Comparison of segmental wall motion abnormalities on echocardiography in patients with anteroseptal versus extensive anterior wall ST-segment elevation myocardial infarction.

OBJECTIVE: Acute anteroseptal ST-segment elevation (STE) myocardial infarction (AS-STEMI), defined as STE limited to leads V1 to V3, has historically been associated with a smaller infarct size than extensive anterior STEMI (EA-STEMI), in which STE extends to leads V4 to V6. We compared the differences in global and regional wall motion by transthoracic echocardiography between patients with AS-STEMI and EA-STEMI. METHODS: Patients who presented with anterior STEMI and underwent primary percutaneous coronary intervention between January 2008 and March 2011 were included. For each subject, a transthoracic echocardiogram that was performed within 24 hours of admission was interpreted by an independent investigator blinded to the patient's electrocardiographic data. RESULTS: Of the 65 subjects who met our inclusion criteria, 30 had AS-STEMI and 35 had EA-STEMI. No differences were observed between groups in baseline characteristics or the mean number of hypokinetic, akinetic, and dyskinetic segments. Apical inferior segment dysfunction occurred more often in patients with EA-STEMI than in patients with AS-ASTEMI (71.4% vs 43.3%; P=.04). Distribution and extent of wall motion abnormalities were similar between patients with AS-STEMI and those with EA-STEMI. CONCLUSION: The term AS-STEMI may be misleading, as it implies that only the anteroseptal segments are involved. We show that regional dysfunction in patients with AS-STEMI extends beyond the anteroseptal region.

Real-life global survey evaluating patients with atrial fibrillation (REALISE-AF): results of an international observational registry.

Despite being one of the most studied arrhythmias, there is paucity of information regarding atrial fibrillation (AF) control in the general population and the treatment strategies utilized by healthcare providers. REALISE-AF is an ongoing international registry investigating the management of AF and its control in nonhospitalized subjects. The registry has enrolled patients in 26 countries worldwide with the primary aim to determine the control of AF. This article presents a review of the initial results from the REALISE-AF registry and compares it to major practice-changing clinical trials conducted in the past. It also gives an overview of the current management strategies, recent updates in treatment and what further developments portend in the future.