Reviews & Analysis

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.

Although vaccination has so far been used mainly for infectious disease, the varied roles of the immune system in atherosclerosis present the possibility of a vaccine being developed against this prevalent disease. Here, Shah and colleagues discuss some of the background and advances being made in this field.

Morbidity and mortality are high for chronic heart failure despite therapeutic advances, but the options are not exhausted. Ulf Landmesser and Helmut Drexler present an overview of heart failure therapy and summarize the major research being done to find new ways forward.

The introduction of drug-eluting stents has revolutionized interventional cardiology. The uptake of this technology has been rapid and widespread, but the long-term data are strikingly few. In this review, an overview is presented of the studies done so far and the emerging information on safety and efficacy. Future directions for this intervention are also discussed.

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 relation between obesity and cardiovascular risk factors is well documented, and risks include hypertension, cardiac remodeling and lipid disturbances. The weight loss outcomes achieved with bariatric surgery can eliminate or ameliorate such cardiovascular effects. Blackburn and Mun present the evidence for cardiovascular benefits seen with this advancing therapy.

Various cardioprotective effects seen with ischemic preconditioning and postconditioning have been documented. The application of these methods in clinical practice is not, however, straightforward because of issues with timing and the need for further elucidation of mechanisms. This review discusses whether implementation in clinical practice is feasible.

This review presents an overview of MRI for assessment of the myocardium. This method is becoming popular for the study of morphology, function, perfusion and ischemia because data on various different biological parameters can be gathered from the same area within the same scanning session simply through changes to the software.

Despite ventricular septal defects being more common than atrial septal defects, fewer trials have been done of transcatheter closure. The available results do, however, suggest positive results with low complication rates. Douglas S Moodie provides in this review an overview of current applications of transcatheter closure for membranous, perimembranous and muscular ventricular septal defects.

Statins are potent inhibitors of cholesterol synthesis and can reduce the risk of cardiovascular disease and strokes in high-risk patients. As discussed here, evidence suggests that statins, in addition to their lipid-lowering capacities, have nonlipid-mediated or pleiotropic roles in stroke prevention.

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.

The management of atrial fibrillation, the most frequent sustained arrhythmia in humans, aims to reduce symptoms and to minimize the risk of thromboembolic events, such as strokes. This review compares and contrasts the rhythm-control and the rate-control approach for treating patients with this arrhythmia.

Risk factors identified by the Framingham Heart Study are useful for assessing a person's risk of cardiovascular disease; however, additional risk factors are needed. In this review, the potential role of lipoprotein-associated phospholipase A₂as a novel inflammatory marker for cardiovascular risk assessment is discussed.

Although excessive epicardial fat increases the work of pumping, this visceral fat depot is important source of free fatty acids and various bioactive molecules, and constitutes a metabolically active organ. Iacobelliset al. discuss its role, in the context of regional fat distribution, in cardiac pathology and the assessment of cardiac disease.

As defibrillator therapy is invasive and expensive, using a defibrillator as primary prevention therapy requires risk stratification to identify suitable patients at significant risk. In this review Antonis A Armoundaset alevaluate whether clinical data support the use of microvolt T-wave alternans testing to identify patients who are unlikely to benefit from primary prevention implantable cardioverter-defibrillator therapy.

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.

Developments in the interpretation of blood pressure curves have enabled assessment of pressure-wave reflections and arterial stiffness in the vascular system. These measurements can be translated into assessment of cardiovascular risk, enabling new features of cardiovascular disease and new drug treatments to be investigated. Here, the structural and functional factors that influence arterial stiffness are discussed.

Alterations in β-adrenergic-receptor signal transduction play a major part in the development of heart failure. Although pharmacologic and device-based therapy can lessen morbidity and mortality, better understanding of these mechanisms should improve outcomes. Much of the current understanding of β-adrenergic signaling pathways and polymorphisms is summarized in this review.