Volume 21 - Issue 5 - May, 2009

Comparison of the Clinical Characteristics of Apical and Non-Apical Variants of “Broken Heart” (full title below)

Refat Jabara, MD, Radhika Gadesam, MD, Lakshmana Pendyala, MD, Nicolas Chronos, MD, Spencer B. King, MD, Jack P. Chen, MD

From the Saint Joseph’s Cardiovascular Research Institute/Saint Joseph’s Hospital of Atlanta, Georgia.
The authors report no financial relationships or conflicts of interest regarding the content herein.
Manuscript submitted November 18, 2008 and accepted December 30, 2008.
Address for correspondence: Refat Jabara, MD, FACC, Saint Joseph’s Cardiovascular Research Institute, Saint Joseph’s Hospital of Atlanta, GA, 5673 Peachtree Dunwoody Road, Suite 675, Atlanta, GA 30342. E-mail: rjabara@sjha.org

ABSTRACT: Objectives. The present study was designed to delineate and compare the clinical characteristics of patients with apical and non-apical takotsubo syndrome in a high-volume U.S. hospital. Background. A comparison between apical and non-apical variants of the “broken heart,” or takotsubo syndrome, has not been performed in the United States. Methods. From 2004 through 2007, patients with takotsubo syndrome were identified according to the following criteria: acute chest pain with electrocardiographic changes or elevation of cardiac enzymes, absence of significant coronary narrowing...

Takotsubo Syndrome: An Opportunity to Better Understand Post-Infarction Myocardial Recovery?

George Vetrovec, MD

From the Kimmerling Professor of Medicine and Chair of Cardiology at VCU Pauley Heart Center, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, Virginia.
The author reports no conflicts of interest regarding the content herein.
Address for correspondence: George W. Vetrovec, MD, Box 980036, VCU Medical Center, Cardiology Division, Room 607, West Hospital, Richmond, VA 23298-0036. E-mail: gvetrovec@mcvh-vcu.edu

In this issue of the Journal, Jabara et al1 provide an intriguing summary of differences between apical and non-apical Tako-tsubo syndrome based on case summaries of individuals with most often stress-induced ischemic events in the absence of major coronary vessel obstruction. The apical-type disorders are associated with larger defects, and not surprisingly, more severe complications. The apical patients probably show more intense ischemia with greater amounts of jeopardized muscle, and thus, the consequences of the ischemic insult are greater. Non-apical events appear more benign, presumably...

Adjunctive Intracoronary Antithrombotic Therapy: Time to Revisit an Old Strategy?

Manivannan Srinivasan, MBBS, MRCP and Abhiram Prasad, MD, FRCP

From the Division of Cardiovascular Diseases and Department of Internal Medicine Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted September 29, 2008, provisional acceptance given December 11, 2008 and final version accepted December 18, 2008.
Address for correspondence: Abhiram Prasad, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Email: prasad.abhiram@mayo.edu

There have been major advances in the field of percutaneous coronary intervention (PCI) since its introduction 30 years ago. The improved safety and outcomes can be attributed to increasing operator experience, advances in device technology and the pivotal role of adjunctive pharmacotherapy. Despite these advances, challenges remain that require further research and development. One such challenge is the treatment of thrombotic lesions. Coronary artery thrombus commonly develops following rupture of an atherosclerotic plaque and undergoes modifications in terms of size and composition over tim...

Update on Laser Lead Extraction

Jeffrey S. Snow, MD and *Sameer Parekh, MD

From Winthrop-University Hospital, Mineola, New York, and *New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
The authors report no conflicts of interest regarding the content herein.
Address for correspondence: Jeffrey S. Snow, MD, Winthrop-University Hospital, Mineola, NY. E-mail: snowmen81@aol.com

In recent years, lead extraction has become an increasingly common procedure which has moved from the realm of cardiothoracic surgery to interventional cardiac electrophysiology. This article reviews indications for lead extraction and briefly discusses the common approaches currently employed to remove leads.


Several converging trends have driven the increase in lead extraction procedures. Twenty years ago, most patients needed to survive a cardiac arrest twice before implantable cardioverter-defibrillator (ICD) implantation would be considered. Today, most implantati...

The ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities (full title below)

Stephen C. Vlay, MD

From the Stony Brook Arrhythmia Study and Sudden Death Prevention Center, Cardiology Division, Department of Medicine, Stony Brook University, Stony Brook, New York.
The author reports no conflicts of interest regarding the content herein.
Address for correspondence: Stephen C. Vlay, MD, SUNY Health Sciences Center T16-080, Stony Brook, NY 11794–8167. E-mail: svlay@notes.cc.sunysb.edu

The ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: Their Relevance to the Cardiologist, Internist and Family Physician

The purpose of this review is to highlight the important and new features of the 2008 Guidelines published in Circulation, the Journal of the American College of Cardiology and Heart Rhythm Journal in 20081–3 and available online (http://tinyurl.com/d9lygp). This comprehensive document, coauthored by a committee of highly respected physicians, contains 527 references, the latest of which have been used to update the current ...

Chronicling the Evolution of Catheter Ablation for Atrial Fibrillation and Ventricular Tachycardia

Dimpi Patel, MD, J. David Burkhardt, MD, Javier E. Sanchez, MD, Luigi Di Biase, MD,
Rodney P. Horton, MD, Andrea Natale, MD

From St. David’s Medical Center, Austin, Texas.
Disclosures: Dr. Andrea Natale has received speaker honoraria from Biosense Webster and St. Jude Medical, and is a consultant to Biosense Webster. Dr. Rodney Horton has received speaker honoraria from Boston Scientific Corp. and is a consultant to Biosense Webster. Dr. Javier Sanchez has received speaker honoraria from Biosense Webster, Boston Scientific Corp. and St. Jude Medical. Dr. David Burkhardt has received speaker honoraria from Biosense Webster and Stereotaxis, Inc. and is a consultant to Stereotaxis, Inc..
Address for correspondence: Andrea Natale, MD, St. David’s Medical Center, 919 East 32nd Street, Austin, TX 78705. E-mail: dr.natale@gmail.com

Catheter Ablation for Atrial Fibrillation: An Attempt at Abating the Epidemic

The evolution of catheter ablation for atrial fibrillation. Over the past decade, atrial fibrillation ablation (AF) has evolved from an investigational therapy to one that many electrophysiologists have in their arsenal. Catheter ablation for AF originally attempted to recreate the Cox-Maze procedure by performing linear lesions in the atrium using radiofrequency or cryothermy. While this technique altered the atrial substrate, there was limited knowledge concerning the importance of the pulmonary veins in ...

Current Procedural Terminology Coding in Electrophysiology: Focus on 2009 Updates

Manish Undavia, MD

From the Mount Sinai Medical Center, New York, New York.
The author reports no conflicts of interest regarding the content herein.
Address for correspondence: Manish Undavia, MD, 242 Merrick Road, Suite 402, Rockville Center, NY 11570.

ABSTRACT: This article highlights the major changes in the current procedural terminology codes (CPT codes) that were announced by the American Medical Association in January 2009. These new CPT codes were developed to more accurately reflect current cardiac device monitoring capabilities, long-distance telemetry and remote interrogation as well as follow-up practices. Some of these new code sets are structured differently than the CPT codes that they replace. Specifically, the new codes for remote monitoring do not have separate professional (-26) and technical components (-TC) applied to an ...

Advances in Atrial Fibrillation Ablation

Alicia Darge, RPA-C, *Matthew R. Reynolds, MD, MSc, Joseph J. Germano, DO

From Winthrop-University Hospital, Mineola, New York, and *Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Disclosure: Dr. Reynolds is a consultant to Biosense Webster; Dr. Germano has received speaker honnoraria from Boston Scientific Corp., Medtronic, Inc., and St. Jude Medical.
Address for correspondence: Joseph Germano, DO, Assistant Professor of Medicine, Health Science Center, SUNY Stony Brook, Winthrop-University Hospital, 120 Mineola Blvd, Suite 500, Mineola, NY 11501.

Atrial fibrillation (AF) is an increasingly common and costly medical problem.1–3 Given the disappointing efficacy and side effects associated with pharmacological therapy for AF, new treatment options are needed. Over the last decade, advances in our understanding of the mechanisms of AF, coupled with iterative improvements in catheter ablation techniques, have spurred the evolution of catheter ablation for AF from an experimental procedure to an increasingly important treatment option.4 This paper will review recent advances in the approaches and outcomes of AF ablation.

Mechanisms o...

Metastatic Renal Cell Carcinoma Masquerading as ST-Segment Elevation Myocardial Infarction

Danai Kitkungvan, MD, *Sandeep Sharma, MD, *Luigi Pacifico, DO, *David H. Spodick, MD, DSc

From the Department of Medicine, and the *Division of Cardiology, Saint Vincent Hospital, Worcester, Massachusetts.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted December 16, 2008, provisional acceptance given February 5, 2009, and final version accepted February 11, 2009.
Address for correspondence: Danai Kitkungvan, MD, Department of Medicine, Saint Vincent Hospital, Worcester, MA 01608. E-mail: kitkungvan@hotmail.com

Case Presentation. A 60-year-old male presented to the emergency department with exertional dyspnea. His past medical history was significant for hypertension and renal cell carcinoma (RCC), which had been diagnosed 2 years previously. He underwent a left nephrectomy followed by combination chemotherapy. However, the cancer was resistant to the chemotherapy and had progressed. His case had been followed by an oncologist from outside the hospital. Therefore, the full details of his medical record were not available to us upon his arrival.

In the emergency department, his electrocardiogram (E...

Letter to the Editor

Fever after BioSTAR® Implantation: Is It a Systemic Reaction to the Collagen Matrix?

“The BioSTAR® septal repair implant for patent foramen ovale (PFO) closure is an exciting development, as it uses a bioabsorbable collagen matrix layer, which is thought to induce low host immune response and is absorbed and replaced by healthy host tissue. In the BEST study (first human trial with the implant), no major adverse events were reported and no evidence of a systematic inflammatory response was recorded.

We report 2 patients who developed fever within 24-hours of receiving a ...

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