The following abstracts are reprinted with permission from the March 2003, April 2003 and May 2003 issues of the Journal of Invasive Cardiology.

Taxol-Based Eluting Stents From Theory to Human Validation:
Clinical and Intravascular Ultrasound Observations
Shinjo Sonoda, MD, Yasuhiro Honda, MD, Toru Kataoka, MD, *Heidi N. Bonneau, RN, MS, Krishnankutty Sudhir, MD, PhD, Paul G. Yock, MD, **Gary S. Mintz, MD, Peter J. Fitzgerald, MD, PhD
From the Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California, *Highlands Consulting, Inc., San Jose, California, and **Cardiovascular Research Institute, Washington Hospital Center, Washington D.C.
ABSTRACT: Treatment with antiproliferative drugs via coated stents appears to be a promising approach to both mechanically remodel target lesions and biologically reduce neointimal hyperplasia. Drug-eluting stents can maximize local drug effects and minimize the potential for systemic toxic effects. The purpose of this review is to describe the effects of a lipophilic microtubular inhibitor, paclitaxel, a strong antiproliferative agent under clinical investigation, and to define the vascular response to taxol-based eluting stents by intravascular ultrasound.
J INVAS CARDIOL 2003;15:109“114

Direct Stenting May Limit Myocardial Injury During Percutaneous Coronary Intervention
Thuraia Nageh, BSc, MD, Martyn R. Thomas, MD, Roy A. Sherwood, DPhil,
Beverley M. Harris, MSc, David E. Jewitt, BSc, MD, Ray J. Wainwright, BSc, MD
From King™s College Hospital, Denmark Hill, London, England, United Kingdom.
ABSTRACT: Background. Direct coronary stenting has been shown to be safe and feasible, with a demonstrable reduction in cost, procedural time and radiation exposure. Direct stenting may limit distal embolization of atherosclerotic plaque and consequently reduce myocardial cell injury following percutaneous coronary intervention, which may have important prognostic implications.
Methods and Results.We assessed cardiac troponin I (cTnI) release in the 24 hours following direct coronary stenting (DS) as compared to stenting with balloon predilatation (PD) in a total of 311 patients and 440 vessels/lesions (vessel to lesion ratio = 1:1) (DS: n = 107 patients and 149 vessels/lesions; PD: n = 204 patients and 291 vessels/lesions). The 2 groups were well matched except for a greater proportion of diabetic patients in the PD group (21%) compared to the DS group (11%) (p < 0.05). There were no significant differences in the distribution of target lesion site or angiographic complexity between the 2 groups. Primary angiographic success was achieved in 97% of vessels in the DS group and 98% of vessels in the PD group (p = NS). DS failed in 7/114 patients (6%) deemed suitable for DS by the operator, but all stents were subsequently successfully deployed following balloon predilatation. Abciximab (ReoPro, Eli Lilly & Company, Indianapolis, Indiana) was used in 11 patients (10%) in the DS group and 24 patients (12%) in the PD group ( p = 0.68). The post-procedural median (IQR) peak cTnI concentrations were 0.2 ± 0.1 µg/L in the DS group and 0.5 ± 0.3 µg/L in the PD group (p = 0.02). Post-procedural cTnI concentrations were > 0.2 µg/L in 11 patients (10%) in the DS group and in 53 patients (26%) in the PD group (X2 = 58.6; p < 0.0001). The rate of major adverse cardiac events at 6“18 month follow-up was 8% in the DS group and 15% in the PD group (X2 = 38.5; p = 0.02).
Conclusion. Direct stenting without balloon predilatation is associated with lower post-procedural cTnI concentrations and lower incidence of major adverse events compared to traditional stenting with predilatation.
J INVAS CARDIOL 2003;15:115“118

Practice and Outcomes of Percutaneous Coronary Intervention in the Community Before Drug-Eluting Stents: A Report from the HCA Database
Aaron D. Kugelmass, MD, *David J. Cohen, MD, MPH, Salvatore L. Battaglia, BS, **Lynn G. Tarkington, RN, §Edmund R. Becker, PhD, §Steven D. Culler, PhD
From the Cardiovascular Division, Henry Ford Hospital, Detroit Michigan, *the Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, **HCA, Inc., Nashville, Tennessee,  Medical City Dallas Hospital, Dallas, Texas, ¡Cardiac Data Solutions, Inc., Indianapolis, Indiana, and §Rollins School of Public Health, Emory University, Atlanta, Georgia.
ABSTRACT: Background. Percutaneous coronary intervention (PCI) using balloon angioplasty and/or intracoronary stents has increasingly become the treatment choice for myocardial revascularization. While acute clinical outcomes of the community-based PCI procedures have been examined, much less is known about long-term revascularization rates, disease progression and other adverse outcomes.
Methods and Results. Information on patient demographics, coronary risk factors, lesion characteristics, procedures and outcomes were derived from an HCA, Inc. database on all patients undergoing a PCI procedure in one of four community cardiac catheterization laboratories. A total of 3,192 consecutive patients were enrolled from July 1, 1999 through September 30, 2000. Analysis was limited to those patients undergoing PCI of native vessels with stents or conventional balloon angioplasty; target lesions in bypass grafts or those treated with atherectomy were excluded. Approximately one-third of enrolled patients were surveyed concerning their utilization of cardiovascular services 1 year following their initial procedure. The 1-year target lesion revascularization (TLR) was 9.9% while target vessel revascularization was 13.5%. Overall, 27.6% of patients underwent repeat revascularization within 1 year; 24.7% underwent at least 1 additional PCI and 5.6% underwent coronary artery bypass graft surgery. A total of 4.5% of patients reported an interval acute myocardial infarction with a major adverse cardiac event rate of 30.3% at 1 year.
Conclusion. While clinically significant restenosis remains a problem for 10“15% of patients undergoing PCI, progression of coronary artery disease elsewhere appears to be an equally powerful driver in the need for recurrent revascularization. This analysis of contemporary PCI practice prior to drug-eluting stent utilization suggests that while these novel devices will likely reduce the incidence of TLR, many patients with coronary artery disease will still require additional revascularization for disease progression.
J INVAS CARDIOL 2003;15:121“127

A Randomized, Multicenter Trial Comparing a New, Low-Pressure Stent Versus a Conventional Stent: Primary Results from the CONSERVE Trial
Sorin J. Brener, MD, *Mark G. Midei, MD,  E. Dean Nukta, MD, §Dean J. Kereiakes, MD, ¡David G. Rizik, MD, Donel Murphy, RN, Danielle Brennan, MS, David J. Moliterno, MD, Eric J. Topol, MD, for the Comparison of New Stents for Equivalency of Reduction in Vascular Events (CONSERVE) Investigators
From Cleveland Clinic Foundation, Cleveland, Ohio, *St. Joseph™s Hospital, Towson, Maryland,  Fairview General Hospital, Cleveland, Ohio, §Christ Hospital, Cincinnati, Ohio, and ¡Shea Hospital, Scottsdale, Arizona.
ABSTRACT: Because it is uncertain whether high-pressure stent deployment may contribute to more exuberant neointimal proliferation, a new stent, the LP, was constructed to allow full expansion at <= 10 atmospheres (atm). We compared in a randomized trial the 6-month target vessel revascularization (TVR) and other clinical outcomes of the LP stent with the most commonly used Food and Drug Administration-approved stent (Guidant Duett and Tristar stents) in 1,003 patients without a recent myocardial infarction. The first 150 patients assigned the LP stent also underwent repeat angiography at 6 months. Baseline characteristics for the two groups were balanced, except for an excess of unstable angina in the LP group. There was slight excess in failure to deliver the LP stent (3.4% versus 1.4%; p = 0.04), and similar 7-day rates of procedural success without ischemic complications (92% versus 93%; p = 0.53). More patients in the LP group had pre-dilation (72% versus 58%; p < 0.001) and post-dilatation (61% versus 50%; p = 0.001). The stent deployment pressure was significantly lower, as expected, in the LP group (10 ± 2 ATM versus 13 ± 4 atm; p < 0.001). At 30 days, the incidence of major adverse cardiac events was similar. At 6 months, the incidence of TVR was 10% and 7.8%, respectively (p = 0.28), hazard ratio was 0.79 (0.52“1.21), and absolute difference was 2.2% (-2.3% to 6.7%), well within the range of equivalency set at 7.5%. Patients without post-dilatation had a significantly higher rate of revascularization with the LP stent than with the Guidant® stent (p = 0.02). Thus, the new LP stent achieves rates of revascularization that are not inferior to the Guidant® stent, but this effect cannot be linked to lower-pressure deployment.
J INVAS CARDIOL 2003;15:128“132

Early and Late Reactions Following the Use of Iopamidol 340, Iomeprol 350 and Iodixanol 320 in Cardiac Catheterization
A.G.C. Sutton, *P. Finn, P.G. Campbell, D.J.A. Price, J.A. Hall, M.J. Stewart, A. Davies, N.J. Linker, A.A. Harcombe, M.A. de Belder
From the Cardiothoracic Division, the James Cook University
Hospital, Middlesbrough, England, and *the Postgraduate Institute, School of Health and Social Care, University of Teesside,
Middlesbrough, England, United Kingdom.
ABSTRACT: Goal. To investigate the incidence of early (< 24 hours) and late (> 24 hours to 7 days) reactions to 3 contrast agents commonly used in cardiac catheterization.
Methods and Results. A total of 2,108 patients undergoing cardiac catheterization in a Regional Cardiothoracic Unit were randomly assigned to receive 1 of 3 commonly used contrast agents in a prospective, double-blind study. The contrast agents were iopamidol 340 (Niopam®), a nonionic monomer; iomeprol 350 (Iomeron®), a nonionic dimer; and iodixanol 320 (Visipaque®), a nonionic dimer. The main outcome measures were the incidence of early (< 24 hours) reactions following catheterization and the incidence of late (24 hours to 7 days) reactions. Early reactions, excluding patients with heat on left ventriculography as the sole symptom, were relatively common (7.4%), but there was no significant difference between the 3 agents (p = 0.35). Late skin reactions, excluding reactions solely at the site of the arterial puncture and continuations of early urticarial reactions, were also relatively common (5.4%), but the incidence differed between the 3 agents. Such reactions occurred in 2.7% of those receiving iopamidol 340 (Niopam®), 3.5% of those receiving iomeprol 350 (Iomeron®) and 10.4% of those receiving iodixanol 320 (Visipaque®) (p < 0.01).
Conclusion. The incidence of early adverse reactions is similar with these 3 contrast agents. However, late skin reactions are significantly more common with iodixanol 320 (Visipaque®) than with the other 2 agents. Although such reactions were rarely troublesome, patients should be advised accordingly.
J INVAS CARDIOL 2003;15:133“138

A Technique for Type 4a Coronary Bifurcation Lesions: Initial Results
and 6-Month Clinical Evaluation
Petros S. Dardas, MD, Dimitris D. Tsikaderis, MD, Nick E. Mezilis, MD,
Giannis Styliadis, MD
From the Thessaloniki Heart Institute, St. Luke™s Hospital,
Cardiac Catheterization Department, Thessaloniki, Greece.
ABSTRACT: In routine practice, lesions in coronary bifurcations are frequent. This relatively high frequency may be underestimated due to the presence of false bifurcation lesions (lesions of the main branch without significant lesion of the sidebranch), which may become true bifurcation lesions after stenting due to axial plaque redistribution. In this report, we describe our initial experience with a new technique for the treatment of type 4a bifurcation lesions (main branch ostial lesion stenosis of the main vessel immediately after the bifurcation, not involving the sidebranch) using a new technique for primary stenting of the main vessel with simultaneous kissing balloon of the sidebranch in an effort to avoid the snowplough effect.
J INVAS CARDIOL 2003;15:180“183

Use of Platelet Glycoprotein IIb/IIIa Inhibitors and Spontaneous Pulmonary Hemorrhage
Arshad Ali, MBBS, MRCP, Mustafa Hashem, MD, Howard S. Rosman, MD,
Ghassan Kazmouz, MD, Julius M. Gardin, MD, Theodore L. Schrieber, MD
From the Division of Cardiology, St. John Hospital & Medical Center,
Detroit, Michigan.
ABSTRACT: Background. The use of platelet glycoprotein (GP) IIb/IIIa inhibitors in patients undergoing percutaneous coronary intervention has resulted in an impressive reduction in adverse events. Pulmonary hemorrhage is a rare but potentially lethal complication of antithrombotic and antiplatelet therapy. We analyzed the incidence of spontaneous pulmonary hemorrhage following the use of platelet GP IIb/IIIa inhibitors.
Methods. The medical records of 1,020 consecutive patients who received GP IIb/IIIa inhibitors and underwent PCI at our institution between August 1997 and December 1999 were reviewed. Results. Diffuse pulmonary hemorrhage developed in 7 patients (0.68%), two of whom died. Five of 7 patients with pulmonary hemorrhage had activated clotting times > 250 seconds during the procedure. Activated partial thromboplastin time measured at the time of pulmonary hemorrhage was elevated in all patients (mean, 85 seconds; range, 69“95 seconds). All patients had history of congestive heart failure and had elevated pulmonary capillary wedge pressure and/or left ventricular end-diastolic pressure at the time of the index procedure. Six patients also had evidence of baseline radiographic abnormalities.
Conclusion. Diffuse pulmonary hemorrhage is a potentially disastrous complication of GP Ilb/Illa antagonists. No specific predictors can be identified, but evidence of pulmonary congestion, baseline pulmonary abnormalities and use of higher heparin dosages may predispose patients to this serious complication.
J INVAS CARDIOL 2003;15:186“188

Arterial Wall Temperature Following Coronary Stent Implantation in Pigs: The Role of Post-Stent Inflammation
Leonidas Diamantopoulos, MD, PhD, Yanming Huang, MD, Xiaosun Liu, MD, Shenggiao Li, MD, Walter Desmet, MD, PhD, Frans Van de Werf, MD, PhD,
Ivan De Scheerder, MD, PhD
From the Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
ABSTRACT: Background. The purpose of this study was to investigate in vivo the arterial wall temperature after coronary stent implantation in pigs.
Methods. We performed cardiac catheterization in 20 pigs with normal coronary arteries. Arterial wall temperature was studied with a thermography system that uses a 4-thermistor sensor tip. A segment was selected in the proximal right coronary artery. Temperature was mapped in this segment by means of a continuous catheter pullback. A stent was then implanted in the middle of this area, and the temperature scan was repeated. Pigs were randomized in two groups (10 + 10 pigs) for arterial temperature scanning: group A to be re-scanned after 5 days and then sacrificed, and group B to be re-scanned after 8 days and then sacrificed.
Results. The temperature of the arterial wall before stent implantation was equal to the adjacent areas. Immediately after stent implantation, the stented area had lower temperature than the adjacent areas (p < 0.001). Five days after implantation, the stented area was significantly warmer than the adjacent areas (p < 0.001); histopathology showed the highest macrophage population at the place of the stent. Eight days after implantation, the temperature differences were reduced to non-significant levels (p = NS) and the macrophage population was significantly lower.
Conclusion. Stent implantation results in an immediate temperature decrease at the stented arterial segment, followed by a significant temperature increase around day 5 after stent implantation. These findings can be correlated with the peri-strut inflammation that follows the stent implantation.
J INVAS CARDIOL 2003;15:191“197

Superficial Femoral Artery Occlusion: Nitinol Stents Achieve Flow and Reduce the Need for Medications Better than Balloon Angioplasty Alone
Leslie Cho, MD, *Marco Roffi, MD,  Debabrata Mukherjee, MD, §Deepak L. Bhatt, MD, §Christopher Bajzer, MD, §Jay S. Yadav, MD
From Loyola University Medical Center, Maywood, Illinois, *University of Hospital Zurich, Switzerland,  University of Michigan Medical Center, Ann Arbor, Michigan, §Cleveland Clinic Foundation, Cleveland, Ohio.
ABSTRACT: Background. Nitinol slotted tube stents are of great potential benefit in superficial femoral artery (SFA) interventions due to their elastic properties. However, a paucity of data exists for their efficacy in total SFA occlusions.
Methods. Using the Cleveland Clinic Foundation Peripheral Database, we identified 40 consecutive patients who underwent percutaneous revascularization for chronically occluded SFA and addressed the outcome stratifying for stent use. We evaluated the reduction in the pressure gradient across the lesion and the need for medication following revascularization.
Results. Of the 40 patients, twenty-six underwent balloon angioplasty alone and 14 received nitinol slotted tube stents. Patients were well matched for age and cardiovascular risk factors. Similarly, there were no differences in baseline ankle brachial index (ABI) or claudication class between the groups. Compared to angioplasty alone, stenting was associated with a greater reduction in translesional pressure gradient (72 mmHg versus 32 mmHg; p = 0.002). In addition, patients treated with stents were less likely to require post-procedure adjunctive medical treatment (7.1% versus 42.6%; p = 0.03).
Conclusion. In SFA occlusion, stenting results in greater reduction in translesional pressure gradient and reduced need for adjunctive medical treatment.
J INVAS CARDIOL 2003;15:198“200

Severe Aortic Coarctation in Infants Less Than 3 Months: Successful Palliation by Balloon Angioplasty
* P. Syamasundar Rao, MD, *Saadeh B. Jureidini, MD, *Ian C. Balfour, MD,
*Gautam K. Singh, MD, *Su-chiung Chen, MD
From the Division of Pediatric Cardiology, Department of Pediatrics,
*Saint Louis University School of Medicine/Cardinal Glennon Children™s Hospital, St. Louis, Missouri and  University of Texas-Houston Medical School/Memorial Hermann Children™s Hospital, Houston, Texas.
ABSTRACT: The optimal management strategy of the neonate and young infant with native aortic coarctation (AC) is controversial. We reviewed our experience with balloon angioplasty (BA) in neonates and infants <= 3 months to test our thesis that BA provides successful palliation, defined as avoidance of surgery for >= 4 weeks along with control of presenting symptoms. We also compared the results of the transumbilical arterial (UA), transfemoral arterial (FA) and transfemoral venous anterograde (FVA) approaches we have used to accomplish BA. During a 6.5-year period ending June 2001, fifty-one neonates and infants <= 3 months presenting with heart failure, hypertension or both underwent UA (n = 16), FA (n = 26) and FVA (n = 9) balloon coarctation angioplasty. Immediate and follow-up results were evaluated. Acute reduction of peak-to-peak gradients across the coarctation (40 ± 17 mmHg vs. 5 ± 6 mmHg; p < 0.001), increase in diameter of the coarcted segment (2.2 ± 0.5 mm vs. 5.6 ± 0.8 mm; p < 0.001) and improvement in symptomatology occurred following BA. Surgical relief of aortic obstruction was required in 4 infants at 5, 21, 24 and 28 days after the procedure. Effective palliation was thus achieved in the remaining 47 infants (92%). During intermediate-term follow-up, twenty-two infants (50%) developed recoarctation requiring repeat balloon (n = 14) or surgical (n = 8) intervention 2“10 months (median, 3 months) after initial BA. The indication for reintervention was hypertension in all patients. At a median follow-up of 3 years (range, 0.5“5.5 years), blood pressures remained low (98 ± 11 mmHg) with an arm/leg blood pressure gradient of 4 ± 6 mmHg. Comparison of the groups revealed similar effectiveness both immediately and at follow-up. However, femoral artery complications were seen in only the FA group. Based on these data, we conclude that effective palliation is achieved with BA in all 3 groups, femoral artery complications are seen only in the FA group and BA is an excellent alternative to surgical intervention in the management of native AC in neonates and young infants.
J INVAS CARDIOL 2003;15:202“208

Safety and Efficacy of Low-Dose Intravenous Enoxaparin and Glycoprotein IIb/IIIa Inhibitor Therapy During Percutaneous Coronary Intervention
Louis Carnendran, MD, Robert Borkowski, MD, Bashar Markabawi, MD,
Mark F. Warner, MD
From the Harrisburg Medical Associates, Harrisonburg, Virginia.
ABSTRACT: The use of intravenous enoxaparin, a glycoprotein (GP) IIb/IIIa inhibitor, during percutaneous coronary intervention (PCI) has been shown to be safe and to possibly reduce in-hospital and 30-day major adverse cardiac events (MACE). NICE-4, a recent PCI observational study, evaluated a reduced dose of intravenous (IV) enoxaparin (0.75 mg/kg) with abciximab. However, prior PCI studies evaluating IV enoxaparin have not used percutaneous closure devices. The purpose of this study was to observe the safety and efficacy of a lower dose of IV enoxaparin (0.5 mg/kg) in conjunction with any GP IIb/IIIa inhibitor. The Angio-Seal femoral closure device was also employed as part of the treatment strategy. We administered 0.5 mg/kg IV enoxaparin and a GP IIb/IIIa inhibitor to 75 eligible PCI patients. None received anticoagulation 24 hours prior to PCI; all received pre-procedural aspirin, post-procedural deployment of the Angio-Seal and clopidogrel therapy, and were discharged home within 36 hours. TIMI minor bleeding was 1.3%; there were no TIMI major bleeding events or major adverse cardiac events during in-hospital stay or at 30-day follow-up. Our small observational study shows that IV enoxaparin is safe and efficacious during PCI when given at a dose 33% lower than previously reported in conjunction with any GP IIb/IIIa inhibitor and Angio-Seal. However, large, randomized PCI trials are needed to confirm the clinical efficacy, safety and cost-effectiveness of lower doses of enoxaparin with GP IIb/IIIa inhibitors and vascular closure devices.
J INVAS CARDIOL 2003;15:235“238

In-Hospital Complications of Peripheral Vascular Interventions Using Unfractionated Heparin as the Primary Anticoagulant
Nicolas W. Shammas, MS, MD, *Jon H. Lemke, PhD, Eric J. Dippel, MD,
*Dawn E. McKinney, MA, Vickie S. Takes, RN, Monica Youngblut, RN,
Melodee Harris, RN, Catherine Harb, Matthew J. Kapalis, BSc, *Jane Holden, RN
From the Genesis Heart Institute, Cardiovascular Medicine, PC,
and *the Genesis Health System, Davenport, Iowa.
ABSTRACT: Unfractionated heparin is the current antithrombotic of choice in peripheral vascular interventions. The rate of in-hospital major complications during peripheral angioplasty procedures (PTA) using heparin as the primary anticoagulant has not been well defined. In this single-center study, the charts of 213 consecutive PTA procedures in a 1-year period were reviewed. Of unstaged procedures, a total of 131 patients (57.3% males; mean age, 66.4 ± 12.1 years) met inclusion criteria. Forty-five patients (34.4%) had recent onset of claudication and 15 (11.5%) had ulceration. Thrombus was angiographically visualized in 16.7% of patients. Unfractionated heparin was administered at a mean of 4,672 ± 1,238 U (59.1 ± 20.0 U/kg) during the procedure. The highest activated clotting time (ACT) during the procedure was recorded in 114 patients. ACTs were < 300, 300“400 and > 400 seconds in 29.0%, 29.0% and 42.1%, respectively. In-hospital clinical events occurred in 12 patients (9.2%) who met any one of the following endpoints: death (0.8%), limb loss (1.5%), major bleeding (4.6%), emergent need for repeat revascularization of the same vessel (7.6%), embolic stroke (0.0%) and vascular complications (1.5%). The best model associated with salvage revascularization included cigarette smoking within the past year, recent onset of claudication and PTA treatment below the knee. Increased dosages of heparin (U/kg) were associated with a trend toward higher rates of complications. A significant number of patients have in-hospital major complications following PTA procedures using unfractionated heparin as the primary anticoagulant. Current ongoing registries are evaluating the feasibility of direct thrombin inhibitors bivalirudin instead of heparin as a primary anticoagulant during PTA.
J INVAS CARDIOL 2003;15:242“246

The Clinical Effectiveness of the Prostar® XL Suture-Mediated Percutaneous Vascular Closure Device for Achievement of Hemostasis in Patients Following Coronary Interventions: Results of the Perclose AcceleRated Ambulation and DISchargE (PARADISE) Trials
Kenya Nasu, MD, *Etsuo Tsuchikane, MD, **Satoru Sumitsuji, MD, on behalf of the PARADISE Investigators
From the Department of Internal Medicine, Hirai Hospital, Nara, Japan, *the Department of Cardiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan and **the Department of Cardiovascular Medicine, Rinku General Hospital, Osaka, Japan.
ABSTRACT: Background. The Prostar® XL is a hemostasis device designed to percutaneously close the arterial puncture site with two nonabsorbable sutures. The Early Discharge and Economical effectiveness study for New hemostasis device (EDEN) trial, which was performed in Japan, showed that the Prostar® XL device shortened time to hemostasis, time to ambulation and the average length of hospital stay, and decreased local vascular complications. However, the ooze of blood from the puncture site incision requires relatively longer time to ambulation.
Objectives. The Perclose AcceleRated Ambulation and DISchargE (PARADISE) trial was performed to assess the effectiveness of the Prostar® XL device on patient comfort, shortened time to ambulation and discharge from hospital by minimizing the oozing problem.
Methods.This multicenter, non-randomized registry was designed to compare times to hemostasis, ambulation and discharge, as well as the incidence of peripheral vascular complications in Prostar® XL patients with the conventional manual compression group in the EDEN trial. Hydrochloride lidocaine containing 1% epinephrine was used as local anesthesia to reduce blood oozing.
Results. Between September 1999 and March 2000, a total of 109 patients were enrolled in this study. The closure device was successfully placed in 108 of 109 attempts. Time to hemostasis was significantly less than with the conventional manual compression group in the EDEN trial. Times to ambulation and discharge were significantly less than with the Prostar® XL and conventional manual compression groups in the EDEN trial.
Conclusion. We conclude that the Prostar® XL device plus hydrochloride lidocaine containing 1% epinephrine as local anesthesia appears to be a safe and effective method to achieve hemostasis, and to improve times to ambulation and discharge after interventional procedures.
J INVAS CARDIOL 2003;15:251“254

Simultaneous Multisite Endocardial Mapping of Sustained and Non-Sustained Atrial Fibrillation in Humans
Martin R. Karch, MD, Gjin Ndrepepa, MD, Bernhard Zrenner, MD, Christoph Saur, MD, Michael A.E. Schneider, Albert Schömig, MD, Claus Schmitt, MD
From the Deutsches Herzzentrum München und 1. Medizinische Klinik,
Klinikum rechts der Isar, Technische
Universität München, Munich, Germany.
ABSTRACT: The aim of this study was to investigate the differences between sustained and non-sustained forms of human atrial fibrillation (AF) using multielectrode endocardial recordings. Methods. Sixty-four pole basket catheters were deployed in the right atrium (RA) of 3 groups of patients: 1) patients with persistent AF (> 48 hours); 2) induced sustained AF (> 15 minutes); and 3) induced non-sustained AF (< 15 minutes). Beat to beat AF intervals (FF) were evaluated for each bipole. On the basis of signal characteristics and direction of wavefront propagation, the degree of spatial and temporal organization of AF was assessed. Results. Persistent AF showed the shortest FF intervals (161 ms) and lowest overall degree of AF organization, induced non-sustained AF the longest FF intervals (192 ms) and highest degree of organization. FF intervals of induced sustained AF were only slightly longer (169 ms) compared to persistent AF. Within each AF group, the lateral wall showed the highest degree of organization, the septal region the lowest. Conclusion. In humans, FF interval and overall degree of AF organization were found to increase significantly from sustained to non-sustained AF. Persistent and induced sustained AF, however, only slightly differed in these parameters.
J INVAS CARDIOL 2003;15:257“262