June 2007

A 58-year-old man with type 2 diabetes and hypertension who was a smoker presented to the outpatient clinic with atypical symptoms.

A number of electrocardiographic abnormalities have been described in athletes.1 Among these are sinus bradycardia and varying degrees of atrioventricular (AV) block. These findings have been attributed to the "athlete's heart," and are felt to be due to enhanced vagal tone seen with excellent physical conditioning. Secondarily it has also been suggested that there are intrinsic changes within the sinoatrial and AV nodes themselves, including prolonged sinus node recovery time and AV nodal Wenckebach, and these abnormalities persist following autonomic blockade.

Radiofrequency catheter ablation (RFA) is a cost-effective approach that has modified the treatment of patients with supraventricular tachycardia. In the Loire-Ardèche-Drôme-Isère-Puy-de-Dôme (LADIP) study, we compared RFA treatment with amiodarone therapy after the first episode of symptomatic atrial flutter. Results showed that RFA should be considered a first-line treatment, especially in elderly patients, because it has a better long-term success rate, the same risk of subsequent atrial fibrillation as amiodarone, and fewer secondary effects compared with amiodarone. Radiofrequency catheter ablation first-line therapy should be recommended in routine clinical practice, even when the atrial flutter is isolated without a previously documented atrial fibrillation episode.

Atrial flutter is an arrhythmia that occurs less commonly than atrial fibrillation and is often resistant to rate control and termination.

We compared the incidence of late clinical events after withdrawal of clopidogrel between subjects treated with drug-eluting stents (DES) and those treated with bare-metal stents. Death and myocardial infarction occurred more frequently among DES-treated subjects during the follow-up period. The results of this study indicate that there may be a penalty for the lower rate of restenosis and reinterventions after DES implantation, in particular, an increased rate of late stent thromboses.

The study by Handke et al focuses on one of the most controversial areas of interventional cardiology—the clinical downside of treatment with drug-eluting stents (DES).

A total of 114 patients with an intermediate pretest likelihood of coronary artery disease were evaluated with both multislice computed tomography (MSCT) and myocardial perfusion imaging (MPI). Results showed that in the majority of cases, a normal MSCT scan was associated with normal perfusion. However, only half of patients with significant stenoses showed abnormal perfusion. Accordingly, MPI and MSCT are intrinsically different techniques and appear to be complementary rather than overlapping as they provide information on atherosclerosis versus ischemia, respectively.

The study by Schuijf and Bax, which compares multislice computed tomography (CT) versus myocardial perfusion imaging, is very timely, as this new cardiac imaging modality has gained rapid acceptance by cardiologists for managing patients.