Volume 7 Issue 3, March 2010

A novel three-catheter radiofrequency ablation system has been reported to reduce procedure time, but maintain ablation success rates, in patients with persistent atrial fibrillation. The findings are promising; however, important limitations and concerns must be overcome before use of this system can be considered the standard-of-care for catheter treatment of persistent atrial fibrillation.

Inflammation might be involved in the pathophysiology of atrial fibrillation. Glucocorticoid use can attenuate inflammation and might be an effective therapy for atrial fibrillation. However, some population-based studies have reported an increased risk of atrial fibrillation associated with glucocorticoid use. Whether this link results from a direct effect of glucocorticoids or from the underlying inflammatory disease remains to be elucidated.

The two CHAMPION trials failed to show superiority of cangrelor (a rapid-acting, reversible intravenous platelet P2Y₁₂ adenosine receptor antagonist) versus clopidogrel in patients with acute coronary syndromes undergoing percutaneous coronary intervention. The CHAMPION PCI trial, however, did show a significant reduction in death and stent thrombosis suggesting benefit in those without clopidogrel pretreatment.

Aldosterone antagonists decrease the mortality of patients with heart failure, but an observational study by Albert and colleagues has found that a surprisingly low number of patients receive aldosterone antagonists before discharge from hospital. This article highlights potential reasons for why there is such an underuse of efficient drugs in heart failure.

As part of our focus issue on atrial fibrillation, Dewire and Calkins review current strategies and emerging technologies for catheter ablation of patients with this arrhythmia. The authors also discuss the current clinical role of AF ablation in various high-risk groups of patients, such as the elderly and those with concomitant heart failure.

Atrial fibrillation (AF) has multifactorial intracardiac and extracardiac causes. Current development of anti-AF agents is focused on modulation of ion channel activity as well as on upstream therapies that reduce structural substrates. In this Review, Burashnikov and Antzelevitch examine new and emerging pharmacological approaches to rhythm control in patients with AF and summarize the available data on these drugs.

Although currently available anticoagulants, such as warfarin, can prevent stroke in patients with atrial fibrillation, the drug-related bleeding risk remains unacceptably high, and therapy could be contraindicated if the risk exceeds that for stroke. In this Review, Freek Verheugt assesses the performance of new anticoagulants that directly inhibit different stages of the coagulation cascade.

The incidence of prehypertension and hypertension among children and adolescents is rising as a result of the epidemic of youth overweight and obesity. Brian McCrindle addresses this important public health problem by reviewing the evaluation and management aspects of this condition that are specific to infants, children, and adolescents.

In this Review, the authors discuss the utilization of multiple, high spatial resolution contrast weightings for thein vivoassessment of carotid atherosclerotic disease. Although 'carotid MRI' is presently an established imaging tool dedicated to research, the burgeoning data from prospective studies has placed it at the precipice of translation to clinical practice.

This Focus issue on atrial fibrillation (AF) contains three specially commissioned Review articles, written by leaders in the field, on promising new developments in catheter ablation, atrial antiarrhythmic drug therapy, and anticoagulants for stroke prevention in patients with AF. The issue also features News & Views commentaries, a Research Highlight, and an Editorial, discussing important advances in AF research that have been reported in the past few months.