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(Circulation. 2007;116:2773.)
© 2007 American Heart Association, Inc.

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

	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

 
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).

	DOES COMORBIDITY ACCOUNT FOR THE EXCESS MORTALITY IN PATIENTS WITH MAJOR BLEEDING IN ACUTE MYOCARDIAL INFARCTION? by Spencer et al

 
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% . . . [Full Text of this Article]

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