Circulation. 2007;116:2773
doi: 10.1161/CIRCULATIONAHA.107.187682
(Circulation. 2007;116:2773.)
© 2007 American Heart Association, Inc.
Issue Highlights
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CAN COMMON-TYPE ATRIAL FLUTTER BE A SIGN OF AN ARRHYTHMOGENIC SUBSTRATE IN PAROXYSMAL ATRIAL FIBRILLATION? CLINICAL AND ABLATIVE CONSEQUENCES IN PATIENTS WITH COEXISTENT PAROXYSMAL ATRIAL FIBRILLATION/ATRIAL FLUTTER, by Moreira et al
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Common atrial flutter due to right atrial reentry is often associated
with atrial fibrillation, although the critical substrate for
atrial fibrillation is more often left atrial. Moreira and coworkers
performed sequential ambulatory monitoring and ablation studies
in patients with paroxysmal atrial fibrillation to define the
presence of atrial flutter and assess the impact of right atrial
flutter ablation and segmental pulmonary vein isolation with
cryoablation on spontaneous arrhythmias. As expected, right
atrial ablation alone was effective for abolishing atrial flutter
but failed to prevent atrial fibrillation. Interestingly, pulmonary
vein isolation was substantially less effective in preventing
recurrent atrial fibrillation in patients with prior atrial
flutter than in those with no prior atrial flutter. These findings
suggest that atrial flutter is a marker for more advanced atrial
disease in patients with paroxysmal atrial fibrillation. Monitoring
for atrial flutter may provide a noninvasive means of assessing
the extent of arrhythmia substrate that might help predict outcomes
and potentially facilitated more individualized ablation strategies.
See p 2786 (editorial p
2774).
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DOES COMORBIDITY ACCOUNT FOR THE EXCESS MORTALITY IN PATIENTS WITH MAJOR BLEEDING IN ACUTE MYOCARDIAL INFARCTION? by Spencer et al
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Major bleeding after treatment for acute myocardial infarction
is associated with a significantly worse overall outcome in
randomized clinical trials. However the incidence in an unselected
group of patients and the factors associated with an increased
bleeding risk are not well described. 40 089 patients with acute
myocardial infarction were enrolled in the Global Registry of
Acute Coronary Events (GRACE) registry. The frequency of major
bleeding in patients with acute myocardial infarction was 2.8%.
In-hospital mortality was increased significantly (hazard ratio=1.9,
95% confidence interval 1.6–2.2) and accounted for 10%
of all hospital deaths. Major bleeding was not a predictor of
mortality after hospital discharge. Bleeding was associated
with invasive procedures, age, and comorbidities, as well as
premature discontinuation of antithrombotic therapy. This study
suggests that bleeding is related to adverse outcomes and is
often a marker for patients at higher risk for adverse outcomes.
See p 2793 (editorial p
2776).
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NF- B IS A KEY MEDIATOR OF CEREBRAL ANEURYSM FORMATION, by Aoki et al
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Cerebral aneurysms are an important source of morbidity and
mortality, yet we know very little about the mechanisms of aneurysm
formation. In this issue, Aoki and colleagues demonstrate that
a key mediator of inflammation, known as NF-
B, is required for
the development of cerebral aneurysms. Inhibition of this target
prevented the formation of aneurysms in animal models. Most
importantly, examination of human specimens revealed this NF-
B
pathway to be activated in cerebral aneurysms. This study provides
us with a potential new therapeutic target for patients in whom
early aneurysm formation is noted. See p
2830.
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Leiomyosarcoma Involving Main and Left Pulmonary Artery Treated
Surgically With Homograft Replacement and Concomitant Left Pneumonectomy.
See p
e559.
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Correspondence
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See p
e562.
Related Articles:
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Atrial Fibrillation–Atrial Flutter Interactions: Clinical Implications for Ablation
- Albert L. Waldo
Circulation 2007 116: 2774-2775.
[Full Text]
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Bleeding Is Bad.... Isn’t It?
- Peter B. Berger and Steven V. Manoukian
Circulation 2007 116: 2776-2778.
[Full Text]
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Leiomyosarcoma Involving Main and Left Pulmonary Artery Treated Surgically With Homograft Replacement and Concomitant Left Pneumonectomy
- Sak Lee, In-Kyu Park, Sang-Ho Cho, and Do-Kyun Kim
Circulation 2007 116: e559-e561.
[Full Text]
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Letter by Tartière et al Regarding Article, "Cardiac Structure and Ventricular–Vascular Function in Persons With Heart Failure and Preserved Ejection Fraction From Olmsted County, Minnesota"
- Jean-Michel Tartière, Lamia Tartière-Kesri, and Alain Cohen Solal
Circulation 2007 116: e562.
[Full Text]
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NF-B Is a Key Mediator of Cerebral Aneurysm Formation
- Tomohiro Aoki, Hiroharu Kataoka, Munehisa Shimamura, Hironori Nakagami, Kouji Wakayama, Takuya Moriwaki, Ryota Ishibashi, Kazuhiko Nozaki, Ryuichi Morishita, and Nobuo Hashimoto
Circulation 2007 116: 2830-2840.
[Abstract]
[Full Text]
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CAN COMMON-TYPE ATRIAL FLUTTER...
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