INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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DES Thrombosis Occurs in 2%; Risk Factors Identified, Outcomes Poor.
The ESTROFA (Estudio ESpañol sobre TROmbosis de stents FArmacoactivos) Study Group studied the issue of drug-eluting stent (DES) thrombosis in the real world setting by collecting standardized data on every case of definite stent thrombosis from 20 cardiac centers throughout Spain. There were 301 cases of definite stent thrombosis (ST) giving a cumulative incidence of 2% at 3 years. Antiplatelet treatment had been discontinued in 32%, 30% were late (1 to 12 months), and 21% were very late (>1 year). Independent predictors of late ST were stents placed during ST-segment elevation myocardial infarction, stents in the left anterior descending artery, and longer stent length. The cumulative incidence of ST after DES implantation in routine clinical practice was 2% at 3 years; one-half of these events occurred in the first month, but the risk for thrombosis extends much longer. See page 986.
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Heart Rhythm Disorders
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Electrogram Characteristics May Define Areas Necessary for Propagating AF.
Complex fractionated electrograms in left atrial tissue may identify areas that are critical for the maintenance of atrial fibrillation (AF). Takahashi and colleagues studied electrogram characteristics in 40 patients with chronic AF. After pulmonary vein isolation and left atrium (LA) roof line ablation, electrogram-based ablation was performed in the LA and coronary sinus. Termination of AF occurred in 73% of cases during electrogram-based ablation. Characteristics of the electrograms that were associated with AF termination included a higher percentage of continuous electrical activity and the presence of a temporal gradient of activation. This study suggests that smaller areas of the LA, which can be identified by electrograms, may be necessary for the propagation of AF. Targeting these areas for ablation may increase the frequency of success for patients with chronic AF. See page 1003.
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Cardiac Imaging
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Pattern of LGE May Diagnose Cardiac Amyloidosis.
Diagnosing cardiac amyloidosis usually requires an endomyocardial biopsy (EMB), which suffers from low sensitivity if an affected area is not sampled. Vogelsberg and colleagues performed cardiovascular magnetic resonance imaging (CMRI) and EMB on 33 people suspected of having amyloidosis. In patients with biopsy-proven cardiac amyloidosis, CMRI revealed a distinct pattern of late gadolinium enhancement (LGE), which was distributed over the entire subendocardial circumference, extending in various degrees into the neighboring myocardium. This pattern was found in 80% of the patients diagnosed with a positive EMB; the specificity was 94%. In patients with biopsy-proven cardiac amyloidosis, LGE frequently occurs in a peculiar pattern, which may be useful for making a noninvasive diagnosis, or possibly for assessing progression of disease. See page 1022. See figure.
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Interventional Cardiology
Heart Rhythm Disorders
