Objectives We studied activating autoantibodies to β1-adrenergic (AAβ1AR) and M2 muscarinic receptors (AAM2R) in the genesis of atrial fibrillation (AF) in Graves’ hyperthyroidism. Background AF frequently complicates hyperthyroidism. AAβ1AR and AAM2R have been described in some patients with dilated cardiomyopathy and AF. We hypothesized their co-presence would facilitate AF in autoimmune Graves’ hyperthyroidism. Methods IgG purified from 38 patients with Graves’ hyperthyroidism with AF (n=17) or sinus rhythm (n=21) and 10 healthy controls was tested for its effects on isolated canine Purkinje fiber contractility with and without atropine and nadolol. IgG electrophysiologic effects were studied using intracellular recordings from isolated canine pulmonary veins. Potential cross-reactivity of AAβ1AR and AAM2R with stimulating thyrotropin receptor (TSHR) antibodies was evaluated before and after adsorption to CHO cells expressing human TSHRs using flow cytometry and enzyme-linked immunosorbent assays. Results The frequency of AAβ1AR and/or AAM2R differed significantly between patients with AF and sinus rhythm (AAβ1AR = 94% vs. 38%, p<0.001; AAM2R = 88% vs. 19%, p<0.001; and AAβ1AR+AAM2R = 82% vs. 10%, p<0.001). The co-presence of AAβ1AR and AAM2R was the strongest predictor of AF (odds ratio 33.61, 95% CI 1.17 - 964.11, p=0.04). IgG from autoantibody-positive patients induced hyperpolarization, decreased action potential duration, enhanced early afterdepolarization formation and facilitated triggered firing in pulmonary veins by local autonomic nerve stimulation. Imunoadsorption studies demonstrated that AAβ1AR and AAM2R were immunologically distinct from TSHR antibodies. Conclusions AAβ1AR and AAM2R when present in patients with Graves’ hyperthyroidism facilitate development of AF.

No abstract

No abstract

Pharmacomechanical thrombolysis (PMT) is an emerging treatment option for symptomatic deep vein thrombosis (DVT). This may obviate the need for systemic or catheter-directed thrombolysis. PubMed, EMBASE, and Cochrane database search of PMT in acute and chronic symptomatic DVT was undertaken. Baseline demographic and clinical characteristics, procedural details, DVT characteristics, and procedural and clinical outcomes are presented. A total of 8 case series (n = 2528; 1998-2009) qualified for inclusion. Lower extremity symptomatic DVTs constituted the majority of the cases (>80%). Both acute (<14 days) and chronic (>14 days) DVTs were included. Procedural success was 59% to 100% and catheter-directed thrombolysis was used as an adjunct in 16% to 53%. No deaths or major bleeding complications were reported. Pharmacomechanical thrombolysis leads to the immediate resolution of clinical symptoms of DVT in the majority of patients. Pharmacomechanical thrombolysis may be a safe and novel method, when appropriate expertise and resources are available, for the treatment of symptomatic acute and chronic DVT.

We report the first case of coil embolization using the "modified neck remodeling technique" in the management of a splenic artery aneurysm. This technique was feasible due to the unique and complex anatomy of the aneurysm. This condition has been largely treated by vascular surgeons and interventional radiologists; however, this patient was referred to the interventional cardiologists for endovascular coiling.