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(Circulation. 2005;112:1375.)
© 2005 American Heart Association, Inc.

Issue Highlights

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	ANATOMIC RELATIONS BETWEEN THE ESOPHAGUS AND LEFT ATRIUM AND RELEVANCE FOR ABLATION OF ATRIAL FIBRILLATION, by Sánchez-Quintana et al.

 
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.

	PROGNOSTIC VALUE OF DOBUTAMINE STRESS MYOCARDIAL CONTRAST PERFUSION ECHOCARDIOGRAPHY, by Tsutsui et al.

 
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 . . . [Full Text of this Article]

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