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(Circulation. 2008;118:1-2.)
© 2008 American Heart Association, Inc.

Clinical Summaries

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

	Role of Conduction Velocity Restitution and Short-Term Memory in the Development of Action Potential Duration Alternans in Isolated Rabbit Hearts

 
T-wave alternans often are a precursor to ventricular fibrillation and thus sudden cardiac death. It has been suggested that spatially discordant alternans (SDA) of action potential duration may lead to T-wave alternans, but the underlying mechanisms of SDA development are not clear. Previous studies have proposed preexisting action potential duration heterogeneities and steep dependence of conduction velocity in the myocardium on the preceding diastolic interval as possible causes of SDA. Our experiments demonstrate that a new mechanism associated with pacing history, ie, short-term memory, might also underlie SDA formation in the heart. In addition, we show that the heterogeneity of action potential duration does not necessarily correlate with the onset of alternans. Our findings have significant clinical relevance because they suggest that new dynamic factors such as the rate at which the heart muscle is paced also may play a role in the development of SDA and subsequently ventricular fibrillation. This suggests that cardiac memory needs to be considered an additional factor that can contribute to arrhythmia initiation. Ultimately, our findings can be used to define a new paradigm in the clinic for testing arrhythmia inducibility and need to be considered in the design of antiarrhythmic drugs. See p 17.

	Gender and Outcome in Adult Congenital Heart Disease

 
Gender differences in prognosis have frequently been reported in cardiovascular disease but less so in adult congenital heart disease. In the CONgenital CORvitia (CONCOR) national registry of adults with congenital heart disease (n=7414), we found that women had a 33% higher risk of pulmonary hypertension, a 33% lower risk . . . [Full Text of this Article]

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