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(Circulation. 2006;113:2373.)
© 2006 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. |
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FOCAL PHARMACOLOGICAL MODULATION OF ATRIOVENTRICULAR NODAL CONDUCTION VIA IMPLANTABLE CATHETER: A NOVEL THERAPY FOR ATRIAL FIBRILLATION? by Sigg et al. |
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Medical treatment of atrial fibrillation using antiarrhythmic agents or ventricular rate control is challenging because of variable success and systemic side effects. In this issue of Circulation, Sigg and colleagues describe a local catheter-based delivery system for administration of drugs to alter atrioventricular nodal conduction. They implanted a catheter at the atrioventricular nodal region for local infusion of acetylcholine and demonstrated proof-of-principle in an acute canine model. Regulation of atrioventricular nodal refractoriness and conduction properties was achieved using low-dose local drug delivery without systemic actions. It is conceivable that focal drug therapy may eventually be combined with an implantable pacemaker-type device using a closed-loop feedback system to chronically modulate ventricular rate control during atrial arrhythmias. See p 2383.
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IMPLEMENTATION OF GUIDELINES IMPROVES STANDARD OF CARE: THE VIENNESE REGISTRY ON REPERFUSION STRATEGIES IN ST-ELEVATION MYOCARDIAL INFARCTION (VIENNA STEMI REGISTRY), by Kalla et al. |
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For the past 25 years, various guidelines for the treatment of acute ST-segment–elevation myocardial infarction (STEMI) have consistently emphasized the importance of time to reperfusion over the importance of the reperfusion method itself. Once emergency departments had successfully optimized speed to diagnosis and reperfusion, ie achieving a door-to-needle or door-to-balloon time of cutaneous coronary intervention (PPCI) became the preferred therapy over intravenous thrombolysis because of its lower stroke rate, value of coronary anatomy definition, and more definitive treatment of the culprit lesion. However, application of a PPCI solution for STEMI in most communities is strategically difficult, and the prioritization of a PPCI strategy over a time-to-reperfusion strategy has resulted in substantial delays with important clinical consequences. Kalla and colleagues describe the implementation of an ambulance triage system that coordinated the
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