Viewpoint in 2005

There has been a rapid increase in the number of catheter ablation procedures for atrial fibrillation. Importantly, several new catheter-based strategies have shown atrial fibrillation to be a treatable condition. In this Viewpoint, Carlo Pappone and Vincenzo Santinelli discuss the best techniques for atrial fibrillation ablation.

The use of organs donated after death is associated with much controversy and currently the supply of organs does not meet the demand, underlining the need for alternative organ sources. In this Viewpoint, Jean-Paul Soulillou examines the possibility of xenotransplantation with the tools and techniques currently available.

The rising incidence of impaired glucose tolerance and diabetes has resulted in a worldwide health-care crisis. Despite lifestyle changes and pharmacotherapy, over 25% of patients with diabetes have severe myocardial ischemia, myocardial infarction or both but without chest pain. Robert O’Rourke examines whether all patients with type 2 diabetes should be investigated for coronary artery disease, and possible treatment options.

There has been an alarming increase in the occurrence of childhood obesity, the long-term consequences of which are at least partly those of adult obesity. The direct consequences of childhood obesity on long-term cardiovascular risk, however, are less certain. Here, Peter H Whincup and John E Deanfield discuss the substantial challenges childhood obesity presents to clinicians.

Electronic pacemakers are lifesaving devices but require regular maintenance and do not readily respond to the demands of exercise and emotion. This viewpoint focuses on the rapidly evolving field of biological pacemakers, addresses the issues that need to be confronted before clinical use and discusses how far we are from a clinical reality.

Hypertrophic cardiomyopathy is a widespread condition that is often neglected and undiagnosed. Although there are still large gaps in our knowledge of the basic disease mechanisms, population studies have shown us that patients can have normal life expectancy but often develop disease-related complications. In this Viewpoint, Franco Cecchi, Magdi Yacoub and Iacopo Olivotto highlight the disease's screening and treatment, and some of the exciting new knowledge in the field.

Informed consent is a necessary element of good clinical practice. It is important that the physician or investigator assesses patients' competence and understanding, and facilitates their participation in the decision-making process, beyond just providing information. Here, Anders Ågård discusses how consent procedures should be adapted to match a patients' degree of involvement in the decision and capacity to understand, in light of how things are in the real world.

Atrial fibrillation affects millions of people worldwide and significantly increases the risk of ischemic stroke. In this month's Viewpoint, Alan Go examines the use of anticoagulant therapy, the problems faced and future therapeutic options for the prevention of stroke in patients with atrial fibrillation.

In 2004, the UK became the first country to make statins available without a prescription. Jonathan Abrams discusses the benefits and dangers of nonprescription statins, as the debate continues about whether low-dose statins should be sold over the counter in the US.

In 2004 the ACC/AHA guideline for the management of patients with STEMI was refocused and expanded. It has become the ultimate reference for managing patients with STEMI, and here Robert Giugliano and Eugene Braunwald highlight the significant changes between the 1999 and 2004 versions that will most affect practicing clinicians.

Since its inception over 30 years ago, the Fontan principle has become well established for the management of single-ventricle circulations. In this Viewpoint, Carin van Doorn and Marc de Leval discuss the procedure's selection criteria, the surgical technique and the management of the Fontan state.

The prevalence of valve disease is increasing worldwide. Given the need to reduce the occurrence of complications experienced with mechanical and tissue valve replacements, and the realization that normal heart valves perform extremely complex functions, tissue engineering of heart valves appears to be the next logical step. In this Viewpoint, Magdi Yacoub and Johanna JM Takkenberg discuss the future of tissue engineered heart valves.

Why do some patients require an altered statin dose to achieve target cholesterol levels? In this month's Viewpoint article, understanding the genetic factors involved in statin therapy, and whether they could be used to limit the variation in patient response is discussed by Daniel Chasman and Paul Ridker.