabilitation/Secondary Prevention Programs: A Raft for the Rapids: Why Have We Missed the Boat?
- Randal J. Thomas
Circulation 2007 116: 1644-1646.
[Full Text]
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Intramyocardial Spontaneous Hematoma Mimicking an Acute Myocardial Infarction
- Leonarda Galiuto, Luigi Natale, Gabriella Locorotondo, Sabrina Barchetta, Maria Mastrantuono, Antonio G. Rebuzzi, Lorenzo Bonomo, and Filippo Crea
Circulation 2007 116: e371-e372.
[Full Text]
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Partially Unroofed Coronary Sinus
- Xin-Sheng Huang
Circulation 2007 116: e373.
[Full Text]
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Letter by Spence et al Regarding Article, "Impact of Patient and Target-Vessel Characteristics on Arterial and Venous Bypass Graft Patency: Insight From a Randomized Trial"
- Mark S. Spence, Peter Klinke, and David Hilton
Circulation 2007 116: e374.
[Full Text]
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Extracorporeal Membrane Oxygenation to Aid Cardiopulmonary Resuscitation in Infants and Children
- Ravi R. Thiagarajan, Peter C. Laussen, Peter T. Rycus, Robert H. Bartlett, and Susan L. Bratton
Circulation 2007 116: 1693-1700.
[Abstract]
[Full Text]
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Effect of Ranolazine, an Antianginal Agent With Novel Electrophysiological Properties, on the Incidence of Arrhythmias in Patients With Non–ST-Segment–Elevation Acute Coronary Syndrome: Results From the Metabolic Efficiency With Ranolazine for Less Ischemia in Non–ST-Elevation Acute Coronary Syndrome–Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) Randomized Controlled Trial
- Benjamin M. Scirica, David A. Morrow, Hanoch Hod, Sabina A. Murphy, Luiz Belardinelli, Chester M. Hedgepeth, Peter Molhoek, Freek W.A. Verheugt, Bernard J. Gersh, Carolyn H. McCabe, and Eugene Braunwald
Circulation 2007 116: 1647-1652.
[Abstract]
[Full Text]
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EFFECT OF RANOLAZINE, AN...
USE OF CARDIAC REHABILITATION...