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Sample records for atrial myxoma case

  1. Systemic Embolism and Septic Shock Complicated Left Atrial Myxoma: Case Report

    PubMed Central

    Trimeche, B.; Bouraoui, H.; Garbaa, R.; Mahdhaoui, A.; Ben Rhomdane, M.; Ernez-Hajri, S.; Jeridi, G.

    2009-01-01

    Myxoma is the most common primary tumor of the heart. The rarity of infected cardiac myxomas leads to numerous diagnostic and therapeutic difficulties. We present a case of infected left atrial myxoma caused by methicillin-sensible Staphylococcus aureus in a 48-year-old woman complicated by systemic embolism and septic shock. PMID:20204064

  2. Oncotic Cerebral Aneurysms in a Case of Left Atrial Myxoma, Role of Imaging in Diagnostics and Treatment

    PubMed Central

    Gupta, Madan Mohan; Agrawal, Neha

    2015-01-01

    Summary Background Myxomatous cerebral (oncotic) aneurysms following atrial myxoma is a rare neurological complication. Case Report We report an 11-year- old boy with left atrial myxoma and multiple cerebral oncotic aneurysms. The characteristics of these aneurysms are indefinite and variable. The “Metastasize and Infiltrate” theory may be the key mechanism in the formation of these aneurysms. Conclusions Magnetic resonance imaging (MRI), computed tomography (CT) and angiography are useful in the diagnostics while digital subtraction angiography (DSA) is the best option. There are no definite guidelines for therapy of these aneurysms. Resection of cardiac myxomas, chemotherapy, radiotherapy, coil embolization and surgical treatment could be helpful. PMID:26600878

  3. Two-time recurrence of a right atrial myxoma

    PubMed Central

    Madhavan, Suresh; Akhil, P. C.; Jayaprakash, K.; George, Raju

    2015-01-01

    We report a case of a second recurrence of a right atrial myxoma in a 38-year-old woman who had surgical excision in March 2008 and excision of a recurrence in August 2012. She presented with a similar clinical picture in December 2014 and again underwent surgical excision. The case is unusual both for its location in the right atrium and its multiple recurrences in a sporadic form without any sign of the myxoma complex. PMID:26424957

  4. A large left atrial myxoma causing multiple cerebral infarcts

    PubMed Central

    Kebede, Saba; Edmunds, Eiry; Raybould, Adrian

    2013-01-01

    A 52-year-old man presented with a history of sudden onset diplopia. On neurological examination, the only abnormality was a right-sided oculomotor (third nerve) palsy. A brain CT was performed and reported as showing no abnormality. He was discharged to be investigated as an outpatient. He presented 1?month later with a new expressive dysphasia and confusional state. MRI was performed which revealed multiple cerebral infarcts. He was discharged on secondary stroke prevention medication. Six months elapsed, before a transthoracic echocardiogram was performed. This showed a large left atrial myxoma. The patient underwent an emergency resection and made a good postoperative recovery. This case report showed the importance of considering a cardiogenic source of emboli in patients who present with cerebral infarcts. Performing echocardiography early will help to detect treatable conditions such as atrial myxoma, and prevent further complications. PMID:24285802

  5. Quality of life after robotically assisted atrial myxoma excision.

    PubMed

    Kesävuori, Risto; Raivio, Peter; Jokinen, Janne J; Sahlman, Antero; Vento, Antti

    2015-09-01

    The aim of this study was to evaluate the clinical outcome after robotically assisted myxoma surgery performed at our institution. Altogether nine patients underwent robotically assisted atrial myxoma excision. A control group was selected from 18 consecutive patients who underwent an isolated atrial myxoma excision via conventional sternotomy. Preoperative patient characteristics were similar between the two study groups. Postoperative health-related quality of life (HRQoL) was also evaluated. All robotic operations were completed successfully using the da Vinci™ telesurgical system. There was no mortality in either of the two study groups. Procedure, cardiopulmonary bypass, aortic occlusion, and ventilation times were shorter in the sternotomy group when compared to the robotic group. Length of stay was statistically significantly shorter in the robotically assisted group. Postoperative quality of life did not differ between the two study groups. We conclude that robotically assisted surgery is a feasible method for treating atrial myxomas. PMID:26531204

  6. Peripheral myxoma of maxilla. A case report.

    PubMed

    Ramaraj, P N; Shah, S P

    2003-01-01

    The intra-oral soft tissue myxoma or peripheral myxoma is a rare, slowly growing, benign mesenchymal tumor. Pathologically, it may be difficult to differentiate from other tumors with myoxid stroma and is occasionally misinterpreted as malignant. Though its counterpart, central odontogenic myxoma shows aggressive local behaviour and high recurrence rate following conservative excision, no much detail is available regarding peripheral myxoma of the oral cavity in the published English literature. In this paper, a rare case of peripheral myxoma of maxilla in a 35 years old female is presented with emphasis on review of relevant literature, histological aspects in differential diagnosis and 'semi-radical approach' in its management. PMID:12800761

  7. Acute Myocardial Infarction due to Left Atrial Myxoma.

    PubMed

    Ito, Shimpei; Endo, Akihiro; Okada, Taiji; Nakamura, Taku; Adachi, Tomoko; Nakashima, Ryuma; Sugamori, Takashi; Takahashi, Nobuyuki; Yoshitomi, Hiroyuki; Tanabe, Kazuaki

    2016-01-01

    Myxoma is a common benign cardiac tumor that may rarely cause an acute myocardial infarction. A 77-year-old woman was admitted to our hospital with chest pain. Electrocardiography showed an ST elevation in leads V3-6. Transthoracic echocardiography revealed an ovoid mass with fragmentation in the left atrium and hypokinesia of the left ventricular apex. Coronary angiography indicated the presence of a coronary embolism that was suspected to be from the left atrial mass. The mass was removed by emergency surgical resection to avoid a further systemic embolism and was diagnosed pathologically as a myxoma. The patient was discharged after 13 days with no complications. PMID:26726085

  8. Right atrial myxoma mistaken for recurrent pulmonary thromboembolism

    PubMed Central

    Jardine, D; Lamont, D

    1997-01-01

    A 69 year old man was admitted for investigation of right sided pleuritic chest pain and dyspnoea, both of which began suddenly four days before admission. Acute pulmonary embolism was diagnosed. Six months after discharge while on warfarin he died. Necropsy found a 50 mm diameter myxoid tumour arising on the right atrial side of the interatrial septum. This lesion may have been discovered earlier by echocardiography although there were no clear indications for this investigation. Presentation was that of recurrent pulmonary embolism with no obvious source or cause of thrombosis. Patients who are thought to have idiopathic pulmonary embolism should undergo early echocardiography to exclude the rare but treatable diseases of the right heart that may be responsible?? Keywords: atrial myxoma PMID:9415015

  9. Coronary Embolization from a Left Atrial Myxoma Containing Malignant Lymphoma Cells

    PubMed Central

    Mihos, Christos G.; Nascimento, Francisco O.; Santana, Orlando; Lamelas, Joseph; Beohar, Nirat

    2015-01-01

    Systemic embolization from a primary cardiac tumor is a relatively frequent presentation. However, an acute myocardial infarction due to coronary embolization is rarely seen. We offer an unusual case of a 50-year-old man who presented with severe angina and was diagnosed with an inferolateral ST-segment-elevation myocardial infarction. Aside from otherwise healthy coronary arteries, his coronary angiogram revealed an acute occlusion of the first obtuse marginal branch, which was treated with balloon angioplasty. Because no residual plaque or dissection was found after the angioplasty, an embolic source was suspected. An echocardiogram then revealed a large mobile left atrial myxoma prolapsing into the left ventricle, so the patient underwent minimally invasive resection. Detailed pathologic examination of the myxoma revealed a concomitant high-grade B-cell lymphoma. PMID:26664313

  10. Left atrial myxoma presenting as pulmonary embolism: potential role of heme oxygenase-1.

    PubMed

    Redford, Daniel T; Thompson, Jess L; McCulloch, James C; Nielsen, Vance G

    2014-09-01

    We present the case of a patient with left atrial myxoma that presented with pulmonary embolism. The patient did not have any intracardiac communication between right and left sides of the heart. Using thrombelastography, the patient was determined to have an abnormally large velocity of plasma thrombus growth and strength with reduced vulnerability to lysis. Critically, increased carboxyhemoglobin concentrations were present, likely secondary to hemolysis from the tumor and engagement of systemic heme oxygenase-1. It was determined that the patient's plasmatic hypercoagulability was in part due to carboxyhemefibrinogen formation via a thrombelastographic method. In addition to circulating hypercoagulability, the patient also had an area of chronic venous stasis in his left ankle that had not changed for over a decade prior to this thrombophilic episode. In conclusion, we present the first case of paradoxical pulmonary embolism in the presence of a left atrial myxoma, potentially secondary to a combination of hemolysis, heme oxygenase-1 up-regulation, systemic hypercoagulability/hypofibrinolysis, and regional venous stasis. PMID:24553061

  11. Surviving catastrophic disintegration of a large left atrial myxoma: the importance of multi-disciplinary team

    PubMed Central

    Habbab, Louay; Alfaraidi, Haifa; Lamy, Andre

    2014-01-01

    Atrial myxomas are the most common primary cardiac tumors, representing ?50% of all benign cardiac tumors. Patients with a left atrial myxoma (LAM) generally present with symptoms of mechanical obstruction of blood flow, systemic emboli or constitutional symptoms. Embolic complications may occur any time with progression of the tumor; therefore, myxoma is usually considered an indication for urgent surgery. This report describes a patient with mobile large LAM who survived multiple emboli to the brain, spleen, kidneys, abdominal aorta and lower limbs during hospitalization for surgery, illustrating the critical nature of this finding and its possible catastrophic complications and demonstrating the importance of multi-disciplinary team in the decision-making process and the management of such complications and supporting the hypothesis that intravenous thrombolysis may be safely used in the treatment of embolic stroke due to cardiac myxoma. PMID:25217477

  12. Right Atrial Thrombus Mimicking Myxoma with Pulmonary Embolism in a Patient with Systemic Lupus Erythematosus and Secondary Antiphospholipid Syndrome

    PubMed Central

    Cianciulli, Tomás F.; Saccheri, María C.; Redruello, Héctor J.; Cosarinsky, Lucas A.; Celano, Leonardo; Trila, Carla S.; Parisi, Coloma E.; Prezioso, Horacio A.

    2008-01-01

    Antiphospholipid syndrome is a well-defined entity that is characterized by spontaneous abortion, thrombocytopenia, and recurrent arterial and venous thromboses. A partially calcified right atrial thrombus mimicking myxoma with recurrent pulmonary embolism has not been previously reported in a patient who also had systemic lupus erythematosus and secondary antiphospholipid syndrome. Herein, we describe the case of a 37-year-old woman with systemic lupus erythematosus and secondary antiphospholipid syndrome who was admitted to the hospital with progressive exertional dyspnea. Ventilation-perfusion scanning showed multiple parenchymal defects in the lungs that portended pulmonary embolism. In addition, the scanning revealed normal regional ventilation. Transthoracic and transesophageal echocardiography showed a right atrial mass that was highly suggestive of myxoma, and the patient subsequently underwent surgery. A histologic examination showed an organized, partially calcified thrombus. Intracardiac thrombus has been rarely reported as a complication of antiphospholipid syndrome. In our patient, the preoperative investigations could not differentiate the partially calcified right atrial thrombus from a myxoma, and the diagnosis was made postoperatively. PMID:19156241

  13. Intramuscular myxoma of the deltoid muscle: report of a case

    PubMed Central

    Costamagna, Daniela; Erra, Stefania; Durando, Riccardo

    2009-01-01

    Intramuscular myxoma is a rare, benign lesion of mesenchymal origin, affecting the skeletal muscles. We report the case of a 75-year-old woman presenting with a mass of the right deltoid region. On the MRI examination it was interpreted as a lipomatous lesion. She underwent marginal excision. The pathological examination revealed the diagnosis of intramuscular myxoma. PMID:21686685

  14. Left Ventricular Myxoma Leading to Stroke: A Rare Case Report.

    PubMed

    Kong, Yan; Li, Huan; Wang, Jin; Chai, Yongna; Hou, Wuhui; Zhang, Ning

    2015-11-01

    Primary cardiac tumors are rare, and most are myxomas. Only approximately 5% of cardiac myxomas originate from the ventricles.We report the case of a 23-year-old man presenting with right hemiplegia and muscle strength degeneration under a diagnosis of stroke. Transthoracic echocardiography revealed a 29?×?26?mm mass arising from the anterior interventricular septum. The tumor was surgically removed, and histology confirmed the diagnosis of left ventricular myxoma.We report its clinical features and treatment to add to the current knowledge. PMID:26559257

  15. Atrial myxoma

    MedlinePLUS

    ... swelling ( clubbing ) of the fingers Fever Fingers that change color upon pressure or with cold or stress General discomfort ( malaise ) Joint pain Swelling in any part of the body Weight loss without trying

  16. Odontogenic Myxoma of the Maxilla- A Rare case Report

    PubMed Central

    Subramaiam, Ramkumar; Narasimhan, Malathi; Giri, Veda; Kumar, Santhosh

    2015-01-01

    Odontogenic myxoma (OM) is an uncommon, benign, locally invasive, non-metastasizing neoplasm arising from the odontogenic ectomesenchyme that usually occurs in the tooth bearing areas of the jaws. These lesions arouse special interest as they pose high diagnostic challenge. Here, we present a rare case of OM of the maxilla in an 18-year-old male. The clinical, radiographic and histopathological features of the lesion are discussed in this paper. PMID:26155585

  17. Atrial myxoma presenting as total occlusion of the abdominal aorta and its major four branches.

    PubMed

    Huang, Chun-Yang; Chang, Yu-Yao; Hsieh, Ming-Yu; Hsu, Chiao-Po

    2012-07-01

    The presentations of cardiac myxoma are diverse, from asymptomatic to a variety of symptoms due to embolization. Occlusion of abdominal aortic bifurcation by straddled myxoma is not common; however, obstructive level above renal artery is very rare. We present a patient with cardiac myxoma who presented with acute onset of paraplegia. The aorta was occluded from the level of the liver dome to the renal arteries, and catastrophic outcome (ischemia/reperfusion) following its removal. PMID:22824050

  18. Peripheral odontogenic myxoma: a review of the literature and report of two cases.

    PubMed

    Raubenheimer, Erich J; Noffke, Claudia E

    2012-03-01

    Two cases of peripheral odontogenic myxoma with a verifiable location in gingival soft tissue and without bone involvement were compared with those reported in the literature. This study showed that they form a distinct albeit rare clinical entity with a potential to grow into large disfiguring lesions. The probability that small peripheral odontogenic myxomas are interpreted as edematous irritation fibromas may contribute to the small number of peripheral odontogenic myxomas recorded in the literature. The differential diagnosis of soft tissue myxoid proliferations is discussed. PMID:23449257

  19. Myxoma of the upper leg originating from an appendiceal mucinous neoplasm: A case report

    PubMed Central

    LI, JUN; ZHANG, XUE-YAN; WANG, BIN; CAO, QING-YONG

    2015-01-01

    Myxoma is rare in the upper leg. The current study presents the case of a large tumor in the right upper leg. The tumor extended to pelvic cavity and was found to be connected with a cystic and solid neoplasm that was adjacent to the ascending colon in the right lower quadrant. The large tumor of the upper leg had existed for 15 years and had ulcerated through the skin 4 days prior to admittance. Palliative surgery was performed, with histological findings of a myxoma. Since appendiceal mucinous neoplasms may invade organizations outside of the mucous layer of the appendix and cause secondary peritoneal myxoma, this myxoma of the upper leg probably originated from an appendiceal mucinous neoplasm.

  20. Oncologic profile of maxillary odontogenic myxoma: A rare case

    PubMed Central

    Sarkar, Reena Radhikaprasad

    2013-01-01

    Odontogenic myxoma (OM) is an ectomesenchyme derived neoplasm, almost exclusively found in jaws. This article presents a maxillary OM with a brief review of the molecular and proteomic antecedents of OMs, capturing its histopathogenesis. PMID:24124309

  1. Peripheral myxoma of the infratemporal region: An unusual case report

    PubMed Central

    Kapoor, Prathmesh; Gandhewar, Trupti M.; Andrade, Neelam N.; Desai, Rajiv S.

    2015-01-01

    Odontogenic myxoma (OM) is a rare locally invasive benign neoplasm, almost exclusively occurring in the jawbones, comprising 3–6% of all the odontogenic tumors. The mandible is more commonly involved than the maxilla. Intraoral soft tissue myxoma is an extremely rare lesion and only few reports are available in the literature. We present probably the first of its kind in literature a soft tissue OM occurring in an unusual location: the infratemporal fossa. PMID:26605148

  2. Fibrous dysplasia of bone associated with soft-tissue myxomas as well as an intra-osseous myxoma in a woman with Mazabraud's syndrome: a case report

    PubMed Central

    2011-01-01

    Introduction Mazabraud's syndrome is a rare but well-described disorder characterized by fibrous dysplasia in single or multiple bones associated with one or more soft-tissue myxomas. In this report, we describe what is, to the best of our knowledge, the first case involving an intra-osseous myxoma. This finding supports, and could provide new insight into, the pathological association between fibrous dysplasia and myxomas. Case presentation In this report, we describe the case of a 49-year-old Caucasian woman known for years to have fibrous dysplasia in the left femur and tibia who presented with progressive pain in her left leg and soft swelling in the left quadriceps region. After surgical intervention with excision of the soft-tissue mass, the diagnosis of Mazabraud's syndrome was confirmed. During follow-up, our patient presented with a painless mass located on the lateral side of the left knee, next to a second, intra-osseous lesion with the same characteristics in the left lateral tibial plateau. The histopathological examination was consistent with a soft-tissue intra-osseous myxoma. Conclusion In the international literature, 67 cases of Mazabraud's syndrome have been described so far. To our knowledge, the present case report is the first to describe the combination of polyostotic fibrous dysplasia and intra-muscular as well as intra-osseous myxoma. PMID:21707965

  3. Treatment of odontogenic myxoma: a multidisciplinary approach-6-year follow-up case.

    PubMed

    de Souza, João Gustavo Oliveira; Claus, Jonathas Daniel Paggi; Ouriques, Felipe Damerau; Gil, Luiz Fernando; Gil, José Nazareno; Cardoso, Antonio Carlos; Bianchini, Marco Aurélio

    2014-01-01

    The most aggressive diseases that affect the oral environment are considered tumors of the jaw. The surgical treatment is preferably done by surgical resection of the lesion, resulting in a great loss of tissue and esthetics. Multidisciplinary planning is required for the rehabilitation of these cases. Autogenous grafting techniques or vascularized flaps allow ridge reconstruction for implant placement, restoring function, and esthetics. This paper reports a 6-year follow-up case of an odontogenic myxoma treated with wide resection and mandibular bone reconstruction for posterior rehabilitation with dental implants. PMID:25580309

  4. Treatment of Odontogenic Myxoma: A Multidisciplinary Approach—6-Year Follow-Up Case

    PubMed Central

    de Souza, João Gustavo Oliveira; Claus, Jonathas Daniel Paggi; Gil, Luiz Fernando; Gil, José Nazareno; Cardoso, Antonio Carlos

    2014-01-01

    The most aggressive diseases that affect the oral environment are considered tumors of the jaw. The surgical treatment is preferably done by surgical resection of the lesion, resulting in a great loss of tissue and esthetics. Multidisciplinary planning is required for the rehabilitation of these cases. Autogenous grafting techniques or vascularized flaps allow ridge reconstruction for implant placement, restoring function, and esthetics. This paper reports a 6-year follow-up case of an odontogenic myxoma treated with wide resection and mandibular bone reconstruction for posterior rehabilitation with dental implants. PMID:25580309

  5. Peripheral odontogenic myxoma of maxillary gingiva: A rare clinical entity.

    PubMed

    Jain, Vijay Kumar; Reddy, Soundarya Narayana

    2013-09-01

    Odontogenic myxoma comprises 3-6% of all odontogenic tumors. Odontogenic myxomas are relatively rare benign mesenchymal tumors found exclusively in the tooth-bearing areas of the jaw and are usually located centrally in the mandible. Soft-tissue localization is rarely seen and is classified as peripheral myxoma. Peripheral myxoma is slow growing and less aggressive, as compared to the central myxoma. It has a low recurrence rate. Till date, only few cases of maxillary gingival myxomas are reported in the literature. Here, we present an unusual case of primary peripheral odontogenic myxoma occurring in the gingiva of anterior maxilla in a 41-year-old female patient. PMID:24174762

  6. Intramuscular myxoma of the left leg—Case report of the lesion observed for several years

    PubMed Central

    Spycha?a, Arkadiusz; Murawa, Dawid; Nizio?ek, Aleksander

    2011-01-01

    Aim The aim of this study was to present the process of diagnosis and treatment of a patient with diagnosed intramuscular myxoma in the left lower limb. Background Myxomas are benign neoplasms which can be found within large muscle groups. Histologically, these neoplasms are composed of a few elongated or star-shaped cells lying in abundant mucoid stroma. These tumours are characterized by expanding growth without forming distant metastases. Case description A man, 58, came to the Surgical Oncology Outpatient Clinic due to pain ailments and a growing tumour located in the rear group of the left shank muscles. The patient had been observing the lesion for several years, but related the occurrence of pain to the change in the nature of his job – from sedentary to standing. The patient underwent diagnostic imaging, a magnetic resonance imaging test, in which a tumour was described. A surgery was carried out where the tumour was resected together with the lateral head of the gastrocnemius muscle. No significant walking disorders, neurological deficits, either sensory or motor were observed. The follow-up imaging examinations, which were carried out a year after the surgery, did not reveal a relapse. The patient remains under the care of the Surgical Oncology Outpatient Clinic. Conclusion Myxomas are a group of benign neoplasms whose first symptom is the appearance of a palpable tumour whose stretching growth causes painful ailments. After magnetic resonance imaging and a diagnosis, it is necessary to plan the surgery. Radical resection of the lesion is a method of choice which guarantees long-lasting recovery. PMID:24376960

  7. Cardiac Myxoma With Unusual Obstructive and Embolic Presentations

    PubMed Central

    Chen, Robert Jeen-Chen; Chou, Hsin-Hua; Tsai, Kuei-Ton; Shen, Ta-Chung; Hu, Chin-Yuan

    2015-01-01

    Abstract We present a case of cardiac myxoma with atypical presentations of concurrent stroke and angiography-negative myocardial infarction. The case emphasizes the importance of basic echocardiography and timely surgery in the management of cardiac myxoma. An elderly woman presented to the emergency department in an unconscious state. Electrocardiogram and elevated cardiac enzymes suggested acute myocardial infarction; however, immediate coronary angiography proved patency. Basic echocardiography revealed an oscillating left atrial myxoma obstructing inflow through the mitral valve. After regaining consciousness while in the intensive care unit, the patient developed respiratory distress and shock, and emergent en bloc resection was performed. Ataxia was noted in her postoperative course and multiple small cerebellar infarcts were found on magnetic resonance imaging. After a 1-month period of rehabilitation, the patient recovered well and continues to be followed as an outpatient. Cardiac myxoma requires timely management and may be missed if not included in the differential diagnoses. Basic echocardiography, also called focused cardiac ultrasound, may aid in the diagnosing of perplexing cardiac cases. PMID:26402823

  8. Odontogenic myxoma of maxilla: A review discussion with two case reports

    PubMed Central

    Limdiwala, Piyush; Shah, Jigna

    2015-01-01

    Odontogenic myxoma (OM) is a rare entity of slowly growing benign neoplasm of ectomesenchymal origin, comprising of 3–6% of all odontogenic tumors that histologically presenting spindle-shaped, stellate and round cells within loosely arranged myxomatous tissue stroma. OM originates from the dental papilla, follicle or periodontal ligament with an exclusive location in the tooth-bearing areas of the jaws, association with missing or unerupted teeth. Clinically and radiographically the reported incidence and demographic information of this tumor has wide variability. Most common clinical variant is associated with the impacted tooth and shows local invasion with destruction of adjacent structures and displacement of teeth. Radiographically, common manifestations are multilocular radiolucent areas with well-defined borders and typical soap bubble or tennis racket appearances. This paper presents two rare case reports of OM of maxilla along with review discussion. PMID:25684930

  9. Carney Complex: case report and review

    PubMed Central

    2011-01-01

    Carney complex is a very rare multiple neoplasia syndrome with cardiac, cutaneous, and neural tumours with a variety of pigmented lesion of skin. We are reporting a rare case of carney complex in which left atrial myxoma with superficial angiomyxoma, giant cell tumour of bone and lentigines showed a unique association. This patient underwent successful surgical excision of left atrial myxoma under cardiopulmonary bypass. PMID:21375769

  10. NASA's First Atrial Fibrillation Case - Deke Slayton

    NASA Technical Reports Server (NTRS)

    Tarver, William J.

    2010-01-01

    Concerns about heart dysrhythmia have been present since the earliest days of the US manned space program. While information about an astronaut's health is general kept private, one of the original seven American astronaut's health status was played out in a very public forum. Donald "Deke" Slayton was removed from the second manned space flight when it was discovered he had idiopathic atrial fibrillation. Referencing the original medical documents, details of how this was discovered and managed from the medical perspective will be reviewed. This is NASA's first heart dysrhythmia case in an astronaut and it proves quite interesting when placed in historic perspective.

  11. Cellular neurothekeoma: case report and its (un) relation with nerve sheath myxoma*

    PubMed Central

    Navarrete-Dechent, Cristián; Curi-Tuma, Maximiliano; Marín, Celeste; González, Sergio; Sandoval-Osses, Mauricio

    2015-01-01

    Neurothekeoma is an uncommon, benign neoplasm presenting in young adults, primarily on the head and neck. It was initially related to nerve sheath myxoma but with the advent of immunohistochemistry, new insights into its cellular differentiation and origin have emerged, unlinking Neurothekeoma and nerve sheath myxoma. Herein we describe a 19-year-old male who had had a frontal, fl esh-colored, asymptomatic papule for 2 years. Histology showed a dermal fusocellular-spindle cell tumor, including an eosinophilic cytoplasm with mild cellular pleomorphism and moderately dense fi brous stroma. IHQ was positive for CD10 and negative for S100 and Claudin-1. These fi ndings were compatible with cellular Neurothekeoma. The lesion was completely extirpated and at the 6-month follow-up, the patient was asymptomatic and had experienced no recurrences. PMID:26312702

  12. Stroke of a cardiac myxoma origin

    PubMed Central

    Yuan, Shi-Min; Humuruola, Gulimila

    2015-01-01

    Objective The clinical features of cardiac myxoma stroke have not been sufficiently described. Debates remain concerning the options and timing of treatment and the clinical outcomes are unknown. This article aims to highlight the pertinent aspects of this rare condition. Methods Data source of the present study came from a comprehensive literature collection of cardiac myxoma stroke in PubMed, Google search engine and Highwire Press for the year range 2000-2014. Results Young adults, female predominance, single cerebral vessel (mostly the middle cerebral artery), multiple territory involvements and solitary left atrial myxoma constituted the outstanding characteristics of this patient setting. The most common affected cerebral vessel (the middle cerebral artery) and areas (the basal ganglion, cerebellum and parietal and temporal regions) corresponded well to the common manifestations of this patient setting, such as conscious alteration, ataxia, hemiparesis and hemiplegia, aphasia and dysarthria. Initial computed tomography scan carried a higher false negative rate for the diagnosis of cerebral infarction than magnetic resonance imaging did. A delayed surgical resection of cardiac myxoma was associated with an increased risk of potential consequences in particular otherwise arterial embolism. The mortality rate of this patient population was 15.3%. Conclusion Cardiac myxoma stroke is rare. Often does it affect young females. For an improved diagnostic accuracy, magnetic resonance imaging of the brain and echocardiography are imperative for young stroke patients in identifying the cerebral infarct and determining the stroke of a cardiac origin. Immediate thrombolytic therapy may completely resolve the cerebral stroke and improve the neurologic function of the patients. An early surgical resection of cardiac myxoma is recommended in patients with not large territory cerebral infarct. PMID:26107455

  13. Orbital nerve seath myxoma with extraocular muscle involvement: a rare case.

    PubMed

    Rodríguez-Uña, Ignacio; Troyano-Rivas, Juan A; González-García, Cristina; Chícharo-de-Freitas, Reinaldo; Ortiz-Zapata, Juan J; Ortega-Medina, Luis; Toledano-Fernández, Nicolás; García-Feijoo, Julián

    2015-07-01

    A 66-year-old woman with breast cancer presented with a painless mass in the left orbit. MRI revealed a well-defined intraconal mass in the temporal quadrant of the orbit. Fifteen months later, a further MRI indicated the mass had grown, displacing the left optic nerve and making contact with the lateral rectus muscle, suggesting its possible intramuscular origin. Despite the clinical and radiological characteristics of the lesion and its slow growth, a PET/CT study was developed because of the history of malignant disease. No metabolic activity of the mass or malignant lesion in other locations was observed. After surgical excision, histopathological examination revealed an abundant myxoid matrix with few spindle-shaped cells and no signs of malignancy. The cells were immunopositive for CD34, positive for S-100 protein, and negative for EMA, actin, and CD57. A diagnosis was made of a nerve sheath myxoma. The orbital location of these tumors is extremely rare. PMID:24475917

  14. Cardiac myxoma in pregnancy: a comprehensive review

    PubMed Central

    Yuan, Shi-Min

    2015-01-01

    Objective Cardiac myxoma in pregnancy is rare and the clinical characteristics of this entity have been insufficiently elucidated. This article aims to describe the treatment options and the risk factors responsible for the maternal and feto-neonatal prognoses. Methods A comprehensive search of the literature of cardiac myxoma in pregnancy was conducted and 44 articles with 51 patients were included in the present review. Results Transthoracic echocardiography was the most common diagnostic tool for the diagnosis of cardiac myxoma during pregnancy. Cardiac myxoma resection was performed in 95.9% (47/49); while no surgical resection was performed in 4.1% (2/49) patients (P=0.000). More patients had an isolated cardiac myxoma resection in comparison to those with a concurrent or staged additional cardiac operation [87.2% (41/47) vs. 12.8% (6/47), P=0.000]. A voluntary termination of the pregnancy was done in 7 (13.7%) cases. In the remaining 31 (60.8%) pregnant patients, cesarean section was the most common delivery mode representing 61.3% and vaginal delivery was more common accounting for 19.4%. Cardiac surgery was performed in the first, second and third trimester in 5 (13.9%), 14 (38.9%) and 17 (47.2%) patients, respectively. No patients died. In the delivery group, 20 (76.9%) neonates were event-free survivals, 4 (15.4%) were complicated and 2 (7.7%) died. Neonatal prognoses did not differ between the delivery modes, treatment options, timing of cardiac surgery and sequence of cardiac myxoma resection in relation to delivery. Conclusion The diagnosis of cardiac myxoma in pregnancy is important. Surgical treatment of cardiac myxoma in the pregnant patients has brought about favorable maternal and feto-neonatal outcomes in the delivery group, which might be attributable to the shorter operation duration and non-emergency nature of the surgical intervention. Proper timing of cardiac surgery and improved cardiopulmonary bypass conditions may result in even better maternal and feto-neonatal survivals. PMID:26313731

  15. A Primary Ossifying Intracranial Myxoma Arising from the Ethmoid Sinus

    PubMed Central

    Ryu, Je Il; Kim, Jae Min; Kim, Choong Hyun

    2015-01-01

    Myxomas are rare benign tumors that originate from mesenchymal tissue. They usually develop in the atrium of the heart, the skin, subcutaneous tissue, or bone. Involvement of the skull base with an intracranial extension is very rare and not well-described in the literature. We report a rare case of primary intracranial ossifying myxoma arising from the anterior skull base and mimicking a huge chondrosarcoma, and we review the relevant literature. PMID:26539274

  16. Right atrial tumor embolism from thoracic chondrosarcoma: A case report

    PubMed Central

    LV, LIYUAN; WANG, XUEQIAN; ZHANG, YING

    2015-01-01

    Chondrosarcoma accounts for ~15% of all primary malignant bone tumors. Chondrosarcoma of the spine is rare, while intra-atrial tumor embolisms as a result of chondrosarcoma are extremely rare. In the present study, the case of a 70-year-old male with thoracic chondrosarcoma, who presented with a fever and exertional dyspnea, is reported. Following anti-infection treatment with cefoperazone sodium and sulbactam sodium, the patient developed shock and a mass was identified in the right atrium by echocardiogram. The patient subsequently developed acute circular breathing failure and succumbed to the disease. To the best of our knowledge, this is the first case of thoracic chondrosarcoma with a tumor embolism in the right atrium to be reported in the literature. PMID:26722246

  17. [Severe tachycardiomyopathy and thrombus in the left atrial appendage--a case report].

    PubMed

    Soba?ski, Piotr; Gilewski, Wojciech; Sled?, Janusz; Klank-Szafran, Monika; Stec, Sebastian; Zagrodzka, Magdalena; Ptaszkiewicz, Krzysztof; Bujak, Robert; B?a?ejewski, Janusz; Sinkiewicz, W?adys?aw

    2011-01-01

    We describe a case of severe left ventricular (LV) heart failure caused by tachycardiomyopathy with concomitant presence of unsolved thrombus in left atrial appendage despite effective oral anticoagulant treatment. Successful ablation of atrial flutter and atrioventricular nodal reentry tachycardia entailed resolution of heart failure symptoms and normalisation of LV function. PMID:21432810

  18. An unusual complication of atrial fibrillation ablation: case report.

    PubMed

    Petrela, Mentor; Rroji, Arben; Enesi, Eugen; Xhumari, Artur; Lame, Artid

    2015-12-01

    The authors report a complication of catheter ablation that, to their knowledge, has never been previously reported. A 63-year-old man had undergone successful transvenous catheter thermoablation for atrial fibrillation. The patient remained well until 3 days prior to further admission when he noticed itching in the right frontal area of his scalp. On palpating his scalp, he discovered a metallic body projecting out of it and he proceeded to extract 20 cm of wire from his head. The following day a progressive left hemiplegia developed, and the patient experienced a deteriorating level of consciousness. A CT scan of the brain showed a right frontotemporal intraparenchymal hemorrhage and revealed a metallic structure in the middle of the hematoma. The hematoma was evacuated and a decompressive craniotomy was performed. The guidewire was identified, but it was only possible to extract part of it. It was covered by fibrous tissue, secondary to inflammatory reaction. To the authors' knowledge, this is the first report of guidewire-induced brain hemorrhage. The guidewire apparently had not been removed and had spontaneously migrated from the heart to the brain and beyond to the scalp where it then exited the patient's head. The patient had been well before he attempted to pull out the wire. Earlier identification of the iatrogenic complication of a retained guidewire might have prevented the fatal outcome in this case. PMID:26047416

  19. Myxoma of the temporal bone: an uncommon neoplasm.

    PubMed

    Sareen, Deepika; Sethi, Ashwani; Mrig, Sumit; Nigam, Sonu; Agarwal, A K

    2010-03-01

    We report the case of an 11-year-old girl who presented with a soft-tissue mass that filled the left external auditory canal and a discharge that resembled chronic suppurative otitis media. The patient underwent mastoid exploration with complete excision of the mass. Findings on the excision biopsy were consistent with a myxoma of the temporal bone. At follow-up 2 years postoperatively, the patient remained disease-free. To the best of our knowledge, this is only the 12th case of a myxoma of the temporal bone to be reported in the English-language literature. PMID:20229465

  20. Non-small cell lung cancer with concomitant intramuscular myxoma of the right psoas mimicking intramuscular metastasis: A case report and literature review

    PubMed Central

    ZHANG, PENG; MENG, XUE; XIA, LIANKE; XIE, PENG; SUN, XINDONG; GAO, YONGSHENG; WANG, SHIJIANG; ZHAO, XIANGUANG; YU, JINMING

    2015-01-01

    Intramuscular myxoma (IMM) as a rare soft-tissue tumor arising from the muscles is completely benign. When IMM accompanies malignance, it may be misdiagnosed as muscle metastasis, and for this extremely rare concurrence, the subsequent treatment would vary accordingly. The current study presents, to the best of our knowledge, the first case of non-small cell lung cancer (NSCLC) concomitant with IMM mimicking skeletal muscle metastasis. A 64-year-old female was hospitalized with a history of chest discomfort and right lumbar pain that had persisted for four months. The computed tomography scan showed a lesion in the left upper lobe of the lung and the right psoas, respectively. Serum biomarkers for NSCLC were abnormal. A presumptive clinical diagnosis was compatible with left NSCLC and right psoas muscle metastasis (cT2aN3M1b, stage IV). Stage IV lung cancer would receive palliative treatment. However, the final diagnosis of synchronous left lung squamous cell carcinoma (cT2aN3M0, stage IIIB) and IMM in the right psoas was confirmed by biopsy. The patient therefore underwent definitive chemoradiotherapy for lung carcinoma, and conservative treatment, including analgesics, for IMM. The diagnosis process for a malignant neoplasm concomitant with IMM is not straightforward due to a lack of clinical experience, and it significantly affects the tumor staging and subsequent treatment strategy. The present case suggests that IMM should be included in the differential diagnosis when an abnormal intramuscular lesion concomitant with malignancy is identified. The value of histopathological diagnosis prior to definitive treatment also requires highlighting. PMID:26722289

  1. Soft Tissue Myxoma- A Rare Differential Diagnosis of Localized Oral Cavity Lesions

    PubMed Central

    Rao, Raghavendra A; Prasad, Vishnu; Kamath, Panduranga M; Rao, Kanishka S

    2014-01-01

    Myxomas have a common histologic appearance of myxoid ground substance and are classified in group of soft tissue tumors. According to literature myxomas occurring in every decade of life have been reported. Very often intraoral soft tissue myxoma can be misinterpreted as malignant and are difficult to differentiate from the other tumours with myxoid stroma. Of the different variants of soft tissue myxoma, intraoral is extremely rare, slow growing, benign mesenchymal tumour. We report a case of a 22-year-old male who presented with swelling in the right cheek and mass in the right buccal mucosa that appeared gradually over two year. No history of pain over the lesion or bleeding on touch. On intraoral examination a lesion measuring 3 X 3 cm was seen in the right buccal mucosa. Biopsy of the lesion revealed oral soft tissue myxoma. Wide excision with clinically clear margins was done under general anaesthesia. Histopathological report revealed the diagnosis as to be oral soft tissue myxoma. A case of oral soft tissue myxoma is presented for its rarity and for differential diagnosis of localized oral cavity lesions. PMID:25653975

  2. Case report: Atrial fibrillation following exposure to ambient air pollution particles

    EPA Science Inventory

    CONTEXT: Exposure to air pollution can result in the onset of atrial fibrillation. CASE PRESENTATION: We present a case of a 58 year old woman who volunteered to participate in a controlled exposure to concentrated ambient particles (CAPs). Twenty minutes into the exposure, there...

  3. Humongous right atrial lipoma: a correlative CT and MR case report

    PubMed Central

    Barbuto, Luigi; Ponsiglione, Andrea; Del Vecchio, Walter; Altiero, Michele; Rossi, Giovanni; De Rosa, Dario; Pisani, Antonio

    2015-01-01

    A 66-year-old man was referred to our department for further investigation of a right atrial mass incidentally discovered on ultrasound examination (US). US showed an oval mass arising from the free wall of the right atrium and projecting into the atrial cavity. The mass was hypoechoic and had a broad base of attachment on the free wall of the right atrium. This case was referred to our department in order to perform an MR cardiac examination. Our diagnosis was supported by a CT scan study that confirmed the diagnosis of a cardiac lipoma subsequently confirmed at surgery. PMID:26682146

  4. Right Atrium Myxoma After Lung Adenocarcinoma

    PubMed Central

    Abbasi Tashnizi, Mohhamad; Soltani, Ghasem; Mehrabi Bahar, Mostafa; Ahmadi, Mahnaz; Golmakani, Ebrahim; Saremi, Elena

    2015-01-01

    Introduction: Heart secondary tumors are much more common than primary tumors. These two types of tumors differ not only by their source but also by their symptoms and location in heart chambers. Case Presentation: This report presents a 66-year-old heavy smoker female with a history of pulmonary lobectomy due to lung adenocarcinoma, hysterectomy due to myoma, and lumpectomy due to benign breast mass, who had symptoms of right heart failure for months. Physical examinations followed by imaging showed a mass in her right atrium, which was most likely, a myxoma. After a successful surgical excision, histopathological findings confirmed the diagnosis. More studies are needed to evaluate a possible combination between these soft tissue masses. Conclusions: A right atrium myxoma in a patient with a history of multiple soft tissue tumors has been limited to only a few cases. This may suggest a genomic affinity or similarity; if so, those with multiple different type soft tissue masses should be screened for a heart mass before the mass becomes complicated.

  5. Neonatal aortic arch obstruction due to pedunculated left ventricular foetal myxoma.

    PubMed

    Kaulitz, Renate; Haen, Susanne; Sieverding, Ludger

    2015-10-01

    Myxoma in neonatal life are extremely rare. We report a case of a neonate with a pedunculated cardiac tumour arising from the anterolateral left ventricular wall protruding across the left ventricular outflow tract and continuously extending into the distal aortic arch. Surgical removal at 14 days of age via combined transaortic approach and apical ventriculotomy was indicated because of the risk of further compromise of aortic valve function and aortic arch obstruction. Histopathologic examination was consistent with a myxoma. PMID:25317783

  6. Maternal antibody-associated fetal second-degree heart block and atrial flutter: case report and review.

    PubMed

    Sacks, Jeffrey H; Samai, Cyrus; Gomez, Kevin; Kanaan, Usama

    2013-01-01

    Exposure to maternal anti-Ro (SS-A) and anti-La (SS-B) antibodies is a well-described risk factor for the development of fetal atrioventricular (AV) block. The role of maternal fluorinated steroids in the treatment and prevention of antibody-mediated fetal AV block is controversial. Fetal atrial flutter has rarely been described in association with maternal antibodies. This report describes a case of fetal exposure to maternal anti-Ro antibodies with associated second-degree AV block and atrial flutter. Interestingly, the reported patient had 2:1 AV conduction during both normal atrial rates (consistent with AV node conduction disease) and episodes of flutter (consistent with physiologic AV node functionality). The fetus was treated with transplacental digoxin and dexamethasone, which resolved both rhythm disturbances. The case report is followed by a brief discussion of AV block and atrial flutter associated with maternal antibody exposure. PMID:23179428

  7. Right atrial aneurysm in adults--report of three cases and review of literature.

    PubMed

    Chockalingam, Anand; Alagesan, R; Gnanavelu, G; Dorairajan, Smrita; Subramaniam, T

    2004-10-01

    Right atrial aneurysm (RAA) or RA diverticula are described as saccular structures originating from the RA free wall. This must be differentiated from aneurysmal dilation of the entire right atrium. We diagnosed three cases of RAA since 2000. The first patient presented with effort intolerance, the second with recurrent palpitations, and the third was totally asymptomatic. In all the cases transthoracic echocardiography was definitive with little additional information obtained from catheterization. We report our experience and review the literature pertaining to adult presentation of this interesting pathology, of which only 20 cases have thus far been reported. PMID:15488094

  8. Renal Myxoma- A Rare Variety of Benign Genitourinary Tumour

    PubMed Central

    Vanikar, Aruna V.; Patel, Rashmi D.; Kanodia, Kamal V.

    2015-01-01

    Renal myxomas are rare neoplasms and very few cases have been reported in literature. Here we report a renal myxoma in a 48-year-old lady with hypothyroidism who presented with abdominal pain. She was found to have a mass lesion of 67 x 61 x 74 mm with exophytic component in the right kidney on ultrasonography and computed tomography. Right radical nephrectomy was performed due to suspicion of malignancy. Grossly the resected kidney showed a gelatinous, semi-translucent mass involving the mid and lower poles. Microscopy revealed marked hypocellular appearance of loose myxoid tissue with foamy histiocytes. Tumour cells were reactive for vimentin. At eight months of follow-up, patient is doing well. PMID:26557531

  9. Cardiac Involvement in Non-Hodgkin Lymphoma, an Incidental Large Atrial Mass: A Case Report

    PubMed Central

    Aledavood, Seyed Amir; Emadi Torghabeh, Ali; Homaee Shandiz, Fateme; Memar, Bahram

    2015-01-01

    Introduction: Cardiac involvement as an initial presentation of malignant lymphoma has been a rare occurrence. Case Presentation: We have reported a 78 year old man with complaint of abdominal pain and vomiting. In patients preoperative evaluation for surgical management of an intra-abdominal mass, a large intracardiac mass has found incidentally during the echocardiography. Pathologic biopsy of right atrial mass that has removed by open heart surgery shown: non Hodgkin-B cell lymphoma. Bone marrow biopsy was taken and was positive for lymphomatous involvement. Conclusions: The patient has treated by CHOP chemotherapy regiment successfully and after completion of treatment, there was complete response.

  10. Supraventricular tachycardia and atrial flutter associated with a coronary sinus diverticulum: A case report.

    PubMed

    Wu, Xiaolin; Zhu, Rui; Jiang, Hong; Liu, Wenwei

    2013-06-01

    The case of a patient with narrow QRS-complex supraventricular tachycardia and atrial flutter is described. The 12-lead surface electrocardiogram (ECG) revealed sinus rhythm with ventricular pre-excitation and negative ? waves in leads II, III and aVF, indicating Wolff-Parkinson-White syndrome with a posteroseptal accessory pathway (AP). Coronary sinus angiography revealed the presence of a diverticulum near the coronary sinus ostium. The AP was successfully ablated using radiofrequency energy applied in the neck of the diverticulum, following several failed attempts at catheter ablation from the endocardial surface of the posteroseptal space. PMID:23837067

  11. Infected Cardiac Myxoma: an Updated Review

    PubMed Central

    Yuan, Shi-Min

    2015-01-01

    OBJECTIVE This study aims to present an updated clinical picture of the infected cardiac myxoma. Revankar & Clark made a systematic review of infected cardiac myxoma based on the literature before 1998. Since then, there has not been any updated information describing its recent changing trends. METHODS A comprehensive literature search of infected cardiac myxoma was conducted on MEDLINE, Highwire Press and Google between 1998 and 2014. RESULTS In comparison with Revankar & Clark's series, the present series disclosed a significantly decreased overall mortality. It is believed that refinement of the prompt diagnosis and timely management (use of sensitive antibiotics and surgical resection of the infected myxoma) have resulted in better outcomes of such patients. CONCLUSION The present series of infected cardiac myxoma illustrated some aggravated clinical manifestations (relative more occasions of high-grade fever, multiple embolic events and the presence of refractory microorganisms), which should draw enough attention to careful diagnosis and treatment. In general, the prognosis of infected cardiac myxoma is relatively benign and the long-term survival is always promising.

  12. Odontogenic myxoma of maxilla: A rare presentation in an elderly female

    PubMed Central

    Vijayabanu, B.; Sreeja, C.; Bharath, N.; Aesha, I.; Kannan, V. Sadesh; Devi, M.

    2015-01-01

    Odontogenic myxomas are rare benign neoplasm of mesenchymal origin, comprising 3–6% of all odontogenic tumors. They are slow growing, non-metastasizing, often asymptomatic with local aggressiveness due to its infiltrative nature and hence high recurrence rate, with a high incidence of occurrence in the mandible. Most frequently occurs in second to third decade of life, seldom occurs beyond these age groups. Hereby, we present a case of odontogenic myxoma occurring in the maxilla in a 65-year-old female managed by partial maxillectomy. PMID:26538962

  13. Tulip deformity with Cera atrial septal defect devices: a report of 3 cases.

    PubMed

    Kohli, Vikas

    2015-02-01

    Device closure of secundum atrial septal defect (ASD) is the treatment of choice when anatomy is favourable. Amplatzer device has remained the gold standard for closure of ASD. Cobra deformity is a well-reported problem with devices. Recently, Tulip deformity has been reported in a single case. We report a series of cases where we noted Tulip deformity along with inability to retract the device in the sheath in Cera Lifetech devices. This resulted in prolongation of procedure, excessive fluoroscopic exposure and additional interventional procedures not usually anticipated in ASD device closure. We believe that the problem is due to the stiffness of the device resulting in its inability to be retracted into the sheath. We also report a unique way of retrieving the device. PMID:25179458

  14. Assessment of percutaneous transluminal coronary angioplasty by atrial pacing and thallium-201 myocardial imaging: a case report

    SciTech Connect

    Stratmann, H.G.; Seuc, C.A.; Mark, A.L.; Walter, K.E.; Kennedy, H.L.

    1986-08-01

    Combined atrial pacing and thallium-201 scintigraphy were performed in a man with multiple coronary artery lesions unable to perform exercise stress testing. Severe angina and ischemic ST depression in the inferior and anterior ECG leads occurred at a peak double product of 22,400 beats-mm Hg/min; thallium-201 scintigraphy showed reversible perfusion defects of the inferior, posterior, and septal segments. After angiographically successful angioplasty of a 95% right coronary artery lesion, repeat atrial pacing/thallium-201 scintigraphy (peak double product 27,750 beats-mm Hg/min) produced mild angina no ST depression in the inferior leads, and a normal thallium-201 scan. This case illustrates the value of the atrial pacing/thallium-201 stress test for evaluating the need for, and results of, coronary angioplasty in patients unable to perform exercise stress testing.

  15. Atrial septal aneurysm associated with additional cardiovascular comorbidities in two middle age female patients with ECG signs of right bundle branch block: two case reports

    PubMed Central

    Bakalli, Aurora; Kamberi, Lulzim; Pllana, Ejup; Gashi, Afrim

    2008-01-01

    Introduction Atrial septal aneurysm (ASA) is often associated with other atrial septal abnormalities, particularly with atrial septal defect type ostium secundum or patent foramen ovale. ECG signs of incomplete or complete right bundle branch block are known to be associated with atrial septal defects, however such correlation with other atrial septal abnormalities is not documented. Case presentations We report here two cases of middle age female patients that presented with dyspnea on physical effort, right bundle branch block (RBBB) on ECG and ASA combined with other cardiac disorders. Transesophageal echocardiography revealed additional information to the ones obtained by surface echocardiography, in both cases. Conclusion ASA associated with RBBB on ECG may serve as a hint for the presence of additional cardiac abnormalities, thus rousing the demand for a detailed cardiac investigation. PMID:18638415

  16. Primary cardiac malignant fibrous histiocytoma with vulvar metastases: A case report

    PubMed Central

    SUN, JUNJIE; LIU, RUIHUA; WANG, WEIWEI; SUN, MINGHUI; WANG, LIHONG; WANG, XIAOFEI; SHI, LEI

    2015-01-01

    Malignant fibrous histiocytoma (MFH) occurring in the heart is rare. To the best of our knowledge, the current study was the first to report a case of left atrial MFH metastasizing to the vulva. A 37-year-old female presenting with a history of exertional dyspnea underwent echocardiography, which revealed a mass in the left atrium, with a short-wide stalk attached to the posterior wall, extending into the pericardium. Furthermore, the mass resulted in severe mitral stenosis during diastole. The tumor was excised together with a section of the left atrial wall. The initial diagnosis was a left atrial myxoma. However, post-operative frozen section histopathology results indicated a diagnosis of MFH. Following surgery, the patient received chemotherapy, however, vulvar metastases and left pleural effusions were identified after 1 month. Following surgical excision of the vulvar tumor and left thoracentesis, the patient began adjuvant chemotherapy. However, the patient succumbed due to local recurrence 6 months later. PMID:26722303

  17. Defining Disease Phenotypes Using National Linked Electronic Health Records: A Case Study of Atrial Fibrillation

    PubMed Central

    Denaxas, Spiros C.; Hunter, Ross J.; Patel, Riyaz S.; Perel, Pablo; Shah, Anoop D.; Timmis, Adam D.; Schilling, Richard J.; Hemingway, Harry

    2014-01-01

    Background National electronic health records (EHR) are increasingly used for research but identifying disease cases is challenging due to differences in information captured between sources (e.g. primary and secondary care). Our objective was to provide a transparent, reproducible model for integrating these data using atrial fibrillation (AF), a chronic condition diagnosed and managed in multiple ways in different healthcare settings, as a case study. Methods Potentially relevant codes for AF screening, diagnosis, and management were identified in four coding systems: Read (primary care diagnoses and procedures), British National Formulary (BNF; primary care prescriptions), ICD-10 (secondary care diagnoses) and OPCS-4 (secondary care procedures). From these we developed a phenotype algorithm via expert review and analysis of linked EHR data from 1998 to 2010 for a cohort of 2.14 million UK patients aged ?30 years. The cohort was also used to evaluate the phenotype by examining associations between incident AF and known risk factors. Results The phenotype algorithm incorporated 286 codes: 201 Read, 63 BNF, 18 ICD-10, and four OPCS-4. Incident AF diagnoses were recorded for 72,793 patients, but only 39.6% (N?=?28,795) were recorded in primary care and secondary care. An additional 7,468 potential cases were inferred from data on treatment and pre-existing conditions. The proportion of cases identified from each source differed by diagnosis age; inferred diagnoses contributed a greater proportion of younger cases (?60 years), while older patients (?80 years) were mainly diagnosed in SC. Associations of risk factors (hypertension, myocardial infarction, heart failure) with incident AF defined using different EHR sources were comparable in magnitude to those from traditional consented cohorts. Conclusions A single EHR source is not sufficient to identify all patients, nor will it provide a representative sample. Combining multiple data sources and integrating information on treatment and comorbid conditions can substantially improve case identification. PMID:25369203

  18. A case of right atrial appendage aneurysm mimicking a pericardial cyst on echocardiogram

    PubMed Central

    Toufan, Mehrnoush; Pourafkari, Leili; Akbarzadeh, Fariborz

    2014-01-01

    Summary Right atrial appendage aneurysms (RAAAs) are rarely encountered. If symptomatic, they present with atrial arrhythmias or embolic events. Surgical resection is indicated for symptomatic patients. We describe a 65-year-old man presenting with palpitation for 6 months. Electrocardiogram showed atrial flutter. Transthoracic echocardiography revealed a large thin-walled cystic mass anterior to right ventricular outflow tract, which was confirmed to be a giant RAAA by contrast transoesophageal echocardiography and later by contrast-enhanced computerised tomography. The patient underwent electrocardioversion, following which he remained in sinus rhythm and was asymptomatic during the 3 months follow-up period. Learning points RAAA can present with atrial flutter.Transoesophageal contrast echocardiography is the most valuable non-invasive tool in diagnosis of RAAA.Although computed tomography scan is not necessary for establishing the diagnosis, it may provide useful information regarding the structural anatomy.

  19. A case of aorta-right atrial tunnel presented with an asymptomatic murmur.

    PubMed

    Kim, Kyoung-Nyoun; Cho, Kyoung-Im; Kim, Jae-Joon; Kang, Ji-Hoon; Goo, Ja-Jun; Lee, Ja-Young; Kim, Seong-Man

    2013-09-01

    Aorta-right atrial tunnel is a rare and distinct congenital anomaly. It is a vascular channel that originates from one of the sinuses of Valsalva with a tortuous course anterior or posterior to the ascending aorta, and terminates either in the superior vena cava or in the right atrium (RA). We report a 42-year-old female briefly with aorta-right atrial tunnel in which the left coronary artery arose from the tunnel and terminated into the RA. PMID:24174967

  20. Right Brachial to Atrial Xenograft Conduit for Hemodialysis Access: A Case Report.

    PubMed

    Lu, Tony; Anaya-Ayala, Javier E; Reardon, Michael J; Peden, Eric K; Davies, Mark G

    2015-11-01

    Biologic grafts may be a viable alternative to their prosthetic counterparts in the patients who have exhausted conventional access alternatives given their superior patency rates and possible resilience to infection. This is a case report of a 66-year-old woman with end-stage renal disease and human immunodeficiency virus who has had multiple failed peripheral arteriovenous (AV) fistulas and grafts as well as inferior vena caval obstruction necessitating a transhepatic catheter for hemodialysis (HD). Given the patient's comorbidities and history, a right brachial artery-to-atrial conduit was created for long-term access. Biologic bovine carotid artery was used given its decreased susceptibility to infection and favorable patency rates. The AV access continues to function at 3.5-year follow-up and remains her primary means of HD. We present this novel use of a biologic graft as an option in patients with central venous obstruction and high risk of infection requiring exotic dialysis access. PMID:26315798

  1. Histoplasma capsulatum endocarditis: multicenter case series with review of current diagnostic techniques and treatment.

    PubMed

    Riddell, James; Kauffman, Carol A; Smith, Jeannina A; Assi, Maha; Blue, Sky; Buitrago, Martha I; Deresinski, Stan; Wright, Patty W; Drevets, Douglas A; Norris, Steven A; Vikram, Holenarasipur R; Carson, Paul J; Vergidis, Paschalis; Carpenter, John; Seidenfeld, Steven M; Wheat, L Joseph

    2014-07-01

    Infective endocarditis is an uncommon manifestation of infection with Histoplasma capsulatum. The diagnosis is frequently missed, and outcomes historically have been poor. We present 14 cases of Histoplasma endocarditis seen in the last decade at medical centers throughout the United States. All patients were men, and 10 of the 14 had an infected prosthetic aortic valve. One patient had an infected left atrial myxoma. Symptoms were present a median of 7 weeks before the diagnosis was established. Blood cultures yielded H. capsulatum in only 6 (43%) patients. Histoplasma antigen was present in urine and/or serum in all but 3 of the patients and provided the first clue to the diagnosis of histoplasmosis for several patients. Antibody testing was positive for H. capsulatum in 6 of 8 patients in whom the test was performed. Eleven patients underwent surgery for valve replacement or myxoma removal. Large, friable vegetations were noted at surgery in most patients, confirming the preoperative transesophageal echocardiography findings. Histopathologic examination of valve tissue and the myxoma revealed granulomatous inflammation and large numbers of organisms in most specimens. Four of the excised valves and the atrial myxoma showed a mixture of both yeast and hyphal forms on histopathology. A lipid formulation of amphotericin B, administered for a median of 29 days, was the initial therapy in 11 of the 14 patients. This was followed by oral itraconazole therapy, in all but 2 patients. The length of itraconazole suppressive therapy ranged from 11 months to lifelong administration. Three patients (21%) died within 3 months of the date of diagnosis. All 3 deaths were in patients who had received either no or minimal (1 day and 1 week) amphotericin B. PMID:25181311

  2. Atrioesophageal fistula following ablation procedures for atrial fibrillation: systematic review of case reports

    PubMed Central

    Chavez, Patricia; Messerli, Franz H; Casso Dominguez, Abel; Aziz, Emad F; Sichrovsky, Tina; Garcia, Daniel; Barrett, Connor D; Danik, Stephan

    2015-01-01

    Background Atrioesophageal fistula (AEF) is a rare but serious adverse event of atrial fibrillation (AF) ablation. Objective To identify the clinical characteristics of AEF following ablation procedures for AF and determine the associated mortality. Methods A systematic review of observational cases of AEF following ablation procedures for AF was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. Results 53 cases were identified. Mean age was 54±13?years; 73% (39/53) of cases occurred in males. Mean interval between procedure and presentation was 20±12?days, ranging from 2 to 60?days. AEF was observed in 12 patients who underwent surgical radiofrequency ablation (RFA) and in 41 patients with percutaneous RFA. Fever was the most common presenting symptom (n=44) followed by neurological deficits (n=27) and haematemesis (n=19). CT of the chest (n=27) was the preferred diagnostic test. Patients who did not receive a primary esophageal repair were more likely to have a deadly outcome (34% vs 83%; p<0.05). No difference in mortality rate was found between patients who underwent surgical RFA when compared with percutaneous RFA (58% vs 56%; p=0.579). No association was found between onset of symptoms and mortality (19±10 vs 23±14?days; p=0.355). Conclusions AEF following ablation procedures for AF is a serious complication with high mortality rates. Presenting symptoms most often include a triad of fever, neurological deficit and/or haematemesis within 60?days of procedure. The preferred diagnostic test is CT of the chest. The treatments of choice is surgical repair. PMID:26380098

  3. Percutaneous Retrieval of Embolized Amplatzer Septal Occluder after Treatment of Double Atrial Septal Defect: A Case Report

    PubMed Central

    Cho, Jae Yeong; Yoon, Hyun Ju; Seon, Hyun Ju; Ahn, Youngkeun; Jeong, Myung Ho; Cho, Jeong Gwan; Park, Jong Chun

    2015-01-01

    Embolization of the occlusion device after percutaneous closure of atrial septal defect (ASD) is a potential disastrous complication. The usual site of embolization is the right side of the heart including pulmonary artery, but the device embolization to the extracardiac aorta is extremely rare. Here, we report a successful percutaneous retrieval case of the embolized Amplatzer Septal Occluder (ASO) to the descending thoracic aorta after the successful deployment of two ASO devices in a patient with double ASD. Competition between the two devices to obtain a stable position may be an explanation for the migration of ASO. PMID:26339180

  4. Percutaneous atrial septal defect closure by using jugular venous access in a case with interrupted inferior vena cava.

    PubMed

    Narin, Nazmi; Pamukcu, Ozge; Baykan, Ali; Argun, Mustafa; Ozyurt, Abdullah; Uzum, Kazim

    2014-01-01

    Femoral venous approach is the classical route of percutaneous atrial septal defect (ASD) closure. But in certain circumstances alternative routes are used. In this report percutaneous ASD closure in a case with interrupted vena cava by jugular venous approach is discussed. Percutaneous closure through femoral venous route was planned in a 6-year-old girl with ASD. Because of interrupted vena cava the jugular venous route was used. Having knowledge of this anatomical variation is important for interventionalists before performing femoral venous approach. Percutaneous transjugular venous access is a feasible alternative route in paediatric population for ASD closure. PMID:25489321

  5. Using the condylar prosthesis after resection of a large odontogenic myxoma tumor in the mandible.

    PubMed

    De Melo, Willian Morais; Pereira-Santos, Darklilson; Brêda, Marcus Antônio; Sonoda, Celso Koogi; Hochuli-Vieira, Eduardo; Serra e Silva, Fabrício Moreira

    2012-09-01

    Odontogenic myxomas are considered to be a benign odontogenic tumor with locally aggressive behavior. Because these neoplasms are rare in the oral cavity, the possible surgical management can be quite variable. Literature recommendation can vary from simple curettage and peripheral ostectomy to segmental resection. The authors report a case of a 20-year-old patient with an odontogenic myxoma tumor located in the left mandibular angle, ascending ramus, and mandibular symphysis. It was treated by radical resection followed by titanium reconstruction with condylar prosthesis, which allowed rapid return of function with improvement in quality of life and restoration of cosmetic and functional deficits. The lesion did not recur after surgical procedure. PMID:22976683

  6. Tachycardia-bradycardia syndrome in a patient with atrial fibrillation: a case report.

    PubMed

    Choi, Sung Hwan; Choi, Sung Lark; Lee, Bong Yeong; Jeong, Mi Ae

    2015-08-01

    An 83-year-old woman was scheduled for a second transurethral resection of a bladder tumor. The preoperative electrocardiogram evaluation revealed atrial fibrillation with a slow ventricular response (ventricular rate: 59 /min). After intravenous injection of 1% lidocaine 40 mg and propofol 60 mg, the ventricular rate increased to 113 beats/min and then fell rapidly to 27 beats/min. Blood pressure was 70/40 mmHg. Later an atrial fibrillation rhythm, with a ventricular rate of 100-130 beats/min, was observed together with a sinus pause and sinus rhythm with a ventricular rate of 40-50 beats/min. An external pacemaker was applied and set at 60 mA, 40 counts. After the patient regained consciousness, she presented an alert mental state and had no chest symptoms. She was discharged 2 weeks later without complications after insertion of a permanent pacemaker. PMID:26257858

  7. Cell cycle and apoptosis regulatory proteins, proliferative markers, cell signaling molecules, CD209, and decorin immunoreactivity in low-grade myxofibrosarcoma and myxoma.

    PubMed

    Cates, Justin M M; Memoli, Vincent A; Gonzalez, Raul S

    2015-08-01

    The histologic differential diagnosis between intramuscular myxoma and low-grade myxofibrosarcoma can be quite difficult in some cases. To identify a diagnostic immunohistochemical marker, we compared the staining profiles of 19 different antigens, including cell cycle proteins, apoptosis proteins, and proliferative markers, and selected other signaling and structural proteins in these two tumors. Ten cases each of intramuscular myxoma and low-grade myxofibrosarcoma were stained with antibodies directed against apoptosis regulatory proteins (Bcl2, activated caspase-3, phospho-H2A.X, and cleaved PARP), cell cycle regulatory proteins (Rb1, Cyclin-A, CDKN1B, and Cdt1), proliferative markers (KI67, MCM2, phospho-histone H3, and geminin), cell signalling molecules (c-Myc, EGF, EGFR, PLA2G4A, and HSP90), a dendritic cell marker (CD209), and the extracellular matrix proteoglycan decorin. Staining patterns of myxoma and myxofibrosarcoma were compared using Fisher's exact test and the Mann-Whitney test. For each potential diagnostic marker studied, the proportions of cases scored as positive on both dichotomous or ordinal scales were not significantly different between myxoma and myxofibrosarcoma. Myxoma and myxofibrosarcoma share a common immunophenotype for each of the markers studied. Distinction between these tumors is still predominantly based on morphologic criteria. PMID:25940995

  8. A case report of atrial fibrillation potentially induced by hydroxycut: a multicomponent dietary weight loss supplement devoid of sympathomimetic amines.

    PubMed

    Karth, Abigail; Holoshitz, Noa; Kavinsky, Clifford J; Trohman, Richard; McBride, Brian F

    2010-06-01

    Multicomponent dietary weight loss supplements comprise the single largest segment of herbal preparations available to the public. As a result of limited de novo regulatory oversight, supplement-related adverse events are underreported secondary to the lack of adequate pharmacodynamic, pharmacokinetic, and clinical data. Here we report the case of an obese 63-year-old caucasian female with a 2-day history of symptomatic paroxysmal atrial fibrillation (AF) with rapid ventricular response following a 2-week course of therapy with hydroxycut, a multicomponent dietary weight loss supplement devoid of sympathomimetic amines. Upon presentation, the patient received 2 doses of intravenous diltiazem, was loaded with intravenous digoxin, and spontaneously converted to normal sinus rhythm 36 hours following her last dose of the product. Epigallocatechin (EGCG), a principal ingredient in the hydroxycut preparation is the suspected causative component. EGCG blocks the atrial-specific KCNA5 potassium channel. Loss of KCNA5 function has been reported in patients with familial lone AF. Thus, causal relationship between hydroxycut and AF in this patient is probable. Given the serious risks associated with AF, patients at risk of developing AF should avoid dietary supplements containing EGCG until more information on the adverse effects of EGCG is known. PMID:21507821

  9. Closure of Nonmalignant Tracheoesophageal Fistula Using an Atrial Septal Defect Occluder: Case Report and Review of the Literature.

    PubMed

    Jiang, Ping; Liu, Ji; Yu, Dong; Jie, Bing; Jiang, Sen

    2015-12-01

    Tracheoesophageal fistula (TEF) is a life-threatening condition for which there are several management techniques. We present a case of nonmalignant TEF closure using an atrial septal defect (ASD) occluder. A 53-year-old man with a severe TEF was admitted to our hospital for TEF caused by stenting of an esophagogastric anastomotic stricture. He was successfully treated with closure of the TEF using an endotracheal ASD occluder. Three hundred and eighteen days after placement of the occluder, he suddenly developed a severe cough after dilatation of the esophagogastric anastomosis and spontaneously coughed out the occluder. The fistula was repaired and complete closure that was confirmed on esophagography. He had no recurrence of fistula during the follow-up period of 13 months. PMID:26048016

  10. Atrial natriuretic peptide and aldosterone synthase gene in essential hypertension: a case-control study.

    PubMed

    Chandra, Sudhir; Saluja, Daman; Narang, Rajiv; Bhatia, Jagriti; Srivastava, Kamna

    2015-08-01

    The renin-angiotensin-aldosterone system (RAAS) and their candidate genes are principally involved in regulation of blood pressure through salt-water homeostasis. Atrial natriuretic peptide (ANP) and Aldosterone synthase (CYP11B2) are the important RAAS mediators, play a major role in hypertension through regulation of cardiorenal homeostasis and water-electrolytes balance, respectively. Present study reports the expression of ANP and CYP11B2 gene at mRNA and proteins levels in patients with essential hypertension in North Indian subjects. Gene expression at mRNA and protein levels was carried out by Real time PCR and Western blot, respectively. We found a significant down regulation in the ANP gene expression at mRNA (85%) and protein (72.6%) levels and significant increase in the CYP11B2 protein expression in patients as compared to controls. A significant increase in Serum creatinine (14.6%), Sodium (1.15%) and decrease in the Blood urea (8.18%) and Potassium (2.32%) levels were also observed among the patients group having higher expression (based on median delta-CT value) in comparison to the lower expression of CYP11B2 gene. Our results suggest that the down-regulation of ANP gene expression at mRNA and protein levels and up-regulated CYP11B2 protein expression levels may be correlated with the essential hypertension and could serve as circulating prognostic biomarkers for essential hypertension. PMID:25917967

  11. Genetics of Atrial Septal Defect

    PubMed Central

    Cascos, Andrés Sánchez

    1972-01-01

    Of 109 cases of atrial septal defect, cases with an isolated defect (92 cases) showed a female preponderance (sex ratio 0·64), but there was a higher risk to the sibs of the male patients, suggesting a multifactorial mechanism. Dermatoglyphs showed a large number of whorls on the fingers. In 17 cases there were multiple malformations, such as Holt-Oram syndrome (hypoplastic and triphalangic thumb, with ostium secundum atrial septal defect), polydactyly plus ostium primum defect, and tracheo-oesophageal fistula. ImagesFIG. 1.FIG. 2.FIG. 3. PMID:4261647

  12. Oncolytic myxoma virus: the path to clinic.

    PubMed

    Chan, Winnie M; Rahman, Masmudur M; McFadden, Grant

    2013-09-01

    Many common neoplasms are still noncurative with current standards of cancer therapy. More therapeutic modalities need to be developed to significantly prolong the lives of patients and eventually cure a wider spectrum of cancers. Oncolytic virotherapy is one of the promising new additions to clinical cancer therapeutics. Successful oncolytic virotherapy in the clinic will be those strategies that best combine tumor cell oncolysis with enhanced immune responses against tumor antigens. The current candidate oncolytic viruses all share the common property that they are relatively nonpathogenic to humans, yet they have the ability to replicate selectively in human cancer cells and induce cancer regression by direct oncolysis and/or induction of improved anti-tumor immune responses. Many candidate oncolytic viruses are in various stages of clinical and preclinical development. One such preclinical candidate is myxoma virus (MYXV), a member of the Poxviridae family that, in its natural setting, exhibits a very restricted host range and is only pathogenic to European rabbits. Despite its narrow host range in nature, MYXV has been shown to productively infect various classes of human cancer cells. Several preclinical in vivo modeling studies have demonstrated that MYXV is an attractive and safe candidate oncolytic virus, and hence, MYXV is currently being developed as a potential therapeutic for several cancers, such as pancreatic cancer, glioblastoma, ovarian cancer, melanoma, and hematologic malignancies. This review highlights the preclinical cancer models that have shown the most promise for translation of MYXV into human clinical trials. PMID:23726825

  13. Myxoma Virus Is a Novel Oncolytic Virus with Significant Antitumor Activity against Experimental Human Gliomas

    PubMed Central

    Alain, Tommy; Shi, Zhong-Qiao; Muzik, Huong; Barrett, John W.; McFadden, Grant; Bell, John; Hamilton, Mark G.; Senger, Donna L.; Forsyth, Peter A.

    2015-01-01

    Myxoma virus, a poxvirus previously considered rabbit specific, can replicate productively in a variety of human tumor cells in culture. The purpose of this study was to determine if there was efficacy or toxicities of this oncolytic virus against experimental models of human malignant gliomas in vitro, in vivo, and ex vivo in malignant glioma specimens. In vitro, the majority of glioma cell lines tested (7 of 8, 87.5%) were fully permissive for myxoma virus replication and killed by infection. In vivo, intracerebral (i.c.) myxoma virus inoculation was well tolerated and produced only minimal focal inflammatory changes at the site of viral inoculation. U87 and U251 orthotopic xenograft models were used to assess myxoma virus efficacy in vivo. A single intratumoral injection of myxoma virus dramatically prolonged median survival compared with treatment with UV-inactivated myxoma virus. Median survival was not reached in myxoma virus–treated groups versus 47.3 days (U87; P = 0.0002) and 50.7 days (U251; P = 0.0027) in UV-inactivated myxoma virus–treated groups. Most myxoma virus–treated animals (12 of 13, 92%) were alive and apparently “cured” when the experiment was finished (>130 days). Interestingly, we found a selective and long-lived myxoma virus infection in gliomas in vivo. This is the first demonstration of the oncolytic activity of myxoma virus in vivo. The nonpathogenic nature of myxoma virus outside of the rabbit host, its capacity to be genetically modified, its ability to produce a long-lived infection in human tumor cells, and the lack of preexisting antibodies in the human population suggest that myxoma virus may be an attractive oncolytic agent against human malignant glioma. (Cancer Res 2005; 65(21): 9982-90) PMID:16267023

  14. Atrial fibrillation

    PubMed Central

    Munger, Thomas M.; Wu, Li-Qun; Shen, Win K.

    2014-01-01

    Atrial fibrillation is the most common arrhythmia affecting patients today. Disease prevalence is increasing at an alarming rate worldwide, and is associated with often catastrophic and costly consequences, including heart failure, syncope, dementia, and stroke. Therapies including anticoagulants, anti-arrhythmic medications, devices, and non-pharmacologic procedures in the last 30 years have improved patients' functionality with the disease. Nonetheless, it remains imperative that further research into AF epidemiology, genetics, detection, and treatments continues to push forward rapidly as the worldwide population ages dramatically over the next 20 years. PMID:24474959

  15. Restoration of sinus rhythm following levothyroxine treatment in a case of primary hypothyroidism presenting with atrial fibrillation and pericardial effusion

    PubMed Central

    Jain, Rajesh; Biswas, Dibakar; Chaurasia, Kundan; Kumar, Manoj; Ghosh, Sujoy; Mukhopadhyay, Satinath; Chowdhury, Subhankar

    2013-01-01

    A 72-year-old man presented with palpitation, dyspnea, and chest discomfort. Initial investigations revealed atrial fibrillation (AF) and pericardial effusion, further investigations unraveled primary hypothyroidism (thyroid stimulating hormone) of 34.7 ?IU/ml and total thyroxine (T4) of 5.57 ?g/dl). Treatment with levothyroxine led to resolution of symptoms, AF, and pericardial effusion. PMID:24251147

  16. A case of paroxysmal atrial fibrillation with a non-pulmonary vein trigger identified by intravenous adenosine triphosphate infusion.

    PubMed

    Esato, Masahiro; Nishina, Naoto; Kida, Yoshitomi; Chun, YeongHwa

    2015-10-01

    A 54-year-old woman was referred to our institution with frequent chest discomfort and was diagnosed with drug-refractory paroxysmal atrial fibrillation. Radiofrequency catheter ablation (RFCA) was performed using a three-dimensional electroanatomic mapping system. After completion of left and right circumferential pulmonary vein isolation (CPVI), an intravenous bolus of adenosine triphosphate (ATP, 20 mg) was administered to evaluate the electric reconduction between the pulmonary vein (PV) and left atrium (LA). Although no PV-LA reconduction was observed, atrial fibrillation (AF) was reproducibly induced. As the duration of AF was very short (<20 s), no further RFCA to the LA was performed. One month later, the patient presented with frequent atrial tachyarrhythmias (ATs), and RFCA was repeated. Although no electric reconduction was observed in the left- or right-sided PVs, incessant ATs and AF were induced after an intravenous bolus administration of ATP. The earliest atrial activation site initiating ATs was consistently identified from electrodes positioned in the superior vena cava (SVC), and both ATs and AF were no longer inducible after electric isolation of the SVC. ATP-induced PV/non-PV ectopy may be a marker of increased susceptibility to autonomic triggers of AF and could potentially predict recurrent AF after CPVI. PMID:26550091

  17. Atrial Fibrillation During an Exploration Class Mission

    NASA Technical Reports Server (NTRS)

    Lipsett, Mark; Hamilton, Douglas; Lemery, Jay; Polk, James

    2011-01-01

    This slide presentation reviews a possible scenario of an astronaut having Atrial Fibrillation during a Mars Mission. In the case review the presentation asks several questions about the alternatives for treatment, medications and the ramifications of the decisions.

  18. [Atrial fibrillation: current trends].

    PubMed

    Bonhorst, D

    2000-06-01

    The author analyses the current relevance of atrial fibrillation (AF), an arrhythmia no longer viewed as a benign situation, being the first arrhythmic cause of hospitalisation. New data related to the conversion of this arrhythmia to sinus rhythm is reviewed, namely internal atrial defibrillation with low energy shocks and the efficacy of new drugs such as ibutilide. The current role of transesophageal echocardiography in permitting a shorter scheme of anticoagulation before the DC shock is also reviewed. About the importance of maintaining sinus rhythm, the author mentions new data from the Framingham Study showing that AF is an independent predictor of mortality. Attention is drawn to the important role of AF duration before cardioversion, since an "electrical remodeling" does occur, quickly reducing the probability of maintaining sinus rhythm. Concerning the limitations of pharmacological therapy, the author mentions the AFFIRM study that, in a few years, will hopefully solve the controversy concerning the best strategy--maintenance of sinus rhythm versus rate control. Also concerning pharmacological therapy, the author mentions two trials suggestive of the efficacy of amiodarone and dofetilide in AF patients with congestive heart failure. Regarding non-pharmacological options, reference is made to recent advances in surgery of AF and to the search for more simplified operative procedures to reduce intervention risks and duration. To overcome the difficulties in reproducing the maze operation with catheter ablation, new alternatives have appeared, such as energy application inside the pulmonary veins, known as the source of most ectopic atrial beats that trigger AF episodes. The author concludes that since AF is a heterogeneous entity, different therapies must exist, but the pharmacological approach will maintain a central role and non pharmacological therapies should be used as an alternative in refractory cases. PMID:10961097

  19. Multifocal atrial tachycardia caused by risperidone.

    PubMed

    Oner, Taliha; Akdeniz, Celal; Adaletli, Hilal

    2016-01-15

    Risperidone, an atypical antipsychotic drug, is one of the most frequently used atypical neuroleptic drugs for the treatment of symptoms of behavioral disorders seen in autism. Although various cardiovascular side effects have been reported with risperidone, to our knowledge, it has not yet been reported that it can also result in multifocal atrial tachycardia. Based on the case reported herein, our aim is to bring awareness that risperidone may cause multifocal atrial tachycardia. PMID:26599751

  20. Delayed aorto-right atrial fistula following percutaneous closure of atrial septal defect.

    PubMed

    Bashir, M; Abudhaise, H; Mustafa, H; Fok, M; Bashir, A; Hammoud, I; Mascaro, J

    2014-07-01

    We present the case of a 27-year-old man who underwent percutaneous atrial septal defect (ASD) repair using the Amplatzer(®) (St Jude Medical, St Paul, MN, US) septal occluder (ASO). Six weeks later, he presented with heart failure and was found to have an aorto-right atrial fistulation. He required urgent surgical device explantation and repair of the existing ASD using a pericardial patch repair technique. This is the first case to be reported from the UK describing a delayed aorto-right atrial fistula following percutaneous closure using ASO. PMID:24992400

  1. Aorto-left atrial tunnel: a rare entity.

    PubMed

    Paul, Sajiv K; Gajjar, Trushar P; Desai, Neelam B

    2013-05-01

    Aorto-left atrial tunnel (ALAT) is a vascular channel that originates from 1 of the sinuses of Valsalva and terminates in the left atrium. The aorto-left atrial tunnel is an extremely rare anomaly. We describe here a case of congenital aorto-left atrial tunnel in a 4-year-old child who underwent successful surgical ligation with good immediate and early results. PMID:23608293

  2. Azathioprine-induced atrial fibrillation

    PubMed Central

    Dogan, Pinar; Grbovic, Enis; Inci, Sinan; Bayraktar, Fatih; Cagli, Kumral

    2015-01-01

    Summary Azathioprine, a purine analogue that competitively inhibits the biosynthesis of purine nucleotides, is used in a wide range of conditions. Although its side-effects are well known, cardiac side effects like paroxysmal atrial fibrillation (AF) are based on only a few case reports. We describe here the case of a 55-year-old woman with primary biliary cirrhosis who presented a first-detected, symptomatic AF 2 h after azathioprine therapy which resolved after discontinuation of the drug with no predisposing factors for supraventricular arrhythmias (systemic hypertension, diabetes or coronary artery disease). The temporal coincidence of atrial fibrillation and azathioprine intake and disappearance of the AF episode after discontinuation of therapy allows us to suggest an intrinsic pro-arrhythmic effect of azathioprine. Therefore, physicians should be aware of this problem when this drug is administered. PMID:26668782

  3. Targeting Human Medulloblastoma: Oncolytic Virotherapy with Myxoma Virus Is Enhanced by Rapamycin

    PubMed Central

    Lun, Xue Qing; Zhou, Hongyuan; Alain, Tommy; Sun, Beichen; Wang, Limei; Barrett, John W.; Stanford, Marianne M.; McFadden, Grant; Bell, John; Senger, Donna L.; Forsyth, Peter A.

    2015-01-01

    We have shown previously the oncolytic potential of myxoma virus in a murine xenograft model of human glioma. Here, we show that myxoma virus used alone or in combination with rapamycin is effective and safe when used in experimental models of medulloblastoma in vitro and in vivo. Nine of 10 medulloblastoma cell lines tested were susceptible to lethal myxoma virus infection, and pretreatment of cells with rapamycin increased the extent of in vitro oncolysis. Intratumoral injection of live myxoma virus when compared with control inactivated virus prolonged survival in D341 and Daoy orthotopic human medulloblastoma xenograft mouse models [D341 median survival: 21 versus 12.5 days; P = 0.0008; Daoy median survival: not reached (three of five mice apparently “cured” after 223 days) versus 75 days; P = 0.0021]. Rapamycin increased the extent of viral oncolysis, “curing” most Daoy tumor-bearing mice and reducing or eliminating spinal cord and ventricle metastases. Rapamycin enhanced tumor-specific myxoma virus replication in vivo and prolonged survival of D341 tumor-bearing mice (median survival of mice treated with live virus (LV) and rapamycin, versus LV alone, versus rapamycin alone, versus inactivated virus: 25 days versus 19, 13, and 11 days, respectively; P < 0.0001). Rapamycin increased the levels of constitutively activated Akt in Daoy and D341 cells, which may explain its ability to enhance myxoma virus oncolysis. These observations suggest that myxoma virus may be an effective oncolytic agent against medulloblastoma and that combination therapy with signaling inhibitors that modulate activity of the phosphatidylinositol 3-kinase/Akt pathway will further enhance the oncolytic potential of myxoma virus. PMID:17875723

  4. Atrial Arrhythmias and Their Implications for Space Flight - Introduction

    NASA Technical Reports Server (NTRS)

    Polk, J. D.; Barr, Y. R.; Bauer, P.; Hamilton, D. R.; Kerstman, E.; Tarver, B.

    2010-01-01

    This panel will discuss the implications of atrial arrhythmias in astronauts from a variety of perspectives; including historical data, current practices, and future challenges for exploration class missions. The panelists will present case histories, outline the evolution of current NASA medical standards for atrial arrhythmias, discuss the use of predictive tools, and consider potential challenges for current and future missions.

  5. Persistent Atrial Fibrillation Related to a Congenital Pericardial Defect and Left Atrial Appendage Herniation

    PubMed Central

    Lee, Heemoon; Jeong, Dong Seop; Kim, In Sook; Park, Byung Jo

    2015-01-01

    Congenital pericardial defects (CPDs) are infrequent anomalies that are usually asymptomatic and are discovered incidentally during unrelated interventions. Here we report the case of a CPD with herniation of an enlarged left atrial appendage identified during total thoracoscopic ablation (TTA) for persistent atrial fibrillation (AF). The persistent AF was successfully treated with a hybrid procedure, in which TTA was followed by an electrophysiological study. PMID:26665114

  6. Protection against myxomatosis and rabbit viral hemorrhagic disease with recombinant myxoma viruses expressing rabbit hemorrhagic disease virus capsid protein.

    PubMed Central

    Bertagnoli, S; Gelfi, J; Le Gall, G; Boilletot, E; Vautherot, J F; Rasschaert, D; Laurent, S; Petit, F; Boucraut-Baralon, C; Milon, A

    1996-01-01

    Two myxoma virus-rabbit hemorrhagic disease virus (RHDV) recombinant viruses were constructed with the SG33 strain of myxoma virus to protect rabbits against myxomatosis and rabbit viral hemorrhagic disease. These recombinant viruses expressed the RHDV capsid protein (VP60). The recombinant protein, which is 60 kDa in size, was antigenic, as revealed by its reaction in immunoprecipitation with antibodies raised against RHDV. Both recombinant viruses induced high levels of RHDV- and myxoma virus-specific antibodies in rabbits after immunization. Inoculations by the intradermal route protected animals against virulent RHDV and myxoma virus challenges. PMID:8764013

  7. [Cardiac pacing for the prevention of atrial fibrillation. A current review].

    PubMed

    Yang, Alexander; Bitzen, Alexander; Schwab, Jörg Otto; Schrickel, Jan; Lüderitz, Berndt; Lewalter, Thorsten

    2005-12-01

    Several prospective randomized clinical trials have reported that atrial-based "physiological" pacing is associated with a lower incidence of paroxysmal and permanent atrial fibrillation than single-chamber ventricular pacing in patients with conventional pacemaker indication. Whether atrial pacing itself is antiarrhythmic remains still uncertain. By contrast, right ventricular pacing is considered to beget atrial fibrillation, even in preserved AV synchrony during dual-chamber pacing. A number of clinical trials investigated the impact of sitespecific atrial pacing and advanced atrial pacing algorithms on the secondary prevention of atrial fibrillation. Multisite pacing (dual-site right atrial or biatrial pacing) was demonstrated to add only minimal benefit for the prevention of atrial fibrillation. By contrast, in some studies septal pacing and specific atrial pacing algorithms were reported to reduce the recurrence of atrial fibrillation in selected patients. At present, however, it remains unclear how to identify these patients. In clinical practice, the effectiveness of specific atrial pacing algorithms and/or septal pacing has to be tested out in the individual case. These therapeutic options should be considered in patients with a conventional indication for antibradycardia pacing and, additionally, symptomatic atrial fibrillation. PMID:16331369

  8. Left Atrial Appendage Exclusion for Atrial Fibrillation

    PubMed Central

    Syed, Faisal F.; DeSimone, Christopher V.; Friedman, Paul A.; Asirvatham, Samuel J.

    2015-01-01

    SYNOPSIS Percutaneous left atrial appendage (LAA) closure is increasingly being used as a treatment strategy to prevent stroke in patients with atrial fibrillation (AF) who have contraindications to anticoagulants. A number of approaches and devices have been developed in the last few years, each with their own unique set of advantages and disadvantages. We review the published studies on surgical and percutaneous approaches to LAA closure; focusing on stroke mechanisms in AF, LAA structure and function relevant to stroke prevention, practical differences in procedural approach, and clinical considerations surrounding management. PMID:25443240

  9. High-intensity interval training improves cardiovascular health, exercise capacity, and quality of life in permanent atrial fibrillation: a case study.

    PubMed

    Reed, Jennifer L; Nery, Pablo B; Birnie, David H; Tulloch, Heather E; Pipe, Andrew L

    2015-12-01

    Persons with permanent atrial fibrillation experience reduced exercise tolerance, weight gain, and an associated decline in overall health. We report on a 74-year-old man with permanent atrial fibrillation who underwent a 10-week high-intensity interval training program. Substantial improvements in heart rate, blood pressure, aerobic and functional capacity, and quality of life were observed. These are desirable as these patients are not candidates for other treatment options and more effective therapies for the treatment of atrial fibrillation are needed. PMID:26584206

  10. Management of Atrial Fibrillation.

    PubMed

    Zamani, Payman; Verdino, Ralph J

    2015-12-01

    Atrial fibrillation remains the most prevalent cardiac arrhythmia, and its incidence is increasing as the population ages. Common conditions associated with an increased incidence include advanced age, hypertension, heart failure, and valvular heart disease. Patients with atrial fibrillation may complain of palpitations, fatigue, and decreased exercise tolerance or may be completely asymptomatic. Options for treating patients who experience atrial fibrillation include rate-controlling drugs such as digoxin, ?-blockers, and calcium channel blockers or a rhythm-controlling strategy with agents such as sodium channel blockers and potassium channel blockers. Atrial fibrillation increases the risk of stroke due to atrial thrombus formation and embolization. Anticoagulation with the vitamin K antagonist, warfarin, remains the most widely prescribed treatment option to decrease stroke risk. Several other antithrombotic agents have recently become available and offer excellent alternatives to warfarin. Catheter ablation can be undertaken as a nonpharmacologic rhythm control option with varying degrees of success depending on duration of atrial fibrillation and follow-up time from the procedure. This review article further describes the management options for patients presenting with atrial fibrillation. PMID:24828991

  11. Fibroma (myxoma) molle in a hamster (Mesocricetus auratus).

    PubMed

    West, W L; Gaillard, E T; O'Connor, S A

    2001-11-01

    An adult female Syrian hamster (Mesocricetus auratus) presented with a large, ulcerated lesion in its right cheek pouch; this wound interfered with the animal's ability to masticate. As a result, the hamster became inappetant and lethargic and lost about 25% of its original body weight within 6 to 9 weeks of presentation. The mass was surgically excised and submitted for histopathological evaluation. Microscopically, the mass was characterized as a neoplastic process partially encapsulated with fibrous connective tissue in the submucosa. Loosely arranged bundles of spindle to stellate cells with round to oval hyperchromatic nuclei and amphophilic cytoplasm were abundant. Some cells had multiple nucleoli, and some mitotic figures were observed. Special stains were used to definitively diagnose fibroma (myxoma) molle, a rare spontaneous neoplastic lesion in the hamster. PMID:11703055

  12. [Repeated electrical cardioversions and amiodarone for recurrent neonatal atrial flutter].

    PubMed

    Crochelet, A-S; Jacquemart, C; Massin, M

    2015-10-01

    Perinatal atrial flutter is a serious arrhythmia. Its management continues to pose a challenge during the fetal period but also, in rare intractable cases, during the postnatal period. This report describes the case of a neonate who required multiple electrical external cardioversions and amiodarone to resolve a recurrent atrial flutter. This case report suggests that neonatal atrial flutter may be recurrent at short term, that repeated electrical cardioversions with low energy are safe for a neonate, that amiodarone is effective as a premedication before cardioversion and in maintaining sinus rhythm afterward, and finally that the long-term prognosis is good, even when the arrhythmia is initially refractory to therapy. PMID:26216065

  13. The Association between Atrial Fibrillation and Stroke in Patients with Obstructive Sleep Apnea: A Population-Based Case-Control Study

    PubMed Central

    Mansukhani, Meghna Prabhdas; Calvin, Andrew Donald; Kolla, Bhanu Prakash; Brown, Robert D.; Lipford, Melissa Curie; Somers, Virend Kristen; Caples, Sean Michael

    2013-01-01

    Background Obstructive sleep apnea (OSA) has been shown to be an independent risk factor for ischemic stroke and may increase the risk of atrial fibrillation (AF) by up to four-fold. Given these relationships, it is possible that OSA may provide a link between stroke and AF. A case-control study was conducted to examine the association between AF and stroke in patients with OSA. Methods Olmsted county, MN, USA, residents with a new diagnosis of OSA based on polysomnography (PSG) between 2005 and 2010 (N=2980) who suffered a first-time ischemic stroke during the same period were identified as cases. Controls with no history of stroke were randomly chosen from the same database. Univariate and multiple logistic regression analyses were performed with age, gender, body mass index (BMI), smoking, hypertension, hyperlipidemia, diabetes mellitus, apnea-hypopnea index (AHI) and coronary artery disease as co-variates, with the diagnosis of AF as the variable of interest. Results A total of 108 subjects were studied. Mean age of cases (n=34) was 73 ±12 years and 53% were men. Among controls (n=74), mean age was 61 ±16 years and 55% were male. On univariate analyses, AF was significantly more common in the cases than among controls (50.0% vs 10.8%, p<0.01). On multivariate regression analyses, the association between AF and stroke was significant after controlling for age, BMI, coronary artery disease, hypertension, diabetes mellitus, hyperlipidemia and smoking status (corrected OR: 5.34; 95% CI: 1.79-17.29). Conclusions Patients with OSA who had a stroke had higher rates of AF even after accounting for potential confounders. PMID:23340087

  14. Atrial Septal Defect

    MedlinePLUS

    ... a swishing sound, which is known as a heart murmur . A heart murmur, along with other specific heart sounds, is often ... defect causes physical symptoms. Diagnosis After hearing the heart murmur that suggests a hole in the atrial septum, ...

  15. Atrial Fibrillation Medications

    MedlinePLUS

    ... think you are pregnant If you notice red, dark brown or black urine or stools If you ... Fibrillation • Introduction • What is Atrial Fibrillation? • Why AFib Matters • Understand your Risk for AFib Children • Symptoms of ...

  16. What Is Atrial Fibrillation?

    MedlinePLUS

    ... atrial fibrillation, random electrical activity interrupts the normal conduction rhythm. This prevents the atria from properly contracting. The illustrations above show normal conduction and contraction. Left atrium Right atrium Sinus node ...

  17. Atrial fibrillation or flutter

    MedlinePLUS

    ... Lancet . 2010;375:1212-1223. Morady F, Zipes DP. Atrial fibrillation: clinical features, mechanisms, and management. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook ...

  18. Surgical Treatment of Primary Intracardiac Myxoma: 20-Year Experience in “Shahid Modarres Hospital”—A Tertiary University Hospital—Tehran, Iran

    PubMed Central

    Ansari Aval, Zahra; Ghaderi, Hamid; Tatari, Hassan; Foroughi, Mahnoosh; Mirjafari, Seyedeh Adeleh; Forozeshfard, Mohammad; Fani, Kamal; Khaheshi, Isa

    2015-01-01

    Although cardiac tumors are not common they may vary in terms of race and surgical approach in different countries. Method. Patients data of 20 years was collected and evaluated in the “Shahid Modarres Hospital”—a tertiary university hospital—Tehran, Iran. Results. 42 patients with cardiac myxoma (all cases in 20 years) were included in study, 17 males and 25 females, age difference: 13 to 76 years (mean 50.6). Most of patients were in functional classes I, II. 35 patients complained of dyspnea and 3 patients had embolic events. 97.6% of tumors were primary (41 patients) and one tumor was recurrent (2.4%), 85.7% of tumors (36 cases) were located in LA, and 88.1% of tumors (37 cases) were pediculated. 40 patients (95%) had one tumor. In 22 patients (52.3%) after tumor resection septal defects were repaired primarily while in 18 patients (42.8%) the defects were repaired with pericardial patch and In one patient, tumor resected without any septal defect. Mean tumor size was about 5.22?cm (range of 2.2 to 8.2?cm). Postoperatively, 33 patients discharged from hospital without any complication. Discussion. The research reveals that patients' age and gender were similar to that of other studies in other countries while tumor's incidence seems to be higher. 3 patients were diagnosed after remote embolic event and one patient was diagnosed after MI reflecting relatively high tumor complications and late diagnosis. Conclusion. In our study mean time from diagnosis to operation was too long. The patients had more preoperative embolic events and complication. However, size of myxoma and location of that was as same as its rate in the other literature. As recommendation we suggested that in all patients with vague chest pain or remote embolic events cardiac myxomas should be ruled out. PMID:25688375

  19. [Prevention of thrombolitic compications with atrial fibrillation].

    PubMed

    Abuladze, G; Jinjolia, N; Narsia, E; Abashidze, R; Kajaia, T

    2008-10-01

    This study presents the modern principles of prevention and treatment of thrombolitic complications in patients with atrial fibrillation. The adequate tactics and algorithm of antithrombotic therapy in the case of variety versions of this disease is considered in this study. It described the efficiency and safety of oral anticoagulants (antagonist Vit K) varfarin with the purpose to inform the practical doctors with principals of prevention and treatment of hemorrhagic complications. This publication appears as a fragment from the series of atrial fibrillation management and destinated for physicians and cardiologist. PMID:18997251

  20. Successful percutaneous closure of spiral atrial septal defect

    PubMed Central

    Alobaidan, Mashail; Saleem, A; Abdo, H

    2015-01-01

    Summary The case report of a 15-year-old patient with an unusual form of atrial septal defect is described. Echocardiography showed separation of the secundum and primum atrial septums due to abnormal posterior and leftward attachment of the primum septum into the roof of the left atrium. The morphology has been variably described as a ‘double’ atrial septum or ‘spiral’ atrial septal defect. Despite the technical challenge of this form of atrial septal defect, it was effectively closed by ensuring that all relevant septal structures were incorporated between the discs of the occlusion device. This was associated with a stable position and good medium-term outcome. This contrasts with the experience of others where device embolisation or technical failure has been described. Learning points The spiral atrial septal defect is characterised by an apparently ‘double’ atrial septum.Such atrial septal defects (ASDs) have been associated with a high rate of technical failure of transcatheter closure.3D echocardiography assists in understanding the anatomy of the defect.Following deployment of the ASD occlusion device transoesophageal echocardiography is essential to ensure that both septum primum and secundum are between the occluder discs.Catheter closure can be successful if close attention is paid to the morphology of the defect and incorporation of margins within the discs of the septal occluder.

  1. Neural mechanisms of atrial arrhythmias.

    PubMed

    Shen, Mark J; Choi, Eue-Keun; Tan, Alex Y; Lin, Shien-Fong; Fishbein, Michael C; Chen, Lan S; Chen, Peng-Sheng

    2012-01-01

    The past 5 years have seen great advances in the knowledge of neural mechanisms of atrial arrhythmogenesis. Direct autonomic nerve recordings demonstrate that simultaneous sympathovagal discharges and intrinsic cardiac nerve activities are common triggers of paroxysmal atrial tachycardia and atrial fibrillation. While activity of the autonomous nervous system (ANS) is crucial in triggering paroxysmal atrial fibrillation, a high incidence of sympathovagal co-activation at baseline is associated with a high vulnerability to pacing-induced sustained atrial fibrillation, suggesting that ANS has a role in the development of persistent atrial fibrillation. Modulation of ANS activity may constitute an important therapeutic strategy for the management of atrial tachyarrhythmias. Specifically, continuous, low-level stimulation of the left cervical vagus nerve effectively suppresses atrial tachyarrhythmias by reducing the nerve activity of the stellate ganglion. Clinically, compared with pulmonary vein isolation alone, the addition of ablation of intrinsic cardiac ganglia may confer better outcomes for patients with paroxysmal atrial fibrillation. These findings suggest that further investigation of the neural mechanisms of atrial arrhythmias might lead to better management of patients with atrial arrhythmias. In this article, we review the role of the ANS in the induction and maintenance of atrial arrhythmias and the role of neural modulation as a treatment strategy for atrial arrhythmias. PMID:21946776

  2. Genome Scale Evolution of Myxoma Virus Reveals Host-Pathogen Adaptation and Rapid Geographic Spread

    PubMed Central

    Kerr, Peter J.; Rogers, Matthew B.; Fitch, Adam; DePasse, Jay V.; Cattadori, Isabella M.; Twaddle, Alan C.; Hudson, Peter J.; Tscharke, David C.; Read, Andrew F.; Holmes, Edward C.

    2013-01-01

    The evolutionary interplay between myxoma virus (MYXV) and the European rabbit (Oryctolagus cuniculus) following release of the virus in Australia in 1950 as a biological control is a classic example of host-pathogen coevolution. We present a detailed genomic and phylogeographic analysis of 30 strains of MYXV, including the Australian progenitor strain Standard Laboratory Strain (SLS), 24 Australian viruses isolated from 1951 to 1999, and three isolates from the early radiation in Britain from 1954 and 1955. We show that in Australia MYXV has spread rapidly on a spatial scale, with multiple lineages cocirculating within individual localities, and that both highly virulent and attenuated viruses were still present in the field through the 1990s. In addition, the detection of closely related virus lineages at sites 1,000 km apart suggests that MYXV moves freely in geographic space, with mosquitoes, fleas, and rabbit migration all providing means of transport. Strikingly, despite multiple introductions, all modern viruses appear to be ultimately derived from the original introductions of SLS. The rapidity of MYXV evolution was also apparent at the genomic scale, with gene duplications documented in a number of viruses. Duplication of potential virulence genes may be important in increasing the expression of virulence proteins and provides the basis for the evolution of novel functions. Mutations leading to loss of open reading frames were surprisingly frequent and in some cases may explain attenuation, but no common mutations that correlated with virulence or attenuation were identified. PMID:24067966

  3. Atrial Fibrillation (AF or AFib)

    MedlinePLUS

    ... keeping your heart healthy. Sign up today! Email:* State: Zip Code: By clicking submit below you agree to the Terms and Conditions Atrial Fibrillation • Introduction • What is Atrial Fibrillation? • Why AFib Matters • Understand your Risk for AFib Children • Symptoms of ...

  4. Atrial Arrhythmias in Astronauts - Summary of a NASA Summit

    NASA Technical Reports Server (NTRS)

    Barr, Yael R.; Watkins, Sharmila D.; Polk, J. D.

    2010-01-01

    Background and Problem Definition: To evaluate NASA s current standards and practices related to atrial arrhythmias in astronauts, Space Medicine s Advanced Projects Section at the Johnson Space Center was tasked with organizing a summit to discuss the approach to atrial arrhythmias in the astronaut cohort. Since 1959, 11 cases of atrial fibrillation, atrial flutter, or supraventricular tachycardia have been recorded among active corps crewmembers. Most of the cases were paroxysmal, although a few were sustained. While most of the affected crewmembers were asymptomatic, those slated for long-duration space flight underwent radiofrequency ablation treatment to prevent further episodes of the arrhythmia. The summit was convened to solicit expert opinion on screening, diagnosis, and treatment options, to identify gaps in knowledge, and to propose relevant research initiatives. Summit Meeting Objectives: The Atrial Arrhythmia Summit brought together a panel of six cardiologists, including nationally and internationally renowned leaders in cardiac electrophysiology, exercise physiology, and space flight cardiovascular physiology. The primary objectives of the summit discussions were to evaluate cases of atrial arrhythmia in the astronaut population, to understand the factors that may predispose an individual to this condition, to understand NASA s current capabilities for screening, diagnosis, and treatment, to discuss the risks associated with treatment of crewmembers assigned to long-duration missions or extravehicular activities, and to discuss recommendations for prevention or management of future cases. Summary of Recommendations: The summit panel s recommendations were grouped into seven categories: Epidemiology, Screening, Standards and Selection, Treatment of Atrial Fibrillation Manifesting Preflight, Atrial Fibrillation during Flight, Prevention of Atrial Fibrillation, and Future Research

  5. Massive left atrial appendage aneurysm presenting as supraventricular tachycardia.

    PubMed

    Chockalingam, Anand; Alagesan, R; Nandakumar, M; Gnanavelu, G

    2003-01-01

    Left atrial appendage aneurysm is a rarely reported condition. Symptoms are absent in childhood and diagnosis is usually incidental. Systemic embolization or arrhythmia can bring these cases to medical attention. We report the case of a 12-year-old male with massive left atrial appendage aneurysm who presented with effort intolerance and supraventricular arrhythmia. The diagnosis was made by transthoracic echocardiography. Magnetic resonance imaging and left atriogram were also done before surgical resection. PMID:14686673

  6. Atrial fibrillation and physical activity

    PubMed Central

    Bosomworth, N. John

    2015-01-01

    Objective To review the evidence on the effects of various levels of physical activity (PA) on the incidence of atrial fibrillation (AF) in both the general population and in endurance athletes. Data sources A PubMed search was done initially using the MeSH headings or text words (with the search-field descriptor TIAB [title and abstract]) atrial fibrillation and exercise or physical activity or athlet* or sport*, without additional filters. Conclusions regarding quality and strength of evidence were based on the GRADE (grading of recommendations, assessment, development, and evaluation) system. Study selection No interventional studies were available. Observational studies were therefore considered acceptable, and, although larger long-term prospective cohort studies were preferred, case-control or cross-sectional trials were also included in this review. Synthesis Available evidence suggests a dose-response association linking increased exercise levels with reduced incident AF in women. The same is true in men at low and moderate levels of exertional activity. In men only, high levels of PA are associated with increased risk of AF in most, but not all, studies. This risk is moderate, with a hazard ratio of 1.29 in one of the better studies. The risk of AF for most people who exercise regularly is lower than that of a matched sedentary population. Conclusion Atrial fibrillation is probably less common as PA increases, with a demonstrable dose-response relationship. Exercise at any level should be promoted for its effect on physical well-being and mortality reduction. In men exercising at high levels, beneficial effects on AF might be lost and risk might exceed that of the sedentary population; however, the evidence is neither robust nor consistent. These men should be made aware of this modest increase in risk should they choose to continue to engage in high levels of PA. PMID:26668285

  7. Monosotic fibrous dysplasia and solitary intramuscular myxoma of the head and neck: A unique presentation of Mazabraud's syndrome and a literature review

    PubMed Central

    FU, SHUITING; TIAN, ZHUOWEI; ZHANG, CHENPING; HE, YUE

    2015-01-01

    Mazabraud's syndrome (MS) is a rare disease that is a combination of fibrous dysplasia and intramuscular myxomas. MS is a benign lesion and there is little data on the disease due to its low incidence. In the present study, the case of a 38-year-old patient who presented with a soft-tissue mass involving the masseter and swelling at the mandibular body and mandibular ramus is reported. Since the mandible is an important aesthetic and functional organ in the oral and maxillofacial region, surgery was primarily aimed at resecting the tumor, with good safety margins, and reconstructing the resultant defect. The lesions were pathologically diagnosed as MS. The unique features of this case included the painless and monostotic fibrous dysplasia, the solitary intramuscular myxomas involving the jaw and the male gender of the patient. MS usually occurs in the lower extremities, with an unusual predilection for the right limb; however, it rarely occurs in the head and neck region. A retrospective analysis of the clinical features and management of MS was also performed in the present study, together with a literature review. From the literature, it was concluded that the incidence of MS is ~2.3-fold greater in female patients than in male patients, and that the age of onset of MS ranges between 17 and 82 years, with an average age of 46.25 years. PMID:26722294

  8. Left-sided atrial flutter originating in the coronary sinus after radiofrequency ablation of atrial fibrillation.

    PubMed

    Jimenez, Alejandro; Shorofsky, Stephen R; Dickfeld, Timm M; Anand, Rishi; Saliaris, Anastasios P; Saba, Magdi

    2010-10-01

    We describe a case of atypical atrial flutter presenting 1 year after radiofrequency ablation for atrial fibrillation (AF). Electrophysiologic study showed a reentry circuit involving the inferolateral aspect of the mitral annulus and the coronary sinus (CS); however, a mitral isthmus line did not terminate the arrhythmia. Participation of the proximal CS musculature in the circuit suggested a possible target for ablation. Radiofrequency energy applications from within the CS terminated the tachycardia. Mapping and ablation within the CS should be considered in patients with post-AF ablation arrhythmias, particularly when the mitral annulus appears to be involved in the tachycardia circuit. PMID:20230470

  9. Myxoma Virus and the Leporipoxviruses: An Evolutionary Paradigm

    PubMed Central

    Kerr, Peter J.; Liu, June; Cattadori, Isabella; Ghedin, Elodie; Read, Andrew F.; Holmes, Edward C.

    2015-01-01

    Myxoma virus (MYXV) is the type species of the Leporipoxviruses, a genus of Chordopoxvirinae, double stranded DNA viruses, whose members infect leporids and squirrels, inducing cutaneous fibromas from which virus is mechanically transmitted by biting arthropods. However, in the European rabbit (Oryctolagus cuniculus), MYXV causes the lethal disease myxomatosis. The release of MYXV as a biological control for the wild European rabbit population in Australia, initiated one of the great experiments in evolution. The subsequent coevolution of MYXV and rabbits is a classic example of natural selection acting on virulence as a pathogen adapts to a novel host species. Slightly attenuated mutants of the progenitor virus were more readily transmitted by the mosquito vector because the infected rabbit survived longer, while highly attenuated viruses could be controlled by the rabbit immune response. As a consequence, moderately attenuated viruses came to dominate. This evolution of the virus was accompanied by selection for genetic resistance in the wild rabbit population, which may have created an ongoing co-evolutionary dynamic between resistance and virulence for efficient transmission. This natural experiment was repeated on a continental scale with the release of a separate strain of MYXV in France and its subsequent spread throughout Europe. The selection of attenuated strains of virus and resistant rabbits mirrored the experience in Australia in a very different environment, albeit with somewhat different rates. Genome sequencing of the progenitor virus and the early radiation, as well as those from the 1990s in Australia and Europe, has shown that although MYXV evolved at high rates there was no conserved route to attenuation or back to virulence. In contrast, it seems that these relatively large viral genomes have the flexibility for multiple pathways that converge on a similar phenotype. PMID:25757062

  10. Cardioversion of persistent atrial arrhythmia after treatment with venlafaxine in successful management of major depression and posttraumatic stress disorder.

    PubMed

    Finch, Susan J; van Zyl, Louis T

    2006-01-01

    There is increasing evidence linking depression and cardiovascular disease. However, the authors could find no literature directly linking depression with atrial fibrillation or atrial flutter. The authors report the case of a patient with uncontrolled atrial arrhythmia who cardioverted to normal sinus rhythm after treatment of major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) with venlafaxine. The authors discuss comorbidity of MDD and atrial fibrillation, and explore evidence of venlafaxine as an antiarrhythmic agent. Further research is needed to establish the clinical role of venlafaxine as a Class 1 antiarrhythmic agent and any association between atrial arrhythmias and MDD and PTSD. PMID:17116959

  11. Endovascular Repair of Supra-Celiac and Abdominal Aortic Pseudo Aneurysms Concomitant with a Right Atrial Mass in a Patient with Behçet’s Disease: A Case Report

    PubMed Central

    Kassaian, Seyed Ebrahim; Abbasi, Kyomars; Shirzad, Mahmood; Anvari, Maryam Sotoudeh; Shahrzad, Maryam; Molavi, Behnam

    2014-01-01

    Abstract Behcet’s disease is a rare immune mediated systemic vasculitis which besides it’s more frequent involvement of eyes and skin, sometimes present with aortic pseudo aneurysm and more rarely cardiac inflammatory masses.A 51-year-old patient with Behçet’s Disease presented with two symptomatic aortic pseudoaneurysms concomitant with a right atrial mass. Computed tomography (CT) revealed one supra-celiac and another infrarenal aortic pseudoaneurysms. Echocardiography showed a large mobile mass in the right atrium. Both pseudoaneurysms were successfully excluded simultaneously via endovascular approach with Zenith stent-grafts, and the atrial mass was surgically removed 10 days later. Post-implant CT showed successful exclusion of both pseudo-aneurysms, patency of all relevant arteries, and patient is now asymptomatic and has returned to normal lifestyle. Multiple pseudoaneurysms concomitant with a right atrial mass can be an initial manifestation of Behçet’s disease. Endovascular repair can be a good treatment option for the pseudoaneurysms. PMID:25870643

  12. Multimodality imaging of a subtotally obstructive right ventricular myxoma in an asymptomatic 10-year-old girl.

    PubMed

    Wiegand, Gesa; Sieverding, Ludger; Kramer, Ulrich; Haen, Susanne; Hofbeck, Michael

    2014-05-01

    A 10-year-old girl presented with a supraventricular tachycardia. A heart murmur was detected during a clinical examination; therefore, echocardiography was performed. This revealed a giant right ventricular myxoma that subtotally obstructed the right ventricular outflow tract. A myxoma in the right ventricle is uncommon in children. This rare intracardiac tumor was examined using multimodality imaging, and the patient underwent surgical resection. The pathologic features confirmed our suspicion and revealed an encapsulated tumor with myxomatoid stroma containing focal hemorrhages. PMID:24987268

  13. [Recurrent right atrial thrombus in a patient with atrial fibrillation and heart failure].

    PubMed

    Elikowski, Waldemar; Wróblewski, Dariusz; Ma?ek-Elikowska, Ma?gorzata; Mazurek, Andrzej; Foremska-Iciek, Joanna; ?azowski, Stanis?aw

    2015-11-01

    Atrial fibrillation and heart failure are factors predisposing to locally formed intracardiac thrombosis, which is usually localized in left-sided chambers. A case report. The authors present a case of a 50-year-old male with permanent atrial fibrillation and dilated cardiomyopathy in whom recurrent right atrial thrombus was observed. Initially, the lesion was detected in echocardiography while he was hospitalized due to extensive right-sided pneumonia. The thrombus was successfully treated with heparin, followed by warfarin. Even though the patient continued warfarin use properly, there was recurrence of the thrombus two years later during a new episode of heart failure exacerbation. Because the thrombus was resistant to intensified anticoagulation, cardiac surgery was needed. A large (30 x 25 mm) pedunculated thrombus, as well as two smaller ones (each of 10 x 10 mm) attached closely to the atrial wall and previously not detected either by echocardiography or by magnetic resonance imaging, were excited. A partially organized pattern of the thrombi in histological examination can explain lack of anticoagulation effectiveness. PMID:26637098

  14. Genetics Home Reference: Carney complex

    MedlinePLUS

    ... Recent literature OMIM - Genetic disorder catalog What other names do people use for Carney complex? Carney Syndrome ... Lentigines, atrial myxoma, mucocutaneous myoma, blue nevus syndrome NAME - Nevi, atrial myxoma, skin myxoma, ephelides syndrome For ...

  15. Atrial fibrillation and female sex.

    PubMed

    Anselmino, Matteo; Battaglia, Alberto; Gallo, Cristina; Gili, Sebastiano; Matta, Mario; Castagno, Davide; Ferraris, Federico; Giustetto, Carla; Gaita, Fiorenzo

    2015-12-01

    Atrial fibrillation is the most common supraventricular arrhythmia. Its prevalence increases with age and preferentially affects male patients. Over 75 years of age, however, female patients being more prevalent, the absolute number of patients affected is similar between sexes. Despite this, few data are available in the literature concerning sex-related differences in atrial fibrillation patients. The present systematic review therefore considers comorbidities, referring symptoms, quality of life, pharmacological approaches and trans-catheter ablation in female rather than in male atrial fibrillation patients in search of parameters that may have an impact on the treatment outcome. In brief, female atrial fibrillation patients more commonly present comorbidities, leading to a higher prevalence of persistent atrial fibrillation; moreover, they refer to hospital care later and with a longer disease history. Atrial fibrillation symptoms relate to low quality of life in female patients; in fact, atrial fibrillation paroxysm usually presents higher heart rate, leading to preferentially adopt a rate rather than a rhythm-control strategy. Female atrial fibrillation patients present an increased risk of stroke, worsened by the lower oral anticoagulant prescription rate related to the concomitant higher haemorrhagic risk profile. Trans-catheter ablation is under-used in female patients and, on the contrary, they are more commonly affected by anti-arrhythmic drug side effects. PMID:25806470

  16. Robotic Ablation of Atrial Fibrillation

    PubMed Central

    Wutzler, Alexander; Wolber, Thomas; Haverkamp, Wilhelm; Boldt, Leif-Hendrik

    2015-01-01

    Background: Pulmonary vein isolation (PVI) is an established treatment for atrial fibrillation (AF). During PVI an electrical conduction block between pulmonary vein (PV) and left atrium (LA) is created. This conduction block prevents AF, which is triggered by irregular electric activity originating from the PV. However, transmural atrial lesions are required which can be challenging. Re-conduction and AF recurrence occur in 20 - 40% of the cases. Robotic catheter systems aim to improve catheter steerability. Here, a procedure with a new remote catheter system (RCS), is presented. Objective of this article is to show feasibility of robotic AF ablation with a novel system. Materials and Methods: After interatrial trans-septal puncture is performed using a long sheath and needle under fluoroscopic guidance. The needle is removed and a guide wire is placed in the left superior PV. Then an ablation catheter is positioned in the LA, using the sheath and wire as guide to the LA. LA angiography is performed over the sheath. A circular mapping catheter is positioned via the long sheath into the LA and a three-dimensional (3-D) anatomical reconstruction of the LA is performed. The handle of the ablation catheter is positioned in the robotic arm of the Amigo system and the ablation procedure begins. During the ablation procedure, the operator manipulates the ablation catheter via the robotic arm with the use of a remote control. The ablation is performed by creating point-by-point lesions around the left and right PV ostia. Contact force is measured at the catheter tip to provide feedback of catheter-tissue contact. Conduction block is confirmed by recording the PV potentials on the circular mapping catheter and by pacing maneuvers. The operator stays out of the radiationfield during ablation. Conclusion: The novel catheter system allows ablation with high stability on low operator fluoroscopy exposure. PMID:26066040

  17. Mobile Right Atrial Thrombi in a Patient with the Hemoglobin SC Disease

    PubMed Central

    Savage, H. O.; Ding, N.; Eso, O.; Sachdev, B.; Lefroy, D. L.

    2011-01-01

    The formation of Intracardiac thrombi is rare in the absence of structural heart disease or atrial fibrillation. We describe a case of spontaneous right atrial thrombus formation that occurred in a patient with a hypercoagulable condition who had been sub optimally anticoagulated. PMID:21912556

  18. Isomerism of the left atrial appendages associated with absence of the spleen.

    PubMed

    Pelosi, G; Guanella, S

    1990-06-01

    We describe a case with the unexpected association of isomerism of the left atrial appendage and absence of the spleen. The left-sided atrial appendage appeared markedly hypoplasic, probably due to the associated atresia of the mitral valve. PMID:2351498

  19. Atrial Fibrillation During an Exploration Class Mission

    NASA Technical Reports Server (NTRS)

    Lipset, Mark A.; Lemery, Jay; Polk, J. D.; Hamilton, Douglas R.

    2010-01-01

    Background: A long-duration exploration class mission is fraught with numerous medical contingency plans. Herein, we explore the challenges of symptomatic atrial fibrillation (AF) occurring during an exploration class mission. The actions and resources required to ameliorate the situation, including the availability of appropriate pharmaceuticals, monitoring devices, treatment modalities, and communication protocols will be investigated. Challenges of Atrial Fibrillation during an Exploration Mission: Numerous etiologies are responsible for the initiation of AF. On Earth, we have the time and medical resources to evaluate and determine the causative situation for most cases of AF and initiate therapy accordingly. During a long-duration exploration class mission resources will be severely restricted. How is one to determine if new onset AF is due to recent myocardial infarction, pulmonary embolism, fluid overload, thyrotoxicosis, cardiac structural abnormalities, or CO poisoning? Which pharmaceutical therapy should be initiated and what potential side effects can be expected? Should anti-coagulation therapy be initiated? How would one monitor the therapeutic treatment of AF in microgravity? What training would medical officers require, and which communication strategies should be developed to enable the best, safest therapeutic options for treatment of AF during a long-duration exploration class mission? Summary: These questions will be investigated with expert opinion on disease elucidation, efficient pharmacology, therapeutic monitoring, telecommunication strategies, and mission cost parameters with emphasis on atrial fibrillation being just one illustration of the tremendous challenges that face a long-duration exploration mission. The limited crew training time, medical hardware, and drugs manifested to deal with such an event predicate that aggressive primary and secondary prevention strategies be developed to protect a multibillion-dollar asset like the International Space Station or a mission to the Moon or Mars. Learning Objectives: The audience will become familiar with the risks and challenges inherent to developing a therapeutic strategy for the treatment of atrial fibrillation during a long-term exploration class mission.

  20. Catheter Ablation for Long-Standing Persistent Atrial Fibrillation

    PubMed Central

    Romero, Jorge; Gianni, Carola; Di Biase, Luigi; Natale, Andrea

    2015-01-01

    Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and represents a major burden to health care systems. Atrial fibrillation is associated with a 4- to 5-fold increased risk of thromboembolic stroke. The pulmonary veins have been identified as major sources of atrial triggers for AF. This is particularly true in patients with paroxysmal AF but not always the case for those with long-standing persistent AF (LSPAF), in which other locations for ectopic beats have been well recognized. Structures with foci triggering AF include the coronary sinus, the left atrial appendage (LAA), the superior vena cava, the crista terminalis, and the ligament of Marshall. More than 30 studies reporting results on radiofrequency ablation of LSPAF have been published to date. Most of these are observational studies with very different methodologies using different strategies. As a result, there has been remarkable variation in short- and long-term success, which suggests that the optimal ablation technique for LSPAF is still to be elucidated. In this review we discuss the different approaches to LSPAF catheter ablation, starting with pulmonary vein isolation (PVI) through ablation lines in different left atrial locations, the role of complex fractionated atrial electrograms, focal impulses and rotor modulation, autonomic modulation (ganglionated plexi), alcohol ablation, and the future of epicardial mapping and ablation for this arrhythmia. A stepwise ablation approach requires several key ablation techniques, such as meticulous PVI, linear ablation at the roof and mitral isthmus, electrogram-targeted ablation with particular attention to triggers in the coronary sinus and LAA, and discretionary right atrial ablation (superior vena cava, intercaval, or cavotricuspid isthmus lines). PMID:26306125

  1. Catheter Ablation for Long-Standing Persistent Atrial Fibrillation.

    PubMed

    Romero, Jorge; Gianni, Carola; Di Biase, Luigi; Natale, Andrea

    2015-01-01

    Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and represents a major burden to health care systems. Atrial fibrillation is associated with a 4- to 5-fold increased risk of thromboembolic stroke. The pulmonary veins have been identified as major sources of atrial triggers for AF. This is particularly true in patients with paroxysmal AF but not always the case for those with long-standing persistent AF (LSPAF), in which other locations for ectopic beats have been well recognized. Structures with foci triggering AF include the coronary sinus, the left atrial appendage (LAA), the superior vena cava, the crista terminalis, and the ligament of Marshall. More than 30 studies reporting results on radiofrequency ablation of LSPAF have been published to date. Most of these are observational studies with very different methodologies using different strategies. As a result, there has been remarkable variation in short- and long-term success, which suggests that the optimal ablation technique for LSPAF is still to be elucidated. In this review we discuss the different approaches to LSPAF catheter ablation, starting with pulmonary vein isolation (PVI) through ablation lines in different left atrial locations, the role of complex fractionated atrial electrograms, focal impulses and rotor modulation, autonomic modulation (ganglionated plexi), alcohol ablation, and the future of epicardial mapping and ablation for this arrhythmia. A stepwise ablation approach requires several key ablation techniques, such as meticulous PVI, linear ablation at the roof and mitral isthmus, electrogram-targeted ablation with particular attention to triggers in the coronary sinus and LAA, and discretionary right atrial ablation (superior vena cava, intercaval, or cavotricuspid isthmus lines). PMID:26306125

  2. Left Atrial Appendage Thrombosis During Therapy with Rivaroxaban in Elective Cardioversion for Permanent Atrial Fibrillation

    PubMed Central

    Li Calzi, Mauro; Coruzzi, Paolo

    2015-01-01

    Electric external cardioversion (EEC) for permanent atrial fibrillation (AF) carries a risk of thromboembolic events (TE). The use of transesophageal echocardiography (TEE) to guide the management of atrial fibrillation may be considered a clinically effective alternative strategy to conventional therapy for patients in whom elective cardioversion is planned. Therapeutic anticoagulation with novel oral anticoagulants (NOAC) is recommended for 3 to 4 weeks before and an anticoagulation life-long therapy is recommended after EEC to reduce TE, in patients with high CHA2DS2-VASc score; however, only few data are currently available about safety of short-term anticoagulation with NOAC in the setting of EEC. Patients with increased risk of thromboembolism have not been adequately studied and the monitoring of anticoagulant effects can also have important benefits in case of drug interactions. We report a case of a 68-year old man with AF from September 2014. Moderate depression of global left ventricular systolic function was detected by echocardiographic exam. On the basis of a high thromboembolic risk, an anticoagulant therapy with rivaroxaban, at the dose of 20 mg/day, was started. TEE showed a thrombus in the left atrial appendage. This case demonstrates the utility of performing TEE prior than EEC in patients with hypokinetic cardiomyopathy other than AF in therapy with NOAC. We underline the presence of significant pharmacodynamic interference of rivaroxaban with other drugs such as oxcarbazepine.

  3. Atrial Fibrillation Surgery - Maze Procedure

    MedlinePLUS

    ... a Thoracic Surgeon? Adult Cardiac Surgery What is Pediatric Heart Disease? What is Risk Adjustment? Valve Repair/Replacement Surgery Esophageal Surgery Lung/Thoracic Surgery Aneurysm Surgery Arrhythmia Surgery Atrial Fibrillation Surgery - Maze Procedure ...

  4. The polyuria of paroxysmal atrial tachycardia

    NASA Technical Reports Server (NTRS)

    Kinney, M. J.; Stein, R. M.; Discala, V. A.

    1974-01-01

    Two patients with paroxysmal atrial fibrillation and an associated polyuria were studied to delineate the mechanism of the increase in urine flow. A striking saluresis was noted in both patients. The increased sodium excretion was probably due to decreased sodium reabsorption, perhaps at proximal tubular nephron sites. This inhibition of sodium reabsorption could explain both the saluresis and some part or all of the polyuria. Re-evaluation of earlier case reports reveals patterns of concomitant salt and water excretion consistent with this mechanism. The saluresis cannot be explained by the previously favored hypothesis of antidiuretic hormone inhibition.

  5. Unusual consequence of a fetal atrial septal aneurysm.

    PubMed

    Sun, Heather Y; Fripp, Raymond R; Printz, Beth F

    2015-06-01

    We describe the case of a significant fetal atrial septal aneurysm causing left ventricular inflow obstruction. Serial fetal echocardiograms demonstrated potential left heart hypoplasia. The fetal cardiologist guided the perinatal team to electively deliver the infant early and modify the course of developing hypoplastic left heart. PMID:26185630

  6. Closure of a secundum atrial septal defect in two infants with chronic lung disease using the Gore HELEX Septal Occluder.

    PubMed

    Zussman, Matt E; Freire, Grace; Cupp, Shawn D; Stapleton, Gary E

    2016-01-01

    Children with a secundum atrial septal defect are usually asymptomatic and are referred for elective closure after 3-4 years of age; however, in premature infants with chronic lung disease, bronchopulmonary dysplasia, or pulmonary hypertension, increased pulmonary blood flow secondary to a left-to-right atrial shunt, may exacerbate their condition. Closure of the atrial septal defect in these patients can result in significant clinical improvement. We report the cases of two premature infants with chronic lung disease, who underwent atrial septal defect closure with the Gore HELEX Septal Occluder and discuss the technical aspects of using the device in these patients and their clinical outcomes. PMID:25599720

  7. Detection of atrial arrhythmia in superconducting quantum interference device magnetocardiography; preliminary result of a totally-noninvasive localization method for atrial current mapping.

    PubMed

    Kim, Doosang; Kim, Kiwoong; Lee, Yong-Ho; Ahn, Hyuk

    2007-06-01

    Map-guided surgery is the goal for treatment of atrial fibrillation (AF), because it minimizes unnecessary incisions or procedures. We propose a totally-noninvasive and even non-contact method to detect atrial arrhythmia with a superconducting quantum interference device magnetocardiography (MCG) system, and report the first clinical application case of MCG map-guided AF surgery. To detect weak atrial excitation, we utilized a high sensitive 64-channel MCG system measuring tangential magnetic field components, which is known to be more sensitive to a deeper current source. We measured the MCG signals from eight patients with chronic AF. Then, we separated the f-wave from the other components by using independent component analysis. The extracted f-wave caused by reentrant myocardial excitation was three-dimensionally localized on the mesh model of a human heart by a novel beamformer technique having a surface action potential activity as its filter output. We localized the abnormal stimulation source of an atrial arrhythmia non-invasively and visualized the current source distribution corresponding to the atrial excitation successfully on the three-dimensional atrial surface, which was separated from the ventricular excitation. Using this atrial mapping, we underwent minimal AF surgery in three patients and converted their AF to sinus rhythm successfully. PMID:17669841

  8. Surgical Ablation of Atrial Fibrillation.

    PubMed

    Ramlawi, Basel; Abu Saleh, Walid K

    2015-01-01

    The Cox-maze procedure for the restoration of normal sinus rhythm, initially developed by Dr. James Cox, underwent several iterations over the years. The main concept consists of creating a series of transmural lesions in the right and left atria that disrupt re-entrant circuits responsible for propagating the abnormal atrial fibrillation rhythm. The left atrial appendage is excluded as a component of the Maze procedure. For the first three iterations of the Cox- maze procedure, these lesions were performed using a surgical cut-and-sew approach that ensured transmurality. The Cox-Maze IV is the most currently accepted iteration. It achieves the same lesion set of the Cox- maze III but uses alternative energy sources to create the transmural lesions, potentially in a minimally invasive approach on the beating heart. High-frequency ultrasound, microwave, and laser energy have all been used with varying success in the past. Today, bipolar radiofrequency heat or cryotherapy cooling are the most accepted sources for creating linear lesions with consistent safety and transmurality. The robust and reliable nature of these energy delivery methods has yielded a success rate reaching 90% freedom from atrial fibrillation at 12 months. Such approaches offer a significant long-term advantage over catheter-based ablation, especially in patients having longstanding, persistent atrial fibrillation with characteristics such as dilated left atrial dimensions, poor ejection fraction, and failed catheter ablation. Based on these improved results, there currently is significant interest in developing a hybrid ablation strategy that incorporates the superior transmural robust lesions of surgical ablation, the reliable stroke prevention potential of epicardial left atrial appendage exclusion, and sophisticated mapping and confirmatory catheter-based ablation technology. Such a minimally invasive hybrid strategy for ablation may lead to the development of multidisciplinary "Afib teams" to obtain optimal long-term sinus rhythm control. This article provides an overview of current surgical strategies for patients with atrial fibrillation and addresses the two main goals in its management. PMID:26306128

  9. Left Atrial Appendage Ligation in Patients With Atrial Fibrillation Leads to a Decrease in Atrial Dispersion

    PubMed Central

    Kawamura, Mitsuharu; Scheinman, Melvin M; Lee, Randall J; Badhwar, Nitish

    2015-01-01

    Background Left atrial appendage (LAA) exclusion has been performed in patients with atrial fibrillation (AF) to prevent thrombus formation and subsequent cardioembolic events. Left atrial electrical remodeling is a recognized factor in the recurrence of AF. The effects of LAA exclusion on P-wave characteristics and left atrial electrical remodeling have not been well described. The purpose of this study was to evaluate the effect of LAA ligation on P-wave morphology in patients with AF. Methods and Results Fifteen patients who were in sinus rhythm during the LAA ligation procedure were included in the study. We evaluated the P-wave characteristics, including P-wave duration, P-wave amplitude, PQ interval, and P-wave dispersion, before and after ligation. Eleven patients had paroxysmal AF and 4 patients had persistent AF (12 male patients and 3 female patients). P-wave duration immediately after ligation was significantly shorter compared with baseline in all limb leads except lead aVR (P<0.05). P-wave amplitude immediately after ligation was significantly greater compared with baseline in inferior leads; however, P-wave amplitude after 1 to 3 months was significantly lower compared with immediately after ligation. PQ interval immediately after ligation was significantly shorter compared with baseline (P=0.01), and P-wave dispersion after 1 to 3 months was significantly shorter compared with baseline (P=0.02). Conclusions LAA exclusion produces consistent P-wave changes consistent with decreased atrial mass and decreased atrial dispersion that may represent reverse electrical atrial remodeling. This is a potential mechanism to explain the role of LAA ligation in maintaining sinus rhythm in patients with AF. PMID:25977469

  10. An extremely rare malformation of an atrial septal defect closure device and use of a new corrective technique.

    PubMed

    Soylu, Korhan; Meriç, Murat; Y?ld?r?m, Ufuk; Gulel, Okan

    2015-06-01

    Tulip malformation is a newly defined complication of transcatheter atrial septal defect closure. This complication, in which the left atrial disc becomes concave, makes it impossible to fully retract the device into the delivery sheath. The case presented is the first report describing a simple new technique which overcomes this novel complication. PMID:26051758

  11. Surgical options in atrial fibrillation

    PubMed Central

    Bedeir, Kareem

    2015-01-01

    Atrial fibrillation (AF) is not benign and its prevalence is increasing. The two main goals in management of atrial fibrillation are to optimize hemodynamics through rate or rhythm control and to prevent systemic thrombo-embolism. To date, these two goals are still sub-optimally achieved, raising the need for alternative methods and strategies both pharmacologically and through interventions. In this review, we discuss surgical strategies of achieving both goals with insights on the evolution and potential future of these strategies. PMID:25713738

  12. Heart Failure and Atrial Fibrillation.

    PubMed

    McCulloch, Brenda

    2015-12-01

    Atrial fibrillation is commonly experienced by patients with heart failure, and as the heart failure progresses and worsens, the more likely the patient is to develop atrial fibrillation. Several factors play into this, including common risk factors, such as advanced age, hypertension, and ischemic or valvular heart disease. Treatment is aimed at anticoagulation, to prevent thromboembolic stroke, and rate control to prevent further hemodynamic compromise. Rhythm control may be beneficial for many patients and this can be accomplished through the use of antiarrhythmic medications, cardioversion, and/or ablation. PMID:26567489

  13. Catapult launch-associated cardioversion of atrial fibrillation.

    PubMed

    Bohnker, B K; Feeks, E F; McEwen, G

    1993-10-01

    A patient is presented with new-onset atrial fibrillation. While being air-evacuated, he cardioverted during the acceleration associated with aircraft carrier catapult launch. This case suggests a possible myocardial response to the kinetic energy produced by the acceleration force, similar to the electrical energy commonly used for cardioversion. Cardioversion using acceleration forces is probably not a clinically useful modality; however, this case demonstrates the importance of acceleration forces on patients during medical evacuation from aircraft carriers. PMID:8240199

  14. Atrial Flutter Ablation and Risk of Right Coronary Artery Injury

    PubMed Central

    Al Aloul, Basel; Sigurdsson, Gardar; Adabag, Selcuk; Li, Jian-Ming; Dykoski, Richard; Tholakanahalli, Venkatakrishna N.

    2015-01-01

    Radiofrequency ablation (RFA) of atrial flutter (AFL) is a commonly performed procedure with low risk of complications. Several case reports and animal studies cautioned about the risk of right coronary artery (RCA) injury following AFL ablation. This risk is due to the anatomic proximity of the RCA to the cavo-tricuspid isthmus where ablation is performed. We present a case report that demonstrates postmortem evidence of RCA injury following RFA of AFL. PMID:25699126

  15. Large free-floating left atrial thrombus with normal mitral valve

    PubMed Central

    Chidambaram, Sundar; Rajkumar, Arunkumar; Ganesan, Gnanavelu; Sangareddi, Venkatesan; Ramasamy, Alagesan; Dhandapani, V.E.; Ravi, M.S.

    2013-01-01

    Left atrial thrombus in the presence of diseased mitral valve and atrial fibrillation is a well known entity. But it is very rare to occur in the presence of normal mitral valve apparatus. We report the case of a 36 year old female who presented with left atrial ball valve thrombus and normal mitral valve apparatus and underwent surgery. This patient with gangrene of right lower limb came for cardiac evaluation. She had infarct in left middle cerebral artery territory- ten months prior to this admission and was on treatment for infertility. She had atrial fibrillation. Emergency surgery to remove the thrombus should be considered given its potential life threatening embolic nature. PMID:23438617

  16. Myxoma and vaccinia viruses exploit different mechanisms to enter and infect human cancer cells

    SciTech Connect

    Villa, Nancy Y.; Bartee, Eric; Mohamed, Mohamed R.; Rahman, Masmudur M.; Barrett, John W.; McFadden, Grant

    2010-06-05

    Myxoma (MYXV) and vaccinia (VACV) viruses have recently emerged as potential oncolytic agents that can infect and kill different human cancer cells. Although both are structurally similar, it is unknown whether the pathway(s) used by these poxviruses to enter and cause oncolysis in cancer cells are mechanistically similar. Here, we compared the entry of MYXV and VACV-WR into various human cancer cells and observed significant differences: 1 - low-pH treatment accelerates fusion-mediated entry of VACV but not MYXV, 2 - the tyrosine kinase inhibitor genistein inhibits entry of VACV, but not MYXV, 3 - knockdown of PAK1 revealed that it is required for a late stage event downstream of MYXV entry into cancer cells, whereas PAK1 is required for VACV entry into the same target cells. These results suggest that VACV and MYXV exploit different mechanisms to enter into human cancer cells, thus providing some rationale for their divergent cancer cell tropisms.

  17. Atrial Septostomy: A Contemporary Review.

    PubMed

    Al Maluli, Hayan; DeStephan, Christine M; Alvarez, René J; Sandoval, Julio

    2015-06-01

    Pulmonary arterial hypertension (PAH) is a rare disease, but it boasts significant morbidity and mortality. Although remarkable achievements have been made in the medical treatment of PAH, there is a role for invasive or surgical procedures in patients with progressive disease despite optimal medical therapy or with no access to such therapy. Atrial septostomy creates a right-to-left intracardiac shunt to decompress the overloaded right ventricle. Despite significant advances to validate and improve this palliative procedure, as well as recent reports of improved outcomes, it is only slowly being adopted. This article aims to detail the history, indications, contraindications, procedural techniques, and outcomes of atrial septostomy. We will also shed light on some of the newer interventions, inspired by the same physiological concept, that are being evaluated as potential palliative modalities in patients with PAH. PMID:25733325

  18. Left Atrial Appendage Closure Devices

    PubMed Central

    Romero, Jorge; Perez, Irving E; Krumerman, Andrew; Garcia, Mario J; Lucariello, Richard J

    2014-01-01

    Atrial fibrillation (AF) increases the risk for thromboembolic stroke five-fold. The left atrial appendage (LAA) has been shown to be the main source of thrombus formation in the majority of strokes associated with AF. Oral anticoagulation with warfarin and novel anticoagulants remains the standard of care; however, it has several limitations, including bleeding and poor compliance. Occlusion of the LAA has been shown to be an alternative therapeutic approach to drug therapy. The purpose of this article is to review the different techniques and devices that have emerged for the purpose of occluding this structure, with a particular emphasis on the efficacy and safety studies published to date in the medical literature. PMID:24963274

  19. Atrial Arrhythmia Summit: Post Summit Report

    NASA Technical Reports Server (NTRS)

    Barr, Yael

    2010-01-01

    The Atrial Arrhythmia Summit brought together nationally and internationally recognized experts in cardiology, electrophysiology, exercise physiology, and space medicine in an effort to elucidate the mechanisms, risk factors, and management of atrial arrhythmias in the unique occupational cohort of the U.S. astronaut corps.

  20. Surgical Treatment of Concomitant Atrial Fibrillation: Focus onto Atrial Contractility

    PubMed Central

    Loardi, Claudia; Alamanni, Francesco; Galli, Claudia; Naliato, Moreno; Veglia, Fabrizio; Zanobini, Marco; Pepi, Mauro

    2015-01-01

    Background. Maze procedure aims at restoring sinus rhythm (SR) and atrial contractility (AC). This study evaluated multiple aspects of AC recovery and their relationship with SR regain after ablation. Methods. 122 mitral and fibrillating patients underwent radiofrequency Maze. Rhythm check and echocardiographic control of biatrial contractility were performed at 3, 6, 12, and 24 months postoperatively. A multivariate Cox analysis of risk factors for absence of AC recuperation was applied. Results. At 2-years follow-up, SR was achieved in 79% of patients. SR-AC coexistence increased from 76% until 98%, while biatrial contraction detection augmented from 84 to 98% at late stage. Shorter preoperative arrhythmia duration was the only common predictor of SR-AC restoring, while pulmonary artery pressure (PAP) negatively influenced AC recuperation. Early AC restoration favored future freedom from arrhythmia recurrence. Minor LA dimensions correlated with improved future A/E value and vice versa. Right atrial (RA) contractility restoring favored better left ventricular (LV) performance and volumes. Conclusions. SR and left AC are two interrelated Maze objectives. Factors associated with arrhythmia “chronic state” (PAP and arrhythmia duration) are negative predictors of procedural success. Our results suggest an association between postoperative LA dimensions and “kick” restoring and an influence of RA contraction onto LV function. PMID:26229956

  1. Dronedarone for the treatment of atrial fibrillation and atrial flutter.

    PubMed

    Maund, E; McKenna, C; Sarowar, M; Fox, D; Stevenson, M; Pepper, C; Palmer, S; Woolacott, N

    2010-10-01

    This paper presents a summary of the evidence review group (ERG) report on the clinical effectiveness and cost-effectiveness of dronedarone for the treatment of atrial fibrillation (AF) or atrial flutter based upon a review of the manufacturer's submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal process. The population considered in the submission were adult clinically stable patients with a recent history of or current non-permanent AF. Comparators were the current available anti-arrhythmic drugs: class 1c agents (flecainide and propafenone), sotalol and amiodarone. Outcomes were AF recurrence, all-cause mortality, stroke, treatment discontinuations (due to any cause or due to adverse events) and serious adverse events. The main evidence came from four phase III randomised controlled trials, direct and indirect meta-analyses from a systematic review, and a synthesis of the direct and indirect evidence using a mixed-treatment comparison. Overall, the results from the different synthesis approaches showed that the odds of AF recurrence appeared statistically significantly lower with dronedarone and other anti-arrhythmic drugs than with non-active control, and that the odds of AF recurrence are statistically significantly higher for dronedarone than for amiodarone. However, the results for outcomes of all-cause mortality, stroke and treatment discontinuations and serious adverse events were all uncertain. A discrete event simulation model was used to evaluate dronedarone versus antiarrhythmic drugs and standard therapy alone. The incremental cost-effectiveness ratio of dronedarone was relatively robust and less than 20,000 pounds per quality-adjusted life-year. Exploratory work undertaken by the ERG identified that the main drivers of cost-effectiveness were the benefits assigned to dronedarone for all-cause mortality and stroke. Dronedarone is not cost-effective relative to its comparators when the only effect of treatment is a reduction in AF recurrences. In conclusion, uncertainties remain in the clinical effectiveness and cost-effectiveness of dronedarone. In particular, the clinical evidence for the major drivers of cost-effectiveness (all-cause mortality and stroke), and consequently the additional benefits attributed in the economic model to dronedarone compared to other anti-arrhythmic drugs are highly uncertain. The final guidance, issued by NICE on 25 August 2010, states that: Dronedarone is recommended as an option for the treatment of non-permanent atrial fibrillation only in people: whose atrial fibrillation is not controlled by first-line therapy (usually including beta-blockers), that is, as a second-line treatment option, and who have at least one of the following cardiovascular risk factors: - hypertension requiring drugs of at least two different classes, diabetes mellitus, previous transient ischaemic attack, stroke or systemic embolism, left atrial diameter of 50 mm or greater, left ventricular ejection fraction less than 40% (noting that the summary of product characteristics [SPC] does not recommend dronedarone for people with left ventricular ejection fraction less than 35% because of limited experience of using it in this group) or age 70 years or older, and who do not have unstable New York Heart Association (NYHA) class III or IV heart failure. Furthermore, 'People who do not meet the criteria above who are currently receiving dronedarone should have the option to continue treatment until they and their clinicians consider it appropriate to stop'. PMID:21047492

  2. Atrial flutter with a large bystander segment without double potentials in the cavotricuspid isthmus.

    PubMed

    Adachi, Masamitsu; Igawa, Osamu; Yano, Akio; Inoue, Yoshiaki

    2007-10-01

    We present two cases of common-type atrial flutter with a large bystander segment without double potentials in the cavotricuspid isthmus. In both cases, right atrial angiography demonstrated a prominent pouch at the center of the isthmus. When radiofrequency energy was applied to the tricuspid side of the isthmus, delayed potentials abruptly appeared on the local electrograms. When radiofrequency energy was applied on the inferior vena cava side of the isthmus, the tachycardia was terminated. Although ablation was not applied to the bottom of the pouch, bidirectional isthmus block was achieved. These outcomes indicate that the pouch represented a bystander segment. PMID:17905342

  3. [Management and therapy of atrial fibrillation in geriatric patients].

    PubMed

    Gosch, M; Roller, R E; Böhmdorfer, B; Benvenuti-Falger, U; Iglseder, B; Lechleitner, M; Sommeregger, U; Dovjak, P

    2012-01-01

    Among geriatric patients, atrial fibrillation is the most common cardiac arrhythmia. In patients over 80 years of age, the prevalence rises to approximately 10%. Atrial fibrillation is associated with serious health implications, including a 2-fold increase in mortality risk and a 5-fold increase in stroke risk. In contrast to these facts, the current guidelines on the management of atrial fibrillation of the European Society of Cardiology (ESC) contain only a short paragraph on these patients. Many relevant clinical aspects go without any comment. Thus, the purpose of our paper is to discuss those special needs of geriatric patients and their physicians which are not mentioned in the guidelines of the ESC. In our review, we discuss rhythm versus rate control, oral anticoagulation, outcome, prevention, falls, adherence, polypharmacy, dementia, nursing home patients, frailty, and geriatric assessment in consideration of geriatric patients. An extended search of the literature on Pubmed served as the basis for this review. Individual aspects of each geriatric patient should be considered when managing these complex patients; however, the complexity of each case must not lead to an individualized therapy that is not in accordance with current guidelines and the literature. A large number of papers which help us to answer most of the clinical questions regarding the management of trial fibrillation in geriatric patients have already been published. PMID:22278008

  4. Recurrent right atrial thrombosis due to Behçet disease.

    PubMed

    Kuno, Toshiki; Tamura, Yuichi; Ono, Tomohiko; Murata, Mitsushige; Kuwana, Masataka; Satoh, Toru; Fukuda, Keiichi

    2014-10-01

    Behçet disease is a rare condition sometimes associated with chronic cardiac inflammation followed by myocardial dysfunction and vascular inflammation. We report a case of recurrent right atrial thrombus due to Behçet disease despite continued anticoagulation therapy. The thrombus disappeared after the initiation of immunosuppressive therapy. To avoid a progression to thrombus or cardiac dysfunction in this recurrent case, the early identification of cardiac involvement of Behçet disease using echocardiography and/or cardiac magnetic resonance imaging might be important. Combined immunosuppressive therapy with prednisone and cyclophosphamide might be needed to treat recurrent thrombosis due to Behçet disease. PMID:25174856

  5. Simultaneous Removal of Right Lung Hydatid Cyst and Repair of Atrial Septal Defect in a Single Session.

    PubMed

    Tong, Guang; Lin, Xi; Ma, Tao; Wang, Xiaowu; Zhang, Weida

    2016-01-01

    Hydatid cyst is the larval stage of echinococcosis caused by the canine tapeworm Echinococcus species, and the lung is the most common site of occurrence. Atrial septal defect is a common congenital heart disease with an incidence of 100 per 100,000 live births. To our knowledge, we report for the first time a case of coexistence of right lung hydatid cyst and atrial septal defect that were both treated with one-stage surgery. PMID:26694269

  6. The wedding cake solution: A percutaneous correction of a form fruste superior sinus venosus atrial septal defect.

    PubMed

    Crystal, Matthew A; Vincent, Julie A; Gray, William A

    2015-12-01

    We present the case of a patient with a superior sinus venosus defect (SSVD), with the atypical finding of an intact atrial septum and posterior atrial wall, which underwent percutaneous closure in the cardiac catheterization laboratory for repair. SSVDs are rare congenital cardiac anomalies, but when the anatomy is amenable to percutaneous strategies, a collaborative and creative approach can result in a safe and effective result. © 2015 Wiley Periodicals, Inc. PMID:26011715

  7. The unexpected pitter patter: new-onset atrial fibrillation in pregnancy.

    PubMed

    White, Sarah; Welch, Janna; Brown, Lawrence H

    2015-01-01

    Background. Atrial fibrillation is a relatively uncommon but dangerous complication of pregnancy. Emergency physicians must know how to treat both stable and unstable tachycardias in late pregnancy. In this case, a 40-year-old female with a cerclage due to incompetent cervix and previous preterm deliveries presents in new-onset atrial fibrillation. Case Report. A previously healthy 40-year-old African American G2 P1 female with a 23-week twin gestation complicated by an incompetent cervix requiring a cervical cerclage presented to the emergency department with intermittent palpitations and shortness of breath for the past two months. EMS noted the patient to have a tachydysrhythmia, atrial fibrillation with rapid ventricular response. She was placed on a diltiazem drip, which was titrated to 15?mg/hr without successful rate control. Her heart rate remained in the 130s and the rhythm continued to be atrial fibrillation with RVR. Digoxin was then added as a second agent, and discussions about the potential risks of cardioversion in pregnancy ensued. Fortunately, the patient converted to sinus rhythm before cardioversion became necessary. The digoxin was discontinued; the diltiazem was also discontinued after the patient subsequently developed hypotension. "Why Should Emergency Physicians Be Aware of This?" New-onset atrial fibrillation is rare in pregnancy but can increase the mortality and morbidity of the mother and fetus if not treated promptly. PMID:25960893

  8. The Unexpected Pitter Patter: New-Onset Atrial Fibrillation in Pregnancy

    PubMed Central

    White, Sarah; Brown, Lawrence H.

    2015-01-01

    Background. Atrial fibrillation is a relatively uncommon but dangerous complication of pregnancy. Emergency physicians must know how to treat both stable and unstable tachycardias in late pregnancy. In this case, a 40-year-old female with a cerclage due to incompetent cervix and previous preterm deliveries presents in new-onset atrial fibrillation. Case Report. A previously healthy 40-year-old African American G2 P1 female with a 23-week twin gestation complicated by an incompetent cervix requiring a cervical cerclage presented to the emergency department with intermittent palpitations and shortness of breath for the past two months. EMS noted the patient to have a tachydysrhythmia, atrial fibrillation with rapid ventricular response. She was placed on a diltiazem drip, which was titrated to 15?mg/hr without successful rate control. Her heart rate remained in the 130s and the rhythm continued to be atrial fibrillation with RVR. Digoxin was then added as a second agent, and discussions about the potential risks of cardioversion in pregnancy ensued. Fortunately, the patient converted to sinus rhythm before cardioversion became necessary. The digoxin was discontinued; the diltiazem was also discontinued after the patient subsequently developed hypotension. “Why Should Emergency Physicians Be Aware of This?” New-onset atrial fibrillation is rare in pregnancy but can increase the mortality and morbidity of the mother and fetus if not treated promptly. PMID:25960893

  9. Myxoma virus suppresses proliferation of activated T lymphocytes yet permits oncolytic virus transfer to cancer cells.

    PubMed

    Villa, Nancy Y; Wasserfall, Clive H; Meacham, Amy M; Wise, Elizabeth; Chan, Winnie; Wingard, John R; McFadden, Grant; Cogle, Christopher R

    2015-06-11

    Allogeneic hematopoietic cell transplant (allo-HCT) can be curative for certain hematologic malignancies, but the risk of graft-versus-host disease (GVHD) is a major limitation for wider application. Ideally, strategies to improve allo-HCT would involve suppression of T lymphocytes that drive GVHD while sparing those that mediate graft-versus-malignancy (GVM). Recently, using a xenograft model, we serendipitously discovered that myxoma virus (MYXV) prevented GVHD while permitting GVM. In this study, we show that MYXV binds to resting, primary human T lymphocytes but will only proceed into active virus infection after the T cells receive activation signals. MYXV-infected T lymphocytes exhibited impaired proliferation after activation with reduced expression of interferon-?, interleukin-2 (IL-2), and soluble IL-2R?, but did not affect expression of IL-4 and IL-10. MYXV suppressed T-cell proliferation in 2 patterns (full vs partial) depending on the donor. In terms of GVM, we show that MYXV-infected activated human T lymphocytes effectively deliver live oncolytic virus to human multiple myeloma cells, thus augmenting GVM by transfer of active oncolytic virus to residual cancer cells. Given this dual capacity of reducing GVHD plus increasing the antineoplastic effectiveness of GVM, ex vivo virotherapy with MYXV may be a promising clinical adjunct to allo-HCT regimens. PMID:25904246

  10. Myxoma virus suppresses proliferation of activated T lymphocytes yet permits oncolytic virus transfer to cancer cells

    PubMed Central

    Villa, Nancy Y.; Wasserfall, Clive H.; Meacham, Amy M.; Wise, Elizabeth; Chan, Winnie; Wingard, John R.; McFadden, Grant

    2015-01-01

    Allogeneic hematopoietic cell transplant (allo-HCT) can be curative for certain hematologic malignancies, but the risk of graft-versus-host disease (GVHD) is a major limitation for wider application. Ideally, strategies to improve allo-HCT would involve suppression of T lymphocytes that drive GVHD while sparing those that mediate graft-versus-malignancy (GVM). Recently, using a xenograft model, we serendipitously discovered that myxoma virus (MYXV) prevented GVHD while permitting GVM. In this study, we show that MYXV binds to resting, primary human T lymphocytes but will only proceed into active virus infection after the T cells receive activation signals. MYXV-infected T lymphocytes exhibited impaired proliferation after activation with reduced expression of interferon-?, interleukin-2 (IL-2), and soluble IL-2R?, but did not affect expression of IL-4 and IL-10. MYXV suppressed T-cell proliferation in 2 patterns (full vs partial) depending on the donor. In terms of GVM, we show that MYXV-infected activated human T lymphocytes effectively deliver live oncolytic virus to human multiple myeloma cells, thus augmenting GVM by transfer of active oncolytic virus to residual cancer cells. Given this dual capacity of reducing GVHD plus increasing the antineoplastic effectiveness of GVM, ex vivo virotherapy with MYXV may be a promising clinical adjunct to allo-HCT regimens. PMID:25904246

  11. [Catheter ablation for atrial fibrillation: clinically established or still an experimental method].

    PubMed

    Willems, S; Hoffmann, B; Steven, D; Drewitz, I; Servatius, H; Rostock, T

    2011-01-01

    Interventional treatment for atrial fibrillation has been introduced as a therapeutic option since the pulmonary veins (PV) have been discovered as the dominant sources of paroxysmal atrial fibrillation (PAF). Elimination of PV conduction is the initial goal during catheter ablation in this setting. The success rate after the initial procedure varies between 60 and 85 %, with more than 80 % after subsequent interventions. Supported by the current guidelines, interventional treatment of AF is indicated in case of symptomatic arrhythmias refractory to antiarrhythmic treatment. The introduction of the combined, stepwise approach has been another important breakthrough with regard to the treatment of chronic persistent atrial fibrillation (CAF). This strategy includes the combination of all conventional ablation strategies (PV isolation, ablation of complex fractionated atrial electrograms, linear ablation) with the goal of AF termination. The first procedure for CAF treatment is quite frequently also only the first step towards stable sinus rhythm with a favourable outcome after AF termination (> 80 % sinus rhythm). In more than half of the patients predominantly other atrial arrhythmias than AF have to be targeted in a second procedure. This approach is currently under clinical investigation and so far not "clinically established" due to the fact that it is a quite time consuming and challenging procedure even in experienced centres. Future studies may help to identify predictors for procedure failure (e.g. LA size, AF duration, atrial cycle length, spectral analysis) in order to improve patient selection. Additionally, it has to be underscored, that in paroxysmal atrial fibrillation the relatively high recurrence rate after the first procedure still is the subject of further investigations. This aspect might be improved by the introduction of novel strategies (i.e. testing of concealed PV conduction after ablation with adenosine) or new technologies (i.e. robotic navigation) for PAF ablation. PMID:21627605

  12. Autonomic influences in atrial ischemia: vagally mediated atrial conduction improvement.

    PubMed

    Guo, H; Euler, D; Wang, Z; Olshansky, B

    1997-09-19

    To investigate the effects of autonomic nerve activation on electrophysiological properties of ischemic atrial myocardium, experiments were performed in 10 open chest adult dogs anesthetized with xylazine and alpha-chloralose. Ischemia was created in the right atrial free wall by ligation of one or more branches of the right coronary artery. Bipolar electrograms were recorded from multiple sites in the ischemic and non-ischemic zones. The atria were paced at 400 ms and 180 ms to assess conduction properties. One hour after ligation, delayed activation, electrogram fractionation, and electrogram alternans were observed in the ischemic zone. All local conduction abnormalities were heart rate dependent in that they were only observed at a pacing cycle length of 180 ms. The average duration of ischemic zone electrograms was significantly prolonged from 17.7+/-1.6 ms to 26.4+/-1.6 ms (P<0.001). Right and left vagal stimulation significantly shortened the electrogram duration in the ischemic zone from 26.4+/-1.6 ms to 19.7+/-1.1 ms (P<0.01) and 20.0+/-1.1 ms (P<0.01), respectively. Ischemia-induced electrogram alternans was eliminated completely. During right and left stellate stimulation, electrogram duration was not altered and alternans was still present. In conclusion, vagal stimulation in this canine model improves local conduction in ischemic myocardium in the right atrium. This effect may be mediated by a reversal of the ischemia-induced membrane depolarization and a shortening of refractoriness in the atrium during vagal activation. PMID:9314209

  13. Towards Low Energy Atrial Defibrillation

    PubMed Central

    Walsh, Philip; Kodoth, Vivek; McEneaney, David; Rodrigues, Paola; Velasquez, Jose; Waterman, Niall; Escalona, Omar

    2015-01-01

    A wireless powered implantable atrial defibrillator consisting of a battery driven hand-held radio frequency (RF) power transmitter (ex vivo) and a passive (battery free) implantable power receiver (in vivo) that enables measurement of the intracardiacimpedance (ICI) during internal atrial defibrillation is reported. The architecture is designed to operate in two modes: Cardiac sense mode (power-up, measure the impedance of the cardiac substrate and communicate data to the ex vivo power transmitter) and cardiac shock mode (delivery of a synchronised very low tilt rectilinear electrical shock waveform). An initial prototype was implemented and tested. In low-power (sense) mode, >5 W was delivered across a 2.5 cm air-skin gap to facilitate measurement of the impedance of the cardiac substrate. In high-power (shock) mode, >180 W (delivered as a 12 ms monophasic very-low-tilt-rectilinear (M-VLTR) or as a 12 ms biphasic very-low-tilt-rectilinear (B-VLTR) chronosymmetric (6ms/6ms) amplitude asymmetric (negative phase at 50% magnitude) shock was reliably and repeatedly delivered across the same interface; with >47% DC-to-DC (direct current to direct current) power transfer efficiency at a switching frequency of 185 kHz achieved. In an initial trial of the RF architecture developed, 30 patients with AF were randomised to therapy with an RF generated M-VLTR or B-VLTR shock using a step-up voltage protocol (50–300 V). Mean energy for successful cardioversion was 8.51 J ± 3.16 J. Subsequent analysis revealed that all patients who cardioverted exhibited a significant decrease in ICI between the first and third shocks (5.00 ? (SD(?) = 1.62 ?), p < 0.01) while spectral analysis across frequency also revealed a significant variation in the impedance-amplitude-spectrum-area (IAMSA) within the same patient group (|?(IAMSAS1-IAMSAS3)[1 Hz ? 20 kHz] = 20.82 ?-Hz (SD(?) = 10.77 ?-Hz), p < 0.01); both trends being absent in all patients that failed to cardiovert. Efficient transcutaneous power transfer and sensing of ICI during cardioversion are evidenced as key to the advancement of low-energy atrial defibrillation. PMID:26404298

  14. Towards Low Energy Atrial Defibrillation.

    PubMed

    Walsh, Philip; Kodoth, Vivek; McEneaney, David; Rodrigues, Paola; Velasquez, Jose; Waterman, Niall; Escalona, Omar

    2015-01-01

    A wireless powered implantable atrial defibrillator consisting of a battery driven hand-held radio frequency (RF) power transmitter (ex vivo) and a passive (battery free) implantable power receiver (in vivo) that enables measurement of the intracardiac impedance (ICI) during internal atrial defibrillation is reported. The architecture is designed to operate in two modes: Cardiac sense mode (power-up, measure the impedance of the cardiac substrate and communicate data to the ex vivo power transmitter) and cardiac shock mode (delivery of a synchronised very low tilt rectilinear electrical shock waveform). An initial prototype was implemented and tested. In low-power (sense) mode, >5 W was delivered across a 2.5 cm air-skin gap to facilitate measurement of the impedance of the cardiac substrate. In high-power (shock) mode, >180 W (delivered as a 12 ms monophasic very-low-tilt-rectilinear (M-VLTR) or as a 12 ms biphasic very-low-tilt-rectilinear (B-VLTR) chronosymmetric (6ms/6ms) amplitude asymmetric (negative phase at 50% magnitude) shock was reliably and repeatedly delivered across the same interface; with >47% DC-to-DC (direct current to direct current) power transfer efficiency at a switching frequency of 185 kHz achieved. In an initial trial of the RF architecture developed, 30 patients with AF were randomised to therapy with an RF generated M-VLTR or B-VLTR shock using a step-up voltage protocol (50-300 V). Mean energy for successful cardioversion was 8.51 J ± 3.16 J. Subsequent analysis revealed that all patients who cardioverted exhibited a significant decrease in ICI between the first and third shocks (5.00 ? (SD(?) = 1.62 ?), p < 0.01) while spectral analysis across frequency also revealed a significant variation in the impedance-amplitude-spectrum-area (IAMSA) within the same patient group (|?(IAMSAS1-IAMSAS3)[1 Hz - 20 kHz] = 20.82 ?-Hz (SD(?) = 10.77 ?-Hz), p < 0.01); both trends being absent in all patients that failed to cardiovert. Efficient transcutaneous power transfer and sensing of ICI during cardioversion are evidenced as key to the advancement of low-energy atrial defibrillation. PMID:26404298

  15. Atrial Fibrillation - Multiple Languages: MedlinePlus

    MedlinePLUS

    ... Supplements Videos & Tools You Are Here: Home ? Multiple Languages ? All Health Topics ? Atrial Fibrillation URL of this page: https://www.nlm.nih.gov/medlineplus/languages/atrialfibrillation.html Other topics A-Z A B ...

  16. Why Atrial Fibrillation (AF or AFib) Matters

    MedlinePLUS

    ... Stroke More Why Atrial Fibrillation (AF or AFib) Matters Updated:Nov 13,2015 Watch this short video ... top of the heart and – like an electrical wave – the current travels to the lower parts of ...

  17. Patient's Guide to Living with Atrial Fibrillation

    MedlinePLUS

    ... Atrial fibrillation. Circulation . 2002 ; 106 : 14 –16. FREE Full Text ? The AFFIRM Investigators. Relationships between sinus rhythm, treatment, ... study. Circulation . 2004 ; 109 : 1509 –1513. Abstract / FREE Full Text ? Shea JB, Maisel WH. Cardioversion. Circulation . 2002 ; 106 : ...

  18. Cellular bases for human atrial fibrillation

    PubMed Central

    Workman, Antony J.; Kane, Kathleen A.; Rankin, Andrew C.

    2008-01-01

    Atrial fibrillation (AF) causes substantial morbidity and mortality. It may be triggered and sustained by either reentrant or nonreentrant electrical activity. Human atrial cellular refractory period is shortened in chronic AF, likely aiding reentry. The ionic and molecular mechanisms are not fully understood and may include increased inward rectifier K+ current and altered Ca2+ handling. Heart failure, a major cause of AF, may involve arrhythmogenic atrial electrical remodeling, but the pattern is unclear in humans. Beta-blocker therapy prolongs atrial cell refractory period; a potentially antiarrhythmic influence, but the ionic and molecular mechanisms are unclear. The search for drugs to suppress AF without causing ventricular arrhythmias has been aided by basic studies of cellular mechanisms of AF. It remains to be seen whether such drugs will improve patient treatment. PMID:18456193

  19. Atrial fibrillation care improvement collaborative

    PubMed Central

    Robelia, Paul; Kopecky, Stephen; Thacher, Tom

    2015-01-01

    Atrial fibrillation (AF) is an increasingly common cardiac arrhythmia. Many patients with new onset or recurrent AF present to the emergency department and are subsequently admitted to the hospital and seen by cardiology specialists for follow up. In an attempt to address this high utilization of acute health care resources, reduce costs, and improve patient care, our institution instituted a collaborative project between the departments of emergency medicine, cardiology, family medicine, and primary care internal medicine. The project team oversaw development of a new emergency department AF order set, encouraged utilization of a new oral anticoagulant (dabigatran), improved the primary care follow up connection, and deployed a multimodal education plan for primary care providers. Between 2012 and 2014, these interventions resulted in a 17% reduction in total AF per member per month (PMPM) cost, a 28% reduction in AF PMPM inpatient cost, and a 24% reduction in inpatient admissions for AF.

  20. Atrial fibrillation cardioversion following acupuncture.

    PubMed

    Dilber, Dario; ?erkez-Habek, Jasna; Bari?, Hrvoje; Gradišer, Marina

    2015-11-01

    Atrial fibrillation (AF) is the most common arrhythmia and it is an independent risk for serious events. Acupuncture has been growing in popularity in the West, and there are reports of its benefits in treating AF. We report a 57-year-old man who was admitted after having an allergic reaction to amiodarone administered to treat paroxysmal AF with fast ventricular response. Cardioversion with intravenous propafenone was uneventful. Before an attempt of electric cardioversion, he was treated with acupuncture as additional therapy to peroral propafenone. After acupuncture treatment consisting of 10 treatments during 30 days period, both immediate cardioversion to sinus rhythm and no paroxysmal AF during 30 days period were recorded. PMID:26593171

  1. Atrial fibrillation cardioversion following acupuncture

    PubMed Central

    Dilber, Dario; ?erkez-Habek, Jasna; Bari?, Hrvoje; Gradišer, Marina

    2015-01-01

    Atrial fibrillation (AF) is the most common arrhythmia and it is an independent risk for serious events. Acupuncture has been growing in popularity in the West, and there are reports of its benefits in treating AF. We report a 57-year-old man who was admitted after having an allergic reaction to amiodarone administered to treat paroxysmal AF with fast ventricular response. Cardioversion with intravenous propafenone was uneventful. Before an attempt of electric cardioversion, he was treated with acupuncture as additional therapy to peroral propafenone. After acupuncture treatment consisting of 10 treatments during 30 days period, both immediate cardioversion to sinus rhythm and no paroxysmal AF during 30 days period were recorded. PMID:26593171

  2. [No Hodgkin Linfoma diagnosis with intra-atrial infiltration].

    PubMed

    Alcocer Gamba, Marco Antonio; León González, Salvador; Castro Montes, Eliodoro; Loarca Piña, Luis Martín; Lugo Gavidia, Leslie Marisol; García Hernández, Enrique; González Galindo, Ulises; Paredes Serrano, Miguel Isaías

    2012-09-01

    Cardiac tumors are rare entities in clinical practice, with an incidence of 0.05%. Approximately 75% are benign and 25% malignant. Among these, Lymphomas are uncommon, representing about 0.25%. The non-Hodgkin lymphomas can occur in extranodal tissues in 20% of the cases and 80% of these non-Hodgkin lymphomas are composed of diffuse B cells. The extranodal presentation is most frequent in young adults, with a high degree of malignancy and rapid growth. It can present with primary infiltration of various organs; cardiac involvement occurs in 20 to 28% of cases, usually located in the right chambers and with nonspecific symptoms, depending on the location and extent of the tumor. The diagnostic test in these cases is undoubtedly the biopsy of the lymph node or the affected tissue. We present the case of non-Hodgkin disease of diffuse large cells, with right intra-atrial involvement in a 23-year-old-female patient, who presented with progressive dyspnea. A transesophageal echocardiography was performed and an intra-atrial tumor mass was detected. A biopsy was performed, by femoral venous catheterization, allowing the establishment of the histopathological diagnosis and treatment. At a one year follow up, the patient shows complete remission. PMID:23248972

  3. The potential role of the left atrial septal pouch in cryptogenic stroke.

    PubMed

    Wong, Jonathan M; Fisher, Mark

    2016-01-01

    The left atrial septal pouch (LASP) is an anatomic variant of the atrial septum that forms a blind-ending pouch, communicating exclusively with the left atrium (LA). Case reports have demonstrated thrombus within LASP and in the setting of cryptogenic stroke. Initial epidemiologic results are mixed, one study showing and others not showing an association between LASP and cryptogenic stroke. Additional investigation should take place to determine the clinical significance of LASP and what interventions are required to prevent ischemic stroke in at-risk individuals. PMID:26488338

  4. Effect of exercise on ventricular response to atrial fibrillation in Wolff-Parkinson-White syndrome.

    PubMed

    Crick, J C; Davies, D W; Holt, P; Curry, P V; Sowton, E

    1985-07-01

    Ten patients with Wolff-Parkinson-White syndrome underwent cardiac electrophysiological study extended to include the induction of atrial fibrillation at maximum exercise in the upright position. This was performed using a new temporary bipolar lead with a helical active fixation tip for atrial pacing. The highest rate of atrioventricular conduction via the accessory pathway was greater during exercise than at rest in all 10 patients (mean increase 28%). In three cases the resulting ventricular rate exceeded 300 beats/min, but no patient had severe symptoms or ventricular arrhythmias. The exercise induced enhancement of accessory pathway conduction may significantly but unpredictably affect the risk from spontaneous atrial fibrillation especially in patients with coronary artery disease or in those taking antiarrhythmic drugs. The test procedure was sufficiently simple and well tolerated to be included in our routine electrophysiological investigation. PMID:4015920

  5. Medical management of connector pin thrombosis with the Amplatzer cardiac plug left atrial closure device.

    PubMed

    Fernández-Rodríguez, Diego; Vannini, Luca; Martín-Yuste, Victoria; Brugaletta, Salvatore; Robles, Rocío; Regueiro, Ander; Masotti, Mónica; Sabaté, Manel

    2013-10-26

    Transcatheter closure of the left atrial appendage with the Amplatzer™ cardiac plug device and double antiplatelet treatment for 3 mo has become an alternative treatment for patients with atrial fibrillation at high embolism risk and contraindications for chronic oral anticoagulation. The inadequate implantation of the left atrial appendage closure device and the discontinuation of double antiplatelet therapy are well-known as factors related to device thrombosis. Nevertheless, device thrombosis after adequate implantation requiring surgical treatment or restarting chronic oral anticoagulation has been reported and can reach 15% of patients. The connector pin thrombosis of the Amplatzer™ cardiac plug, despite a good adherence to antiplatelet treatment, has been recently described as a potential mechanism for device thrombosis. Our clinical case reports the management of this condition for the first time, showing that the early detection of thrombotic complications by transesophageal echocardiography permits solving this serious complication with medical treatment only. PMID:24198910

  6. Medical management of connector pin thrombosis with the Amplatzer cardiac plug left atrial closure device

    PubMed Central

    Fernández-Rodríguez, Diego; Vannini, Luca; Martín-Yuste, Victoria; Brugaletta, Salvatore; Robles, Rocío; Regueiro, Ander; Masotti, Mónica; Sabaté, Manel

    2013-01-01

    Transcatheter closure of the left atrial appendage with the Amplatzer™ cardiac plug device and double antiplatelet treatment for 3 mo has become an alternative treatment for patients with atrial fibrillation at high embolism risk and contraindications for chronic oral anticoagulation. The inadequate implantation of the left atrial appendage closure device and the discontinuation of double antiplatelet therapy are well-known as factors related to device thrombosis. Nevertheless, device thrombosis after adequate implantation requiring surgical treatment or restarting chronic oral anticoagulation has been reported and can reach 15% of patients. The connector pin thrombosis of the Amplatzer™ cardiac plug, despite a good adherence to antiplatelet treatment, has been recently described as a potential mechanism for device thrombosis. Our clinical case reports the management of this condition for the first time, showing that the early detection of thrombotic complications by transesophageal echocardiography permits solving this serious complication with medical treatment only. PMID:24198910

  7. [Atrial fibrillation and flutter in athletes].

    PubMed

    Inama, Giuseppe; Pedrinazzi, Claudio; Durin, Ornella; Inama, Lorenza; Furlanello, Francesco

    2010-10-01

    Atrial fibrillation (AF) is one of the most frequent findings in the general population, with an incidence of about 0.1% per year and a mean prevalence of 0.95%. However, prevalence values are known to vary with age, being very low (0.1-0.2%) in subjects less than 55 years old, the age group comprising the greatest number of individuals who practice sport at various levels. Long-term, regular, intense physical training determines an increase in vagal tone, leading to bradycardia, and during physical activity, particularly competitive sport, a marked release of catecholamines occurs as a result of both the intense physical effort and the emotional stress involved in competition. Both these adaptive phenomena on the part of the autonomous nervous system may promote the development of AF. Heart diseases with a certain degree of severity are not generally compatible with sport, unless the activity undertaken involves a low expenditure of energy and is noncompetitive. In any case, in the presence of AF, the arrhythmia must be well controlled and well tolerated during performance of the activity. PMID:21416837

  8. Autonomic modulation in a patient with syncope and paroxysmal atrial-fibrillation.

    PubMed

    Laranjo, Sérgio; Tavares, Cristiano; Oliveira, Mário; Rocha, Isabel

    2014-07-01

    We report a case of a patient with recurrent syncope and paroxysmal atrial fibrillation whose clinical status greatly improved after a period of orthostatic training. The potential efficacy of this non-pharmacological measure in modulating the autonomic tone is discussed below. PMID:24674835

  9. Massive hemoptysis due to pulmonary vein stenosis following catheter ablation for atrial fibrillation.

    PubMed

    Lee, Jung Yeon; Chon, Gyu Rak; Park, Jong Hoon; Kang, Byung Ju; Shim, Tae Sun; Jo, Kyung-Wook

    2015-03-01

    Pulmonary vein stenosis, which is one of the rare complications of radiofrequency catheter ablation for atrial fibrillation, has various symptoms. Here, we report a rare case of massive hemoptysis due to pulmonary vein stenosis following radiofrequency catheter ablation, which was successfully managed with pneumonectomy. PMID:25316885

  10. Applying non-linear dynamics to atrial appendage flow data to understand and characterize atrial arrhythmia

    SciTech Connect

    Chandra, S.; Grimm, R.A.; Katz, R.; Thomas, J.D.

    1996-06-01

    The aim of this study was to better understand and characterize left atrial appendage flow in atrial fibrillation. Atrial fibrillation and flutter are the most common cardiac arrhythmias affecting 15% of the older population. The pulsed Doppler velocity profile data was recorded from the left atrial appendage of patients using transesophageal echocardiography. The data was analyzed using Fourier analysis and nonlinear dynamical tools. Fourier analysis showed that appendage mechanical frequency ({ital f{sub f}}) for patients in sinus rhythm was always lower (around1 Hz) than that in atrial fibrillation (5-8 Hz). Among patients with atrial fibrillation spectral power below {ital f{sub f}} was significantly different suggesting variability within this group of patients. Results that suggested the presence of nonlinear dynamics were: a) the existence of two arbitrary peak frequencies {ital f{sub 1}, f{sub 2}}, and other peak frequencies as linear combinations thereof ({ital mf{sub 1}{+-}nf{sub 2}}), and b) the similarity between the spectrum of patient data and that obtained using the Lorenz equation. Nonlinear analysis tools, including Phase plots and differential radial plots, were also generated from the velocity data using a delay of 10. In the phase plots, some patients displayed a torus-like structure, while others had a more random-like pattern. In the differential radial plots, the first set of patients (with torus-like phase plots) showed fewer values crossing an arbitrary threshold of 10 than did the second set (8 vs. 27 in one typical example). The outcome of cardioversion was different for these two set of patients. Fourier analysis helped to: differentiate between sinus rhythm and atrial fibrillation, understand the characteristics of the wide range of atrial fibrillation patients, and provide hints that atrial fibrillation could be a nonlinear process. Nonlinear dynamical tools helped to further characterize and sub-classify atrial fibrillation.

  11. Spontaneous multicentric myxoma of the dermal nerve sheaths in farmed European eels Anguilla anguilla.

    PubMed

    Gjur?evi?, E; Kužir, S; Sfacteria, A; Drašner, K; Marino, F

    2014-09-30

    This report describes a peripheral nerve sheath tumour in 8 European eels Anguilla anguilla L. from a fish farm located in Croatia. The newborn tissue appeared as smooth and soft skin nodules without pronounced colour change. Nodules were dome-shaped with a pale crater and were present on different body areas. In general, nodules were located as series of differently sized protrusions extending along the lateral line on both sides of the fish, as well as sensory canals on the head. Cut sections showed a homogeneous, pale white-grey texture. Histologically, the pathological tissue was located in the dermis, occasionally intruding into the hypodermis, and pushing as a space-occupying mass against the underlying muscle tissue without any evident boundaries. The pressure also caused changes in the overlying epidermis, such as atrophy, spongiosis and erosion. In some areas, the epidermis was 1 cell thick and club and goblet cells had completely disappeared. Ultimately, these changes resulted in shallow ulceration. Tumour tissue was characterized by a scant population of spindle or stellate cells, with oval, hyperchromatic nuclei and pale cytoplasm embedded in a copious myxoid matrix. Cells were arranged in fascicles and whorls, extending in a poorly defined manner among the dermal collagen bundles. Occasionally, adipose cells were also detected, mainly in the central portion of the bulges. Myxoid areas appeared rich in metachromatic and alcianophilic mucous ground substance. Reticular fibres and collagenous connective tissue were scarce. Immunohistochemistry (IHC) using antibodies against S-100 and glial fibrillary acidic protein caused a slight positive reaction in neoplastic dendritic cells. High magnification showed the immunostaining to be cytoplasmic in all tumour cells. IHC with anti-calretinin antibody gave only negative results. Macroscopic, histological, histochemical and immunohistochemical findings were consistent with a diagnosis of multicentric myxoma of the dermal nerve sheaths, a tumour not yet reported in fish. PMID:25266905

  12. A Whole-Genome RNA Interference Screen for Human Cell Factors Affecting Myxoma Virus Replication

    PubMed Central

    Teferi, Wondimagegnehu M.; Dodd, Kristopher; Maranchuk, Rob; Favis, Nicole

    2013-01-01

    Myxoma virus (MYXV) provides an important model for investigating host-pathogen interactions. Recent studies have also highlighted how mutations in transformed human cells can expand the host range of this rabbit virus. Although virus growth depends upon interactions between virus and host proteins, the nature of these interactions is poorly understood. To address this matter, we performed small interfering RNA (siRNA) screens for genes affecting MYXV growth in human MDA-MB-231 cells. By using siRNAs targeting the whole human genome (21,585 genes), a subset of human phosphatases and kinases (986 genes), and also a custom siRNA library targeting selected statistically significant genes (“hits”) and nonsignificant genes (“nonhits”) of the whole human genome screens (88 genes), we identified 711 siRNA pools that promoted MYXV growth and 333 that were inhibitory. Another 32 siRNA pools (mostly targeting the proteasome) were toxic. The overall overlap in the results was about 25% for the hits and 75% for the nonhits. These pro- and antiviral genes can be clustered into pathways and related groups, including well-established inflammatory and mitogen-activated protein kinase pathways, as well as clusters relating to ?-catenin and the Wnt signaling cascade, the cell cycle, and cellular metabolism. The validity of a subset of these hits was independently confirmed. For example, treating cells with siRNAs that might stabilize cells in G1, or inhibit passage into S phase, stimulated MYXV growth, and these effects were reproduced by trapping cells at the G1/S boundary with an inhibitor of cyclin-dependent kinases 4/6. By using 2-deoxy-d-glucose and plasmids carrying the gene for phosphofructokinase, we also confirmed that infection is favored by aerobic glycolytic metabolism. These studies provide insights into how the growth state and structure of cells affect MYXV growth and how these factors might be manipulated to advantage in oncolytic virus therapy. PMID:23408614

  13. Transoccipital endoscopic fenestration of atrial cysts causing ventricular entrapment.

    PubMed

    Ellis, Jason A; McCormick, Paul C; Feldstein, Neil A; Ghatan, Saadi

    2015-06-01

    OBJECT Cystic lesions in the atrium (trigone) of the lateral ventricle may become symptomatic due to obstruction of physiological CSF circulation and/or from mass effect on adjacent structures. A minimally invasive approach that not only allows for straightforward access to multiple regions of the atrial cyst wall, but also enables direct inspection of the entire lateral ventricular system, has not been elaborated. In this paper the authors describe their experience with the endoscopic transoccipital horn approach for treating cystic lesions in the atrium of the lateral ventricle. METHODS A retrospective review was performed of all patients who underwent endoscopic surgical treatment for cysts in the atrium of the lateral ventricle between 1999 and 2014. RESULTS The cohort consisted of 13 consecutive patients who presented with symptomatic lateral ventricular entrapment due to the presence of an atrial cyst. There were 9 male and 4 female patients, with a median age of 5 years. Headache was the most common complaint at presentation. The transoccipital horn approach facilitated successful cyst reduction and fenestration in all cases. Temporal and occipital horn entrapment was reversed in all cases, with reestablishment of a physiological CSF flow pattern throughout the ventricles. Hydrocephalus was also reversed in all patients presenting with this neuroimaging finding at presentation. No cyst or ventricular entrapment was noted to recur during a mean follow-up period of 36 months. No patient in the study cohort required repeat surgery or permanent CSF diversion postoperatively. CONCLUSIONS The endoscopic transoccipital horn approach represents a safe and effective treatment strategy for patients with symptomatic atrial cysts of the lateral ventricle. Using this minimally invasive technique, all poles of the lateral ventricular system can be visualized and the unobstructed flow of CSF can be confirmed after cyst resection obviating the need for additional diversion. PMID:25815633

  14. Atrial myocardial infarction: A tale of the forgotten chamber.

    PubMed

    Lu, Marvin Louis Roy; De Venecia, Toni; Patnaik, Soumya; Figueredo, Vincent M

    2016-01-01

    It has been almost a century since atrial infarction was first described, yet data describing its significance remain limited. To date, there are still no universally accepted criteria for the diagnosis of atrial infarction. Atherosclerosis is the leading cause of atrial infarction but it has also been described in cor pulmonale and pulmonary hypertension. Atrial infarction almost always occurs concomitantly with ventricular infarction. Its clinical presentation depends largely on the extent and site of ventricular involvement. Atrial infarction can present with supraventricular tachyarrhythmias. Electrocardiographic (ECG) criteria for diagnosing atrial infarction have been described but none have yet to be validated by prospective studies. Atrial ECG patterns include abnormal P-wave morphologies, PR-segment deviations, as well as transient rhythm abnormalities, including atrial fibrillation, atrial flutter, atrial tachycardia, wandering atrial pacemaker (WAP) and atrioventricular (AV) blocks. Complications of atrial infarction include thromboembolic events and cardiogenic shock. There are no specific additional recommendations in the management of myocardial infarction with suspected involvement of the atria. The primary goal remains coronary reperfusion and maintenance of, or conversion to, sinus rhythm. PMID:26485186

  15. Surgical Treatment of Atrial Fibrillation: A Review

    PubMed Central

    Hiari, Nadine

    2011-01-01

    Atrial fibrillation is the most commonly sustained arrhythmia in man. While it affects millions of patients worldwide, its incidence will markedly increase with an aging population. Primary goals of AF therapy are to (1) reduce embolic complications, particularly stroke, (2) alleviate symptoms, and (3) prevent long-term heart remodelling. These have been proven to be a challenge as there are major limitations in our knowledge of the pathological and electrophysiological mechanisms underlying AF. Although advances continue to be made in the medical management of this condition, pharmacotherapy is often unsuccessful. Because of the high recurrence rate of AF despite antiarrhythmic drug therapy for maintenance of sinus rhythm and the adverse effects of these drugs, there has been growing interest in nonpharmacological strategies. Surgery for treatment of AF has been around for some time. The Cox-Maze procedure is the gold standard for the surgical treatment of atrial fibrillation and has more than 90% success in eliminating atrial fibrillation. Although the cut and sew maze is very effective, it has been superseded by newer operations that rely on alternate energy sources to create lines of conduction block. In addition, the evolution of improved ablation technology and instrumentation has facilitated the development of minimally invasive approaches. In this paper, the rationale for surgical ablation for atrial fibrillation and the different surgical techniques that were developed will be explored. In addition, it will detail the new approaches to surgical ablation of atrial fibrillation that employ alternate energy sources. PMID:21738854

  16. Catheter closure of secundum atrial septal defects.

    PubMed Central

    O'Laughlin, M P

    1997-01-01

    Catheter occlusion of atrial septal defects has its roots in the 1950s, with early devices being implanted during closed-heart surgery without cardiopulmonary bypass. For the past 20 years, various catheter-delivered devices have undergone testing and refinement. Designs have included single- and double-disk prostheses, with a variety of materials, delivery systems, and techniques. In this monograph, the history of atrial septal defect occluders and their evaluation, results, and prognoses will be outlined. The early work of King and Mills has been advanced in the forms of the Rashkind and Lock-USCI Clamshell occluders (USCI; Billerica, Mass), the "buttoned" device (custom made by E.B. Sideris), the Babic atrial septal defect occlusion system (Osypka, GmbH; Grenzach-Wyhlen, Germany), the Das-Angel Wings atrial septal defect occlusion device (Microvena Corporation; White Bear Lake, Minn), and others. The future holds promise for approved devices in the treatment of selected secundum atrial septal defects. Images PMID:9456481

  17. Global epidemiology of atrial fibrillation.

    PubMed

    Rahman, Faisal; Kwan, Gene F; Benjamin, Emelia J

    2014-11-01

    Atrial fibrillation (AF) is a major public health burden worldwide, and its prevalence is set to increase owing to widespread population ageing, especially in rapidly developing countries such as Brazil, China, India, and Indonesia. Despite the availability of epidemiological data on the prevalence of AF in North America and Western Europe, corresponding data are limited in Africa, Asia, and South America. Moreover, other observations suggest that the prevalence of AF might be underestimated-not only in low-income and middle-income countries, but also in their high-income counterparts. Future studies are required to provide precise estimations of the global AF burden, identify important risk factors in various regions worldwide, and take into consideration regional and ethnic variations in AF. Furthermore, in response to the increasing prevalence of AF, additional resources will need to be allocated globally for prevention and treatment of AF and its associated complications. In this Review, we discuss the available data on the global prevalence, risk factors, management, financial costs, and clinical burden of AF, and highlight the current worldwide inadequacy of its treatment. PMID:25113750

  18. Aneurysm of the Left Atrial Appendage

    PubMed Central

    Victor, Solomon; Nayak, Vijaya M.

    2001-01-01

    A 43-year-old woman underwent excision of an aneurysm of the left atrial appendage, which had been causing cerebrovascular embolic episodes. We attribute the aneurysm to congenital dysplasia of the musculi pectinati in the left atrial appendage and of the bands of atrial muscle from which they arise. In Appendix I, we draw attention to the morphologically similar arrangements of inner and outer bands that emanate from a common transverse interatrial band and yield morphologically similar medial, descending, and ascending palm-leaf arrangements of musculi pectinati. In addition, we observe that the strap-like arrangements of musculi in both atria connect the outer band with the para-annular segment of the inner band. In Appendix II, we briefly review the literature concerning musculi pectinati and related bands. PMID:11453121

  19. Atrial fibrillation and electrical appliance injury.

    PubMed

    Shoenfeld, P; Rupp, J; Savage, R W

    1991-05-01

    Electrocardiographic changes and cardiac arrhythmias have been reported frequently in patients suffering high tension (greater than 1,000 V) electrical injuries as well as low tension (less than 350 V) electrical injuries. An association of atrial fibrillation with low tension electrical injury from a household appliance, however, has not been described in the recent literature. We describe a patient with atrial fibrillation induced by a shock from a household toaster. Pathophysiologic mechanisms and approach to treatment are reviewed, emphasizing the transient nature of most electrically induced arrhythmias. PMID:2057080

  20. Myxoma Virus Expressing a Fusion Protein of Interleukin-15 (IL15) and IL15 Receptor Alpha Has Enhanced Antitumor Activity

    PubMed Central

    Tosic, Vesna; Thomas, Diana L.; Kranz, David M.; Liu, Jia; McFadden, Grant; Shisler, Joanna L.; MacNeill, Amy L.; Roy, Edward J.

    2014-01-01

    Myxoma virus, a rabbit poxvirus, can efficiently infect various types of mouse and human cancer cells. It is a strict rabbit-specific pathogen, and is thought to be safe as a therapeutic agent in all non-rabbit hosts tested including mice and humans. Interleukin-15 (IL15) is an immuno-modulatory cytokine with significant potential for stimulating anti-tumor T lymphocytes and NK cells. Co-expression of IL15 with the ? subunit of IL15 receptor (IL15R?) greatly enhances IL15 stability and bioavailability. Therefore, we engineered a new recombinant myxoma virus (vMyx-IL15R?-tdTr), which expresses an IL15R?-IL15 fusion protein plus tdTomato red fluorescent reporter protein. Permissive rabbit kidney epithelial (RK-13) cells infected with vMyx-IL15R?-tdTr expressed and secreted the IL15R?-IL15 fusion protein. Functional activity was confirmed by demonstrating that the secreted fusion protein stimulated proliferation of cytokine-dependent CTLL-2 cells. Multi-step growth curves showed that murine melanoma (B16-F10 and B16.SIY) cell lines were permissive to vMyx-IL15R?-tdTr infection. In vivo experiments in RAG1-/- mice showed that subcutaneous B16-F10 tumors treated with vMyx-IL15R?-tdTr exhibited attenuated tumor growth and a significant survival benefit for the treated group compared to the PBS control and the control viruses (vMyx-IL15-tdTr and vMyx-tdTr). Immunohistological analysis of the subcutaneous tumors showed dramatically increased infiltration of NK cells in vMyx-IL15R?-tdTr treated tumors compared to the controls. In vivo experiments with immunocompetent C57BL/6 mice revealed a strong infiltrate of both NK cells and CD8+ T cells in response to vMyx-IL15R?-tdTr, and prolonged survival. We conclude that delivery of IL15R?-IL15 in a myxoma virus vector stimulates both innate and adaptive components of the immune system. PMID:25329832

  1. Catheter ablation of supraventricular arrhythmias and atrial fibrillation.

    PubMed

    Shapira, Adam R

    2009-11-15

    Supraventricular arrhythmias are relatively common, often persistent, and rarely life-threatening cardiac rhythm disturbances that arise from the sinus node, atrial tissue, or junctional sites between the atria and ventricles. The term "supraventricular arrhythmia" most often is used to refer to supraventricular tachycardias and atrial flutter. The term "supraventricular tachycardia" commonly refers to atrial tachycardia, atrioventricular nodal reentrant tachycardia, and atrioventricular reciprocating tachycardia, an entity that includes Wolff-Parkinson-White syndrome. Atrial fibrillation is a distinct entity classified separately. Depending on the arrhythmia, catheter ablation is a treatment option at initial diagnosis, when symptoms develop, or if medical therapy fails. Catheter ablation of supraventricular tachycardias, atrial flutter, and atrial fibrillation offers patients high effectiveness rates, durable (and often permanent) therapeutic end points, and low complication rates. Catheter ablation effectiveness rates exceed 88 percent for atrioventricular nodal reentrant tachycardia, atrioventricular reciprocating tachycardia, and atrial flutter; are greater than 86 percent for atrial tachycardia; and range from 60 to 80 percent for atrial fibrillation. Complication rates for supraventricular tachycardias and atrial flutter ablation are 0 to 8 percent. The complication rates for atrial fibrillation ablation range from 6 to 10 percent. Complications associated with catheter ablation result from radiation exposure, vascular access (e.g., hematomas, cardiac perforation with tamponade), catheter manipulation (e.g., cardiac perforation with tamponade, thromboembolic events), or ablation energy delivery (e.g., atrioventricular nodal block). PMID:19904893

  2. Percutaneous Left Atrial Appendage Ligation for Stroke Prevention in Atrial Fibrillation

    PubMed Central

    Valderrábano, Miguel; Price, Matthew J.

    2015-01-01

    Prevention of thromboembolic complications in atrial fibrillation remains a tremendous clinical challenge. Knowledge that the left atrial appendage (LAA) is the most common anatomical origin of cardioembolic strokes1 has been the main motivation to develop clinical and procedural strategies to exclude the LAA from the circulation, either surgically or percutaneously. This review discusses the rationale behind these strategies, their relative merits, and future prospects for LAA exclusion strategies. PMID:26306126

  3. Effect of adenosine triphosphate on left atrial electrogram interval and dominant frequency in human atrial fibrillation?

    PubMed Central

    Kogawa, Rikitake; Okumura, Yasuo; Watanabe, Ichiro; Kofune, Masayoshi; Nagashima, Koichi; Mano, Hiroaki; Sonoda, Kazumasa; Sasaki, Naoko; Iso, Kazuki; Takahashi, Keiko; Ohkubo, Kimie; Nakai, Toshiko; Hirayama, Atsushi

    2015-01-01

    Background Complex fractionated atrial electrograms (CFAEs) and high dominant frequency (DF) are targets for atrial fibrillation (AF) ablation. Although adenosine triphosphate (ATP) is known to promote AF by shortening the atrial refractory period, its role in the pathogenesis of CFAEs and DF during AF is not fully understood. Methods We recorded electrical activity from a 64-electrode basket catheter placed in the left atrium (LA) of patients with paroxysmal AF (PAF, n=18) or persistent AF (PerAF, n=19) before ablation. Atrial electrogram fractionation intervals (FIs) and DFs were measured from bipolar electrograms of each adjacent electrode pair. Offline mean atrial FIs and DFs were obtained before bolus injection of 30 mg ATP. Peak effect was defined as an R–R interval >3 s. Results With ATP, the mean FI decreased (from 110.4±29.1 ms to 90.5±24.7 ms, P<0.0001) and DF increased (from 6.4±0.6 Hz to 7.1±0.8 Hz, P<0.0001) in all patients. There was no difference in the FI decrease between the two groups (?20.3±20.5 ms vs. ?19.6±14.5 ms, P=0.6032), but the increase in DF was significantly greater in PAF patients (1.1±0.8 Hz vs. 0.3±0.6 Hz, P=0.0051). Conclusions ATP shortens atrial FIs and increases DFs in both PAF and PerAF patients. The significant increase in DF in PAF patients suggests that pathophysiologic characteristics related to the frequency of atrial fractionation change as atrial remodeling progresses. PMID:26702319

  4. Adjusted Left Atrial Emptying Fraction as a Predictor of Procedural Outcome after Catheter Ablation for Atrial Fibrillation

    PubMed Central

    Im, Sung Il; Kim, Sun Won; Choi, Cheol Ung; Kim, Jin Won; Yong, Hwan Seok; Kim, Eung Ju; Rha, Seung-Woon; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo; Lim, Hong Euy

    2015-01-01

    Structural remodeling of the left atrium is a risk factor for recurrent arrhythmia after catheter ablation for atrial fibrillation; however, data are sparse regarding the role of functional left atrial remodeling in predicting procedural outcomes. We evaluated whether left atrial transport function could be used to predict recurrent atrial fibrillation. From July 2008 through August 2010, we enrolled 202 consecutive patients who underwent catheter ablation for atrial fibrillation (paroxysmal=120, persistent=82). Left atrial volumes (LAVs) were measured by means of multislice computed tomography at every 10% of the R-R interval, and measurements were adjusted for body surface area to yield the LAV index (LAVI) at baseline. The left atrial emptying fraction (LAEF) was calculated according to LAV differences. During the mean follow-up period of 10 ± 4 months after a single ablation procedure, atrial fibrillation recurred in 59 patients (paroxysmal=19, persistent=40). Multivariate analysis revealed that persistent atrial fibrillation, early mitral inflow velocity, LAVImax, LAVImin, LAEF, LAVImax/LAEF, and LAVImin/LAEF were all independent predictors of atrial fibrillation, but the best predictor was LAVImin/LAEF (?=1.329, P=0.001). The cutoff value was 1.61 (mL/m2)/%, and the sensitivity and specificity were 74.6% and 62.2%, respectively (area under the curve=0.761). Our study shows that adjusted left atrial emptying fraction with use of multislice computed tomography might be a useful, noninvasive method to select patients for ablation. PMID:26175632

  5. [Extracardiac Aorto-right Atrial Fistula after Aortic Valve Replacement].

    PubMed

    Matsumoto, Kazuhisa; Yotsumoto, Goichi; Yamamoto, Hiroyuki; Hisashi, Yosuke; Tao, Koji; Mukaihara, Kosuke; Shigehisa, Yoshiya; Matsuba, Tomoyuki; Moriyama, Yukinori; Imoto, Yutaka

    2015-08-01

    The development of a fistula between the aorta and the right atrium is a relatively rare but well-documented complication after cardiac surgery and proximal aortic dissection, and has a high mortality rate if it is not diagnosed adequately and surgically treated without delay. We report a rare case of extracardiac aorta-right atrial fistula. An 86-year-old woman underwent aortic valve replacement via median sternotomy. Two weeks after surgery, the upper median skin incision reopened, which exposed the sternum and revealed purulent discharge inside the wound. Wound and blood cultures were positive for methicillin-resistant Staphylococcus aureus. The wound was treated, and healed in approximately 2 weeks. Six weeks after surgery, the patient suddenly presented with dyspnea because of heart failure.Extracardiac aorto-right atrial fistula was confirmed by computed tomography. During surgery, we found an extracardiac fistula formed in the hematoma between the sites where the aortic vent suture was tied and the caval cannula was removed. The infection seemed to have contributed to the development of the fistula and may have persisted in the ascending aorta or artificial valve, which may have led to cerebral hemorrhage resulting in death 4 months later. PMID:26329705

  6. Angiotensin II receptor blockers in the prevention of atrial fibrillation.

    PubMed

    Barra, Silvia; Silvestri, Nunzia; Vitagliano, Giancarlo; Madrid, Alfredo; Gaeta, Giovanni

    2009-06-01

    Atrial fibrillation (AF) is the most common sustained arrhythmia. While antiarrhythmic agents and electrical cardioversion are highly effective in restoring sinus rhythm, the results obtained in prevention of recurrences are disappointing. Recently, angiotensin II has been recognized as a key factor in atrial structural and electrical remodeling associated with AF. So there are several potential mechanisms by which inhibition of the renin-angiotensin-aldosterone system may reduce AF. In this review, we report the results of studies evaluating the effect of angiotensin II receptor blockers (ARBs) in various clinical settings (i.e., lone AF, hypertension, high-risk patients, congestive heart failure, secondary prevention). However, many of these studies are small and retrospective and have a limited follow-up; moreover, since AF is related to several causes, chiefly heart diseases, patients with different characteristics have often been enrolled. Thus, it is not surprising that the results obtained are frequently conflicting. With these limitations and considering only the results of larger studies with longer follow-up, ARBs are effective in preventing AF in patients with congestive heart failure or hypertension with left ventricular hypertrophy or coronary artery/cerebrovascular disease. In any case, the use of ARBs is not recommended at present in clinical practice to prevent AF. PMID:19466911

  7. M148R and M149R are two virulence factors for myxoma virus pathogenesis in the European rabbit

    PubMed Central

    Blanié, Sophie; Mortier, Jérémy; Delverdier, Maxence; Bertagnoli, Stéphane; Camus-Bouclainville, Christelle

    2009-01-01

    Myxoma virus (MYXV), a member of the Poxviridae family, is the agent responsible for myxomatosis, a fatal disease in the European rabbit (Oryctolagus cuniculus). MYXV has a linear double-stranded DNA genome that encodes several factors important for evasion from the host immune system. Among them, four ankyrin (ANK) repeat proteins were identified: M148R, M149R, M150R and M-T5. To date, only M150R and M-T5 were studied and characterized as critical virulence factors. This article presents the first characterization of M148R and M149R. Green Fluorescent Protein (GFP) fusions allowed us to localize them in a viral context. Whereas M149R is only cytoplasmic, interestingly, M148R is in part located in the nucleolus, a unique feature for an ANK repeat poxviral protein. In order to evaluate their implication in viral pathogenicity, targeted M148R, M149R, or both deletions were constructed in the wild type T1 strain of myxoma virus. In vitro infection of rabbit and primate cultured cells as well as primary rabbit cells allowed us to conclude that M148R and M149R are not likely to be implicated in cell tropism or host range functions. However, in vivo experiments revealed that they are virulence factors since after infection of European rabbits with mutant viruses, a delay in the onset of clinical signs, an increase of survival time and a dramatic decrease in mortality rate were observed. Moreover, histological analysis suggests that M148R plays a role in the subversion of host inflammatory response by MYXV. PMID:19019281

  8. Reversible cardiomyopathy after radiofrequency ablation of 30-year persistent atrial tachycardia

    PubMed Central

    Suzuki, Atsushi; Shiga, Tsuyoshi; Arai, Kotaro; Shoda, Morio

    2013-01-01

    Tachycardia-induced cardiomyopathy (TIC) is a reversible form of the left ventricular (LV) systolic dysfunction and is believed to be a relatively acute process. We report a TIC case with a 30-year history of long-lasting persistent atrial tachycardia involving a 44-year-old man previously diagnosed with dilated cardiomyopathy and a low LV ejection fraction (LVEF) of 20%. ECG revealed atrial tachycardia at 110–120?bpm. He was hospitalised with a worsening heart failure. His clinical status was New York Heart Association functional class III, and echocardiography revealed LV dilation and an LVEF of 9%. A two-dimensional speckle-tracking strain measurement revealed LV mechanical dyssynchrony. He underwent radiofrequency ablation for atrial tachycardia. After restoring sinus rhythm, his cardiac symptoms improved immediately. The LV mechanical dyssynchrony decreased a week after ablation, without changes in the LV dilation or LVEF. Thereafter, the LV dilation and systolic function gradually improved, and atrial tachycardia and heart failure remained absent. PMID:24326427

  9. Prevalence of oral anticoagulation in atrial fibrillation

    PubMed Central

    Bartholomay, Eduardo; Polli, Ismael; Borges, Anibal Pires; Kalil, Carlos; Arroque, André; Kohler, Ilmar; Danzmann, Luiz Cláudio

    2014-01-01

    OBJECTIVES: Atrial fibrillation is the most common sustained arrhythmia and is associated with poor outcomes, including stroke. The ability of anticoagulation therapy to reduce the risk of stroke has been well established; however, the prevalence of anticoagulation therapy use in the Public Health System is unknown. The aim of this study is to evaluate both the prevalence of anticoagulation therapy among patients with atrial fibrillation and the indications for the treatment. METHODS: In this cross-sectional study, we included consecutive patients who had atrial fibrillation documented by an electrocardiogram performed between September 2011 and March 2012 at a university hospital of the Public Health System. The variables analyzed included the risk of a thromboembolic event and/or bleeding, the use of antiplatelet or anticoagulation therapy, the location where the electrocardiogram report was initially reviewed and the specialty of the physician who initially reviewed it. RESULTS: We included 162 patients (mean age 68.9 years, 56% men). Hypertension (90.1%), heart failure (53.4%) and stroke (38.9%) were the most prevalent diseases found. Only 50.6% of the patients knew that they had atrial fibrillation. Regarding the use of therapy, only 37.6% of patients classified as high risk according to the CHADS2 scores and 35.5% according to the CHA2DS2VASc used oral anticoagulation. A presumptive diagnosis of heart failure and the fact that the electrocardiogram was evaluated by a cardiologist were the only independent predictors of the use of anticoagulants. CONCLUSIONS: Our study found a low prevalence of oral anticoagulation therapy among patients with atrial fibrillation and an indication for stroke prophylaxis for the use of this therapy, including among those with high CHADS2 and CHA2DS2VASc scores. PMID:25318093

  10. Pulse Check: The Importance of Self-Screening for Atrial Fibrillation Twice a Year

    MedlinePLUS

    Pulse Check The importance of self-screening for atrial fibrillation twice a year What is atrial fibrillation? Atrial fibrillation ( ... do, Here's how... How to do a Pulse Check Don a watch (or look at a clock) ...

  11. Quantification of Phase Recurrences in Atrioventricular (AV) Conduction during Atrial Arrhythmias

    E-print Network

    Glass, Leon

    Quantification of Phase Recurrences in Atrioventricular (AV) Conduction during Atrial Arrhythmias M a new method to characterize atrioventricular (AV) coupling during atrial arrhythmias, based node dynamics during atrial arrhythmias and characterizing AV pharmacological control. 1. Introduction

  12. Extreme variation in the atrial septation of caecilians (Amphibia: Gymnophiona).

    PubMed

    de Bakker, Desiderius M; Wilkinson, Mark; Jensen, Bjarke

    2015-01-01

    Caecilians (order Gymnophiona) are elongate, limbless, snake-like amphibians that are the sister-group (closest relatives) of all other recent amphibians (frogs and salamanders). Little is known of their cardiovascular anatomy and physiology, but one nearly century old study suggests that Hypogeophis (family Indotyphlidae), commonly relied upon as a representative caecilian species, has atrial septation in the frontal plane and more than one septum. In contrast, in other vertebrates there generally is one atrial septum in the sagittal plane. We studied the adult heart of Idiocranium (also Indotyphlidae) using immunohistochemistry and confirm that the interatrial septum is close to the frontal plane. Additionally, a parallel right atrial septum divides three-fourths of the right atrial cavity of this species. Idiocranium embryos in the Hill collection reveal that atrial septation initiates in the sagittal plane as in other tetrapods. Late developmental stages, however, see a left-ward shift of visceral organs and a concordant rotation of the atria that reorients the atrial septa towards the frontal plane. The gross anatomies of species from six other caecilian families reveal that (i) the right atrial septum developed early in caecilian evolution (only absent in Rhinatrematidae) and that (ii) rotation of the atria evolved later and its degree varies between families. In most vertebrates a prominent atrial trabeculation associates with the sinuatrial valve, the so-called septum spurium, and the right atrial septum seems homologous to this trabeculation but much more developed. The right atrial septum does not appear to be a consequence of body elongation because it is absent in some caecilians and in snakes. The interatrial septum of caecilians shares multiple characters with the atrial septum of lungfishes, salamanders and the embryonic septum primum of amniotes. In conclusion, atrial septation in caecilians is based on evolutionarily conserved structures but possibly exhibits greater variation than in any other vertebrate order. PMID:25400089

  13. Successful percutaneous epicardial ablation of an accessory pathway located at the right atrial appendage.

    PubMed

    Köse, Sedat; Ba?ar?c?, Ibrahim; Kabul, Kutsi Hasan; Barç?n, Cem

    2011-10-01

    In patients with Wolff-Parkinson-White syndrome, difficulty in ablation of accessory pathways is associated with failures and recurrences. Epicardially located accessory pathways may require different management strategies when conventional ablation attempts fail. In particular, an epicardial accessory pathway communicating the right atrial appendage to the right ventricle is an extraordinary situation resulting in difficulties in ablation. Hereby, we report on a challenging case of percutaneous epicardial ablation of an epicardial accessory pathway located at right atrial appendage in a 28-year-old man with Wolff-Parkinson-White syndrome, who had a prior history of unsuccessful endocardial ablation. Percutaneous epicardial ablation may be a viable option obviating the necessity of surgical ablation procedures for difficult ablation cases with epicardial accessory pathways. PMID:21983769

  14. Emergency department diagnosis of pulmonary hypertension in a patient with left atrial sarcoma.

    PubMed

    Dela Cruz, Maricel; Devey, Jeremy Seelinger

    2014-01-01

    Pulmonary hypertension is a disease with many etiologies and is responsible for 200,000 admissions and 25,000 hospitalizations in the United States each year. We report the case of a previously healthy 58-year-old woman who presented to the emergency department with a months-long history of worsening dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. Despite the severity of her symptoms, she had no corroborative physical exam findings, including jugular venous distension or peripheral edema. Bedside emergency department ultrasonography revealed a dilated right ventricle and bowing of the intraventricular septum into the left ventricle, consistent with pulmonary hypertension. CT angiography of the chest performed in the emergency department revealed a large left atrial mass, found on pathology to be a left atrial sarcoma. This case illustrates how severely symptomatic pulmonary hypertension can have few to no physical exam findings and the utility of bedside emergency department ultrasound in making the presumptive diagnosis. PMID:25635192

  15. Pheochromocytoma diagnosed after anticoagulation for atrial fibrillation ablation procedure: a giant in disguise.

    PubMed

    Galvão Braga, Carlos; Ribeiro, Sílvia; Martins, Juliana; Arantes, Carina; Ramos, Vítor; Primo, João; Magalhães, Sónia; Correia, Adelino

    2014-04-01

    Pheochromocytoma is a rare catecholamine-producing tumor, discovered incidentally in 50% of cases. We present the case of a 44-year-old male with a history of paroxysmal palpitations. Baseline ECG, transthoracic echocardiogram and ECG stress test showed no relevant alterations. Paroxysmal atrial fibrillation was detected on 24-hour Holter ECG. After antiarrhythmic therapy, the patient remained symptomatic, and was accordingly referred for electrophysiological study and atrial fibrillation ablation. Anticoagulation was initiated before the procedure. After ablation and still anticoagulated, he complained of hematospermia. The abdominal and pelvic imaging study showed a 10-cm left adrenal mass, predominantly cystic, compatible with pheochromocytoma, which was confirmed after biochemical tests (increased urine metanephrines and plasma catecholamines). Metaiodobenzylguanidine scintigraphy scanning confirmed localized disease in the adrenal gland, excluding other uptake foci. Following appropriate preoperative management, surgical resection of the giant mass was performed successfully and without complications. PMID:24780129

  16. Biventricular Pacing in Conjunction with Epicardial Atrial Pacing Adversely Affects Timing of Intra-Aortic Balloon Pump

    PubMed Central

    Cross, David A.; Johnston, William E.

    2010-01-01

    Abstract: A case of accidental triggering of an intra-aortic balloon pump during systole is presented. The patient had a cardiac resynchronization therapy device in place preoperatively for heart failure. A temporary epicardial atrial pacing wire was used during separation from cardiopulmonary bypass for rate control. An intra-aortic balloon pump was necessary for separation from bypass. Although the pacemaker functioned properly, the intra-aortic balloon triggered from the atrial pacing spike and was inflated during systole. Pacemaker and intra-aortic balloon electronics and timing settings that caused this are discussed in detail. Suggestions for prevention are presented. PMID:20648901

  17. Coherex WAVECREST I Left Atrial Appendage Occlusion Study

    ClinicalTrials.gov

    2015-01-13

    Non-valvular Paroxysmal, Persistent, or Permanent Atrial Fibrillation; LAA Anatomy Amenable to Treatment by Percutaneous Technique; Anticoagulation Indication for Potential Thrombus Formation in the Left Atrium

  18. [Axillary approach for surgical closure of atrial septal defect].

    PubMed

    Gil-Jaurena, J M; Castillo, R; Zabala, J I; Conejo, L; Cuenca, V; Picazo, B

    2013-08-01

    Mid-line sternotomy is the routine approach for surgical repair of congenital heart diseases. However, its noticeable scar is a constant reminder of having undergone heart surgery. Several alternative approaches have been developed for simple cardiac conditions to hide the scar. Our series, consisting of 26 patients with axillary closure of atrial septal defect, is presented. The median age was 5.45 years (range 3-13), and median weight was 19.84 Kg. (range 13-37). The defect was closed directly in 13 cases, and with an autologous pericardial patch in the other 13. The number of surgical steps and time taken were the same as in median sternotomy. Functional recovery, intensive care unit stay, and hospital discharge were also standard. The cosmetic result, assessed both by patients and relatives, was excellent. PMID:23462094

  19. Atrial septal defect: a coincidental ?nding on a screening medical.

    PubMed

    Elliott, Elizabeth J

    2015-06-01

    An otherwise ?t, healthy medical practitioner who was a recreational diver underwent a medical assessment for a remote posting as an Antarctic Medical Practitioner at which a coincidental ?nding of an atrial septal defect (ASD) was made. ASDs can have health implications in extreme environments such as high altitude and is contraindicated in scuba diving. ASDs are common, being present in 1:1,500 live births and comprise 10% of all cardiac abnormalities. In this case, a percutaneous occlusive device was inserted under general anaesthetic with subsequent improvements in the practitioner's exercise capacity, return to diving and full employment, including Antarctic deployment, and right-sided heart remodelling 18 months post closure. PMID:26165535

  20. Unruptured Noncoronary Sinus of Valsalva Aneurysm Associated with Atrial Septal Defect (ASD)

    PubMed Central

    Dadhania, Divyesh; Dey, Amit Kumar; Gadewar, Rohit; Hira, Priya

    2015-01-01

    Sinus of Valsalva aneurysms are rare cardiac anomalies. Incidence of this anomaly is higher in Asian population with male preponderance. Our case highlights a rare association between unruptured sinus of Valsalva aneurysm and atrial septal defect (ASD). Rarely diagnosis of sinus of Valsalva aneurysm is missed on two dimensional echocardiography. Multi slice CT scan is done to confirm echocardiographic findings and to detect any missed complications, other cardiac abnormalities and anatomy for a precise surgical approach. PMID:26468470

  1. Lipid-altering therapy and atrial fibrillation.

    PubMed

    Bachmann, Justin M; Majmudar, Maulik; Tompkins, Christine; Blumenthal, Roger S; Marine, Joseph E

    2008-01-01

    Atrial fibrillation (AF) is a common cardiac arrhythmia with significant morbidity and public health cost. Because of limitations of efficacy and safety of conventional antiarrhythmic agents, alternative therapies for AF are needed. The potential antiarrhythmic properties of lipid-altering therapy, including the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors and fish oils, are increasingly recognized, particularly in light of their potential anti-inflammatory properties. This review examines the known effects of lipid-altering therapy on atrial arrhythmias in both experimental and clinical settings. Inflammatory states, such as post-cardiac surgery and AF of recent onset, show promise as targets. In contrast, lipid-lowering therapy is less likely to affect longstanding persistent AF. Current recommendations for the use of lipid-altering therapy for prevention and treatment of AF are summarized. PMID:18562810

  2. The fibrosis and atrial fibrillation: is the transforming growth factor-beta 1 a candidate etiology of atrial fibrillation.

    PubMed

    Li, Xuping; Ma, Changsheng; Dong, Jianzeng; Liu, Xingpeng; Long, Deyong; Tian, Yin; Yu, Ronghui

    2008-01-01

    Atrial fibrillation (AF) is the most commonly occurring arrhythmia in clinical practice, however, the mechanism of atrial fibrillation is not well explained. It has been considered that myocardial fibrosis plays a role in atrial fibrillation. Within the heart, this fibrosis is thought to be mediated by transforming growth factor-beta 1 (TGF-beta 1), a potent stimulator of collagen-producing cardiac fibroblasts. Recent studies indicate that atrial fibrillation is associated with elevated serum concentrations of TGF-beta 1 and C-terminal propeptide of procollagen type I (a marker of collagen type I synthesis). TGF-beta 1 was not only associated with the presence of atrial fibrillation but may also predict patients at increased risk for future development of atrial fibrillation. Why TGF-beta 1 in atrial fibrillation is high is a puzzling problem. We hypothesized that TGF-beta 1 is a possible cause of atrial fibrillation by initiating fibrosis response. Atrial interstitial fibrosis has been seen in patients with CHF and in animal models of pacing-induced heart failure. It was demonstrated that TGF-beta 1 levels were increased in the atria after the development of congestive heart failure in dogs. In a similar study, mice with increased expression of TGF-beta 1 were prone to atrial fibrillation development as a result of raised levels of atrial fibrosis. If the hypothesis is confirmed, administration of TGF-beta 1 monoclonal antibodies may be used to eliminate the etiology. It will be a new target point to treat atrial fibrillation. PMID:17689021

  3. Predictive value of various Doppler-derived parameters of atrial conduction time for successful atrial fibrillation ablation

    PubMed Central

    Valtuille, Lucas; Choy, Jonathan B; Becher, Harald

    2015-01-01

    Various Doppler-derived parameters of left atrial electrical remodeling have been demonstrated to predict recurrence of atrial fibrillation (AF) after AF ablation. The aim of this study was to compare three Doppler-derived measures of atrial conduction time in patients undergoing AF ablation, and to investigate their predictive value for successful procedure. In 32 prospectively enrolled patients undergoing the first AF ablation, atrial conduction time was estimated by measuring the time delay between the onset of P-wave on the surface ECG to the peak of the a?-wave on the pulsed-wave Doppler and color-coded tissue Doppler imaging of the left atrial lateral wall, and to the peak of the A-wave on the pulsed-wave Doppler of the mitral inflow. There was a significant difference in the baseline atrial conduction time measured by different echocardiographic techniques. Most (88%) patients had normal or only mildly dilated left atrium. At 6 months, 12 patients (38%) had recurrent AF/atrial tachycardia. The duration of history of AF was the only predictor of AF/atrial tachycardia recurrence following the first AF ablation (P=0.024; OR 1.023, CI 1.003–1.044). A combination of normal left atrial volume and history of paroxysmal AF of ?48 months was associated with the best outcome. Predictive value of the Doppler derived parameters of atrial conduction time may be reduced in the early stages of left atrial remodeling. Future studies may determine which echocardiographic parameter correlates best with the extent of left atrial remodeling and is most predictive of successful AF ablation.

  4. Sequential Hybrid Procedure for Persistent Atrial Fibrillation

    PubMed Central

    Bulava, Alan; Mokracek, Ales; Hanis, Jiri; Kurfirst, Vojtech; Eisenberger, Martin; Pesl, Ladislav

    2015-01-01

    Background Catheter ablation of persistent atrial fibrillation yields an unsatisfactorily high number of failures. The hybrid approach has recently emerged as a technique that overcomes the limitations of both surgical and catheter procedures alone. Methods and Results We investigated the sequential (staged) hybrid method, which consists of a surgical thoracoscopic radiofrequency ablation procedure followed by radiofrequency catheter ablation 6 to 8 weeks later using the CARTO 3 mapping system. Fifty consecutive patients (mean age 62±7 years, 32 males) with long?standing persistent atrial fibrillation (41±34 months) and a dilated left atrium (>45 mm) were included and prospectively followed in an unblinded registry. During the electrophysiological part of the study, all 4 pulmonary veins were found to be isolated in 36 (72%) patients and a complete box?lesion was confirmed in 14 (28%) patients. All gaps were successfully re?ablated. Twelve months after the completed hybrid ablation, 47 patients (94%) were in normal sinus rhythm (4 patients with paroxysmal atrial fibrillation required propafenone and 1 patient underwent a redo catheter procedure). The majority of arrhythmias recurred during the first 3 months. Beyond 12 months, there were no arrhythmia recurrences detected. The surgical part of the procedure was complicated by 7 (13.7%) major complications, while no serious adverse events were recorded during the radiofrequency catheter part of the procedure. Conclusions The staged hybrid epicardial–endocardial treatment of long?standing persistent atrial fibrillation seems to be extremely effective in maintenance of normal sinus rhythm compared to radiofrequency catheter or surgical ablation alone. Epicardial ablation alone cannot guarantee durable transmural lesions. Clinical Trial Registration URL: www.ablace.cz Unique identifier: cz?060520121617 PMID:25809548

  5. Animal studies of epicardial atrial ablation.

    PubMed

    Schuessler, Richard B; Lee, Anson M; Melby, Spencer J; Voeller, Rochus K; Gaynor, Sydney L; Sakamoto, Shun-Ichiro; Damiano, Ralph J

    2009-12-01

    The Cox maze procedure is an effective treatment of atrial fibrillation, with a long-term freedom from recurrence greater than 90%. The original procedure was highly invasive and required cardiopulmonary bypass. Modifications of the procedure that eliminate the need for cardiopulmonary bypass have been proposed, including use of alternative energy sources to replace cut-and-sew lesions with lines of ablation made from the epicardium on the beating heart. This has been challenging because atrial wall muscle thickness is extremely variable, and the muscle can be covered with an epicardial layer of fat. Moreover, the circulating intracavitary blood acts as a potential heat sink, making transmural lesions difficult to obtain. In this report, we summarize the use of nine different unidirectional devices (four radiofrequency, two microwave, two lasers, one cryothermic) for creating continuous transmural lines of ablation from the atrial epicardium in a porcine model. We define a unidirectional device as one in which all the energy is applied by a single transducer on a single heart surface. The maximum penetration of any device was 8.3 mm. All devices except one, the AtriCure Isolator pen, failed to penetrate 2 mm in some nontransmural sections. Future development of unidirectional energy sources should be directed at increasing the maximum depth and the consistency of penetration. PMID:19959142

  6. Efficacy of anticoagulation in resolving left atrial and left atrial appendage thrombi: A transesophageal echocardiographic study

    NASA Technical Reports Server (NTRS)

    Jaber, W. A.; Prior, D. L.; Thamilarasan, M.; Grimm, R. A.; Thomas, J. D.; Klein, A. L.; Asher, C. R.

    2000-01-01

    BACKGROUND: Transesophageal echocardiography (TEE) is the gold standard for evaluation of the left atrium and the left atrial appendage (LAA) for the presence of thrombi. Anticoagulation is conventionally used for patients with atrial fibrillation to prevent embolization of atrial thrombi. The mechanism of benefit and effectiveness of thrombi resolution with anticoagulation is not well defined. METHODS AND RESULTS: We used a TEE database of 9058 consecutive studies performed between January 1996 and November 1998 to identify all patients with thrombi reported in the left atrium and/or LAA. One hundred seventy-four patients with thrombi in the left atrial cavity (LAC) and LAA were identified (1.9% of transesophageal studies performed). The incidence of LAA thrombi was 6.6 times higher than LAC thrombi (151 vs 23, respectively). Almost all LAC thrombi were visualized on transthoracic echocardiography (90.5%). Mitral valve pathology was associated with LAC location of thrombi (P <.0001), whereas atrial fibrillation or flutter was present in most patients with LAA location of thrombi. Anticoagulation of 47 +/- 18 days was associated with thrombus resolution in 80.1% of the patients on follow-up TEE. Further anticoagulation resulted in limited additional benefit. CONCLUSIONS: LAC thrombi are rare and are usually associated with mitral valve pathology. Transthoracic echocardiography is effective in identifying these thrombi. LAA thrombi occur predominantly in patients with atrial fibrillation or flutter. Short-term anticoagulation achieves a high rate of resolution of LAA and LAC thrombi but does not obviate the need for follow-up TEE.

  7. Low prevalence of connexin-40 gene variants in atrial tissues and blood from atrial fibrillation subjects

    PubMed Central

    2012-01-01

    Background The atrial gap junction protein connexin-40 (Cx40) has been implicated to play an important role in atrial conduction and development of atrial fibrillation (AF). However, the frequency of Cx40 mutations in AF populations and their impact on Cx40 expression remains unclear. In this study, we sought to identify polymorphisms in the Cx40 gene GJA5, investigate the potential functional role of these polymorphisms, and determine their allelic frequencies. The prevalence of nonsynonymous Cx40 mutations in blood and atrial tissue was also compared to mutation frequencies reported in prior studies. Methods We conducted direct sequencing of the GJA5 coding and 3? UTR regions in blood samples from 91 lone AF subjects and 67 atrial tissue-derived samples from a lone cohort, a mixed AF cohort, and several transplant donors. Reporter gene transfection and tissue allelic expression imbalance assays were used to assess the effects of a common insertion/deletion polymorphism on Cx40 mRNA stability and expression. Results We identified one novel synonymous SNP in blood-derived DNA from a lone AF subject. In atrial tissue-derived DNA from lone and mixed AF subjects, we observed one novel nonsynonymous SNP, one rare previously reported synonymous SNP, and one novel 3? UTR SNP. A previously noted 25 bp insertion/deletion polymorphism in the 3? UTR was found to be common (minor allele frequency = 0.45) but had no effect on Cx40 mRNA stability and expression. The observed prevalence of nonsynonymous Cx40 mutations in atrial tissues derived from lone AF subjects differed significantly (p = 0.03) from a prior atrial tissue study reporting a high mutation frequency in a group of highly selected young lone AF subjects. Conclusions Our results suggest that Cx40 coding SNPs are uncommon in AF populations, although rare mutations in this gene may certainly lead to AF pathogenesis. Furthermore, a common insertion/deletion polymorphism in the Cx40 3? UTR does not appear to play a role in modulating Cx40 mRNA levels. PMID:23134779

  8. Introduction Atrial fibrillation (AF) is the most frequently occurring heart

    E-print Network

    Utrecht, Universiteit

    /mhj 12 Introduction Atrial fibrillation (AF) is the most frequently occurring heart arrhythmia ectopic arrhythmia generators (a pacemaker current arising from atrial cells other than the sinus node) can lead to the initiation of AF. Ectopic arrhythmia generators are often originate from the pulmonary

  9. Right coronary artery occlusion during RF ablation of typical atrial flutter.

    PubMed

    Mykytsey, Andrew; Kehoe, Richard; Bharati, Saroja; Maheshwari, Pradeep; Halleran, Sean; Krishnan, Kousik; Razminia, Mansour; Mina, Adel; Trohman, Richard G

    2010-07-01

    Right coronary artery (RCA) occlusion and acute myocardial infarction are rare during radiofrequency (RF) ablation of the cavotricuspid isthmus. Ventricular fibrillation (VF) or cardiac arrest in the periprocedural period may be the initial or only clinical manifestation. Septal or lateral RF delivery may increase the risk. We report 2 cases of RCA occlusion during ablation of typical atrial flutter (AFL). Angiographic and anatomical correlations are illustrated. One patient was ablated with a septal approach, the other with a lateral approach, and in each instance the RCA occluded near the ablative lesions. If septal or lateral ablation lines are contemplated during ablation of isthmus-dependent atrial flutter, fluoroscopic or electroanatomic confirmation of catheter position is pivotal. Smaller tipped catheters, energy titration (to minimally effective dose), saline irrigation, or cryoablation should also be considered to help avoid this serious complication. PMID:20132383

  10. A new concept for atrial triggered pulse generators.

    PubMed

    Pehrsson, K; Lentell, J; Levander-Lindgren, M; Svensson, B

    1979-11-01

    In order to avoid the potential risk of a short refractory period and the inconvenience of the electronic blocking mechanism at the highest synchronous rate with the conventional atrial triggered pulse generator, two more functions have been added to the normal atrial triggered (VAT) pulse generator. First, it has been designed to be ventricular inhibited; second, a highest synchronous rate detector has been added. When the highest synchronous rate of about 140 is exceeded, the atrial signals are blocked and the frequency of the basic rate generator is increased to about 130. Two patients could hardly feel the change from atrial triggered pacing to ventricular inhibited stimulation, and both were able to work at higher loads with this type of pacing compared with the conventional atrial triggered pulse generator. PMID:95217

  11. Paroxysmal Atrial Fibrillation in Cryptogenic Stroke: an Overlooked Explanation?

    PubMed

    Zhang, Cen; Kasner, Scott E

    2015-12-01

    Approximately one third of ischemic strokes are labeled cryptogenic because the etiology is unknown despite a thorough evaluation. Paroxysmal atrial fibrillation carries the same risk of ischemic stroke as persistent atrial fibrillation and has increasingly gained attention as a potential source of cryptogenic stroke. Recent trials utilizing long-term cardiac monitoring devices have demonstrated high rates of previously undetected paroxysmal atrial fibrillation in patients with cryptogenic stroke. Newly detected atrial fibrillation has subsequently changed treatment and increased the use of oral anticoagulation in these studies. Other trials have shown an increased risk of stroke and thromboembolism in patients with device-detected subclinical tachyarrhythmias. Together, these studies suggest an important relationship between episodes of paroxysmal atrial fibrillation and the risk of cryptogenic stroke, but further investigations are needed to guide diagnostic and therapeutic decisions. PMID:26486510

  12. Atrial Arrhythmias in Astronauts. Summary of a NASA Summit

    NASA Technical Reports Server (NTRS)

    Barr, Yael; Watkins, Sharmila; Polk, J. D.

    2011-01-01

    This slide presentation reviews the findings of a panel of heart experts brought together to study if atrial arrhythmias more prevalent in astronauts, and potential risk factors that may predispose astronauts to atrial arrhythmias. The objective of the panel was to solicit expert opinion on screening, diagnosis, and treatment options, identify gaps in knowledge, and propose relevant research initiatives. While Atrial Arrhythmias occur in approximately the same percents in astronauts as in the general population, they seem to occur at younger ages in astronauts. Several reasons for this predisposition were given: gender, hypertension, endurance training, and triggering events. Potential Space Flight-Related Risk factors that may play a role in precipitating lone atrial fibrillation were reviewed. There appears to be no evidence that any variable of the space flight environment increases the likelihood of developing atrial arrhythmias during space flight.

  13. Acute Myeloid Leukemia Targeting by Myxoma Virus In Vivo Depends on Cell Binding But Not Permissiveness to Infection In Vitro

    PubMed Central

    Madlambayan, Gerard J.; Bartee, Eric; Kim, Manbok; Rahman, Masmudur M.; Meacham, Amy; Scott, Edward W.; McFadden, Grant; Cogle, Christopher R.

    2012-01-01

    Some oncolytic viruses, such as myxoma virus (MYXV), can selectively target malignant hematopoietic cells, while sparing normal hematopoietic cells. This capacity for discrimination creates an opportunity to use oncolytic viruses as ex vivo purging agents of autologous hematopoietic cell grafts in patients with hematologic malignancies. However, the mechanisms by which oncolytic viruses select malignant hematopoietic cells are poorly understood. In this study, we investigated how MYXV specifically targets human AML cells. MYXV prevented chloroma formation and bone marrow engraftment of two human AML cell lines, KG-1 and THP-1. The reduction in human leukemia engraftment after ex vivo MYXV treatment was dose-dependent and required a minimum MOI of 3. Both AML cell lines demonstrated MYXV binding to leukemia cell membranes following co-incubation: however, evidence of productive MYXV infection was observed only in THP-1 cells. This observation, that KG-1 can be targeted in vivo even in the absence of in vitro permissive viral infection, contrasts with the current understanding of oncolytic virotherapy, which assumes that virus infection and productive replication is a requirement. Preventing MYXV binding to AML cells with heparin abrogated the purging capacity of MYXV, indicating that binding of infectious virus particles is a necessary step for effective viral oncolysis. Our results challenge the current dogma of oncolytic virotherapy and show that in vitro permissiveness to an oncolytic virus is not necessarily an accurate predictor of oncolytic potency in vivo. PMID:22341701

  14. Acute myeloid leukemia targeting by myxoma virus in vivo depends on cell binding but not permissiveness to infection in vitro.

    PubMed

    Madlambayan, Gerard J; Bartee, Eric; Kim, Manbok; Rahman, Masmudur M; Meacham, Amy; Scott, Edward W; McFadden, Grant; Cogle, Christopher R

    2012-05-01

    Some oncolytic viruses, such as myxoma virus (MYXV), can selectively target malignant hematopoietic cells, while sparing normal hematopoietic cells. This capacity for discrimination creates an opportunity to use oncolytic viruses as ex vivo purging agents of autologous hematopoietic cell grafts in patients with hematologic malignancies. However, the mechanisms by which oncolytic viruses select malignant hematopoietic cells are poorly understood. In this study, we investigated how MYXV specifically targets human AML cells. MYXV prevented chloroma formation and bone marrow engraftment of two human AML cell lines, KG-1 and THP-1. The reduction in human leukemia engraftment after ex vivo MYXV treatment was dose-dependent and required a minimum MOI of 3. Both AML cell lines demonstrated MYXV binding to leukemia cell membranes following co-incubation: however, evidence of productive MYXV infection was observed only in THP-1 cells. This observation, that KG-1 can be targeted in vivo even in the absence of in vitro permissive viral infection, contrasts with the current understanding of oncolytic virotherapy, which assumes that virus infection and productive replication is a requirement. Preventing MYXV binding to AML cells with heparin abrogated the purging capacity of MYXV, indicating that binding of infectious virus particles is a necessary step for effective viral oncolysis. Our results challenge the current dogma of oncolytic virotherapy and show that in vitro permissiveness to an oncolytic virus is not necessarily an accurate predictor of oncolytic potency in vivo. PMID:22341701

  15. Possible involvement of TGF-?/periostin in fibrosis of right atrial appendages in patients with atrial fibrillation

    PubMed Central

    Wu, Han; Xie, Jun; Li, Guan-Nan; Chen, Qin-Hua; Li, Ran; Zhang, Xin-Lin; Kang, Li-Na; Xu, Biao

    2015-01-01

    Atrial fibrosis contributes to development and recurrence of atrial fibrillation (AF). TGF-? and periostin have been reported to be involved in fibrogenesis. Here we investigated the role of TGF-? and periostin in atrial fibrosis of AF and in the recurrence of AF after surgery ablation. Western blot, Masson staining, immunohistochemistry and colorimetry were performed to detect the degree of atrial fibrosis and the expression of TGF-?, periostin and collagens in 70 biopsies of right atrial appendage (RAA) obtained in this study. Then the patients who received surgical ablation were followed up for about one year. The results showed an increasing gradient of atrial expression of TGF-?, periostin and collagens paralleled by a higher level of atrial fibrosis in control, SR and AF groups. The expression of TGF-? and periostin was significantly correlated with fibrotic markers. In addition, LAD and the expression of TGF-? were larger or higher in recurrence group than that in nonrecurrence group after surgery ablation. The results suggest that upregulated expression of TGF-? and periostin in RAAs is correlated with the degree of atrial fibrosis in patients with AF. PMID:26261573

  16. [Glass of water or ablation? - episodes of malignant atrial tachyarrhythmias during swimming in a lake in a woman with overt Wolff-Parkinson-White syndrome and benign palpitations for several decades of life].

    PubMed

    Bodalski, Robert; Maryniak, Agnieszka; Walczak, Franciszek; Szumowski, Lukasz; Jedynak, Zbigniew

    2008-12-01

    We present a case of a 41 year old woman with overt Wolff-Parkinson-White syndrome (WPW) and benign palpitations for over four decades of life who suffered from a malignant atrial tachyarrhythmias (typical atrial flutter concomitant with left atrial fibrillation) during swimming in a lake. Loading dose of amiodarone increased frequency of attacks of sustained AVRT. In spite of treatment with amiodarone, effective refractory period of accessory pathway was still short. After ablation of accessory pathway, during five years of follow-up, there was no arrhytmia recureence. PMID:19169985

  17. Frequent Atrial Premature Complexes and Their Association With Risk of Atrial Fibrillation.

    PubMed

    Acharya, Tushar; Tringali, Steven; Bhullar, Manminder; Nalbandyan, Marta; Ilineni, Vishnu Karthik; Carbajal, Enrique; Deedwania, Prakash

    2015-12-15

    Identification of precursors of atrial fibrillation (AF) may lead to early detection and prevent associated morbidity and mortality. This study aimed to examine the association between frequent atrial premature complexes (APCs) and incidence of AF. For this retrospective cohort study, we analyzed Holter recordings obtained from 2000 to 2010 of 1,357 veterans free of AF at baseline. All pertinent data in electronic medical records were reviewed to ascertain baseline characteristics. Holter groups with frequent (?100/day) and infrequent (<100/day) APCs were compared for development of new AF over a median follow-up of 7.5 years. Multivariate Cox regression analyses were performed before and after propensity score matching. Mean age was 64 years with 93% men. Mean body mass index, hemoglobin A1C, low-density lipoprotein, left atrial size, and heart rate were 31.24 kg/m(2), 6.42%, 107.92 mg/dl, 4.26 cm, and 73 beats/min, respectively. AF was noted in 21.8% of patients with frequent APCs compared to 5.6% of those with infrequent APCs. After adjusting for demographics, medication use, co-morbidities, and laboratory and echocardiographic findings, multivariate Cox regression analyses confirmed frequent APCs to be independently associated with higher incidence of AF (hazard ratio [HR] 2.97, 95% confidence interval [CI] 1.85 to 4.80; p <0.001). In propensity-matched groups, this association remained significant (HR 2.87, 95% CI 1.65 to 4.98; p <0.001). Additionally, atrial couplets (?50/day), atrial bigeminy (?50/day), frequent runs of ?3 APCs (?20 runs/day), and longer runs (?10 beats/run) were significantly associated with AF (HR 3.11, 3.67, 2.94, and 1.73, respectively, all p <0.05). In conclusion, frequent APCs (?100/day) are associated with greater risk of AF. PMID:26611122

  18. Disrupted Calcium Release as a Mechanism for Atrial Alternans Associated with Human Atrial Fibrillation

    PubMed Central

    Chang, Kelly C.; Bayer, Jason D.; Trayanova, Natalia A.

    2014-01-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia, but our knowledge of the arrhythmogenic substrate is incomplete. Alternans, the beat-to-beat alternation in the shape of cardiac electrical signals, typically occurs at fast heart rates and leads to arrhythmia. However, atrial alternans have been observed at slower pacing rates in AF patients than in controls, suggesting that increased vulnerability to arrhythmia in AF patients may be due to the proarrythmic influence of alternans at these slower rates. As such, alternans may present a useful therapeutic target for the treatment and prevention of AF, but the mechanism underlying alternans occurrence in AF patients at heart rates near rest is unknown. The goal of this study was to determine how cellular changes that occur in human AF affect the appearance of alternans at heart rates near rest. To achieve this, we developed a computational model of human atrial tissue incorporating electrophysiological remodeling associated with chronic AF (cAF) and performed parameter sensitivity analysis of ionic model parameters to determine which cellular changes led to alternans. Of the 20 parameters tested, only decreasing the ryanodine receptor (RyR) inactivation rate constant (kiCa) produced action potential duration (APD) alternans seen clinically at slower pacing rates. Using single-cell clamps of voltage, fluxes, and state variables, we determined that alternans onset was Ca2+-driven rather than voltage-driven and occurred as a result of decreased RyR inactivation which led to increased steepness of the sarcoplasmic reticulum (SR) Ca2+ release slope. Iterated map analysis revealed that because SR Ca2+ uptake efficiency was much higher in control atrial cells than in cAF cells, drastic reductions in kiCa were required to produce alternans at comparable pacing rates in control atrial cells. These findings suggest that RyR kinetics may play a critical role in altered Ca2+ homeostasis which drives proarrhythmic APD alternans in patients with AF. PMID:25501557

  19. Heart failure after transvenous closure of atrial septal defect associated with atrial standstill and thiamine-responsive megaloblastic anemia.

    PubMed

    Do?an, Vehbi; Senocak, Filiz; Orün, Utku Arman; Ceylan, Ozben

    2013-10-01

    Despite advances in device closure for atrial septal defect, post-closure heart failure remains a clinical problem in adult patients but is seen only rarely in children. An eight-year-old boy, who had been followed by a local pediatrician with the diagnosis of diabetes mellitus and congenital heart disease, was consulted to us for cardiac re-evaluation. Electrocardiography demonstrated absent P waves, and echocardiography revealed enlargement of the right ventricle and both atria and secundum atrial septal defect. With the diagnosis of atrial standstill, secundum atrial septal defect and thiamine-responsive megaloblastic anemia, acute heart failure developed after transvenous closure of the atrial septal defect, which improved dramatically with thiamine and supportive treatment. PMID:24164997

  20. Minimally invasive surgery for atrial fibrillation

    PubMed Central

    Suwalski, Piotr

    2013-01-01

    Atrial fibrillation (AF) remains the most common cardiac arrhythmia, affecting nearly 2% of the general population worldwide. Minimally invasive surgical ablation remains one of the most dynamically evolving fields of modern cardiac surgery. While there are more than a dozen issues driving this development, two seem to play the most important role: first, there is lack of evidence supporting percutaneous catheter based approach to treat patients with persistent and long-standing persistent AF. Paucity of this data offers surgical community unparalleled opportunity to challenge guidelines and change indications for surgical intervention. Large, multicenter prospective clinical studies are therefore of utmost importance, as well as honest, clear data reporting. Second, a collaborative methodology started a long-awaited debate on a Heart Team approach to AF, similar to the debate on coronary artery disease and transcatheter valves. Appropriate patient selection and tailored treatment options will most certainly result in better outcomes and patient satisfaction, coupled with appropriate use of always-limited institutional resources. The aim of this review, unlike other reviews of minimally invasive surgical ablation, is to present medical professionals with two distinctly different, approaches. The first one is purely surgical, Standalone surgical isolation of the pulmonary veins using bipolar energy source with concomitant amputation of the left atrial appendage—a method of choice in one of the most important clinical trials on AF—The Atrial Fibrillation Catheter Ablation Versus Surgical Ablation Treatment (FAST) Trial. The second one represents the most complex approach to this problem: a multidisciplinary, combined effort of a cardiac surgeon and electrophysiologist. The Convergent Procedure, which includes both endocardial and epicardial unipolar ablation bonds together minimally invasive endoscopic surgery with electroanatomical mapping, to deliver best of the two worlds. One goal remains: to help those in urgent need for everlasting relief. PMID:24251031

  1. Recovery of atrial systolic function after pharmacological conversion of chronic atrial fibrillation to sinus rhythm: a Doppler echocardiographic study.

    PubMed Central

    Jovi?, A.; Troskot, R.

    1997-01-01

    OBJECTIVE: To evaluate the time course of the recovery of atrial mechanical function after pharmacological cardioversion of chronic atrial fibrillation to sinus rhythm. PATIENTS AND METHODS: 21 patients (12 male, 9 female, aged 37-77 years) with chronic atrial fibrillation (< 6 months) were followed up by serial transmitral pulsed Doppler echocardiography. Echocardiographic studies were performed within the first 24 hours and on day 8, 15, and 30 after cardioversion. RESULTS: There was a significant increase (mean (SD)) in the peak A-wave velocity (from 0.35 (0.10) on day 1 to 0.50 (1.73) on day 8, and thereafter a gradual increase to 0.61 (0.14) m/s on day 30). Similarly, integrated late atrial velocities increased from 4.50 (1.46) on day 1 to 5.61 (1.73) on day 8 and 5.97 (1.47) cm/s2 on day 30. The atrial contribution to total transmitral flow increased significantly from 26 (7)% immediately after conversion of atrial fibrillation to sinus rhythm to 34 (7)% on day 30, indicating the haemodynamic benefit of the restoration of sinus rhythm. Left atrial diameter decreased but not significantly, from 4.11 (0.37) to 3.98 (0.34) cm (P < 0.005). CONCLUSIONS: These results suggest that restoration of atrial mechanical function after pharmacological cardioversion in patients with chronic atrial fibrillation is slow and gradual, as it is after electrical DC restoration of sinus rhythm. This time course may have important implications for determining how long treatment with anticoagulants and antiarrhythmic agents needs to continue in individual patients. It will also influence the clinical assessment of the haemodynamic benefit of restoring sinus rhythm in patients with chronic atrial fibrillation. Images PMID:9038694

  2. Comparison of pro-atrial natriuretic peptide and atrial remodeling in marathon versus non-marathon runners.

    PubMed

    Wilhelm, Matthias; Nuoffer, Jean-Marc; Schmid, Jean-Paul; Wilhelm, Ilca; Saner, Hugo

    2012-04-01

    Long-term endurance sports are associated with atrial remodeling and an increased risk for atrial fibrillation (AF) and atrial flutter. Pro-atrial natriuretic peptide (pro-ANP) is a marker of atrial wall tension and elevated in patients with AF. The aim of this study was to test the hypothesis that atrial remodeling would be perpetuated by repetitive episodes of atrial stretching during strenuous competitions, reflected by elevated levels of pro-ANP. A cross-sectional study was performed on nonelite runners scheduled to participate in the 2010 Grand Prix of Bern, a 10-mile race. Four hundred ninety-two marathon and nonmarathon runners applied for participation, 70 were randomly selected, and 56 entered the final analysis. Subjects were stratified according to former marathon participations: a control group (nonmarathon runners, n = 22), group 1 (1 to 4 marathons, n = 16), and group 2 (?5 marathons, n = 18). Results were adjusted for age, training years, and average weekly endurance training hours. The mean age was 42 ± 7 years. Compared to the control group, marathon runners in groups 1 and 2 had larger left atria (25 ± 6 vs 30 ± 6 vs 34 ± 7 ml/m(2), p = 0.002) and larger right atria (27 ± 7 vs 31 ± 8 vs 35 ± 5 ml/m(2), p = 0.024). Pro-ANP levels at baseline were higher in marathon runners (1.04 ± 0.38 vs 1.42 ± 0.74 vs 1.67 ± 0.69 nmol/L, p = 0.006). Pro-ANP increased significantly in all groups after the race. In multiple linear regression analysis, marathon participation was an independent predictor of left atrial (? = 0.427, p <0.001) and right atrial (? = 0.395, p = 0.006) remodeling. In conclusion, marathon running was associated with progressive left and right atrial remodeling, possibly induced by repetitive episodes of atrial stretching. The altered left and right atrial substrate may facilitate atrial arrhythmias. PMID:22221947

  3. Predictors of the risk of falls among elderly with chronic atrial fibrillation

    PubMed Central

    dos Santos, Angela Cristina Silva; Nobre, Moacyr Roberto Cucê; Nussbacher, Amit; de Paula Rodrigues, Giselle Helena; Gebara, Otavio Celso Eluf; Azul, João Batista Carvalho Serro; Wajngarten, Mauricio

    2012-01-01

    OBJECTIVES: Though elderly persons with chronic atrial fibrillation have more comorbidities that could limit indications for the chronic use of anticoagulants, few studies have focused on the risk of falls within this particular group. To evaluate the predictors of the risk of falls among elderly with chronic atrial fibrillation, a cross-sectional, observational study was performed. METHODS: From 295 consecutive patients aged 60 years or older with a history of atrial fibrillation who were enrolled within the last 2 years in the cardiogeriatrics outpatient clinic of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 107 took part in this study. Their age was 77.9±6.4 years, and 62 were female. They were divided into two groups: a) no history of falls in the previous year and b) a history of one or more falls in the previous year. Data regarding the history of falls and social, demographic, anthropometric, and clinical information were collected. Multidimensional assessment instruments and questionnaires were applied. RESULTS: At least one fall was reported in 55 patients (51.4%). Among them, 27 (49.1%) presented recurrent falls, with body lesions in 90.4% and fractures in 9.1% of the cases. Multivariate logistic regression showed that self-reported difficulty maintaining balance, use of amiodarone, and diabetes were independent variables associated with the risk of falls, with a sensitivity of 92.9% and a specificity of 44.9%. CONCLUSION: In a group of elderly patients with chronic atrial fibrillation who were relatively independent and able to attend an outpatient clinic, the occurrence of falls with recurrence and clinical consequences was high. Difficulty maintaining balance, the use of amiodarone and a diagnosis of diabetes mellitus were independent predictors of the risk for falls. Thus, simple clinical data predicted falls better than objective functional tests. PMID:22522754

  4. Action of ciguatoxin on human atrial trabeculae.

    PubMed

    Lewis, R J; Hoy, A W; McGiffin, D C

    1992-08-01

    This report describes the action of ciguatoxin-1, the major ciguatoxin present in fishes that cause ciguatera, on the contractile activity of human cardiac musculature. Ciguatoxin-1 caused a large, sustained and concentration-dependent positive inotropy in human atrial trabeculae that were obtained during coronary artery bypass surgery from otherwise healthy hearts. Atenolol (a beta 1-adrenoceptor selective antagonist without local anaesthetic-type activity) or low concentrations of tetrodotoxin abolished the positive inotropy caused by ciguatoxin-1, indicating that ciguatoxin-1 stimulated neural elements present in this tissue to release noradrenaline. The positive inotropic action of ciguatoxin-1 did not stem from a significant direct action on myocardial voltage-dependent sodium channels, nor did it stem from significant alpha 1- or beta 2-adrenoreceptor stimulation. Ciguatoxin-1 caused positive inotropy in preparations stimulated at between 0.02 and 2.0 Hz. Mannitol, currently the treatment of choice for ciguatera, did not significantly reverse the positive inotropy induced by ciguatoxin-1 in human atrial trabeculae. PMID:1523682

  5. Mitochondrial oxidative stress promotes atrial fibrillation

    PubMed Central

    Xie, Wenjun; Santulli, Gaetano; Reiken, Steven R.; Yuan, Qi; Osborne, Brent W.; Chen, Bi-Xing; Marks, Andrew R.

    2015-01-01

    Oxidative stress has been suggested to play a role in the pathogenesis of atrial fibrillation (AF). Indeed, the prevalence of AF increases with age as does oxidative stress. However, the mechanisms linking redox state to AF are not well understood. In this study we identify a link between oxidative stress and aberrant intracellular Ca2+ release via the type 2 ryanodine receptor (RyR2) that promotes AF. We show that RyR2 are oxidized in the atria of patients with chronic AF compared with individuals in sinus rhythm. To dissect the molecular mechanism linking RyR2 oxidation to AF we used two murine models harboring RyR2 mutations that cause intracellular Ca2+ leak. Mice with intracellular Ca2+ leak exhibited increased atrial RyR2 oxidation, mitochondrial dysfunction, reactive oxygen species (ROS) production and AF susceptibility. Both genetic inhibition of mitochondrial ROS production and pharmacological treatment of RyR2 leakage prevented AF. Collectively, our results indicate that alterations of RyR2 and mitochondrial ROS generation form a vicious cycle in the development of AF. Targeting this previously unrecognized mechanism could be useful in developing effective interventions to prevent and treat AF. PMID:26169582

  6. Current hot potatoes in atrial fibrillation ablation.

    PubMed

    Roten, Laurent; Derval, Nicolas; Pascale, Patrizio; Scherr, Daniel; Komatsu, Yuki; Shah, Ashok; Ramoul, Khaled; Denis, Arnaud; Sacher, Frédéric; Hocini, Mélèze; Haïssaguerre, Michel; Jaïs, Pierre

    2012-11-01

    Atrial fibrillation (AF) ablation has evolved to the treatment of choice for patients with drug-resistant and symptomatic AF. Pulmonary vein isolation at the ostial or antral level usually is sufficient for treatment of true paroxysmal AF. For persistent AF ablation, drivers and perpetuators outside of the pulmonary veins are responsible for AF maintenance and have to be targeted to achieve satisfying arrhythmia-free success rate. Both complex fractionated atrial electrogram (CFAE) ablation and linear ablation are added to pulmonary vein isolation for persistent AF ablation. Nevertheless, ablation failure and necessity of repeat ablations are still frequent, especially after persistent AF ablation. Pulmonary vein reconduction is the main reason for arrhythmia recurrence after paroxysmal and to a lesser extent after persistent AF ablation. Failure of persistent AF ablation mostly is a consequence of inadequate trigger ablation, substrate modification or incompletely ablated or reconducting linear lesions. In this review we will discuss these points responsible for AF recurrence after ablation and review current possibilities on how to overcome these limitations. PMID:22920482

  7. Transseptal fine needle aspiration of a large left atrial tumour.

    PubMed

    Wong, Chi Wing; Ruygrok, Peter; Sutton, Timothy; Ding, Patricia; van Vliet, Chris; Occleshaw, Christopher; Smith, Warren

    2010-07-01

    The diagnosis of cardiac tumours is often based on images without tissue diagnosis or tissue obtained at surgery. Percutaneous myocardial biopsy via a transvenous approach has been described in literatures but this technique is not feasible with left atrial tumours. We report a patient presenting with heart failure and left atrial tumour. The diagnosis of spindle cell neoplasm was established pre-operatively via successful transseptal fine needle aspiration of cells from a left atrial tumour. We believe this technique worth consideration to aid pre-surgery diagnosis. PMID:19656723

  8. The ?2,3-Sialyltransferase Encoded by Myxoma Virus Is a Virulence Factor that Contributes to Immunosuppression

    PubMed Central

    Boutard, Bérengère; Vankerckhove, Sophie; Markine-Goriaynoff, Nicolas; Sarlet, Mickaël; Desmecht, Daniel; McFadden, Grant; Vanderplasschen, Alain; Gillet, Laurent

    2015-01-01

    Myxoma virus (MYXV) induces a lethal disease called Myxomatosis in European rabbits. MYXV is one of the rare viruses that encodes an ?2,3-sialyltransferase through its M138L gene. In this study, we showed that although the absence of the enzyme was not associated with any in vitro deficit, the M138L deficient strains are highly attenuated in vivo. Indeed, while all rabbits infected with the parental and the revertant strains died within 9 days post-infection from severe myxomatosis, all but one rabbit inoculated with the M138L deficient strains survived the infection. In primary lesions, this resistance to the infection was associated with an increased ability of innate immune cells, mostly neutrophils, to migrate to the site of virus replication at 4 days post-infection. This was followed by the development of a better specific immune response against MYXV. Indeed, at day 9 post-infection, we observed an important proliferation of lymphocytes and an intense congestion of blood vessels in lymph nodes after M138L knockouts infection. Accordingly, in these rabbits, we observed an intense mononuclear cell infiltration throughout the dermis in primary lesions and higher titers of neutralizing antibodies. Finally, this adaptive immune response provided protection to these surviving rabbits against a challenge with the MYXV WT strain. Altogether, these results show that expression of the M138L gene contributes directly or indirectly to immune evasion by MYXV. In the future, these results could help us to better understand the pathogenesis of myxomatosis but also the importance of glycans in regulation of immune responses. PMID:25705900

  9. Clinical Significance of Additional Ablation of Atrial Premature Beats after Catheter Ablation for Atrial Fibrillation

    PubMed Central

    Kim, In-Soo; Yang, Pil-Sung; Kim, Tae-Hoon; Park, Junbeum; Park, Jin-Kyu; Uhm, Jae Sun; Joung, Boyoung; Lee, Moon Hyoung

    2016-01-01

    Purpose The clinical significance of post-procedural atrial premature beats immediately after catheter ablation for atrial fibrillation (AF) has not been clearly determined. We hypothesized that the provocation of immediate recurrence of atrial premature beats (IRAPB) and additional ablation improves the clinical outcome of AF ablation. Materials and Methods We enrolled 200 patients with AF (76.5% males; 57.4±11.1 years old; 64.3% paroxysmal AF) who underwent catheter ablation. Post-procedure IRAPB was defined as frequent atrial premature beats (?6/min) under isoproterenol infusion (5 µg/min), monitored for 10 min after internal cardioversion, and we ablated mappable IRAPBs. Post-procedural IRAPB provocations were conducted in 100 patients. We compared the patients who showed IRAPB with those who did not. We also compared the IRAPB provocation group with 100 age-, sex-, and AF-type-matched patients who completed ablation without provocation (No-Test group). Results 1) Among the post-procedural IRAPB provocation group, 33% showed IRAPB and required additional ablation with a longer procedure time (p=0.001) than those without IRAPB, without increasing the complication rate. 2) During 18.0±6.6 months of follow-up, the patients who showed IRAPB had a worse clinical recurrence rate than those who did not (27.3% vs. 9.0%; p=0.016), in spite of additional IRAPB ablation. 3) However, the clinical recurrence rate was significantly lower in the IRAPB provocation group (15.0%) than in the No-Test group (28.0%; p=0.025) without lengthening of the procedure time or raising complication rate. Conclusion The presence of post-procedural IRAPB was associated with a higher recurrence rate after AF ablation. However, IRAPB provocation and additional ablation might facilitate a better clinical outcome. A further prospective randomized study is warranted. PMID:26632385

  10. Virotherapy Using Myxoma Virus Prevents Lethal Graft-versus-Host Disease following Xeno-Transplantation with Primary Human Hematopoietic Stem Cells

    PubMed Central

    Bartee, Eric; Meacham, Amy; Wise, Elizabeth; Cogle, Christopher R.; McFadden, Grant

    2012-01-01

    Graft-versus-host disease (GVHD) is a potentially lethal clinical complication arising from the transfer of alloreactive T lymphocytes into immunocompromised recipients. Despite conventional methods of T cell depletion, GVHD remains a major challenge in allogeneic hematopoietic cell transplant. Here, we demonstrate a novel method of preventing GVHD by ex vivo treatment of primary human hematopoietic cell sources with myxoma virus, a rabbit specific poxvirus currently under development for oncolytic virotherapy. This pretreatment dramatically increases post-transplant survival of immunocompromised mice injected with primary human bone marrow or peripheral blood cells and prevents the expansion of human CD3+ lymphocytes in major recipient organs. Similar viral treatment also prevents human-human mixed alloreactive T lymphocyte reactions in vitro. Our data suggest that ex vivo virotherapy with myxoma virus can be a simple and effective method for preventing GVHD following infusion of hematopoietic products containing alloreactive T lymphocytes such as: allogeneic hematopoietic stem and progenitor cells, donor leukocyte infusions and blood transfusions. PMID:22905251

  11. Virotherapy using myxoma virus prevents lethal graft-versus-host disease following xeno-transplantation with primary human hematopoietic stem cells.

    PubMed

    Bartee, Eric; Meacham, Amy; Wise, Elizabeth; Cogle, Christopher R; McFadden, Grant

    2012-01-01

    Graft-versus-host disease (GVHD) is a potentially lethal clinical complication arising from the transfer of alloreactive T lymphocytes into immunocompromised recipients. Despite conventional methods of T cell depletion, GVHD remains a major challenge in allogeneic hematopoietic cell transplant. Here, we demonstrate a novel method of preventing GVHD by ex vivo treatment of primary human hematopoietic cell sources with myxoma virus, a rabbit specific poxvirus currently under development for oncolytic virotherapy. This pretreatment dramatically increases post-transplant survival of immunocompromised mice injected with primary human bone marrow or peripheral blood cells and prevents the expansion of human CD3(+) lymphocytes in major recipient organs. Similar viral treatment also prevents human-human mixed alloreactive T lymphocyte reactions in vitro. Our data suggest that ex vivo virotherapy with myxoma virus can be a simple and effective method for preventing GVHD following infusion of hematopoietic products containing alloreactive T lymphocytes such as: allogeneic hematopoietic stem and progenitor cells, donor leukocyte infusions and blood transfusions. PMID:22905251

  12. Prevalence of Chronic Atrial Fibrillation in Dialysis Patients

    E-print Network

    Wetmore, James B.

    2011-05-31

    Background: Atrial fibrillation (AF) is reported to be common in patients on maintenance dialysis, but estimates of prevalence vary substantially. To date, no Medicare claims-based approach has been employed to rigorously assess prevalence...

  13. Radiofrequency Ablation for Atrial Fibrillation: A Guide for Adults

    MedlinePLUS

    ... and Plug-ins EHC Component EPC Project Topic Title Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation Full Reports Research Review Dec. 2, 2008 Appendixes Dec. 2, 2008 Related Products for this Topic Disposition of Comments Report ...

  14. Have Atrial Fibrillation? Blood Thinners Can Prevent Strokes, Save Lives

    MedlinePLUS

    ... Related Consumer Updates FDA Helps Women Get Heart Smart Can an Aspirin a Day Help Prevent a Heart Attack? For More Information Atrial fibrillation, oral anticoagulant drugs, and their reversal agents More in Consumer Updates ...

  15. Myxoma virus M-T7, a secreted homolog of the interferon-gamma receptor, is a critical virulence factor for the development of myxomatosis in European rabbits.

    PubMed

    Mossman, K; Nation, P; Macen, J; Garbutt, M; Lucas, A; McFadden, G

    1996-01-01

    Myxoma virus is a leporipoxvirus of New World rabbits (Sylvilagus sp.) that induces a rapidly lethal infection known as myxomatosis in the European rabbit (Oryctolagus cuniculus). Like all poxviruses, myxoma virus encodes a plethora of proteins to circumvent or inhibit a variety of host antiviral immune mechanisms. M-T7, the most abundantly secreted protein of myxoma virus-infected cells, was originally identified as an interferon-gamma receptor homolog (Upton, Mossman, and McFadden, Science 258, 1369-1372, 1992). Here, we demonstrate that M-T7 is dispensable for virus replication in cultured cells but is a critical virulence factor for virus pathogenesis in European rabbits. Disruption of both copies of the M-T7 gene in myxoma virus was achieved by the deletion of 372 bp of M-T7 coding sequences, replacement with a selectable marker, p7.5Ecogpt, and selection of a recombinant virus (vMyxlac-T7gpt) resistant to mycophenolic acid. vMyxlac-T7gpt expressed no detectable M-T7 protein and infected cells supernatants were devoid of any detectable interferon-gamma binding activities. Immunohistochemical staining with anti-beta-galactosidase and anti-CD43 antibodies demonstrated that in vMyxlac-T7gpt-infected rabbits the loss of M-T7 not only caused a dramatic reduction in disease symptoms and viral dissemination to secondary sites, but also dramatically influenced host leukocyte behavior. Notably, primary lesions in wild-type virus infections were generally underlayed by large masses of inflammatory cells that did not effectively migrate into the dermal sites of viral replication, whereas in vMyxlac-T7gpt infections this apparent block to leukocyte influx was relieved. A second major phenotypic distinction noted for the M-T7 knockout virus was the extensive activation of lymphocytes in secondary immune organs, particularly the spleen and lymph nodes, by Day 4 of the infection. This is in stark contrast to infection by wild-type myxoma virus, which results in relatively little, if any, cellular activation of germinal centers of spleen and lymph node by Day 4. We conclude that M-T7 functions early in infection to (1) retard inflammatory cell migration into infected tissues and (2) disrupt the communication between sentinel immune cells at the site of primary virus infection in the subdermis and lymphocytes in the secondary lymphoid organs, thereby disabling the host from mounting an effective cellular immune response. To summarize, in addition to neutralizing host interferon-gamma at infected sites, we propose that M-T7 protein also modifies leukocyte traffic in the vicinity of virus lesions, thus effectively severing the link between antigen presenting cells of the infected tissue and the effector lymphocytes of the peripheral immune organs. PMID:8553583

  16. Novel fibro-inflammation markers in assessing left atrial remodeling in non-valvular atrial fibrillation

    PubMed Central

    Sonmez, Osman; Ertem, Furkan U.; Vatankulu, Mehmet Akif; Erdogan, Ercan; Tasal, Abdurrahman; Kucukbuzcu, S?tk?; Goktekin, Omer

    2014-01-01

    Background Structural remodeling is associated with the fibroinflammatory process in the atrial extracellular matrix. In the present study we aimed to investigate whether serum levels of new circulating remodeling markers differ in patients with atrial fibrillation (AF) compared to patients with sinus rhythm. Material/Methods The study population included 52 patients diagnosed with non-valvular AF and 33 age-matched patients with sinus rhythm. Serum levels of Galectin-3, matrix metalloproteinase-9 (MMP-9), lipocalin-2 (Lcn2/NGAL), N-terminal propeptide of type III procollagen (PIIINP), Hs-Crp, and neutrophil-to-lymphocyte ratio (NLR) were measured. The left atrial volume (LAV) was calculated by echocardiographic method and LAV index was calculated. Results Galectin-3, MMP-9, and PIIINP levels were significantly higher in AF patients except NGAL levels (1166 pg/ml (1126–1204) and 1204 pg/ml (1166–1362) p=0.001, 104 (81–179) pg/ml and 404 (162–564) pg/ml p<0.0001, and 1101 (500–1960) pg/ml and 6710 (2370–9950) pg/ml p<0.0001, respectively). The NLR and Hs-CRP levels were also higher in AF (2.1±1.0 and 2.7±1.1 p=0.02 and 4.2±1.9 mg/L and 6.0±4.7 mg/L p=0.04, respectively). In correlation analyses, NLR showed a strongly significant correlation with LAVi, but Hs-CRP did not (p=0.007 r=0.247, Pearson test and p=0.808 r=0.025, Pearson test, respectively). Moreover, Galectin-3, MMP-9, and PIIINP had a strong positive correlation with LAVi (p=0.021 r=640, Spearman test and p=0.004 r=0.319 Pearson test, and p=0.004 r=0.325 Pearson test, respectively). Conclusions Novel fibrosis and inflammation markers in AF are correlated with atrial remodeling. Several unexplained mechanisms of atrial remodeling remain, but the present study has taken the first step in elucidating the mechanisms involving fibrosis and inflammation markers. PMID:24651058

  17. Three-dimensional transesophageal echocardiography of the atrial septal defects

    PubMed Central

    Roldán, Francisco-Javier; Vargas-Barrón, Jesús; Vázquez-Antona, Clara; Castellanos, Luis Muñoz; Erdmenger-Orellana, Julio; Romero-Cárdenas, Ángel; Martínez-Ríos, Marco-Antonio

    2008-01-01

    Transesophageal echocardiography has advantages over transthoracic technique in defining morphology of atrial structures. Even though real time three-dimensional echocardiographic imaging is a reality, the off-line reconstruction technique usually allows to obtain higher spatial resolution images. The purpose of this study was to explore the accuracy of off-line three-dimensional transesophageal echocardiography in a spectrum of atrial septal defects by comparing them with representative anatomic specimens. PMID:18638394

  18. Alpha-adrenoceptor blockade modifies neurally induced atrial arrhythmias.

    PubMed

    Richer, Louis-Philippe; Vinet, Alain; Kus, Teresa; Cardinal, René; Ardell, Jeffrey L; Armour, John Andrew

    2008-10-01

    Our objective was to determine whether neuronally induced atrial arrhythmias can be modified by alpha-adrenergic receptor blockade. In 30 anesthetized dogs, trains of five electrical stimuli (1 mA; 1 ms) were delivered immediately after the P wave of the ECG to mediastinal nerves associated with the superior vena cava. Regional atrial electrical events were monitored with 191 atrial unipolar electrodes. Mediastinal nerve sites were identified that reproducibly initiated atrial arrhythmias. These sites were then restimulated following 1 h (time control, n = 6), or the intravenous administration of naftopidil (alpha(1)-adrenergic blocker: 0.2 mg/kg, n = 6), yohimbine (alpha(2)-adrenergic blocker: 1 mg/kg, n = 6) or both (n = 8). A ganglionic blocker (hexamethonium: 1 mg/kg) was tested in four dogs. Stimulation of mediastinal nerves sites consistently elicited atrial tachyarrhythmias. Repeat stimulation after 1 h in the time-control group exerted a 19% decrease of the sites still able to induce atrial tachyarrhythmias. Hexamethonium inactivated 78% of the previously active sites. Combined alpha-adrenoceptor blockade inactivated 72% of the previously active sites. Bradycardia responses induced by mediastinal nerve stimulation were blunted by hexamethonium, but not by alpha(1,2)-adrenergic blockade. Naftopidil or yohimbine alone eliminated atrial arrhythmia induction from 31% and 34% of the sites (similar to time control). We conclude that heterogeneous activation of the intrinsic cardiac nervous system results in atrial arrhythmias that involve intrinsic cardiac neuronal alpha-adrenoceptors. In contrast to the global suppression exerted by hexamethonium, we conclude that alpha-adrenoceptor blockade targets intrinsic cardiac local circuit neurons involved in arrhythmia formation and not the flow-through efferent projections of the cardiac nervous system. PMID:18716036

  19. Novel oral anticoagulants for atrial fibrillation

    PubMed Central

    How, Choon How

    2015-01-01

    Anticoagulation therapy is effective in preventing primary and secondary thromboembolic events due to atrial fibrillation. Warfarin, which was approved by the United States in 1954, was the only long-term oral anticoagulation therapy till the approval of dabigatran in 2010, and of rivaroxaban and other direct factor Xa inhibitors from 2011, forming a group known as novel oral anticoagulants (NOAC). NOAC have fewer food and drug interactions compared to warfarin; hence, the patient will require fewer clinic visits. However, the short half-life of NOAC means that twice-a-day dosing is needed and there is higher risk of a prothrombotic state when doses are missed. Other disadvantages are the lack of long-term data on NOAC, their high cost and the current lack of locally available antidotes. PMID:26702159

  20. Bridging the gender gap in atrial fibrillation.

    PubMed

    Oza, Nishaki Mehta; Baveja, Swati; Tedrow, Usha

    2015-03-01

    Women have a similar lifetime prevalence of non-valvular atrial fibrillation (NVAF) compared with that of men. Given the significant morbidity and potential mortality associated with NVAF, it is crucial to understand gender differences with NVAF. Women can be more symptomatic than men. Despite a higher baseline stroke risk, they are less likely to be on anticoagulation. Women have a greater risk of thromboembolism and a similar rate of bleeding risk compared with men on anticoagulation. Initial experience suggests that novel oral anticoagulants have similar safety and efficacy profile in men and women. Although women can have more adverse reactions from antiarrhythmic therapies, they are often referred later than men for ablation. As a group, a mitigating factor in ablation referral is that women also have a higher incidence of procedural complications from catheter ablation. This review summarizes the available literature highlighting significant gender-based differences and also highlights areas for research to improve NVAF outcomes in women. PMID:25586881

  1. Variability of the Left Atrial Appendage in Human Hearts

    PubMed Central

    Kami?ski, Rafa?; Kosi?ski, Adam; Brala, Mariola; Piwko, Grzegorz; Lewicka, Ewa; D?browska-Kugacka, Alicja; Raczak, Grzegorz; Koz?owski, Dariusz; Grzybiak, Marek

    2015-01-01

    Atrial fibrillation increases the risk of thrombus formation. It is commonly responsible for cerebral stroke whereas less frequently for pulmonary embolism. The aim of the study was to describe the morphology of the left atrial appendage in the human heart with respect to sex, age and weight. Macroscopic examination was carried out on 100 left appendages taken from the hearts of the patients aged 18–77, both sexes. All hearts preserved in 4% water solution of formaldehyde carried neither marks of coronary artery disease nor congenital abnormalities. Three axes of appendage orientation were performed. After the appendage had been cut off, morphological examination was performed in long and perpendicular axes. Measurements of the appendages were taken from anatomical specimens and their silicone casts. We classified the left atrial appendage into 4 morphological groups according to the number of lobes. Most left atrial appendages in female population were composed of 2 lobes. In the male group typically 2 or 3-lobed appendages were observed. The mean left atrial appendage orifice ranged from 12.0 to 16.0 mm and the most significant difference in the orifices between males and females was observed in LAA type 2 (about 3.3 mm). A smaller orifice and narrower, tubular shape of the LAA lobes could explain a higher risk of thrombus formation during nonvalvular atrial fibrillation in women. Knowledge of anatomical variability of the LAA helps diagnose some undefined echoes in the appendage during transesophageal echocardiographic examination. PMID:26544191

  2. [Occult pre-excitation. Differential diagnosis between latent Wolf-Parkinson-White syndrome and concealed atrial pre-excitation (endocavitary electrophysiological study)].

    PubMed

    Mobilij, A; D'Annunzio, E; Volpi, G; Paloscia, L; Griffi, E; Rasetti, G; Pontano, O

    1982-01-14

    Sixty patients (pts) with very disabling symptoms during supraventricular tachycardia (SVT) underwent electrophysiological study to determinate the mechanism of arrhythmia. 20 pts had, during normal sinus rythm (NSR), ECG pattern of ventricular pre-excitation (V-P); 40 pts, instead, had ECG pattern within normal limits (WNL). In V-P pts, circus movement tachycardia by overt accessory pathway (AP) was initiated. Among ECG-WNL pts group: 10 pts showed ectopic atrial rythm; 22 pts had SVT due to A-V nodal reciprocation; and 8 pts revealed the participation of concealed AP in the reentrant circuit of tachycardia. Among these latter, atrial stimulation at various sites and drugs-administration discovered extranodal by-pass liable for concealed V-P in 2 pts; in the remaining 4 pts it was possible to demonstrate concealed atrial preexcitation by ventricular stimulation, during NSR and SVT, and by atrial mapping during ventricular stimulation and SVT. Our report confirms the significative incidence of concealed AP at the basis of numerous cases of SVT (26%) and outlines the distinction between the latent W.P.W. syndrome and the atrial preexcitation, due to anomalous by-pass with anterograde block. PMID:7057999

  3. Multiple Biomarkers and Atrial Fibrillation in the General Population

    PubMed Central

    Schnabel, Renate B.; Wild, Philipp S.; Wilde, Sandra; Ojeda, Francisco M.; Schulz, Andreas; Zeller, Tanja; Sinning, Christoph R.; Kunde, Jan; Lackner, Karl J.

    2014-01-01

    Background Different biological pathways have been related to atrial fibrillation (AF). Novel biomarkers capturing inflammation, oxidative stress, and neurohumoral activation have not been investigated comprehensively in AF. Methods and Results In the population-based Gutenberg Health Study (n?=?5000), mean age 56±11 years, 51% males, we measured ten biomarkers representing inflammation (C-reactive protein, fibrinogen), cardiac and vascular function (midregional pro adrenomedullin [MR-proADM], midregional pro atrial natriuretic peptide [MR-proANP], N-terminal pro-B-type natriuretic peptide [Nt-proBNP], sensitive troponin I ultra [TnI ultra], copeptin, and C-terminal pro endothelin-1), and oxidative stress (glutathioneperoxidase-1, myeloperoxidase) in relation to manifest AF (n?=?161 cases). Individuals with AF were older, mean age 64.9±8.3, and more often males, 71.4%. In Bonferroni-adjusted multivariable regression analyses strongest associations per standard deviation increase in biomarker concentrations were observed for the natriuretic peptides Nt-proBNP (odds ratio [OR] 2.89, 99.5% confidence interval [CI] 2.14–3.90; P<0.0001), MR-proANP (OR 2.45, 99.5% CI 1.91–3.14; P<0.0001), the vascular function marker MR-proADM (OR 1.54, 99.5% CI 1.20–1.99; P<0.0001), TnI ultra (OR 1.50, 99.5% CI 1.19–1.90; P<0.0001) and. fibrinogen (OR 1.44, 99.5% CI 1.19–1.75; P<0.0001). Based on a model comprising known clinical risk factors for AF, all biomarkers combined resulted in a net reclassification improvement of 0.665 (99.3% CI 0.441–0.888) and an integrated discrimination improvement of >13%. Conclusions In conclusion, in our large, population-based study, we identified novel biomarkers reflecting vascular function, MR-proADM, inflammation, and myocardial damage, TnI ultra, as related to AF; the strong association of natriuretic peptides was confirmed. Prospective studies need to examine whether risk prediction of AF can be enhanced beyond clinical risk factors using these biomarkers. PMID:25401728

  4. Protective effects of epigallocatechin-3 gallate on atrial electrical and structural remodeling in a rabbit rapid atrial pacing model.

    PubMed

    Zhu, Jifa; Zhang, Xiao; Li, Ling; Su, Gang

    2015-03-01

    Epigallocatechin-3 gallate (EGCG) is the major catechin in green tea. The aim of this study is to investigate the effects of EGCG on atrial electrical and structural remodeling in a rabbit rapid atrial pacing (RAP) model. New Zealand white rabbits were subjected to RAP with or without EGCG treatment. The atrial electrophysiology was studied. ELISA, Western blots, and RT-PCR were performed to determine the level of the inflammation markers, oxidative stress, and fibrogenic agents. Atrial tissue was stained with Masson's trichrome stain for fibrosis detection. RAP rabbits showed a significantly shorter atrial effective refractory period than control rabbits. Higher AF inducibility and longer AF duration were seen in the RAP group. AERP of rabbits received high dose EGCG were prolonged compared to RAP rabbits, and AF inducibility and duration of rabbits received high dose EGCG were lower. RAP rabbits have higher inflammation markers, higher oxidative stress, and more significant fibrosis within atrium, while high dose intervention of EGCG can lower the inflammation, oxidative stress, and fibrosis induced by RAP. Results showed that EGCG have protective effects on atrial electrical and structural remodeling in a rabbit RAP model in terms of attenuating of inflammation and oxidative stress. PMID:25312479

  5. High 18F-FDG uptake in a systemic right ventricle after atrial switch.

    PubMed

    Demeure, Fabian; Vancraeynest, David; Moniotte, Stéphane; Hanin, François-Xavier

    2015-05-01

    A 21-year-old patient with a D-transposition of the great arteries and a single coronary ostium underwent an atrial switch operation as newborn (Senning correction at 6 days of life in 1992). For an unrelated oncological evaluation, she underwent a recent F-FDG PET/CT. The myocardial uptake was clearly more intense in the morphological right ventricle, as this ventricle has become the systemic ventricle. On the contrary, the morphological left ventricle showed a very faint FDG uptake. This case illustrates the physiological changes related to a previous cardiac surgery. PMID:25549346

  6. Surgical Ablation of Atrial Fibrillation during Mitral-Valve Surgery

    PubMed Central

    Gillinov, A. Marc; Gelijns, Annetine C.; Parides, Michael K.; DeRose, Joseph J.; Moskowitz, Alan J.; Voisine, Pierre; Ailawadi, Gorav; Bouchard, Denis; Smith, Peter K.; Mack, Michael J.; Acker, Michael A.; Mullen, John C.; Rose, Eric A.; Chang, Helena L.; Puskas, John D.; Couderc, Jean-Philippe; Gardner, Timothy J.; Varghese, Robin; Horvath, Keith A.; Bolling, Steven F.; Michler, Robert E.; Geller, Nancy L.; Ascheim, Deborah D.; Miller, Marissa A.; Bagiella, Emilia; Moquete, Ellen G.; Williams, Paula; Taddei-Peters, Wendy C.; O’Gara, Patrick T.; Blackstone, Eugene H.; Argenziano, Michael

    2015-01-01

    Background Among patients undergoing mitral-valve surgery, 30 to 50% present with atrial fibrillation, which is associated with reduced survival and increased risk of stroke. Surgical ablation of atrial fibrillation has been widely adopted, but evidence regarding its safety and effectiveness is limited. Methods We randomly assigned 260 patients with persistent or long-standing persistent atrial fibrillation who required mitral-valve surgery to undergo either surgical ablation (ablation group) or no ablation (control group) during the mitral-valve operation. Patients in the ablation group underwent further randomization to pulmonary-vein isolation or a biatrial maze procedure. All patients underwent closure of the left atrial appendage. The primary end point was freedom from atrial fibrillation at both 6 months and 12 months (as assessed by means of 3-day Holter monitoring). Results More patients in the ablation group than in the control group were free from atrial fibrillation at both 6 and 12 months (63.2% vs. 29.4%, P<0.001). There was no significant difference in the rate of freedom from atrial fibrillation between patients who underwent pulmonary-vein isolation and those who underwent the biatrial maze procedure (61.0% and 66.0%, respectively; P = 0.60). One-year mortality was 6.8% in the ablation group and 8.7% in the control group (hazard ratio with ablation, 0.76; 95% confidence interval, 0.32 to 1.84; P = 0.55). Ablation was associated with more implantations of a permanent pacemaker than was no ablation (21.5 vs. 8.1 per 100 patient-years, P = 0.01). There were no significant between-group differences in major cardiac or cerebrovascular adverse events, overall serious adverse events, or hospital readmissions. Conclusions The addition of atrial fibrillation ablation to mitral-valve surgery significantly increased the rate of freedom from atrial fibrillation at 1 year among patients with persistent or long-standing persistent atrial fibrillation, but the risk of implantation of a permanent pacemaker was also increased. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00903370.) PMID:25853744

  7. 77 FR 11121 - Scientific Information Request on Treatment of Atrial Fibrillation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-24

    ...Scientific Information Request on Treatment of Atrial Fibrillation...AHRQ), HHS. ACTION: Request for Scientific Information...through public information requests, including via the...atrial fibrillation treatment, including those...

  8. Atrial Fibrillation, Neurocognitive Decline and Gene Expression After Cardiopulmonary Bypass

    PubMed Central

    Dalal, Rahul S.; Sabe, Ashraf A.; Elmadhun, Nassrene Y.; Ramlawi, Basel; Sellke, Frank W.

    2015-01-01

    OBJECTIVE Atrial fibrillation and neurocognitive decline are common complications after cardiopulmonary bypass. By utilizing genomic microarrays we investigate whether gene expression is associated with postoperative atrial fibrillation and neurocognitive decline. METHODS Twenty one cardiac surgery patients were prospectively matched and underwent neurocognitive assessments pre-operatively and four days postoperatively. The whole blood collected in the pre-cardiopulmonary bypass, 6 hours after-cardiopulmonary bypass, and on the 4th postoperative day was hybridized to Affymetrix Gene Chip U133 Plus 2.0 Microarrays. Gene expression in patients who developed postoperative atrial fibrillation and neurocognitive decline (n=6; POAF+NCD) was compared with gene expression in patients with postoperative atrial fibrillation and normal cognitive function (n=5; POAF+NORM) and patients with sinus rhythm and normal cognitive function (n=10; SR+NORM). Regulated genes were identified using JMP Genomics 4.0 with a false discovery rate of 0.05 and fold change of >1.5 or <-1.5. RESULTS Eleven patients developed postoperative atrial fibrillation. Six of these also developed neurocognitive decline. Of the 12 patients with sinus rhythm, only 2 developed neurocognitive decline. POAF+NCD patients had unique regulation of 17 named genes preoperatively, 60 named genes six hours after cardiopulmonary bypass, and 34 named genes four days postoperatively (P<0.05) compared with normal patients. Pathway analysis demonstrated that these genes are involved in cell death, inflammation, cardiac remodeling and nervous system function. CONCLUSION Patients who developed postoperative atrial fibrillation and neurocognitive decline after cardiopulmonary bypass may have differential genomic responses compared to normal patients and patients with only postoperative atrial fibrillation, suggesting common pathophysiology for these conditions. Further exploration of these genes may provide insight into the etiology and improvements of these morbid outcomes.

  9. Atrial Fibrillation in Decompensated Heart Failure: Associated Factors and In-Hospital Outcome

    PubMed Central

    Mendes, Fernanda de Souza Nogueira Sardinha; Atié, Jacob; Garcia, Marcelo Iorio; Gripp, Eliza de Almeida; de Sousa, Andréa Silvestre; Feijó, Luiz Augusto; Xavier, Sergio Salles

    2014-01-01

    Background Studies on atrial fibrillation (AF) in decompensated heart failure (DHF) are scarce in Brazil. Objectives To determine AF prevalence, its types and associated factors in patients hospitalized due to DHF; to assess their thromboembolic risk profile and anticoagulation rate; and to assess the impact of AF on in-hospital mortality and hospital length of stay. Methods Retrospective, observational, cross-sectional study of incident cases including 659 consecutive hospitalizations due to DHF, from 01/01/2006 to 12/31/2011. The thromboembolic risk was assessed by using CHADSVASc score. On univariate analysis, the chi-square, Student t and Mann Whitney tests were used. On multivariate analysis, logistic regression was used. Results The prevalence of AF was 40%, and the permanent type predominated (73.5%). On multivariate model, AF associated with advanced age (p < 0.0001), non-ischemic etiology (p = 0.02), right ventricular dysfunction (p = 0.03), lower systolic blood pressure (SBP) (p = 0.02), higher ejection fraction (EF) (p < 0.0001) and enlarged left atrium (LA) (p < 0.0001). The median CHADSVASc score was 4, and 90% of the cases had it ? 2. The anticoagulation rate was 52.8% on admission and 66.8% on discharge, being lower for higher scores. The group with AF had higher in-hospital mortality (11.0% versus 8.1%, p = 0.21) and longer hospital length of stay (20.5 ± 16 versus 16.3 ± 12, p = 0.001). Conclusions Atrial fibrillation is frequent in DHF, the most prevalent type being permanent AF. Atrial fibrillation is associated with more advanced age, non-ischemic etiology, right ventricular dysfunction, lower SBP, higher EF and enlarged LA. Despite the high thromboembolic risk profile, anticoagulation is underutilized. The presence of AF is associated with longer hospital length of stay and high mortality. PMID:25352505

  10. Catheter ablation for atrial fibrillation: results from the first European Snapshot Survey on Procedural Routines for Atrial Fibrillation Ablation (ESS-PRAFA) Part II.

    PubMed

    Chen, Jian; Dagres, Nikolaos; Hocini, Melece; Fauchier, Laurent; Bongiorni, Maria Grazia; Defaye, Pascal; Hernandez-Madrid, Antonio; Estner, Heidi; Sciaraffia, Elena; Blomström-Lundqvist, Carina

    2015-11-01

    The European Snapshot Survey on Procedural Routines in Atrial Fibrillation Ablation (ESS-PRAFA) is a prospective, multicentre snapshot survey collecting patient-based data on current clinical practices during atrial fibrillation (AF) ablation. The participating centres were asked to prospectively enrol consecutive patients during a 6-week period (from September to October 2014). A web-based case report form was employed to collect information of patients and data of procedures. A total of 455 eligible consecutive patients from 13 countries were enrolled (mean age 59 ± 10.8 years, 28.8% women). Distinct strategies and endpoints were collected for AF ablation procedures. Pulmonary vein isolation (PVI) was performed in 96.7% and served as the endpoint in 91.3% of procedures. A total of 52 (11.5%) patients underwent ablation as first-line therapy. The cryoballoon technique was employed in 31.4% of procedures. Procedure, ablation, and fluoroscopy times differed among various types of AF ablation. Divergences in patient selection and complications were observed among low-, medium-, and high-volume centres. Adverse events were observed in 4.6% of AF ablation procedures. In conclusion, PVI was still the main strategy for AF ablation. Procedure-related complications seemed not to have declined. The centre volume played an important role in patient selection, strategy choice, and had impact on the rate of periprocedural complication. PMID:26462700

  11. The Left Atrial Appendage: Target for Stroke Reduction in Atrial Fibrillation

    PubMed Central

    Ramlawi, Basel; Abu Saleh, Walid K.; Edgerton, James

    2015-01-01

    A patient with atrial fibrillation (AF) has a greater than 5% annual risk of major stroke, a 5-fold increase compared to the general population. While anticoagulation remains the standard stroke prevention strategy, the nature of lifelong anticoagulation inevitably carries an increased risk of bleeding, increased stroke during periods of interruption, increased cost, and significant lifestyle modification. Many patients with atrial fibrillation have had their left atrial appendage (LAA) ligated or excised by surgeons during cardiac surgery, a decision based largely on intuition and with no clear evidence of efficacy in stroke risk reduction. The observation that 90% of the thrombi found in nonvalvular AF patients and 57% found in valvular AF are in the LAA, triggered significant interest in the LAA as a potential therapeutic target. Until recently, the results were inconsistent, and high rates of incomplete occlusions precluded the medical community from confirming a definite relationship between LAA and stroke. As a result, anticoagulation is still the recommended first-line stroke risk reduction in AF, and the American College of Cardiology/American Heart Association guidelines recommend LAA exclusion only with surgical ablation of AF or in the context of concomitant mitral valve surgery. A handful of devices have been developed for LAA exclusion. This includes percutaneous options such as WATCHMAN™ Left Atrial Appendage Closure Device (Boston Scientific Corporation, Marlborough, MA), hybrid epicardial devices such as the LARIAT Suture Delivery Device (SentreHEART, Inc., Redwood City, CA), and epicardial surgical devices such as AtriClip® LAA Occlusion System (AtriCure, Inc., West Chester, OH). Studies of the Watchman device have shown noninferiority to Warfarin in stroke prevention and this device has recently gained approval from the U.S. Food and Drug Administration (FDA) following lengthy delays due to safety concerns. The Lariat device, which received 510K clearance by the FDA for tissue approximation but not LAA exclusion, has been the target of significant criticism due to serious procedural safety concerns and high incomplete closure rates. The surgical AtriClip has been FDA approved since 2009 and is currently the most widely used LAA exclusion device placed through an epicardial approach. Small studies have shown excellent reliability and success of complete LAA closure with the AtriClip device, which is implanted through an epicardial approach. Currently, we are conducting a multicenter trial to demonstrate the stroke prevention potential of this epicardial device through a short (45 minute), stand-alone, minimally invasive procedure in lieu of lifelong anticoagulation in patients at high risk of bleeding. PMID:26306127

  12. Identifying Future Research Priorities Using Value of Information Analyses: Left Atrial Appendage Occlusion Devices in Atrial Fibrillation

    PubMed Central

    Micieli, Andrew; Bennell, Maria C.; Pham, Ba’; Krahn, Murray; Singh, Sheldon M.; Wijeysundera, Harindra C.

    2014-01-01

    Background Left atrial appendage occlusion devices are cost effective for stroke prophylaxis in atrial fibrillation when compared with dabigatran or warfarin. We illustrate the use of value?of?information analyses to quantify the degree and consequences of decisional uncertainty and to identify future research priorities. Methods and Results A microsimulation decision?analytic model compared left atrial appendage occlusion devices to dabigatran or warfarin in atrial fibrillation. Probabilistic sensitivity analysis quantified the degree of parameter uncertainty. Expected value of perfect information analyses showed the consequences of this uncertainty. Expected value of partial perfect information analyses were done on sets of input parameters (cost, utilities, and probabilities) to identify the source of the greatest uncertainty. One?way sensitivity analyses identified individual parameters for expected value of partial perfect information analyses. Population expected value of perfect information and expected value of partial perfect information provided an upper bound on the cost of future research. Substantial uncertainty was identified, with left atrial appendage occlusion devices being preferred in only 47% of simulations. The expected value of perfect information was $8542 per patient and $227.3 million at a population level. The expected value of partial perfect information for the set of probability parameters represented the most important source of uncertainty, at $6875. Identified in 1?way sensitivity analyses, the expected value of partial perfect information for the odds ratio for stroke with left atrial appendage occlusion compared with warfarin was calculated at $7312 per patient or $194.5 million at a population level. Conclusion The relative efficacy of stroke reduction with left atrial appendage occlusion devices in relation to warfarin is an important source of uncertainty. Improving estimates of this parameter should be the priority for future research in this area. PMID:25227405

  13. Influence of atrial stretch receptors on hypothalamic neurosecretory neurones.

    PubMed Central

    Koizumi, K; Yamashita, H

    1978-01-01

    1. The effects of stimulation of atrial receptors on hypothalamic neurosecretory cells were investigated in anaesthetized dogs and cats. Atrial receptors were activated by stretching the left and the right atria while action potentials of individual neurosecretory neurones in the supraoptic (s.o.n.) and paraventricular (p.v.m.) nuclei of the hypothalamus were recorded. 2. Stretching the left atrium markedly decreased firing frequencies of 'antidromically identified' s.o.n. and p.v.n. neurones in dogs and cats; 98% of neurones in dogs and 70% in cats were thus inhibited. Heart rate accelerated following a transient reflexly induced deceleration. The blood pressure was not affected. The magnitude and duration of inhibitory effects produced by atrial stretch on s.o.n. and p.v.n. neurones paralleled changes observed in heart rate. Approximately one third of 'unidentified' cells in s.o.n. and p.v.n. (those which could not be activated antidromically) were inhibited by left atrium stretch. 3. Bilateral vagotomy abolished the effects on neurosecretory neurones as well as on heart rate produced by left atrial stretch, indicating that the vagus nerves carry afferent impulses responsible for the observed changes. 4. Stretching the right atrium did not produce changes in firing frequencies of s.o.n. and p.v.n. neurones in dogs and cats, although cardiac rate was increased considerably by such stretch. Stimulation of the left and right atria was tested in the same animal in succession to permit comparison of the diverse results. 5. Interaction of responses originating from atrial receptors, baro- and chemoreceptors were studied. During carotid occlusion or stimulation of chemoreceptors activity of the neurosecretory cells was greatly augmented. Left atrial stretch when then applied evoked slight or no reduction in activity in s.o.n. and p.v.n. neurones. These results were interpreted to mean that the influence of baro- or chemoreceptors on neurosecretory neurones probably is stronger than that originating from atrial receptors. 6. Unlike the observations made in rats, no rhythmically bursting neurones (phasic cells) were found in dogs and cats. However, atrial stretch sometimes evoked a rhythmic bursting pattern which appeared only during stretch. 7. It is concluded that activation of left atrial receptors, through afferent impulses carried mainly by vagus nerves, inhibits neurosecretory neurones in s.o.n. and p.v.n. The implications of this finding in relation to the role of ADH in the maintenance of blood volume control were discussed. PMID:745091

  14. Isolated right atrial compression as a late sequela of aortic valve replacement.

    PubMed Central

    Grishkin, B A; Catalano, P W; Watts, M A

    1994-01-01

    Isolated right atrial compression occurred 31 months after aortic valve replacement. Aortic bleeding contained by adjacent pericardium produced a pseudoaneurysm and local atrial tamponade. Transthoracic echocardiography could not distinguish the extracardiac hematoma from an intra-atrial thrombus, temporarily misleading investigators. Images PMID:8000271

  15. Sibjotang Increases Atrial Natriuretic Peptide Secretion in Beating Rabbit Atria.

    PubMed

    Kwon, Oh Jeong; Oh, Hyun Cheol; Lee, Yun Jung; Kim, Hye Yoom; Tan, Rui; Kang, Dae Gill; Lee, Ho Sub

    2015-01-01

    Sibjotang (Shizaotang), traditional herbal medicine formula, which was first documented in the Shanghanlun, has long been prescribed for the treatment of impairment of the body fluid homeostasis. The purpose of the present study was to identify the effects of Sibjotang on the secretion of a cardiac hormone, atrial natriuretic peptide (ANP), one of the main hormones involved in the regulation of the body fluid and blood pressure homeostasis. Water extract of Sibjotang increased ANP secretion concomitantly with an increase in atrial dynamics in a concentration-dependent manner. Sibjotang-induced increase in ANP secretion and positive inotropic effect were attenuated by GO6976 and LY333531, selective inhibitors of conventional protein kinase C, but not Rottlerin, an inhibitor of novel PKC ? . Similarly to the effect of Sibjotang, extracts of components of Sibjotang, Euphorbia kansui, and Daphne genkwa, but not Euphorbia pekinensis and Ziziphus jujuba, increased ANP secretion and atrial dynamics. Ingredients of Sibjotang, apigenin, rosmarinic acid, and salvianolic acid B decreased ANP secretion and atrial dynamics. These findings suggest that Sibjotang increases ANP secretion and atrial dynamics via activation of conventional protein kinase C signaling. This finding provides experimental evidence for the rationale in the use of Sibjotang in the treatment of impairment of the regulation of body fluid and blood pressure homeostasis. PMID:26495007

  16. Sibjotang Increases Atrial Natriuretic Peptide Secretion in Beating Rabbit Atria

    PubMed Central

    Kwon, Oh Jeong; Oh, Hyun Cheol; Lee, Yun Jung; Kim, Hye Yoom; Tan, Rui; Kang, Dae Gill; Lee, Ho Sub

    2015-01-01

    Sibjotang (Shizaotang), traditional herbal medicine formula, which was first documented in the Shanghanlun, has long been prescribed for the treatment of impairment of the body fluid homeostasis. The purpose of the present study was to identify the effects of Sibjotang on the secretion of a cardiac hormone, atrial natriuretic peptide (ANP), one of the main hormones involved in the regulation of the body fluid and blood pressure homeostasis. Water extract of Sibjotang increased ANP secretion concomitantly with an increase in atrial dynamics in a concentration-dependent manner. Sibjotang-induced increase in ANP secretion and positive inotropic effect were attenuated by GO6976 and LY333531, selective inhibitors of conventional protein kinase C, but not Rottlerin, an inhibitor of novel PKC?. Similarly to the effect of Sibjotang, extracts of components of Sibjotang, Euphorbia kansui, and Daphne genkwa, but not Euphorbia pekinensis and Ziziphus jujuba, increased ANP secretion and atrial dynamics. Ingredients of Sibjotang, apigenin, rosmarinic acid, and salvianolic acid B decreased ANP secretion and atrial dynamics. These findings suggest that Sibjotang increases ANP secretion and atrial dynamics via activation of conventional protein kinase C signaling. This finding provides experimental evidence for the rationale in the use of Sibjotang in the treatment of impairment of the regulation of body fluid and blood pressure homeostasis. PMID:26495007

  17. Infection of human cancer cells with myxoma virus requires Akt activation via interaction with a viral ankyrin-repeat host range factor

    PubMed Central

    Wang, Gen; Barrett, John W.; Stanford, Marianne; Werden, Steven J.; Johnston, James B.; Gao, Xiujuan; Sun, Mei; Cheng, Jin Q.; McFadden, Grant

    2006-01-01

    We demonstrate that the susceptibility of human cancer cells to be infected and killed by an oncolytic poxvirus, myxoma virus (MV), is related to the basal level of endogenous phosphorylated Akt. We further demonstrate that nonpermissive tumor cells will switch from resistant to susceptible for MV infection after expression of ectopically active Akt (Myr-Akt) and that permissive cancer cells can be rendered nonpermissive by blocking Akt activation with a dominant-negative inhibitor of Akt. Finally, the activation of Akt by MV involves the formation of a complex between the viral host range ankyrin-repeat protein, M-T5, and Akt. We conclude that the Akt pathway is a key restriction determinant for permissiveness of human cancer cells by MV. PMID:16537421

  18. Atrial natriuretic factor increases vascular permeability

    NASA Technical Reports Server (NTRS)

    Lockette, Warren; Brennaman, Bruce

    1990-01-01

    An increase in central blood volume in microgravity may result in increased plasma levels of atrial natriuretic factor (ANF). In this study, it was determined whether ANF increases capillary permeability to plasma protein. Conscious, bilaterally nephrectomized male rats were infused with either saline, ANF + saline, or hexamethonium + saline over 2 h following bolus injections of (I-125)-albumin and (C-14)-dextran of similar molecular size. Blood pressure was monitored, and serial determinations of hematocrits were made. Animals infused with 1.0 microg/kg per min ANF had significantly higher hematocrits than animals infused with saline vehicle. Infusion of ANF increased the extravasation of (I-125)-albumin, but not (C-14)-dextran from the intravascular compartment. ANF also induced a depressor response in rats, but the change in blood pressure did not account for changes in capillary permeability to albumin; similar depressor responses induced by hexamethonium were not accompanied by increased extravasation of albumin from the intravascular compartment. ANF may decrease plasma volume by increasing permeability to albumin, and this effect of ANF may account for some of the signs and symptoms of space motion sickness.

  19. Sinus venosus atrial septal defect presenting with brain abscesses in a 77-year-old immunocompetent patient.

    PubMed

    Alhamshari, Yaser Sm; Punjabi, Chitra; Pressman, Gregg S; Govil, Anita

    2015-01-01

    We present a case of 77-year-old immunocompetent patient who initially presented with vertigo, nausea and vomiting, with symptoms later progressing to headaches and increased lethargy. Brain MRI revealed ring-enhancing lesions typical of abscesses in the right cerebellum. Transoesophageal echocardiogram (TEE) was performed to look for the source of his abscesses, and uncovered a sinus venosus type atrial septal defect. Cardiac CT was carried out; the patient was found to have a sinus venosus atrial septal defect with partial anomalous pulmonary venous return. Moreover, dental examination showed multiple dental caries with poor oral hygiene. The patient was started on intravenous empiric antibiotics and steroids. Subsequent brain imaging showed almost complete resolution of the abscesses. The patient's symptoms started to improve, and he was eventually sent to an intensive rehabilitation centre with future plans to surgically correct his congenital heart disease to prevent further complications. PMID:26475881

  20. The Role of Left Atrial Imaging in the Management of Atrial Fibrillation.

    PubMed

    Walters, Tomos E; Ellims, Andris H; Kalman, Jonathan M

    2015-01-01

    Atrial fibrillation (AF) is the most commonly encountered sustained cardiac rhythm disorder, is an independent risk factor for stroke, heart failure and death, and its development is promoted by a range of common cardiovascular pathologies. The management of AF is directed at these predisposing conditions, at reducing the risk of systemic thromboembolism, and towards rate or rhythm control of the arrhythmia. Guidelines increasingly support the use of catheter ablation (CA) as an early management strategy, with the efficacy of CA crucially dependent on the extent of left atrial (LA) structural remodeling; LA imaging plays a central role in each of identifying comorbidities, risk stratification for stroke, and identification of suitable candidates for CA. An understanding of the strengths and limitations of various echocardiographic modalities, of cardiac computed tomography and of cardiac magnetic resonance imaging is therefore an increasingly important part of the armory of the electrophysiologist. In particular, individualized use of imaging to select patients more likely to benefit from CA of AF is important, and post-procedural imaging to evaluate the extent of reverse LA remodeling after CA is critical to appropriate decisions regarding ongoing anti-arrhythmic therapy and long-term anticoagulation. PMID:26241303

  1. Surgical Left Atrial Appendage Exclusion Does Not Impair Left Atrial Contraction Function: A Pilot Study

    PubMed Central

    De Maat, Gijs E.; Benussi, Stefano; Hummel, Yoran M.; Krul, Sebastien; Pozzoli, Alberto; Driessen, Antoine H. G.; Mariani, Massimo A.; Van Gelder, Isabelle C.; Van Boven, Wim-Jan; de Groot, Joris R.

    2015-01-01

    Background. In order to reduce stroke risk, left atrial appendage amputation (LAAA) is widely adopted in recent years. The effect of LAAA on left atrial (LA) function remains unknown. The objective of present study was to assess the effect of LAAA on LA function. Methods. Sixteen patients with paroxysmal AF underwent thoracoscopic, surgical PVI with LAAA (LAAA group), and were retrospectively matched with 16 patients who underwent the same procedure without LAA amputation (non-LAAA group). To objectify LA function, transthoracic echocardiography with 2D Speckle Tracking was performed before surgery and at 12 months follow-up. Results. Mean age was 57 ± 9 years, 84% were male. Baseline characteristics did not differ significantly except for systolic blood pressure (p = 0.005). In both groups, the contractile LA function and LA ejection fraction were not significantly reduced. However, the conduit and reservoir function were significantly decreased at follow-up, compared to baseline. The reduction of strain and strain rate was not significantly different between groups. Conclusions. In this retrospective, observational matched group comparison with a convenience sample size of 16 patients, findings suggest that LAAA does not impair the contractile LA function when compared to patients in which the appendage was unaddressed. However, the LA conduit and reservoir function are reduced in both the LAAA and non-LAAA group. Our data suggest that the LAA can be removed without late LA functional consequences. PMID:26221586

  2. Application of Hurst exponents to assess atrial reverse remodeling in paroxysmal atrial fibrillation.

    PubMed

    Julián, Matilde; Alcaraz, Raúl; Rieta, José J

    2015-11-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice. Although its termination mechanisms are not still completely known, previous works have reported significant electrocardiographic differences between immediately and non-immediately terminating episodes of paroxysmal AF (PAF). However, none studied how long these differences still hold as we move backward in time. The present work studies a time interval long enough to identify earlier signs forecasting atrial reverse remodeling that will provoke spontaneous AF termination. Reverse remodeling was estimated by measuring AF organisation with the second-order generalised Hurst exponent, H(2), which provided the highest accuracy. Organisation is associated with the number of simultaneous reentries in the atria, which plays a key role in reverse remodeling, thus causing arrhythmia termination. The computation of H(2) depended on two critical parameters: the analysed interval length (L) and the maximum search window for self-similarities ([Formula: see text]). A study with 660 combinations on these two parameters was performed together with the sampling frequency ([Formula: see text]) of the recording. The results reported that optimal computational parameters are L???=???15 s, [Formula: see text] milliseconds and [Formula: see text] Hz. A statistically significant organisation increase was observed during the last 2 min before AF termination, thus suggesting that reverse remodeling only occurs very close to the termination event. PMID:26393825

  3. Large Right Atrial Thrombus Associated with Central Venous Catheter Requiring Open Heart Surgery

    PubMed Central

    Hussain, Nasir; Shattuck, Paul Eric; Senussi, Mourad Hussein; Velasquez Kho, Erwin; Mohammedabdul, Mubeenkhan; Sanghavi, Devang K.; Mustafa, Usman; Balavenkataraman, Arvind; Obradovic, Dragic M.

    2012-01-01

    Central venous catheters (CVC) are used commonly in clinical practice. Incidences of CVC-related right atrial thrombosis (CRAT) are variable, but, when right atrial thrombus is present, it carries a mortality risk of 18% in hemodialysis patients and greater than 40% risk in nonhemodialysis patients. Different pathogenic mechanisms have been postulated for the development of CRAT, which includes mechanical irritation of the myocardial wall, propagation of intraluminal clot, hypercoagulability, and hemodynamics of right atria. Presentation of CRAT may be asymptomatic or may be associated with one of the complications of CRAT like pulmonary embolism, systemic embolism, infected thrombi, or hemodynamic compromise. There are no established treatment guidelines for CRAT. We describe an interesting case of a 59-year-old asymptomatic male successfully treated with open heart surgery after failure of medical treatment for a large CRAT discovered during a preoperative evaluation for a kidney transplant. Our case underscores that early detection of CRAT may carry a favorable prognosis as opposed to waiting until catastrophic complications arise. It also underscores the importance of transesophageal echocardiography in the detection of thrombus and perhaps guides clinicians on which treatment modality to be used according to the size of the thrombus. PMID:23251176

  4. Assessing the atrial electromechanical coupling during atrial focal tachycardia, flutter, and fibrillation using electromechanical wave imaging in humans.

    PubMed

    Provost, Jean; Costet, Alexandre; Wan, Elaine; Gambhir, Alok; Whang, William; Garan, Hasan; Konofagou, Elisa E

    2015-10-01

    Minimally-invasive treatments of cardiac arrhythmias such as radio-frequency ablation are gradually gaining importance in clinical practice but still lack a noninvasive imaging modality which provides insight into the source or focus of an arrhythmia. Cardiac deformations imaged at high temporal and spatial resolution can be used to elucidate the electrical activation sequence in normal and paced human subjects non-invasively and could potentially aid to better plan and monitor ablation-based arrhythmia treatments. In this study, a novel ultrasound-based method is presented that can be used to quantitatively characterize focal and reentrant arrhythmias. Spatio-temporal maps of the full-view of the atrial and ventricular mechanics were obtained in a single heartbeat, revealing with otherwise unobtainable detail the electromechanical patterns of atrial flutter, fibrillation, and tachycardia in humans. During focal arrhythmias such as premature ventricular complex and focal atrial tachycardia, the previously developed electromechanical wave imaging methodology is hereby shown capable of identifying the location of the focal zone and the subsequent propagation of cardiac activation. During reentrant arrhythmias such as atrial flutter and fibrillation, Fourier analysis of the strains revealed highly correlated mechanical and electrical cycle lengths and propagation patterns. High frame rate ultrasound imaging of the heart can be used non-invasively and in real time, to characterize the lesser-known mechanical aspects of atrial and ventricular arrhythmias, also potentially assisting treatment planning for intraoperative and longitudinal monitoring of arrhythmias. PMID:26361338

  5. Novel Anticoagulants in Atrial Fibrillation: Monitoring, Reversal and Perioperative Management

    PubMed Central

    Shamoun, Fadi; Obeid, Hiba; Ramakrishna, Harish

    2015-01-01

    Atrial fibrillation continues to be a significant source of morbidity and mortality worldwide. Effective anticoagulation remains the cornerstone of outpatient and inpatient treatment. The use of the new generation of anticoagulants (NOACs) continues to grow. Recently published data indicate their cost-effectiveness and overall safety in stroke prevention; compared to vitamin K antagonists, they can be prescribed in fixed doses for long-term therapy without the need for coagulation monitoring. Both United States and European Guidelines recommend NOACs for stroke prevention in patients with atrial fibrillation. This review discusses each of the NOACs, along with their efficacy and safety data. It explores the most recent guidelines regarding their perioperative use in atrial fibrillation patients. It also discusses bleeding complications, perioperative management, and reversal agents. PMID:26221593

  6. Atrial flutter: arrhythmia circuit and basis for radiofrequency catheter ablation.

    PubMed

    Földesi, Csaba; Pandozi, Claudio; Peichl, Petr; Bulava, Alan; Castro, Antonio; Lamberti, Filippo; Calò, Leonardo; Loricchio, Maria Luisa; Santini, Massimo

    2003-06-01

    The term atrial flutter was introduced 90 years ago for an arrhythmia with a unique electrocardiographic pattern. The development of endocardial mapping techniques in the last decade allowed the detailed characterization of the tachycardia circuit and the identification of the cavotricuspid isthmus as its critical part. This review stresses the position of atrial flutter in the new classification of atrial tachycardias and focuses on its unique electrophysiological characteristics and different variants described in humans. Transcatheter radiofrequency ablation across the cavotricuspid isthmus constitutes a feasible and safe therapy, which prevents flutter recurrences during the long-term follow-up. This paper describes the different techniques that validate bidirectional isthmus block, which is an important endpoint for successful ablation. PMID:12898804

  7. Modeling atrial arrhythmias: impact on clinical diagnosis and therapies.

    PubMed

    Jacquemet, Vincent; Kappenberger, Lukas; Henriquez, Craig S

    2008-01-01

    Atrial arrhythmias are the most frequent sustained rhythm disorders in humans and often lead to severe complications such as heart failure and stroke. Despite the important insights provided by animal models into the mechanisms of atrial arrhythmias, direct translation of experimental findings to new therapies in patients has not been straightforward. With the advances in computer technology, large-scale electroanatomical computer models of the atria that integrate information from the molecular to organ scale have reached a level of sophistication that they can be used to interpret the outcome of experimental and clinical studies and aid in the rational design of therapies. This paper reviews the state-of-the-art of computer models of the electrical dynamics of the atria and discusses the evolving role of simulation in assisting the clinical diagnosis and treatment of atrial arrhythmias. PMID:22274901

  8. Atrial septal pacing: a method for pacing both atria simultaneously.

    PubMed

    Spencer, W H; Zhu, D W; Markowitz, T; Badruddin, S M; Zoghbi, W A

    1997-11-01

    By pacing both atria simultaneously, one could reliably predict and optimize left-sided AV timing without concern for IACT. With synchronous depolarization of the atria, reentrant arrhythmias might be suppressed. We studied four male patients (73 +/- 3 years) with paroxysmal atrial fibrillation and symptomatic bradyarrhythmias using TEE and fluoroscopy as guides; a standard active fixation screw-in lead (Medtronic model #4058) was attached to the interatrial septum and a standard tined lead was placed in the ventricle. The generators were Medtronic model 7960. The baseline ECG was compared to the paced ECG and the conduction time were measured to the high right atrium, distal coronary sinus and atrial septum in normal sinus rhythm, atrial septal pacing, and AAT pacing. On the surface ECG, no acceleration or delay in AV conduction was noted during AAI pacing from the interatrial septum as compared with normal sinus rhythm. The mean interatrial conduction time for all 4 patients was 106 +/- 2 ms; the interatrial conduction time measured during AAT pacing utilizing the atrial septal pacing lead was 97 +/- 4 ms (P = NS). During atrial septal pacing, the mean conduction time to the high right atrium was 53 +/- 2 ms. The mean conduction time to the lateral left atrium during atrial septal pacing, was likewise 53 +/- 2 ms. We conclude that it is possible to pace both atria simultaneously from a single site using a standard active fixation lead guided by TEE and fluoroscopy. Such a pacing system allows accurate timing of the left-sided AV delay. PMID:9392804

  9. New-onset atrial fibrillation in critically ill patients

    PubMed Central

    Sibley, Stephanie; Muscedere, John

    2015-01-01

    New-onset atrial fibrillation is a common problem in critically ill patients, with reported incidence ranging from 5% to 46%. It is associated with significant morbidity and mortality. The present review summarizes studies investigating new-onset atrial fibrillation conducted in the critical care setting, focusing on the etiology, management of the hemodynamically unstable patient, rate versus rhythm control, ischemic stroke risk and anticoagulation. Recommendations for an approach to management in the intensive care unit are drawn from the results of these studies. PMID:26057373

  10. [More with atrial fibrillation, anticoagulants since the coming of NOAK ].

    PubMed

    Forslund, Tomas; von Euler, Mia; Johnsson, Hans; Holmström, Margareta; Wettermark, Björn; Hjemdahl, Paul

    2015-01-01

    Since the introduction of NOAC (non-vitamin K antagonist oral anticoagulants) in 2011 as thromboprophylactic treatment for patients with atrial fibrillation, AF, the number of patients with a diagnosis of atrial fibrillation has increased markedly in our health care registers. The proportion of patients treated with warfarin or NOAC has increased from 47?% to 58?% in 2013. The use of acetylsalicylic acid in patients is decreasing rapidly in patients with AF. NOAC are mostly prescribed by specialists and are mainly used in younger patients with lower CHA2DS2-VASc scores and lower risk for renal insufficiency and bleeding. PMID:25584610

  11. Effects of Persistent Atrial Fibrillation-Induced Electrical Remodeling on Atrial Electro-Mechanics – Insights from a 3D Model of the Human Atria

    PubMed Central

    Adeniran, Ismail; MacIver, David H.; Garratt, Clifford J.; Ye, Jianqiao; Hancox, Jules C.; Zhang, Henggui

    2015-01-01

    Aims Atrial stunning, a loss of atrial mechanical contraction, can occur following a successful cardioversion. It is hypothesized that persistent atrial fibrillation-induced electrical remodeling (AFER) on atrial electrophysiology may be responsible for such impaired atrial mechanics. This simulation study aimed to investigate the effects of AFER on atrial electro-mechanics. Methods and Results A 3D electromechanical model of the human atria was developed to investigate the effects of AFER on atrial electro-mechanics. Simulations were carried out in 3 conditions for 4 states: (i) the control condition, representing the normal tissue (state 1) and the tissue 2–3 months after cardioversion (state 2) when the atrial tissue recovers its electrophysiological properties after completion of reverse electrophysiological remodelling; (ii) AFER-SR condition for AF-remodeled tissue with normal sinus rhythm (SR) (state 3); and (iii) AFER-AF condition for AF-remodeled tissue with re-entrant excitation waves (state 4). Our results indicate that at the cellular level, AFER (states 3 & 4) abbreviated action potentials and reduced the Ca2+ content in the sarcoplasmic reticulum, resulting in a reduced amplitude of the intracellular Ca2+ transient leading to decreased cell active force and cell shortening as compared to the control condition (states 1 & 2). Consequently at the whole organ level, atrial contraction in AFER-SR condition (state 3) was dramatically reduced. In the AFER-AF condition (state 4) atrial contraction was almost abolished. Conclusions This study provides novel insights into understanding atrial electro-mechanics illustrating that AFER impairs atrial contraction due to reduced intracellular Ca2+ transients. PMID:26606047

  12. Inferior and right-sided juxtaposition of the left atrial appendage with an unexpected type of inter-atrial communication.

    PubMed

    Sarwark, Anne E; Anderson, Robert H; Spicer, Diane E

    2016-01-01

    We have re-investigated an unusual cardiac specimen with juxtaposition of the atrial appendages. The original description dates to 1962, when the autopsy was performed at the Children's Memorial Hospital in Chicago, now Ann & Robert H. Lurie Children's Hospital of Chicago. The heart was subsequently stored in the Farouk S. Idriss Cardiac Registry at the same institution. The specimen shows usual atrial arrangement, but with the morphologically left appendage juxtaposed in a rightward manner, passing behind the heart rather than through the transverse sinus so as to reach its location inferior to the morphologically right appendage. The heart also demonstrated an inter-atrial communication between the cavities of the juxtaposed left appendage and the morphologically right atrium. We provide a detailed description of the morphology, and provide images of this lesion, which to the best of our knowledge has not previously been described. PMID:25761513

  13. Atrial fibrillation and cor triatriatum sinister: a case report.

    PubMed

    Tran, Hoa Jeannie; Gordon, Robert; Alloggiamento, Thomas; Nagi, Sukhvinder Kaur; Krishnaswami, Ashok

    2015-01-01

    A 29-year-old man presented to our hospital with palpitations, shortness of breath, and orthopnea. After being admitted, he progressed to cardiogenic shock and respiratory failure, which required ventilator support and cardioversion. Subsequent evaluation revealed a fibromuscular membrane across the left atrium, requiring urgent corrective surgery. PMID:25902348

  14. Stroke and Bleeding Risk in Atrial Fibrillation

    PubMed Central

    Senoo, Keitaro; Lane, Deirdre

    2014-01-01

    Non-valvular atrial fibrillation (AF) is the most common cardiac arrhythmia in the clinical setting. AF increases both the risk and severity of strokes, and is associated with substantial morbidity and mortality. Despite the clear net clinical benefit of oral anticoagulants (OACs) in patients with AF at risk for stroke, major bleeding events, especially intracranial bleeds, may be devastating. In the last decade, four new OACs have been approved for stroke prevention in patients with AF and are at least as effective as warfarin with better bleeding profiles. These new agents have changed and simplified our approach to stroke prevention because the threshold for initiation of OACs is lowered. An important clinical practice shift is the initial identification of "low-risk" patients who do not need antithrombotic therapy, with low-risk comprising CHA2DS2-VASc {Congestive heart failure, Hypertension, Age ?75 years (double), Diabetes mellitus, previous Stroke/transient ischemic attack/thromboembolism (double), Vascular disease, Age 65-74 years, and female gender (score of 0 for males and 1 for female)}. Subsequent to this step, effective stroke prevention consisting of OACs can be offered to patients with one or more stroke risk factors. Apart from stroke risk, another consideration is bleeding risk assessment, with a focus on the use of the validated HAS-BLED {Hypertension, Abnormal renal/liver function, Stroke, Bleeding history, Labile international normalized ratio (INR), Elderly (age >65 years), drugs or alcohol concomitantly} score. A high HAS-BLED score can flag patients potentially at risk for bleeding, and alert clinicians to the need for careful review and follow up, and the need to consider potentially correctable bleeding risk factors that include uncontrolled hypertension, labile INRs, concomitant aspirin use, and alcohol excess. PMID:25278980

  15. Cardiac melanocytes influence atrial reactive oxygen species involved with electrical and structural remodeling in mice

    PubMed Central

    Hwang, Hayoung; Liu, Fang; Petrenko, Nataliya B; Huang, Jianhe; Schillinger, Kurt J; Patel, Vickas V

    2015-01-01

    Cardiac melanocyte-like cells (CMLCs) contribute to atrial arrhythmias when missing the melanin synthesis enzyme dopachrome tautomerase (Dct). While scavenging reactive oxygen species (ROS) in Dct-null mice partially suppressed atrial arrhythmias, it remains unclear if CMLCs influence atrial ROS and structure or if the electrical response of CMLCs to ROS differs from that of atrial myocytes. This study is designed to determine if CMLCs contribute to overall atrial oxidative stress or structural remodeling, and if ROS affects the electrophysiology of CMLCs differently than atrial myocytes. Immunohistochemical analysis showed higher expression of the oxidative marker 8-hydroxy-2?-deoxyguanosine in Dct-null atria versus Dct-heterozygous (Dct-het) atria. Exposing isolated CMLCs from Dct-het and Dct-null mice to hydrogen peroxide increased superoxide anion more in Dct-null CMLCs. Trichrome staining showed increased fibrosis in Dct-null atria, and treating Dct-null mice with the ROS scavenger Tempol reduced atrial fibrosis. Action potential recordings from atrial myocytes and isolated Dct-het and Dct-null CMLCs in response to hydrogen peroxide showed that the EC50 for action potential duration (APD) prolongation of Dct-null CMLCs was 8.2 ± 1.7 ?mol/L versus 16.8 ± 2.0 ?mol/L for Dct-het CMLCs, 19.9 ± 2.1 ?mol/L for Dct-null atrial myocytes, and 20.5 ± 1.9 ?mol/L for Dct-het atrial myocytes. However, APD90 was longer in CMLCs versus atrial myocytes in response to hydrogen peroxide. Hydrogen peroxide also induced more afterdepolarizations in CMLCs compared to atrial myocytes. These studies suggest that Dct within CMLCs contributes to atrial ROS balance and remodeling. ROS prolongs APD to a greater extent and induces afterdepolarizations more frequently in CMLCs than in atrial myocytes. PMID:26400986

  16. Cardiac melanocytes influence atrial reactive oxygen species involved with electrical and structural remodeling in mice.

    PubMed

    Hwang, Hayoung; Liu, Fang; Petrenko, Nataliya B; Huang, Jianhe; Schillinger, Kurt J; Patel, Vickas V

    2015-09-01

    Cardiac melanocyte-like cells (CMLCs) contribute to atrial arrhythmias when missing the melanin synthesis enzyme dopachrome tautomerase (Dct). While scavenging reactive oxygen species (ROS) in Dct-null mice partially suppressed atrial arrhythmias, it remains unclear if CMLCs influence atrial ROS and structure or if the electrical response of CMLCs to ROS differs from that of atrial myocytes. This study is designed to determine if CMLCs contribute to overall atrial oxidative stress or structural remodeling, and if ROS affects the electrophysiology of CMLCs differently than atrial myocytes. Immunohistochemical analysis showed higher expression of the oxidative marker 8-hydroxy-2'-deoxyguanosine in Dct-null atria versus Dct-heterozygous (Dct-het) atria. Exposing isolated CMLCs from Dct-het and Dct-null mice to hydrogen peroxide increased superoxide anion more in Dct-null CMLCs. Trichrome staining showed increased fibrosis in Dct-null atria, and treating Dct-null mice with the ROS scavenger Tempol reduced atrial fibrosis. Action potential recordings from atrial myocytes and isolated Dct-het and Dct-null CMLCs in response to hydrogen peroxide showed that the EC50 for action potential duration (APD) prolongation of Dct-null CMLCs was 8.2 ± 1.7 ?mol/L versus 16.8 ± 2.0 ?mol/L for Dct-het CMLCs, 19.9 ± 2.1 ?mol/L for Dct-null atrial myocytes, and 20.5 ± 1.9 ?mol/L for Dct-het atrial myocytes. However, APD90 was longer in CMLCs versus atrial myocytes in response to hydrogen peroxide. Hydrogen peroxide also induced more afterdepolarizations in CMLCs compared to atrial myocytes. These studies suggest that Dct within CMLCs contributes to atrial ROS balance and remodeling. ROS prolongs APD to a greater extent and induces afterdepolarizations more frequently in CMLCs than in atrial myocytes. PMID:26400986

  17. Estimation of the cost-effectiveness of apixaban versus vitamin K antagonists in the management of atrial fibrillation in Argentina.

    PubMed

    Giorgi, Mariano Anibal; Caroli, Christian; Giglio, Norberto Damian; Micone, Paula; Aiello, Eleonora; Vulcano, Cristina; Blanco, Julia; Donato, Bonnie; Quevedo, Joaquin Mould

    2015-12-01

    Apixaban, a novel oral anticoagulant which has been approved for the prevention of stroke and systemic embolism in non-valvular atrial fibrillation, reduces both ischemic and haemorrhagic stroke and produces fewer bleedings than vitamin K antagonist warfarin. These clinical results lead to a decrease in health care resource utilization and, therefore, have a positive impact on health economics of atrial fibrillation. The cost-effectiveness of apixaban has been assessed in a variety of clinical settings and countries. However, data from emergent markets, as is the case of Argentina, are still scarce.We performed a cost-effectiveness analysis of apixaban versus warfarin in non-valvular atrial fibrillation (NVAF) in patients suitable for oral anticoagulation in Argentina. A Markov-based model including both costs and effects were used to simulate a cohort of patients with NVAF. Local epidemiological, resource utilization and cost data were used and all inputs were validated by a Delphi Panel of local experts. We adopted the payer's perspective with costs expressed in 2012 US Dollars.The study revealed that apixaban is cost-effective compared with warfarin using a willingness to pay threshold ranging from 1 to 3 per capita Gross Domestic Product (11558 - 34664 USD) with an incremental cost-effectiveness ratio of 786.08 USD per QALY gained. The benefit is primarily a result of the reduction in stroke and bleeding events.The study demonstrates that apixaban is a cost-effective alternative to warfarin in Argentina. PMID:26112219

  18. Postoperative amnesia in a patient undergoing general anesthesia for electro-physiologic (EP) catheter ablation of an irritable atrial focus

    PubMed Central

    Sophocles, Aris; Chen, Linda; Lin, David; Liu, Renyu

    2014-01-01

    This case report describes the anesthetic management of a 67-year-old who underwent a catheter based pulmonary vein isolation (PVI) of long-standing, persistent atrial fibrillation. When the patient awoke from the 6.5 hour procedure, he was found to have a transient retrograde and anterograde amnesia that persisted for 18–24 hours postoperatively. This is a unique instance of global amnesia following a cardiac ablation procedure under prolonged general anesthesia. This case study highlights important topics in postoperative cognitive deficits including the differential diagnosis, risk factors, and strategies for optimizing patient outcomes in high risk procedures. PMID:25429367

  19. Postoperative amnesia in a patient undergoing general anesthesia for electro-physiologic (EP) catheter ablation of an irritable atrial focus.

    PubMed

    Sophocles, Aris; Chen, Linda; Lin, David; Liu, Renyu

    2014-10-31

    This case report describes the anesthetic management of a 67-year-old who underwent a catheter based pulmonary vein isolation (PVI) of long-standing, persistent atrial fibrillation. When the patient awoke from the 6.5 hour procedure, he was found to have a transient retrograde and anterograde amnesia that persisted for 18-24 hours postoperatively. This is a unique instance of global amnesia following a cardiac ablation procedure under prolonged general anesthesia. This case study highlights important topics in postoperative cognitive deficits including the differential diagnosis, risk factors, and strategies for optimizing patient outcomes in high risk procedures. PMID:25429367

  20. Myocardial Metabolic Abnormality in a Primary Left Atrial Rhabdomyosarcoma: Localized 1H MR Spectroscopy

    PubMed Central

    Kim, Tae Hoon; Jeong, Gwang Woo; Kim, Tae Su; Kim, Yun Hyeon

    2015-01-01

    We report a 73-year-old woman with primary left atrial rhabdomyosarcoma and its 1H MR spectroscopy (MRS) findings. The tumor showed a 2.8 cm sized lesion in the posteroinferior atrial wall on MRI. 1H MR spectra were acquired using a point-resolved spectroscopy (PRESS) sequence with electrocardiographic (ECG) gating and respiratory motion. The use of 1H-MRS allowed the quantification of triglyceride (TG) peak groups at 0.9 and 1.3 ppm, and unsaturated group of lipids at 2.1 ppm, creatine (Cr) at 3.0 ppm, and choline (Cho) at 3.2 ppm. The percentages of the myocardial metabolites based on water-peak in the interventricular septum were TG 18.4%, Cr 1.6%, Cho 3.3% and unsaturated group 4.0%, whereas the rhabdomyosarcoma showed TG 118.8%, unsaturated group 5.1%, Cr 1.3%, Cho 3.5% and the olefinic components of fatty acid at 5.4 ppm 24.5%. This case demonstrates that 1H-MRS is potentially useful to diagnose the rhabdomyosarcoma by quantifying the myocardial metabolites which are important biomarkers for heart function and diseases. PMID:26557276

  1. Atrial Fibrillation Due to Over The Counter Stimulant Drugs in A Young Adult.

    PubMed

    Thyagarajan, Braghadheeswar; Alagusundaramoorthy, Sayee Sundar; Agrawal, Abhinav

    2015-08-01

    The usage of over the counter stimulant drugs and energy drinks is increasing on a day to day basis for various purposes including work, sports and leisure among individuals in all age groups. Multiple formulations are available in the market including pills, liquid capsules and drinks in various flavours. Many of them contain excessively high doses of caffeine along with a variety of stimulant compounds that have multiple effects in different parts of the human body. The consumption of such high amounts of caffeine itself has shown to have caused cardiac arrhythmias in healthy individuals and when it is mixed with a number of stimulant compounds can be associated with a number of adverse effects in the human body. However, the awareness of such life threatening complications associated with these energy drinks does not exist among people who consume it on a day to day basis. We report a case of 25-year-old Caucasian male with no significant past medical history for cardiac diseases, no risk factors for atrial fibrillation, non smoker, occasional alcohol drinker who presents with new onset atrial fibrillation with rapid ventricular response due to the consumption of over the counter stimulant energy capsule which had high doses of caffeine. PMID:26435989

  2. Atrial Fibrillation Due to Over The Counter Stimulant Drugs in A Young Adult

    PubMed Central

    Alagusundaramoorthy, Sayee Sundar; Agrawal, Abhinav

    2015-01-01

    The usage of over the counter stimulant drugs and energy drinks is increasing on a day to day basis for various purposes including work, sports and leisure among individuals in all age groups. Multiple formulations are available in the market including pills, liquid capsules and drinks in various flavours. Many of them contain excessively high doses of caffeine along with a variety of stimulant compounds that have multiple effects in different parts of the human body. The consumption of such high amounts of caffeine itself has shown to have caused cardiac arrhythmias in healthy individuals and when it is mixed with a number of stimulant compounds can be associated with a number of adverse effects in the human body. However, the awareness of such life threatening complications associated with these energy drinks does not exist among people who consume it on a day to day basis. We report a case of 25-year-old Caucasian male with no significant past medical history for cardiac diseases, no risk factors for atrial fibrillation, non smoker, occasional alcohol drinker who presents with new onset atrial fibrillation with rapid ventricular response due to the consumption of over the counter stimulant energy capsule which had high doses of caffeine. PMID:26435989

  3. Monitoring of ANP secretion from single atrial myocytes using densitometry.

    PubMed

    Ryu, Shin Young; Lee, Suk-Ho; Isenberg, Gerrit; Ho, Won-Kyung; Earm, Yung E

    2002-07-01

    Atrial myocytes secrete atrial natriuretic peptide (ANP) in response to mechanical stretch and can serve as a challenging model for studying stretch-secretion coupling. We have developed a technique for monitoring ANP secretion from single atrial myocytes, using neutral red and a CCD video camera. Atrial-specific granules (ASGs) containing ANP were stained with neutral red. The cells were illuminated with monochromatic light (550 mm) and the grey value monitored within the region of interest (ROI) surrounding the region in which ASGs were densely located. Assuming that neutral red is evenly distributed in ASGs, the change in optical density (OD) was considered to represent the total amount of secretion. Under control, non-stimulated conditions, the OD decreased spontaneously (19.7+/-1.4%/10 min, n=14). Direct mechanical stretch (cell length increased by 20%) with two micropipettes or hypotonic swelling (200 mOsm) accelerated the decrease in OD significantly (48.7+/-7.4%/10 min; n=3, 47.2+/-2.4%/10 min; n=7, respectively). In conclusion, this method allows monitoring of ANP secretion with a relatively high time resolution while mechanical stress is applied. Furthermore, patch-clamp or intracellular perfusion techniques can be combined with the present technique for studying cellular mechanisms of stretch-secretion coupling. PMID:12136277

  4. Emodin accentuates atrial natriuretic peptide secretion in cardiac atria.

    PubMed

    Zhou, Guang Hai; Zhang, Feng; Wang, Xin Nong; Kwon, Oh Jeong; Kang, Dae Gill; Lee, Ho Sub; Jin, Song Nan; Cho, Kyung Woo; Wen, Jin Fu

    2014-07-15

    Emodin, an active anthraquinone constituent isolated from the rhubarb, a traditional Chinese herbal medicine which is widely used in clinical treatment, has cardiovascular protective properties. However, it remains unclear whether the cardiovascular protective actions of emodin are related to an activation of cardiac natriuretic hormone secretion. The purpose of the present study was to explore the effect of emodin on the secretion of ANP, a member of the family of cardiac natriuretic hormones, and its mechanisms involved. Experiments were performed in isolated perfused beating rabbit atria allowing measurement of ANP secretion, atrial pulse pressure, and stroke volume. Emodin increased ANP secretion concomitantly with a decrease in atrial pulse pressure and stroke volume in a concentration-dependent manner. These effects were reversible. Inhibition of K(+) channels with tetraethylammonium and glibenclamide attenuated the emodin-induced changes in ANP secretion and atrial dynamics. Furthermore, the emodin-induced changes in ANP secretion and atrial dynamics were attenuated by inhibition of L-type Ca(2+) channels with nifedipine. Atropine, methoctramine, tertiapin-Q, and pertussis toxin had no significant effect on the emodin-induced changes in ANP secretion and mechanical dynamics. The present study demonstrates that emodin increases ANP secretion via inhibition of L-type Ca(2+) channels through an activation of K(+)ATP channel in isolated beating rabbit atria. The results also provide a rationale for the use of emodin in the treatment of impairment of the regulation of the cardiovascular homeostasis. PMID:24751713

  5. T wave alternans during exercise and atrial pacing in humans

    NASA Technical Reports Server (NTRS)

    Hohnloser, S. H.; Klingenheben, T.; Zabel, M.; Li, Y. G.; Albrecht, P.; Cohen, R. J.

    1997-01-01

    INTRODUCTION: Evidence is accumulating that microvolt T wave alternans (TWA) is a marker of increased risk for ventricular tachyarrhythmias. Initially, atrial pacing was used to elevate heart rate and elicit TWA. More recently, a noninvasive approach has been developed that elevates heart rate using exercise. METHODS AND RESULTS: In 30 consecutive patients with a history of ventricular tachyarrhythmias, the spectral method was used to detect TWA during both atrial pacing and submaximal exercise testing. The concordance rate for the presence or absence of TWA using the two measurement methods was 84%. There was a patient-specific heart rate threshold for the detection of TWA that averaged 100 +/- 14 beats/min during exercise compared with 97 +/- 9 beats/min during right atrial pacing (P = NS). Beyond this threshold, there was a significant and comparable increase in level of TWA with decreasing pacing cycle length and increasing exercise heart rates. CONCLUSIONS: The present study is the first to demonstrate that microvolt TWA can be assessed reliably and noninvasively during exercise stress. There is a patient-specific heart rate threshold beyond which TWA continues to increase with increasing heart rates. Heart rate thresholds for the onset of TWA measured during atrial pacing and exercise stress were comparable, indicating that heart rate alone appears to be the main factor of determining the onset of TWA during submaximal exercise stress.

  6. Stroke prevention in atrial fibrillation patients with chronic kidney disease.

    PubMed

    Hart, Robert G; Eikelboom, John W; Brimble, K Scott; McMurtry, M Sean; Ingram, Alistair J

    2013-07-01

    Chronic kidney disease (CKD) is prevalent in elderly patients with atrial fibrillation and is an independent risk factor for stroke. Warfarin anticoagulation is efficacious for stroke prevention in atrial fibrillation patients with moderate CKD (stage III, estimated glomerular filtration rate 30-59 mL/min), but recent observational studies have challenged its value for patients with end-stage renal disease requiring dialysis. The novel oral anticoagulants (i.e., dabigatran, apixaban, rivaroxaban) all undergo renal metabolism to varying degrees, and hence dosing, efficacy, and safety require special consideration in CKD patients. In randomized trials to date involving 11,169 patients with moderate CKD, the novel oral anticoagulants performed well, with similar efficacy and safety profiles as for non-CKD patients. For atrial fibrillation patients with stage III CKD, the available data are strongest for dabigatran 150 mg twice daily as superior to warfarin for stroke prevention and for apixaban as superior to warfarin regarding reduced major hemorrhage. Renal function should be monitored at least annually in patients receiving a novel oral anticoagulant, and more often in elderly patients and those with underlying CKD or comorbidities who are at special risk for dehydration and deterioration of renal function. Much remains to be learned about the optimal use of the novel oral anticoagulants in CKD patients; additional studies about optimal dosing of the novel oral anticoagulants and frequency of monitoring renal function in CKD patients with atrial fibrillation are needed. Anticoagulation options for hemodialysis patients require testing in randomized trials. PMID:23790601

  7. Elevated impedance during cardioversion in neonates with atrial flutter.

    PubMed

    Ceresnak, Scott R; Starc, Thomas J; Hordof, Allan J; Pass, Robert H; Bonney, William J; Liberman, Leonardo

    2009-05-01

    Direct-current cardioversion is a common treatment modality for acute termination of atrial flutter in neonates. Studies in children have demonstrated that cardioversion is often successful with as little as 0.25-0.5 J/kg with the current biphasic devices. We hypothesize that during cardioversion of atrial flutter in neonates, however, the impedance may be high and more energy may be required for successful cardioversion. A retrospective chart review of our institutional experience from 2005 through 2008 was performed. Neonates with atrial flutter requiring cardioversion who had strips available for review were included. Six patients met the inclusion criteria. The median age at the time of cardioversion was 2.6 h (range, 1.3-336 h) and the mean weight was 3.22 +/- 0.4 kg (SD). The mean electrical impedance of the successful shocks was elevated, at 234 +/- 136 Omega. The mean energy delivered for successful cardioversion was 0.9 +/- 0.3 J/kg, and the current was 1 A in all patients. In conclusion, the shock impedance was elevated in the neonates studied during cardioversion of atrial flutter. Low current was sufficient for successful cardioversion. Further studies are needed in this specific population. PMID:19365665

  8. Hybrid approaches in atrial fibrillation ablation: why, where and who?

    PubMed Central

    Mangrum, J. Michael

    2015-01-01

    Hybrid strategies involving surgical and catheter ablation of atrial fibrillation (AF) are rapidly evolving. Hybrid techniques may improve procedural success and minimize risks by combining the strengths and minimizing limitations of either surgical or catheter ablation alone. Further study, including randomized controlled trials, will be necessary to determine the optimal approach to hybrid ablation. PMID:25713731

  9. Mechanisms of ranolazine's dual protection against atrial and ventricular fibrillation

    PubMed Central

    Verrier, Richard L.; Kumar, Kapil; Nieminen, Tuomo; Belardinelli, Luiz

    2013-01-01

    Coronary artery disease and heart failure carry concurrent risk for atrial fibrillation and life-threatening ventricular arrhythmias. We review evidence indicating that at therapeutic concentrations, ranolazine has potential for dual suppression of these arrhythmias. Mechanisms and clinical implications are discussed. PMID:23220484

  10. Percutaneous catheter closure of secundum atrial septal defects: a review.

    PubMed

    Ebeid, Makram R

    2002-01-01

    Attempts at catheter closure of atrial septal defects began over 3 decades ago. Several devices have been designed attempting to achieve this objective safely and effectively. These devices have been (or are being) subjected to extensive clinical trials. This review outlines the background and current status of these devices. It addresses the design, delivery method, results and complications. In addition to historical background, the devices discussed here include (in alphabetical order) the Amplatzer Septal Occluder, the Atrial Septal Defect Occlusion System, the Buttoned Device, the Guardian Angel (Angel Wings), the Helex Septal Occluder, the StarFlex (Cardioseal, Clamshell), and transcatheter patch closure of atrial septal defects. These devices have come a long way to avoid potential complications and a number of them show very promising results. Issues to consider when choosing the device/atrial septal defect compatibility are also discussed. It is hoped that a number of these devices will be available in the near future to allow the physician and patient to choose the most appropriate method or device. PMID:11773692

  11. Managing atrial fibrillation in the elderly: critical appraisal of dronedarone

    PubMed Central

    Trigo, Paula; Fischer, Gregory W

    2012-01-01

    Atrial fibrillation is the most commonly seen arrhythmia in the geriatric population and is associated with increased cardiovascular morbidity and mortality. Treatment of the elderly with atrial fibrillation remains challenging for physicians, because this unique subpopulation is characterized by multiple comorbidities requiring chronic use of numerous medications, which can potentially lead to severe drug interactions. Furthermore, age-related changes in the cardiovascular system as well as other physiological changes result in altered drug pharmacokinetics. Dronedarone is a new drug recently approved for the treatment of arrhythmias, such as atrial fibrillation and/or atrial flutter. Dronedarone is a benzofuran amiodarone analog which lacks the iodine moiety and contains a methane sulfonyl group that decreases its lipophilicity. These differences in chemical structure are responsible for making dronedarone less toxic than amiodarone which, in turn, results in fewer side effects. Adverse events for dronedarone include gastrointestinal side effects and rash. No dosage adjustments are required for patients with renal impairment. However, the use of dronedarone is contraindicated in the presence of severe hepatic dysfunction. PMID:22291468

  12. Comparison of Magnetic Navigation System and Conventional Method in Catheter Ablation of Atrial Fibrillation: Is Magnetic Navigation System Is More Effective and Safer Than Conventional Method?

    PubMed Central

    Choi, Min Seok; Jang, Sung Won; Kim, Ji Hoon; Shin, Woo Seung; Youn, Ho-Joong; Jung, Wook Sung; Lee, Man Young; Seong, Ki Bae

    2011-01-01

    Background and Objectives Although there have been so many reports of catheter ablation of atrial fibrillation (AF) with magnetic navigation system (MNS), it is not necessarily obvious that MNS is more effective than conventional ablation. We performed AF ablation with MNS and compared the clinical outcomes and radiofrequency ablation parameters with those of conventional ablation. Subjects and Methods One hundred eleven consecutive patients (conventional group, n=70 vs. MNS group, n=41) undergoing catheter ablation of AF were enrolled. We compared and analyzed the procedural parameters, namely fluoroscopic time, procedural time, acute procedural success and 3 months success rate of both groups. Results The MNS group was associated with slightly larger left atrial size (43.7±6.3 mm vs. 41.2±6.3 mm, p=0.04), significantly longer total procedure time (352±50 minutes vs. 283±75 minutes, p<0.0001), and shorter total fluoroscopic time (99±28 minutes vs. 238±45 minutes, p<0.0001) than the conventional group. The MNS and conventional group did not differ with respect to acute procedural success, AF recurrence, atrial flutter/atrial tachycardia recurrence, or total arrhythmia recurrence. While no complications were observed in the MNS group, eight cases of significant pericardial effusion occurred in the conventional group. Conclusion The MNS system seems to be effective and safe in the catheter ablation of AF, particularly in the population of patients with persistent AF and slightly dilated left atria. PMID:21731565

  13. Assessment of atrial electromechanical delay in patients with migraine.

    PubMed

    Celikbilek, Asuman; Sarikaya, Savas; Zararsiz, Gokmen; Tanik, Nermin; Erbay, Ali Riza

    2014-12-01

    Evidence suggests that symptoms of migraine are related to the involvement of the autonomic nervous system. Data on atrial conduction system are limited in migraineurs. We aimed to assess atrial electromechanical delay using tissue Doppler imaging (TDI) in patients with migraine. Forty-five migraine patients and age- and sex-matched 26 control subjects were enrolled in the study. All the patients and controls underwent resting surface electrocardiogram (ECG) and TDI. The maximum P-wave duration (Pmax), minimum P-wave duration (Pmin) and P-wave dispersion (Pd) were measured from the 12-lead ECG. Atrial conduction time was determined from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septal), and lateral tricuspid annulus (PA tricuspid) by TDI. Interatrial (PA lateral-PA tricuspid) and intraatrial (PA septal-PA tricuspid) electromechanical delays were calculated. Pd was significantly higher in migraine patients than in controls (p < 0.05), whereas Pmax and Pmin were not different between both groups (p > 0.05). PA lateral and PA septal durations were significantly higher in migraine patients than in controls (p < 0.001 and p < 0.05, respectively). However, PA tricuspid duration was similar between the groups (p > 0.05). Both interatrial and intraatrial conduction times were delayed in migraineurs as compared to the controls (p < 0.001). Interatrial delay and intraatrial delay variables were found as an independent risk factors separately on predicting atrial conduction abnormalities in migraineurs. An interatrial delay of 18 ms and an intraatrial delay of 5 ms were found to be cutoff values in ROC analysis (p < 0.001). This is the first report to provide a hypothetical suggestion that there is an atrial electromechanical delay in patients with migraine. PMID:24399200

  14. Incidence of stroke and acute renal failure in patients of postoperative atrial fibrillation after myocardial revascularization

    PubMed Central

    Barbieri, Lucas Regatieri; Sobral, Marcelo Luiz Peixoto; Gerônimo, Glaucio Mauren da Silva; dos Santos, Gilmar Geraldo; Sbaraíni, Evandro; Dorfman, Fabio Kirzner; Stolf, Noedir Antônio Groppo

    2013-01-01

    Introduction Postoperative atrial fibrillation is the most common arrhythmia in cardiac surgery, its incidence range between 20% and 40%. Objective Quantify the occurrence of stroke and acute renal insufficiency after myocardial revascularization surgery in patients who had atrial fibrillation postoperatively. Methods Cohort longitudinal bidirectional study, performed at Portuguese Beneficent Hospital (SP), with medical chart survey of patients undergoing myocardial revascularization surgery between June 2009 to July 2010. From a total of 3010 patients were weaned 382 patients that presented atrial fibrillation preoperatively and/or associated surgeries. The study was conducted in accordance with national and international following resolutions: ICH Harmonized Tripartite Guidelines for Good Clinical Practice - 1996; CNS196/96 Resolution, and Declaration of Helsinki. Results The 2628 patients included in this study were divided into two groups: Group I, who didn't show postoperative atrial fibrillation, with 2302 (87.6%) patients; and group II, with 326 (12.4%) who developed postoperative atrial fibrillation. The incidence of stroke in patients was 1.1% without postoperative atrial fibrillation vs. 4% with postoperative atrial fibrillation (P<0.001). Postoperative acute renal failure was observed in 12% of patients with postoperative atrial fibrillation and 2.4% in the group without postoperative atrial fibrillation (P<0.001), that is a relation 5 times greater. Conclusion In this study there was a high incidence of stroke and acute renal failure in patients with postoperative atrial fibrillation, with rates higher than those reported in the literature. PMID:24598947

  15. The controversial relationship between exercise and atrial fibrillation: clinical studies and pathophysiological mechanisms.

    PubMed

    D'Ascenzi, Flavio; Cameli, Matteo; Ciccone, Marco M; Maiello, Maria; Modesti, Pietro A; Mondillo, Sergio; Muiesan, Maria L; Scicchitano, Pietro; Novo, Salvatore; Palmiero, Pasquale; Saba, Pier S; Pedrinelli, Roberto

    2015-12-01

    Atrial fibrillation is the most common clinically significant arrhythmia observed both in the general population and in competitive athletes. The most important risk factors are all preventable by regular physical activity. However, although the benefits of moderate physical activity in controlling cardiovascular risk factors and decreasing the risk of atrial fibrillation have been extensively proved, concerns have arisen about the potential negative effects of vigorous exercise, particularly in endurance athletes. Furthermore, in a subset of patients with atrial fibrillation younger than 60 years, routine evaluation does not reveal any cardiovascular disease or any other known causal factor. This condition is called 'lone atrial fibrillation', and the potential mechanisms underlying this condition are speculative and remain to be clarified. Atrial ectopy, increased vagal tone, changes in electrolytes, left atrial dilatation, and fibrosis have been proposed among others as potential mechanisms. However, no convincing data still exist. Particularly, the increase in left atrial size represents in athletes a physiological adaptation to exercise conditioning and the presence of biatrial fibrosis has not been demonstrated in humans. Thus, contrary to patients with cardiovascular disorders, the atrial substrate seems to play a secondary role in healthy athletes. This review article analyzes the controversial relationship between atrial fibrillation and physical activity, with a particular attention on the pathophysiological mechanisms that could be responsible for atrial fibrillation in the athletic population. PMID:25469735

  16. Stability of atrial sensing and pacing after dual chamber pulse generator implantation.

    PubMed

    Klementowicz, P T; Furman, S

    1985-12-01

    The continued efficacy of dual chamber pacing is predicated on the stability of both atrial and ventricular electrodes. The introduction of the tined atrial J lead has decreased the incidence of atrial lead dislodgment, allowing for continued effective sensing and pacing. To study the evolution of atrial pacing and sensing threshold, 54 patients with identical pulse generators and atrial electrodes were evaluated for 58 +/- 29 weeks (mean +/- SD). Immediately after pacemaker implantation in 39 patients, the amplitude of the atrial signal was measured by programming the pulse generator to the lowest sensitivity that assured pacing in the atrial synchronous mode. Three levels of atrial sensing were possible: high (0.5 mV), intermediate (1.3 mV) and low (2.5 mV) sensitivity. Three patients had a high, 16 patients had a medium and 20 patients had a low atrial sensitivity. The P wave amplitude and slew rate measured on a physiologic recorder did not differ significantly between the latter two groups. The atrial charge threshold increased from 1.8 +/- 1.3 microcoulombs (microC) to a maximal value of 2.5 +/- 1.3 microC, 3 days to 1 week after implantation (p = 0.02). This remained elevated for 1 to 3 months (p = 0.05) and then decreased, remaining stable over the ensuing year. The atrial sensitivity for the group with noninvasive measurement did not change significantly, although there was considerable patient variation. For 54% of the patients, atrial sensing remained stable or improved. In 26% of the patients, further programming to higher sensitivity settings ws required. In the remaining 20% of the patients, the atrial sensitivity setting fluctuated.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:4067113

  17. Clinical Differences between Subtypes of Atrial Fibrillation and Flutter: Cross-Sectional Registry of 407 Patients

    PubMed Central

    Almeida, Eduardo Dytz; Guimarães, Raphael Boesche; Stephan, Laura Siga; Medeiros, Alexandre Kreling; Foltz, Katia; Santanna, Roberto Tofani; Pires, Leonardo Martins; Kruse, Marcelo Lapa; de Lima, Gustavo Glotz; Leiria, Tiago Luiz Luz

    2015-01-01

    Introduction Atrial fibrillation and atrial flutter account for one third of hospitalizations due to arrhythmias, determining great social and economic impacts. In Brazil, data on hospital care of these patients is scarce. Objective To investigate the arrhythmia subtype of atrial fibrillation and flutter patients in the emergency setting and compare the clinical profile, thromboembolic risk and anticoagulants use. Methods Cross-sectional retrospective study, with data collection from medical records of every patient treated for atrial fibrillation and flutter in the emergency department of Instituto de Cardiologia do Rio Grande do Sul during the first trimester of 2012. Results We included 407 patients (356 had atrial fibrillation and 51 had flutter). Patients with paroxysmal atrial fibrillation were in average 5 years younger than those with persistent atrial fibrillation. Compared to paroxysmal atrial fibrillation patients, those with persistent atrial fibrillation and flutter had larger atrial diameter (48.6 ± 7.2 vs. 47.2 ± 6.2 vs. 42.3 ± 6.4; p < 0.01) and lower left ventricular ejection fraction (66.8 ± 11 vs. 53.9 ± 17 vs. 57.4 ± 16; p < 0.01). The prevalence of stroke and heart failure was higher in persistent atrial fibrillation and flutter patients. Those with paroxysmal atrial fibrillation and flutter had higher prevalence of CHADS2 score of zero when compared to those with persistent atrial fibrillation (27.8% vs. 18% vs. 4.9%; p < 0.01). The prevalence of anticoagulation in patients with CHA2DS2-Vasc ? 2 was 40%. Conclusions The population in our registry was similar in its comorbidities and demographic profile to those of North American and European registries. Despite the high thromboembolic risk, the use of anticoagulants was low, revealing difficulties for incorporating guideline recommendations. Public health strategies should be adopted in order to improve these rates. PMID:26016782

  18. Association of Common Variations on Chromosome 4q25 and Left Atrial Volume in Patients with Atrial Fibrillation

    PubMed Central

    Mints, Yuliya; Yarmohammadi, Hirad; Khurram, Irfan M; Hoyt, Hana; Hansford, Rozann; Zimmerman, Stefan L; Steinberg, Steven J; Judge, Daniel P; Tomaselli, Gordon F; Calkins, Hugh; Zipunnikov, Vadim; Nazarian, Saman

    2015-01-01

    AIMS Recent studies have shown that several genetic variants near the PITX2 locus on chromosome 4q25 are associated with atrial fibrillation (AF). However, the mechanism that mediates this association remains unclear. Basic murine studies suggest that reduced PITX2 expression is associated with left atrial dilatation. We sought to examine the association between single nucleotide polymorphisms (SNPs) near PITX2 and left atrial size in patients with AF. METHODS We prospectively enrolled 96 consecutive patients (mean age 60 ± 10 years, 72% male) with drug-resistant AF (57% paroxysmal, 38% persistent, and 5% long-standing persistent) who underwent catheter ablation. Following DNA extraction from blood obtained pre-operatively, SNPs rs10033464 and rs2200733 were genotyped using the Sequenom MassARRAY. Left atrial volume (LAV) was determined using three-dimensional imaging (CT or MRI prior to first ablation) and by investigators blinded to genotype results. RESULTS The minor allele frequencies at SNPs rs10033464 and rs2200733 were 0.14 and 0.25, respectively. Using multivariable linear regression, homozygosity for the minor allele at rs10033464 (recessive model) was independently associated with larger LAV (P = 0.002) after adjustment for age, gender, BMI, height, type, and duration of AF, left ventricular ejection fraction, history of hypertension, valve disease, and antiarrhythmic drug use. The strength of the association was reconfirmed in a bootstrap study with 1000 resamplings. In contrast, no association was found between rs2200733 variant alleles and LAV. CONCLUSION SNP rs10033464 near the PITX2 locus on 4q25 is associated with LAV. Left atrial dilatation may mediate the association of common variants at 4q25 with AF. PMID:26005361

  19. Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

    PubMed Central

    Swaans, Martin J.; Alipour, Arash; Rensing, Benno J.W.M.; Post, Martijn C.; Boersma, Lucas V.A.

    2013-01-01

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting millions of individuals worldwide 1-3. The rapid, irregular, and disordered electrical activity in the atria gives rise to palpitations, fatigue, dyspnea, chest pain and dizziness with or without syncope 4, 5. Patients with AF have a five-fold higher risk of stroke 6. Oral anticoagulation (OAC) with warfarin is commonly used for stroke prevention in patients with AF and has been shown to reduce the risk of stroke by 64% 7. Warfarin therapy has several major disadvantages, however, including bleeding, non-tolerance, interactions with other medications and foods, non-compliance and a narrow therapeutic range 8-11. These issues, together with poor appreciation of the risk-benefit ratio, unawareness of guidelines, or absence of an OAC monitoring outpatient clinic may explain why only 30-60% of patients with AF are prescribed this drug 8. The problems associated with warfarin, combined with the limited efficacy and/or serious side effects associated with other medications used for AF 12,13, highlight the need for effective non-pharmacological approaches to treatment. One such approach is catheter ablation (CA), a procedure in which a radiofrequency electrical current is applied to regions of the heart to create small ablation lesions that electrically isolate potential AF triggers 4. CA is a well-established treatment for AF symptoms 14, 15, that may also decrease the risk of stroke. Recent data showed a significant decrease in the relative risk of stroke and transient ischemic attack events among patients who underwent ablation compared with those undergoing antiarrhythmic drug therapy 16. Since the left atrial appendage (LAA) is the source of thrombi in more than 90% of patients with non-valvular atrial fibrillation 17, another approach to stroke prevention is to physically block clots from exiting the LAA. One method for occluding the LAA is via percutaneous placement of the WATCHMAN LAA closure device. The WATCHMAN device resembles a small parachute. It consists of a nitinol frame covered by fabric polyethyl terephthalate that prevents emboli, but not blood, from exiting during the healing process. Fixation anchors around the perimeter secure the device in the LAA (Figure 1). To date, the WATCHMAN is the only implanted percutaneous device for which a randomized clinical trial has been reported. In this study, implantation of the WATCHMAN was found to be at least as effective as warfarin in preventing stroke (all-causes) and death (all-causes) 18. This device received the Conformité Européenne (CE) mark for use in the European Union for warfarin eligible patients and in those who have a contraindication to anticoagulation therapy 19. Given the proven effectiveness of CA to alleviate AF symptoms and the promising data with regard to reduction of thromboembolic events with both CA and WATCHMAN implantation, combining the two procedures is hoped to further reduce the incidence of stroke in high-risk patients while simultaneously relieving symptoms. The combined procedure may eventually enable patients to undergo implantation of the WATCHMAN device without subsequent warfarin treatment, since the CA procedure itself reduces thromboembolic events. This would present an avenue of treatment previously unavailable to patients ineligible for warfarin treatment because of recurrent bleeding 20 or other warfarin-associated problems. The combined procedure is performed under general anesthesia with biplane fluoroscopy and TEE guidance. Catheter ablation is followed by implantation of the WATCHMAN LAA closure device. Data from a non-randomized trial with 10 patients demonstrates that this procedure can be safely performed in patients with a CHADS2 score of greater than 1 21. Further studies to examine the effectiveness of the combined procedure in reducing symptoms from AF and associated stroke are therefore warranted. PMID:23486416

  20. Impact of Atrial Fibrillation Ablation on Left Ventricular Filling Pressure and Left Atrial Remodeling

    PubMed Central

    dos Santos, Simone Nascimento; Henz, Benhur Davi; Zanatta, André Rodrigues; Barreto, José Roberto; Loureiro, Kelly Bianca; Novakoski, Clarissa; dos Santos, Marcus Vinícius Nascimento; Giuseppin, Fabio F.; Oliveira, Edna Maria; Leite, Luiz Roberto

    2014-01-01

    Background Left ventricular (LV) diastolic dysfunction is associated with new-onset atrial fibrillation (AF), and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process. Objective To evaluate the impact of AF ablation on estimated LV filling pressure. Methods A total of 141 patients underwent radiofrequency (RF) ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind), and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e') were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation. Results One hundred seventeen patients (82.9%) were free of AF during the follow-up (average, 18 ± 5 months). LAVind reduced in the successful group (30.2 mL/m2 ± 10.6 mL/m2 to 22.6 mL/m2 ± 1.1 mL/m2, p < 0.001) compared to the non-successful group (37.7 mL/m2 ± 14.3 mL/m2 to 37.5 mL/m2 ± 14.5 mL/m2, p = ns). Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001) but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns). The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001). Conclusion Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure. PMID:25590928

  1. Ablation of atrial fibrillation with the Epicor system: a prospective observational trial to evaluate safety and efficacy and predictors of success

    PubMed Central

    2010-01-01

    Background High intensity focused ultrasound (HIFU) energy has evolved as a new surgical tool to treat atrial fibrillation (AF). We evaluated safety and efficacy of AF ablation with HIFU and analyzed predictors of success in a prospective clinical study. Methods From January 2007 to June 2008, 110 patients with AF and concomitant open heart surgery were enrolled into the study. Main underlying heart diseases were aortic valve disease (50%), ischemic heart disease (48%), and mitral valve disease (18%). AF was paroxysmal in 29%, persistent in 31%, and long standing persistent in 40% of patients, lasting for 1 to 240 months (mean 24 months). Mean left atrial diameter was 50 ± 7 mm. Each patient underwent left atrial ablation with the Epicor system prior to open heart surgery. After surgery, the patients were treated with amiodarone and coumadin for 6 months. Follow-up studies including resting ECG, 24 h Holter ECG, and echocardiography were obtained at 6 and 12 months. Results All patients had successful application of the system on the beating heart prior to initiation of extracorporeal circulation. On average, 11 ± 1 ultrasound transducer elements were used to create the box lesion. The hand-held probe for additional linear lesions was employed in 83 cases. No device-related deaths occurred. Postoperative pacemaker insertion was necessary in 4 patients. At 6 months, 62% of patients presented with sinus rhythm. No significant changes were noted at 12 months. Type of AF and a left atrial diameter > 50 mm were predictors for failure of AF ablation. Conclusion AF ablation with the Epicor system as a concomitant procedure during open heart surgery is safe and acceptably effective. Our overall conversion rate was lower than in previously published reports, which may be related to the lower proportion of isolated mitral valve disease in our study population. Left atrial size may be useful to determine patients who are most likely to benefit from the procedure. PMID:20444285

  2. Is the thrombus truly free-floating? A case report.

    PubMed

    Demir, Kenan; Avci, Ahmet; Altunkeser, Bulent Behlul; Ugras, Nevzat Serdar

    2014-05-01

    A free-floating thrombus in the left atrium is very rare in mitral stenosis. Such a thrombus can lead to sudden circulatory arrest and syncope or can cause severe cerebral or peripheral thromboembolic events. Clinical diagnosis is difficult, but left atrial thrombus should be suspected if patients with mitral stenosis and atrial fibrillation have intermittent or changing murmurs, emboli, or syncope. We describe the case of a patient with mild mitral stenosis under warfarin therapy, and a left atrial pedunculated thrombus discovered during the investigation for syncope attacks. PMID:24150976

  3. ECG characterization of paroxysmal atrial fibrillation: parameter extraction and automatic diagnosis algorithm.

    PubMed

    Ros, E; Mota, S; Fernández, F J; Toro, F J; Bernier, J L

    2004-12-01

    Paroxysmal atrial fibrillation (PAF) is one of the most common heart arrhythmias. It is very difficult to detect unless an explicit Atrial Fibrillation episode occurs during the exploration. The present paper describes a number of low level parameters extracted from ECG traces where no Atrial Fibrillation process is present. The ability of this parameter set to characterize PAF patients is studied and discussed. Based on these parameters a modular automatic classification algorithm for PAF diagnosis is developed and evaluated. PMID:15518652

  4. [Pulmonary zygomycosis in a diabetic child complicated with thrombus of the left atrial auricle].

    PubMed

    Ayadi-Kaddour, A; Ammar, J; Ismail, O; Braham, E; Hamzaoui, A; Kilani, T; Zidi, A; El Mezni, F

    2014-11-01

    Mucormycosis is a rare but fatal, opportunistic fungal infection caused by fungi of the order of mucorales in the class of Zygomycetes. Isolated pulmonary mucormycosis is rare and occurs principally in particular conditions, especially in patients with uncontrolled diabetes. The fungi invades the blood vessels and causes distal ischemic necrosis. We report a case in a 13-year-old girl with diabetes mellitus who developed pulmonary zygomycosis complicated with thrombus of the left atrial auricle. The diagnosis of mucormycosis was confirmed by histologic examination of endobronchial biopsies. Combined treatment with systemic amphotericin B and surgery resulted in a favorable outcome. This difficult diagnosis must be raised in diabetic patients with unresponsive lung infections in order to apply early aggressive therapy. Successful management continues to be early diagnosis, followed by systemic antifungal therapy and surgical resection combined with control of the underlying disease. PMID:25282464

  5. Anesthetic management of right atrial mass removal and pulmonary artery thrombectomy in a patient with primary antiphospholipid antibody syndrome.

    PubMed

    Rawat, S K S; Mehta, Yatin; Vats, Mayank; Mishra, Yugal; Khurana, Poonam; Trehan, Naresh

    2010-01-01

    Antiphospholipid antibody syndrome (APLAS) characterises a clinical condition of arterial and venous thrombosis associated with phospholipids directed antibodies. APLAS occurs in 2% of the general population. However, one study demonstrated that 7.1% of hospitalised patients were tested positive for at least one of the three anticardiolipin antibody idiotype. Antiphospholipid antibodies often inhibit phospholipids dependent coagulation in vitro and interfere with laboratory testing of hemostasis. Therefore, the management of anticoagulation during cardiopulmonary bypass can be quite challenging in these patients. Here, we present a case of right atrial mass removal and pulmonary thrombectomy in a patient of APLAS. PMID:20075534

  6. Extracorporeal Membrane Oxygenation as a Bridge to Surgery for Infective Endocarditis Complicated by Aorto-Atrial Fistula and Cardiopulmonary Collapse

    PubMed Central

    Ramu, Bhavadharini; Parker, Matthew W.; Underhill, David; Gluck, Jason A.

    2015-01-01

    The timing of surgery for active infective endocarditis is challenging when patients exhibit mechanical dysfunction and hemodynamic compromise. Extracorporeal membrane oxygenation has been described in treating sepsis but not, insofar as we know, in treating the acute mechanical sequelae that arise from infective endocarditis. We report perhaps the first case that shows the usefulness of extracorporeal membrane oxygenation as a bridge to definitive treatment in a 35-year-old man who had infective endocarditis followed by aorto-atrial fistula and cardiopulmonary collapse. PMID:26504445

  7. Extracorporeal Membrane Oxygenation as a Bridge to Surgery for Infective Endocarditis Complicated by Aorto-Atrial Fistula and Cardiopulmonary Collapse.

    PubMed

    Noyes, Adam M; Ramu, Bhavadharini; Parker, Matthew W; Underhill, David; Gluck, Jason A

    2015-10-01

    The timing of surgery for active infective endocarditis is challenging when patients exhibit mechanical dysfunction and hemodynamic compromise. Extracorporeal membrane oxygenation has been described in treating sepsis but not, insofar as we know, in treating the acute mechanical sequelae that arise from infective endocarditis. We report perhaps the first case that shows the usefulness of extracorporeal membrane oxygenation as a bridge to definitive treatment in a 35-year-old man who had infective endocarditis followed by aorto-atrial fistula and cardiopulmonary collapse. PMID:26504445

  8. Pinball-Like Free-Floating Left Atrial Ball Thrombus Presenting with Hemiplegia: A Challenging Treatment Decision.

    PubMed

    Demir, Tolga; Ergenoglu, Mehmet Umit; Tanrikulu, Nursen; Cizgici, Ahmet Yasar; Yildirim, Kemal Ilker; Demirsoy, Ergun

    2015-01-01

    We describe a case of a patient with a history of chronic atrial fibrillation who presented with sudden onset of left hemiplegia. Nine months earlier the longstanding warfarin therapy had been suspended due to a hemorrhagic stroke. Transthoracic echocardiography revealed a large free-floating highly mobile mass in the left atrium and severe mitral valve regurgitation. Due to the potential risk of an embolic event or a hemodynamic collapse, a decision to carry out an emergency operation was made irrespective of the neurological condition of the patient. Unfortunately, the patient died on the 18th postoperative day after a freshly occurring hemorrhagic stroke. PMID:26726718

  9. Patient-specific characteristics determine success of surgical atrial fibrillation ablation in patients with persistent atrial fibrillation.

    PubMed

    Hong, Kimberly N; Russo, Mark J; Williams, Mathew R; Abbasi, Adeel; Sorabella, Robert; Martens, Timothy P; Smith, Craig R; Oz, Mehmet C; Argenziano, Michael

    2007-01-01

    Surgical atrial fibrillation ablation (SAFA) has not achieved the efficacy of Cox's original maze procedure, although technical improvements continue to be made. It is possible that biologic factors determine SAFA success. Therefore we examined how patient-specific characteristics affected SAFA success in 353 atrial fibrillation (AF) patients who underwent SAFA at a single institution. Among these, 257 (72.8%) had continuous AF and 96 (27.2%) had intermittent AF. For 297 patients (84.1%) postoperative follow-up was > 3 months. We compared SAFA success in patients whose procedure involved only pulmonary vein isolation with those whose procedure involved extensive lesion sets. Multivariate analysis included AF duration, left atrial size, preoperative atrial flutter, concomitant procedures, lesion sets, and energy source. Early SAFA success was classified as freedom from AF between postoperative months 3 and 6, and intermediate success between postoperative months 6 and 12. Receiver-operating characteristic (ROC) curves and stratum-specific likelihood ratios (SSLR) were generated to compare intermediate failure by left atrial size (LAS) thresholds. SAFA was more successful in the intermittent than the continuous AF group (n = 66, 86% vs n = 165, 71%; P = .014). When pulmonary vein isolation was compared only to more extensive lesion sets, there was no difference in success in the intermittent (34, 91% vs 32, 81%; P = .24) or continuous groups (67, 73% vs. 98, 69%; P = .603). Success for intermittent AF patients was not correlated with variables considered; in continuous AF patients, predictors included presence of concomitant mitral valve repair/replacement (P = .075), decreasing LAS (P = .025) and absence of preoperative atrial flutter (P = .001). In the continuous AF group, ROC curves and corresponding areas under the curve (AUC) were 0.60 (0.50-0.71) for failure at 6 months to 1 year. SSLR analysis generated 2 strata for LAS: < 8 cm with SSLR = 0.87 (0.74-1.0) and < or = 8 cm SSLR = 2.98 (1.07-8.3). In patients with intermittent AF, SAFA achieved acceptable results regardless of tested preoperative and intraoperative variables. In continuous AF, patient-specific characteristics affected success more than intraoperative variables. Failure was more than 3-fold greater in continuous AF patients with an LAS < or = 8 cm. In both patient types, more extensive lesion sets were not shown to improve outcomes. Future improvements in SAFA may depend on pharmacologic and/or surgical substrate modification. PMID:18187380

  10. Multi-event capture–recapture modeling of host–pathogen dynamics among European rabbit populations exposed to myxoma and Rabbit Hemorrhagic Disease Viruses: common and heterogeneous patterns

    PubMed Central

    2014-01-01

    Host–pathogen epidemiological processes are often unclear due both to their complexity and over-simplistic approaches used to quantify them. We applied a multi-event capture–recapture procedure on two years of data from three rabbit populations to test hypotheses about the effects on survival of, and the dynamics of host immunity to, both myxoma virus and Rabbit Hemorrhagic Disease Virus (MV and RHDV). Although the populations shared the same climatic and management conditions, MV and RHDV dynamics varied greatly among them; MV and RHDV seroprevalences were positively related to density in one population, but RHDV seroprevalence was negatively related to density in another. In addition, (i) juvenile survival was most often negatively related to seropositivity, (ii) RHDV seropositives never had considerably higher survival, and (iii) seroconversion to seropositivity was more likely than the reverse. We suggest seropositivity affects survival depending on trade-offs among antibody protection, immunosuppression and virus lethality. Negative effects of seropositivity might be greater on juveniles due to their immature immune system. Also, while RHDV directly affects survival through the hemorrhagic syndrome, MV lack of direct lethal effects means that interactions influencing survival are likely to be more complex. Multi-event modeling allowed us to quantify patterns of host–pathogen dynamics otherwise difficult to discern. Such an approach offers a promising tool to shed light on causative mechanisms. PMID:24708296

  11. Idiopathic aneurysmal giant right atrial enlargement with thrombus formation.

    PubMed

    Khare, Rashi; Chandra, Sharad; Agarwal, Vikas; Dwivedi, Sudhanshu

    2014-01-01

    A 12-year-old boy presented to our outpatient department with progressive dyspnoea and palpitations of 6-month duration. Cardiovascular system examination revealed a short ejection systolic murmur at the left lateral heart border. Chest X-ray showed gross cardiomegaly. Two-dimensional ECHO revealed massive aneurysmal right atrial (RA) enlargement, low-pressure tricuspid regurgitation and dysplastic tricuspid valve with compression of the left atrium (LA) and left ventricle (LV). Cardiac CT showed grossly enlarged RA compressing the LA, LV, right pulmonary artery and right upper lobe pulmonary vein. Initially, the patient refused surgery. On follow-up, a thrombus was seen in the giant RA and the patient agreed to and underwent successful surgery. Absence of pericardium was specifically excluded on cardiac MRI and on surgery. Resected atrial tissue showed wall thinning and focal fibrosis establishing idiopathic dilation of the RA. The patient is on regular follow-up. PMID:25540215

  12. Imaging before and after catheter ablation of atrial fibrillation.

    PubMed

    Ohana, M; Bakouboula, B; Labani, A; Jeung, M-Y; El Ghannudi, S; Jesel-Morel, L; Roy, C

    2015-11-01

    Catheter ablation of arrhythmogenic triggers has been validated for the treatment of atrial fibrillation that is refractory to anti-arrhythmic medication. Imaging plays an important role in guiding the procedure as well as in planning and follow-up. The goal of pre-procedural imaging is to obtain a detailed anatomical description of the pulmonary veins, to eliminate a thrombus of the left atrium and to define the prognostic factors. MDCT angiography effectively and simply meets nearly all of these needs. Thus, a precise description of the left atrium anatomy before the procedure is a key factor to success and left atrium volume is a reliable prognostic factor of recurrence. Radiologists should be aware of early and late complications, sometimes severe such as pulmonary vein stenosis, cardiac tamponade or atrial-esophageal fistula, whose positive diagnosis is based on imaging. PMID:26025160

  13. [Improvements in oral anticoagulant therapy for atrial fibrillation].

    PubMed

    Briongos Figuero, Sem; García Santos-Gallego, Carlos; Badimón, Juan José

    2013-12-01

    For the last decades vitamin K antagonists have been the most effective anticoagulant treatment of atrial fibrillation. New molecules are being designed, mainly due to the great amount of disadvantages in the management of conventional anticoagulation. Dabigatran, rivaroxaban and apixaban will soon be available as an alternative to warfarin/acenocumarol. All of them have demonstrated to be non-inferior to warfarin in preventing stroke and systemic embolism, with even dabigatran 150 mg bid and apixaban being superior. They have also a lower risk of bleeding, especially regarding severe/fatal and intracranial hemorrhages. This is a real revolution. The advance of these new anticoagulants will be limited only by the higher cost, and will progressively become the protagonists of oral anticoagulation in patients with nonvalvular atrial fibrillation. PMID:23597953

  14. Initial Independent Outcomes from Focal Impulse and Rotor Modulation Ablation for Atrial Fibrillation: Multicenter FIRM Registry

    PubMed Central

    MILLER, JOHN M.; KOWAL, ROBERT C.; SWARUP, VIJAY; DAUBERT, JAMES P.; DAOUD, EMILE G.; DAY, JOHN D.; ELLENBOGEN, KENNETH A.; HUMMEL, JOHN D.; BAYKANER, TINA; KRUMMEN, DAVID E.; NARAYAN, SANJIV M.; REDDY, VIVEK Y.; SHIVKUMAR, KALYANAM; STEINBERG, JONATHAN S.; WHEELAN, KEVIN R.

    2014-01-01

    Introduction The success of pulmonary vein isolation (PVI) for atrial fibrillation (AF) may be improved if stable AF sources identified by Focal Impulse and Rotor Mapping (FIRM) are also eliminated. The long-term results of this approach are unclear outside the centers where FIRM was developed; thus, we assessed outcomes of FIRM-guided AF ablation in the first cases at 10 experienced centers. Methods We prospectively enrolled n = 78 consecutive patients (61 ± 10 years) undergoing FIRM guided ablation for persistent (n = 48), longstanding persistent (n = 7), or paroxysmal (n = 23) AF. AF recordings from both atria with a 64-pole basket catheter were analyzed using a novel mapping system (Rhythm View™; Topera Inc., CA, USA). Identified rotors/focal sources were ablated, followed by PVI. Results Each institution recruited a median of 6 patients, each of whom showed 2.3 ± 0.9 AF rotors/focal sources in diverse locations. 25.3% of all sources were right atrial (RA), and 50.0% of patients had ?1 RA source. Ablation of all sources required a total of 16.6 ± 11.7 minutes, followed by PVI. On >1 year follow-up with a 3-month blanking period, 1 patient lost to follow-up (median time to 1st recurrence: 245 days, IQR 145–354), single-procedure freedom from AF was 87.5% (patients without prior ablation; 35/40) and 80.5% (all patients; 62/77) and similar for persistent and paroxysmal AF (P = 0.89). Conclusions Elimination of patient-specific AF rotors/focal sources produced freedom-from-AF of ?80% at 1 year at centers new to FIRM. FIRM-guided ablation has a rapid learning curve, yielding similar results to original FIRM reports in each center’s first cases. PMID:24948520

  15. Giant right atrial mass obliterating the right atrium

    PubMed Central

    Al-Fakhouri, Ahmad; Hwang, Inyong; Alsafwah, Shadwan F.

    2015-01-01

    A73-year-old man with past medical history of mechanical aortic valve replacement, metastatic melanoma of unknown primaries with liver metastasis, presented with progressive shortness of breath and dyspnea on exertion. Transthoracic echocardiography (TTE) showed a large homogenous mass completely occupying the right atrial cavity and extending to and nearly obstructing the inflow area of the tricuspid valve. He was treated with chemotherapy. PMID:26486123

  16. Left atrial appendage exclusion—Where do we stand?

    PubMed Central

    Sakellaridis, Timothy; Argiriou, Mihalis; Charitos, Christos; Tsakiridis, Kosmas; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Machairiotis, Nikolaos; Tsiouda, Theodora; Arikas, Stamatis; Mpakas, Andreas; Beslevis, Thomas; Koletas, Alexander; Zarogoulidis, Konstantinos

    2014-01-01

    Atrial fibrillation (AF) is consider to be the most common cardiac arrhythmia with an increasingly prevalence. It is postulated that the source of thromboembolism in 90% of patients with non-valvular AF arises from the left atrial appendage (LAA). Stroke is the most feared and life threatening consequence of thromboembolism. Oral anticoagulation (OAC) with vitamin-K-antagonists is the standard medical therapy for stroke prevention in patients with AF. Unfortunately, chronic therapy with vitamin-K-antagonists is contraindicated in 14% to 44% of patients with AF who are at risk for stroke, and its benefits are limited by underutilization, narrow therapeutic window and increased risk for bleeding, making it often undesired. Therefore, mechanical LAA exclusion is a means of preventing thrombus formation in the appendage and subsequent thromboembolic events in these patients. The LAA can be excluded from the systemic circulation via surgical, percutaneous, or thoracoscopic approaches. Several studies of percutaneous transcatheter delivery of dedicated LAA exclusion devices, such as the percutaneous left atrial appendage transcatheter occlusion (PLAATO) device, Watchman device and the Amplatzer cardiac plug, have shown encouraging results as an alternative to vitamin-K-antagonists therapy for selected patients, good feasibility and efficacy, with a high rate of successful implantation. We discuss the current evidence for LAA exclusion in patients and review their results. PMID:24672702

  17. Noninvasive characterization of atrioventricular conduction in patients with atrial fibrillation.

    PubMed

    Corino, Valentina D A; Sandberg, Frida; Mainardi, Luca T; Platonov, Pyotr G; Sörnmo, Leif

    2015-01-01

    The atrioventricular (AV) node plays a fundamental role in patients with atrial fibrillation (AF), acting as a filter to the numerous irregular atrial impulses which bombard the node. A phenomenological approach to better understand AV nodal electrophysiology is to analyze the ventricular response with respect to irregularity. In different cohorts of AF patients, such analysis has been performed with the aim to evaluate the association between ventricular response characteristics and long-term clinical outcome and to determine whether irregularity is affected by rate-control drugs. Another approach to studying AV nodal characteristics is to employ a mathematical model which accounts for the refractory periods of the two AV nodal pathways. With atrial fibrillatory rate and RR intervals as input, the model has been considered for analyzing data during (i) rest and head-up tilt test, (ii) tecadenoson and esmolol, and (iii) rate-control drugs. The present paper provides an overview of our recent work on the characterization and assessment of AV nodal conduction using these two approaches. PMID:26324177

  18. Artificial Intelligence Methods Applied to Parameter Detection of Atrial Fibrillation

    NASA Astrophysics Data System (ADS)

    Arotaritei, D.; Rotariu, C.

    2015-09-01

    In this paper we present a novel method to develop an atrial fibrillation (AF) based on statistical descriptors and hybrid neuro-fuzzy and crisp system. The inference of system produce rules of type if-then-else that care extracted to construct a binary decision system: normal of atrial fibrillation. We use TPR (Turning Point Ratio), SE (Shannon Entropy) and RMSSD (Root Mean Square of Successive Differences) along with a new descriptor, Teager- Kaiser energy, in order to improve the accuracy of detection. The descriptors are calculated over a sliding window that produce very large number of vectors (massive dataset) used by classifier. The length of window is a crisp descriptor meanwhile the rest of descriptors are interval-valued type. The parameters of hybrid system are adapted using Genetic Algorithm (GA) algorithm with fitness single objective target: highest values for sensibility and sensitivity. The rules are extracted and they are part of the decision system. The proposed method was tested using the Physionet MIT-BIH Atrial Fibrillation Database and the experimental results revealed a good accuracy of AF detection in terms of sensitivity and specificity (above 90%).

  19. Simultaneous pulmonary vein cryoablation and cavotricuspid isthmus radiofrequency ablation in patients with combined atrial fibrillation and typical atrial flutter.

    PubMed

    Peyrol, Michaël; Sbragia, Pascal; Ronchard, Thibault; Cautela, Jennifer; Villacampa, Chloé; Laine, Marc; Bonello, Laurent; Thuny, Franck; Paganelli, Franck; Lévy, Samuel

    2015-01-01

    Pulmonary vein isolation (PVI) using cryoballoon (CB) technique and cavotricuspid isthmus (CTI) ablation using radiofrequency (RF) are established interventions for drug-resistant atrial fibrillation (AF) and typical atrial flutter (AFL). Twelve patients with a mean age of 62 ± 12 years underwent simultaneous delivery of RF energy at the CTI during CB applications at the PV ostia. Pulmonary vein isolation was achieved in all PVs and sustained bidirectional CTI conduction block obtained in all patients. The reported ablation protocol of combined paroxysmal AF and typical AFL did not result in prolongation of the procedure duration or in prolonged radiation exposure when compared to CB-PVI alone. No interferences between both ablation energy systems were observed. These preliminary results suggest that combined paroxysmal AF and typical AFL can be successfully and safely ablated using hybrid energy sources with simultaneous CTI ablation using RF during CB applications at the PV ostia. PMID:25796100

  20. MicroRNA-1 Accelerates the Shortening of Atrial Effective Refractory Period by Regulating KCNE1 and KCNB2 Expression: An Atrial Tachypacing Rabbit Model

    PubMed Central

    Jia, Xiaomeng; Zheng, Shaohua; Xie, Xinxing; Zhang, Yujiao; Wang, Weizong; Wang, Zhongsu; Zhang, Yong; Wang, Jiangrong; Gao, Mei; Hou, Yinglong

    2013-01-01

    Background The potential mechanisms of microRNA-1 (miR-1) in the electrical remodeling of atrial fibrillation remain unclear. The purpose of this study was to evaluate the effects of miR-1 on the atrial effective refractory period (AERP) in a right atrial tachypacing model and to elucidate the potential mechanisms. Methods and Results QRT-PCR and western blot were used to detect the expression of the miR-1, KCNE1, and KCNB2 genes after 1-week of right atrial tachypacing in New Zealand white rabbits. The AERP was measured using a programmable multichannel stimulator, and atrial fibrillation was induced by burst stimulation in vivo. The slowly activating delayed rectifier potassium current (IKs) and AERP in atrial cells were measured by whole cell patch clamp in vitro. Right atrial tachypacing upregulated miR-1 expression and downregulated KCNE1 and KCNB2 in this study, while the AERP was decreased and the atrial IKs increased. The downregulation of KCNE1 and KCNB2 levels was greater when miR-1 was further upregulated through in vivo lentiviral infection. Electrophysiological tests indicated a shorter AERP, a great increase in the IKs and a higher atrial fibrillation inducibility. In addition, similar results were found when the levels of KCNE1 and KCNB2 were downregulated by small interfering RNA while keeping miR-1 level unaltered. Conversely, knockdown of miR-1 by anti-miR-1 inhibitor oligonucleotides alleviated the downregulation of KCNE1 and KCNB2, the shortening of AERP, and the increase in the IKs. KCNE1 and KCNB2 as the target genes for miR-1 were confirmed by luciferase activity assay. Conclusions These results indicate that miR-1 accelerates right atrial tachypacing-induced AERP shortening by targeting potassium channel genes, which further suggests that miR-1 plays an important role in the electrical remodeling of atrial fibrillation and exhibits significant clinical relevance as a potential therapeutic target for atrial fibrillation. PMID:24386485

  1. Severe Gastroparesis following Radiofrequency Catheter Ablation for Atrial Fibrillation: Suggestion for Diagnosis, Treatment, and Device for Gastroparesis after RFCA

    PubMed Central

    Lee, Dong Seok; Lee, Sang Jin

    2014-01-01

    Gastroparesis following radiofrequency catheter ablation (RFCA) is a very rare complication, as only two cases have been reported in the English literature. A 42-year-old man underwent RFCA due to recurrent drug-resistant symptomatic atrial fibrillation. The patient complained of indigestion and early satiety 2 days after the procedure. Contrast-enhanced computed tomography and an upper gastrointestinal series of the abdomen showed a large amount of material remaining in the stomach area. All food material was removed by endoscopy, and the patient received medical treatment. We suggest a flow chart for diagnosis and treatment of AFGS based on the present case and previous cases. Endoscopic medical patent was designed on the basis of this case. PMID:25614842

  2. Atrial arrhythmia burden on long-term monitoring in asymptomatic patients late after atrial fibrillation ablation.

    PubMed

    Winkle, Roger A; Mead, R Hardwin; Engel, Gregory; Kong, Melissa H; Patrawala, Rob A

    2012-09-15

    Patients appearing free of atrial fibrillation (AF) based on limited electrocardiographic monitoring/clinical history late after ablation may still have a large silent AF burden and thus have failed ablations and may be at risk of thromboembolism. We evaluated long-term monitoring (LTM; 7 days or 1 year) in 203 patients off antiarrhythmic drugs who were clinically free of AF >1 year after ablation. A 7-day monitor was done in 186 and 17 had pacemakers in whom the most recent year was analyzed. Arrhythmia recurrence was >30 seconds of AF, flutter, or tachycardia. LTM was done 3.1 ± 1.3 years (range 1.1 to 7.3) after the last ablation. AF recurred in only 8 of 186 (4.3%) on 7-day monitoring. One had persistent AF. For the other 7, AF burden was 0.0075% to 3.34% with 3 of 7 having an AF burden ?0.037%. AF recurred in 4 of 17 patients (23.5%) with pacemakers. The 4 patients with pacemakers and AF had a 1-year AF burden of 0.0037% to 0.16%. Given the longer duration of monitoring, pacemakers detected more AF than 7-day monitors (p <0.011). AF duration before ablation was the only predictor of AF recurrence on LTM (p = 0.01). In patients with symptomatic AF who appeared free of AF on clinical grounds an average of 3 years after ablation, AF burden on LTM was low. In conclusion, monitoring by implanted devices detects more AF than 7-day monitors, most patients exceeding the failure definition of >30 seconds have a small AF burden, and when using LTM for follow-up the definition of "ablation failure" may be better described by an AF burden >0.5% rather than a single 30-second arrhythmia recurrence. PMID:22658502

  3. Clinical and histological predictive risk factors of atrial fibrillation in patients undergoing open-heart surgery

    PubMed Central

    TINICA, GRIGORE; MOCANU, VERONICA; ZUGUN-ELOAE, FLORIN; BUTCOVAN, DOINA

    2015-01-01

    Postoperative atrial fibrillation (POAF) is a common complication subsequent to cardiac surgery. Various risk factors have been reported for the development of this complication; however, their precise role in POAF is unknown. In the present study, we attempted to identify clinical factors and histopathological changes in atrial tissue that may predict the development of POAF. Atrial tissue was sampled from 103 patients in sinus rhythm that had undergone open-heart surgery, including elective coronary artery bypass grafting (79.61%) and heart valve surgery (20.38%). Atrial surgical biopsies were obtained from the right atrial appendage at the site of cannulation, prior to cardiopulmonary bypass. Tissues were processed routinely for light microscopy, then stained with hematoxylin and eosin and sirius red. Microscopical exams were used to observe the atrial lesions and morphometry was conducted for quantification. In total, 37 patients (35.92%) developed POAF and atrial lesions were identified in the majority of patients in the normal postoperative sinus rhythm and POAF groups, but were most common in the POAF patients. The most common risk factors involved in developing POAF were found to be: Age of >60 years, male gender, ejection fraction of <50% and increased pulmonary hypertension. Furthermore, interstitial fibrosis and myocytolysis were the most common injuries identified. Abnormalities in atrial surgical biopsies may indicate the susceptibility of a patient to developing POAF. The present results suggest that the pre-existent alterations in the structure of the right atrium may be a major determinant in the development of POAF. PMID:26668632

  4. Safety and efficacy of ibutilide in cardioversion of atrial flutter and fibrillation.

    PubMed

    Nair, Madhuri; George, Lekha K; Koshy, Santhosh K G

    2011-01-01

    This article reviews the safety and efficacy of ibutilide for use in patients with atrial fibrillation and flutter. Ibutilide, a class III antiarrhythmic agent, is primarily used for conversion of atrial flutter and fibrillation and is a good alternative to electrical cardioversion. Ibutilide has a conversion rate of up to 75% to 80% in recent-onset atrial fibrillation and flutter; the conversion rate is higher for atrial flutter than for atrial fibrillation. It is also safe in the conversion of chronic atrial fibrillation/flutter among patients receiving oral amiodarone therapy. Ibutilide pretreatment facilitates transthoracic defibrillation and decreases the energy requirement of electrical cardioversion by both monophasic and biphasic shocks. Pretreatment with ibutilide before electrical defibrillation has a conversion rate of 100% compared with 72% with no pretreatment. Ibutilide is also safe and efficient in the treatment of atrial fibrillation in patients who have had cardiac surgery, and in accessory pathway-mediated atrial fibrillation Where the conversion rate of ibutilide is as high as 95%. There is up to a 4% risk of torsade de pointes and a 4.9% risk of monomorphic ventricular tachycardia. Hence, close monitoring in an intensive care unit setting is warranted during and at least for 4 hours after drug infusion. The anticoagulation strategy is the same as for any other mode of cardioversion. PMID:21209348

  5. Low energy biphasic cardioversion of atrial flutter: results from a pilot trial.

    PubMed

    Mortensen, Kai; Aydin, Muhammet Ali; Schwemer, Tjark F; Ventura, Rodolfo; Reppel, Michael; Bode, Frank; Mletzko, Ralph; Schunkert, Heribert; Risius, Tim

    2010-11-19

    A pilot study was performed to determine the efficacy of low energy biphasic external cardioversion in common type atrial flutter. In the majority of patients (70%) successful cardioversion was achieved with low energy levels of 20 or 30 J; however a considerable number of patients (15%) were initially cardioverted to atrial fibrillation, needing an additional cardioversion with an even higher energy level. PMID:20303606

  6. Connexin43 ablation in foetal atrial myocytes decreases electrical coupling, partner connexins,

    E-print Network

    Parker, Kevin Kit

    on transjunctional voltage, Vj, single gap junction channel conductances, and INa. 3D reconstructions of Cx43, Cx40 2010; revised 10 January 2012; accepted 23 January 2012; online publish-ahead-of-print 27 January 2012) are thought to contribute to atrial electrical dys- function and atrial fibrillation. We assessed the effect

  7. Prognostic Significance of Premature Atrial Complexes Burden in Prediction of Long-Term Outcome

    PubMed Central

    Lin, Chin-Yu; Lin, Yenn-Jiang; Chen, Yun-Yu; Chang, Shih-Lin; Lo, Li-Wei; Chao, Tze-Fan; Chung, Fa-Po; Hu, Yu-Feng; Chong, Eric; Cheng, Hao-Min; Tuan, Ta-Chuan; Liao, Jo-Nan; Chiou, Chuen-Wang; Huang, Jin-Long; Chen, Shih-Ann

    2015-01-01

    Background The prognostic significance of premature atrial complex (PAC) burden is not fully elucidated. We aimed to investigate the relationship between the burden of PACs and long-term outcome. Methods and Results We investigated the clinical characteristics of 5371 consecutive patients without atrial fibrillation (AF) or a permanent pacemaker (PPM) at baseline who underwent 24-hour electrocardiography monitoring between January 1, 2002, and December 31, 2004. Clinical event data were retrieved from the Bureau of National Health Insurance of Taiwan. During a mean follow-up duration of 10±1 years, there were 1209 deaths, 1166 cardiovascular-related hospitalizations, 3104 hospitalizations for any reason, 418 cases of new-onset AF, and 132 PPM implantations. The optimal cut-off of PAC burden for predicting mortality was 76 beats per day, with a sensitivity of 63.1% and a specificity of 63.5%. In multivariate analysis, a PAC burden >76 beats per day was an independent predictor of mortality (hazard ratio: 1.384, 95% CI: 1.230 to 1.558), cardiovascular hospitalization (hazard ratio: 1.284, 95% CI: 1.137 to 1.451), new-onset AF (hazard ratio: 1.757, 95% CI: 1.427 to 2.163), and PPM implantation (hazard ratio: 2.821, 95% CI: 1.898 to 4.192). Patients with frequent PAC had increased risk of mortality attributable to myocardial infarction, heart failure, and sudden cardiac death. Frequent PACs increased risk of PPM implantation owing to sick sinus syndrome, high-degree atrioventricular block, and/or AF. Conclusions The burden of PACs is independently associated with mortality, cardiovascular hospitalization, new-onset AF, and PPM implantation in the long term. PMID:26316525

  8. Meta-analysis identifies six new susceptibility loci for atrial fibrillation

    PubMed Central

    Ellinor, Patrick T; Lunetta, Kathryn L; Albert, Christine M; Glazer, Nicole L; Ritchie, Marylyn D; Smith, Albert V; Arking, Dan E; Müller-Nurasyid, Martina; Krijthe, Bouwe P; Lubitz, Steven A; Bis, Joshua C; Chung, Mina K; Dörr, Marcus; Ozaki, Kouichi; Roberts, Jason D; Smith, J Gustav; Pfeufer, Arne; Sinner, Moritz F; Lohman, Kurt; Ding, Jingzhong; Smith, Nicholas L; Smith, Jonathan D; Rienstra, Michiel; Rice, Kenneth M; Van Wagoner, David R; Magnani, Jared W; Wakili, Reza; Clauss, Sebastian; Rotter, Jerome I; Steinbeck, Gerhard; Launer, Lenore J; Davies, Robert W; Borkovich, Matthew; Harris, Tamara B; Lin, Honghuang; Völker, Uwe; Völzke, Henry; Milan, David J; Hofman, Albert; Boerwinkle, Eric; Chen, Lin Y; Soliman, Elsayed Z; Voight, Benjamin F; Li, Guo; Chakravarti, Aravinda; Kubo, Michiaki; Tedrow, Usha B; Rose, Lynda M; Ridker, Paul M; Conen, David; Tsunoda, Tatsuhiko; Furukawa, Tetsushi; Sotoodehnia, Nona; Xu, Siyan; Kamatani, Naoyuki; Levy, Daniel; Nakamura, Yusuke; Parvez, Babar; Mahida, Saagar; Furie, Karen L; Rosand, Jonathan; Muhammad, Raafia; Psaty, Bruce M; Meitinger, Thomas; Perz, Siegfried; Wichmann, H-Erich; Witteman, Jacqueline C M; Kao, W H Linda; Kathiresan, Sekar; Roden, Dan M; Uitterlinden, Andre G; Rivadeneira, Fernando; McKnight, Barbara; Sjögren, Marketa; Newman, Anne B; Liu, Yongmei; Gollob, Michael H; Melander, Olle; Tanaka, Toshihiro; Ch Stricker, Bruno H; Felix, Stephan B; Alonso, Alvaro; Darbar, Dawood; Barnard, John; Chasman, Daniel I; Heckbert, Susan R; Benjamin, Emelia J; Gudnason, Vilmundur; Kääb, Stefan

    2012-01-01

    Atrial fibrillation is a highly prevalent arrhythmia and a major risk factor for stroke, heart failure and death1. We conducted a genome-wide association study (GWAS) in individuals of European ancestry, including 6,707 with and 52,426 without atrial fibrillation. Six new atrial fibrillation susceptibility loci were identified and replicated in an additional sample of individuals of European ancestry, including 5,381 subjects with and 1 0,030 subjects without atrial fibrillation (P < 5 × 10?8). Four of the loci identified in Europeans were further replicated in silico in a GWAS of Japanese individuals, including 843 individuals with and 3,350 individuals without atrial fibrillation. The identified loci implicate candidate genes that encode transcription factors related to cardiopulmonary development, cardiac-expressed ion channels and cell signaling molecules. PMID:22544366

  9. Diagnosing Paroxysmal Atrial Fibrillation in Patients With Ischemic Strokes and Transient Ischemic Attacks Using Echocardiographic Measurements of Left Atrium Function.

    PubMed

    Skaarup, Kristoffer Grundtvig; Christensen, Hanne; Høst, Nis; Mahmoud, Masti Mahdy; Ovesen, Christian; Olsen, Flemming Javier; Biering-Sørensen, Tor

    2016-01-01

    Twenty-five to 35 percentage of stroke cases are cryptogenic, and it has been demonstrated that paroxysmal atrial fibrillation (AF) is the causal agent in up to 25% of these incidents. The purpose of this study was to investigate if left atrial (LA) parameters have value for diagnosing paroxysmal AF in patients with ischemic stroke (IS) and transient ischemic attack (TIA). We retrospectively analyzed 219 patients who after acute IS or TIA underwent a transthoracic echocardiographic examination. Patients were designated as patients with paroxysmal AF if they had one or more reported incidents of AF before or after their echocardiographic examination. Patients in the paroxysmal AF group were significantly older and had higher CHA2DS2-VASc score than patients without paroxysmal AF (p <0.05 for both). None of the conventional echocardiographic parameters were significantly associated with paroxysmal AF. However, the atrial measurements evaluating LA function (min LA volume and LA emptying fraction) were significantly different (LA emptying fraction: 45% ± 10% vs 50% ± 10%, p = 0.004; minimal LA volume: 30.2 ml ± 17.3 ml vs 24 ml ± 10 ml, p = 0.035 in patients with paroxysmal AF, even after adjustment for age, gender, CHA2DS2-VASc score, and stroke severity [p <0.05 for both]). By combining the cut-off values of age, LA emptying fraction, and minimal LA volume the diagnostic accuracy of paroxysmal AF was improved, resulting in a sensitivity of 95% and negative predictive value of 97%. In conclusion, in patients with IS and TIA, LA function measurements (minimal LA volume and LA emptying fraction) are independently associated with paroxysmal AF and may improve risk stratification for paroxysmal AF presence after IS or TIA. PMID:26525212

  10. Surgical correction of atrial septal defect in the elderly

    PubMed Central

    Gumbiene, Lina; Dranenkiene, Alicija; Karalius, Rimantas; Sirmenis, Raimondas; Tarutis, Virgilijus

    2014-01-01

    Introduction Atrial septal defects (ASDs) are one of the most common congenital malformations in adults. Correction of ASDs in advanced age remains controversial, even though beneficial effects in this patient group were found in recent studies. In older patients, less invasive transcatheter closure of ASDs has been recommended. Aim The aim of this study was to analyze our advanced age ASD surgical cohort: early and late results. Material and methods Retrospective analysis of 32 patients operated on at an age of ? 60 years (i.e. age 66.13 ± 4.8, range from 60 to 78) in our center between 2001 and 2011 was carried out. We reviewed our experience of surgical ASD closure in elderly patients over a 10-year period to assess the effects of this type of treatment on early postoperative and long-term survival, early and late complications, preoperative and postoperative clinical status (New York Heart Association [NYHA] functional class), pulmonary hypertension (PH) and atrial arrhythmias. The patients were divided into two groups according to age. Results The frequency of comorbidities was lower in younger age group patients (11 [61%] vs. 13 [93%], p < 0.05). Atrial fibrillation/flutter was found in 21 (66%) of all patients. Late postoperative mortality was higher in the older patient group (3 [21%] vs. 1 [5.6%]). Despite this, we observed significant improvement of symptoms and functional ability in the older population after surgical ASD closure (group I, n = 10 [56%] vs. group II, n = 12 [86%]). Conclusions Surgical correction of clinically significant ASD is effective even in older patients with comorbidities. PMID:26336455

  11. Lifestyle Modification in the Prevention and Treatment of Atrial Fibrillation.

    PubMed

    Menezes, Arthur R; Lavie, Carl J; De Schutter, Alban; Milani, Richard V; O'Keefe, James; DiNicolantonio, James J; Morin, Daniel P; Abi-Samra, Freddy M

    2015-01-01

    Atrial fibrillation (AF) is the most common arrhythmia worldwide and has a significant impact on morbidity and mortality. Additionally, the incidence and prevalence of AF is expected to increase in the United States and worldwide over the next few decades. While the pathophysiology concerning the development of AF is not completely understood, multiple modifiable, as well as non-modifiable risk factors, for AF development have been discovered. The goal of this paper is to provide an overview of the modifiable risk factors that contribute to the development and recurrence of AF, in addition to discussing potential lifestyle changes that may aid in the prevention and treatment of AF. PMID:26184674

  12. Atrial Fibrillation in the Young: A Neurologist's Nightmare

    PubMed Central

    Raphael, Claire E.

    2015-01-01

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia seen in clinical practice with prevalence in excess of 33 million worldwide. Although often asymptomatic and until recently considered a “benign” arrhythmia, it is now appreciated that thromboembolism resulting from AF results in significant morbidity and mortality predominantly due to stroke. Although an arrhythmia more commonly affecting the elderly, AF can also occur in the young. This review focuses on the impact of AF in the younger population and discusses the dilemmas of managing younger patients with AF. PMID:25922764

  13. Sinus bradycardia treated by long-term atrial pacing

    PubMed Central

    Clarke, Malcolm; Evans, David W.; Milstein, B. B.

    1970-01-01

    A technique for long-term atrial pacing is described. It uses the system whereby power from an external pulse-generator (including battery) is transferred through the intact skin by inductive-coupling. Once installed, there is no requirement for further surgery to effect battery changes, and the patient can control his heart rate over a wide range to suit his needs. It is suggested that pacing by such means may offer a preferable alternative to drug therapy in the treatment of low cardiac output due to pathological sinus bradycardia. Two patients successfully treated in this way are reported. Images PMID:4988398

  14. Usefulness of the Electrocardiographic P-Wave Axis as a Predictor of Atrial Fibrillation.

    PubMed

    Rangel, Maria Octavia; O'Neal, Wesley T; Soliman, Elsayed Z

    2016-01-01

    The association between abnormal electrocardiographic P-wave axis with atrial fibrillation (AF) has not been systematically studied in community-based populations. We examined the association between abnormal P-wave axis and AF in 4,274 participants (41% men and 95% white) from the Cardiovascular Health Study. Axis values between 0° and 75° were considered normal. AF cases were identified from study electrocardiograms and from hospitalization discharge data. During a median follow-up of 12.1 years, a total of 1,274 participants (30%) developed AF. The incidence rate of AF was 26 cases per 1,000 person-years for those with abnormal P-wave axis and 24 cases per 1,000 person-years for subjects with normal P-wave axis. Abnormal P-wave axis was associated with a 17% increased risk of AF (95% confidence interval 1.03 to 1.33) after adjustment for age, gender, race, education, income, smoking, diabetes, coronary heart disease, stroke, heart failure, heart rate, systolic blood pressure, body mass index, total cholesterol, high-density lipoprotein cholesterol, antihypertensive medications, aspirin, and statins. The results were consistent in subgroup analyses stratified by age, gender, and race. In conclusion, abnormal P-wave axis, a routinely reported electrocardiographic measurement, is associated with an increased risk of AF. This finding suggests a potential role for P-wave axis in AF risk assessment. PMID:26552511

  15. Device closure of secundum atrial septal defect's and the risk of cardiac erosion

    PubMed Central

    Qureshi, S A

    2015-01-01

    Cardiac erosion related to transcatheter atrial septal defect closure devices is of increasing concern. Erosion is reported to have occurred with most of currently available occluder devices. Perhaps due to the very large number of implants worldwide, the Amplatzer (St Jude) occluder is associated with the majority of cardiac erosion events reported in the literature. Best current estimates of the incidence of erosion with the St Jude device are between one and three cases per 1000 implants. Most events occur early after implantation and it is rare, although not unheard of, for events to occur after a year following device insertion. It is important that those involved with closure programmes are vigilant for the problem, because device-related erosion is associated with a significant mortality risk. Despite considerable debate, the risk factors (either patient or device) for erosion remain unclear and require further investigation. Currently available data sets have focussed largely on erosion cohorts and are unable to place these cases in appropriate context with non-erosion closure cases. What is certain is that programmes implanting these devices must take care to implant appropriately sized devices and have in place plans to ensure that patients are both well informed and can access help and advice in the event of developing symptoms.

  16. Evaluation of left atrial deformation to predict left atrial stasis in patients with non-valvular atrial fibrillation – a pilot-study

    PubMed Central

    2013-01-01

    Background Speckle tracking-derived strain and strain rate are recently available parameters to assess left atrial (LA) deformation. We hypothesized that such new parameters could be of interest to evaluate the risk of LA stasis among patients with atrial fibrillation (AF). Methods Single-centre study enrolling all patients with non-valvular AF lasting longer than 48 hours for whom no therapeutic anticoagulation was given in the preceding 3 weeks and who were assessed through transesophageal and transthoracic echocardiogram during a 6 month time interval. LA deformation was assessed by transthoracic echocardiogram through speckle tracking analysis, whereas LA stasis parameters were sought on transesophageal echocardiogram. Results Among the 82 assessed patients, LA appendage thrombi or sludge were found in 16 (19.5%). A moderate positive correlation was found between peak positive strain rate and maximum emptying velocity (r?=?0.589; P <0.001) and peak positive strain rate and maximum filling velocity of the LA appendage (r?=?0.651; P <0.001). Peak negative strain rate was also found to be associated with both maximum emptying velocity (r?=?-0.513; P <0.001) and maximum filling velocity of the LAA (r?=?-0.552; P <0.001). AF duration, peak negative strain rate and time-to-peak positive strain were independent predictors of LAA thrombi or sludge on multivariate analysis logistic regression. The area under the curve for the estimated probabilities using the obtained logistic regression model was 0.89 (95%CI 0.81-0.96; P <0.001). Conclusion Our findings suggest that LA mechanical dysfunction assessed through speckle tracking may be of interest to predict LA stasis in the setting of AF. PMID:24354939

  17. The value of diastolic function parameters in the prediction of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation

    PubMed Central

    2014-01-01

    Background Left ventricular diastolic impairment and consequently elevated filling pressure may contribute to stasis leading to left atrial appendage thrombus (LAAT) in nonvalvular atrial fibrillation (AF). We investigated whether transthoracic echocardiographic parameters can predict LAAT independent of traditional clinical predictors. Methods We conducted a retrospective cohort study of 297 consecutive nonvalvular AF patients who underwent transthoracic echocardiogram followed by a transesophageal echocardiogram within one year. Multivariate logistic regression analysis models were used to determine factors independently associated with LAAT. Results Nineteen subjects (6.4%) were demonstrated to have LAAT by transesophageal echocardiography. These patients had higher mean CHADS2 scores [2.6?±?1.2 vs. 1.9?±?1.3, P?=?0.009], higher E:e’ ratios [16.6?±?6.1 vs. 12.0?±?5.4, P?=?0.001], and lower mean e’ velocities [6.5?±?2.1 cm/sec vs. 9.1?±?3.2 cm/sec, P?=?0.001]. Both E:e’ and e’ velocity were associated with LAAT formation independent of the CHADS2 score, warfarin therapy, left ventricular ejection fraction (LVEF), and left atrial volume index (LAVI) [E:e’ odds-ratio?=?1.14 (95% confidence interval?=?1.03 – 1.3), P?=?0.009; e’ velocity odds-ratio?=?0.68 (95% confidence interval?=?0.5 – 0.9), P?=?0.007]. Similarly, diastolic function parameters were independently associated with spontaneous echo contrast. Conclusion The diastolic function indices E:e’ and e’ velocity are independently associated with LAAT in nonvalvular AF patients and may help identify patients at risk for LAAT. PMID:24568305

  18. Atrial tracking (synchronous) pacing in a pediatric and young adult population.

    PubMed

    Gillette, P C; Zinner, A; Kratz, J; Shannon, C; Wampler, D; Ott, D

    1987-04-01

    One hundred pediatric and young adult patients underwent implantation of an atrial tracking pacemaker. Seventy-four pacemakers paced in an atrioventricular (AV) sequential mode at the lower rate limit (DDD) while 26 paced in a ventricular demand mode at the lower rate limit (VDD). Five patients required reoperation during follow-up of 1 month to 2.5 years (mean 1.5 years). Six additional patients required programming to ventricular demand (3) or AV sequential (3) pacing, because of development of sinus bradycardia (2), atrial sensing problems (1) or pacemaker-mediated tachycardia (3). Pulse generators that could sense atrial signals less than 1.0 mV and had a programmable atrial refractory period did not require reprogramming out of the atrial tracking mode. No patient developed atrial flutter or fibrillation. Sensing problems during exercise occurred in 37% of the first 60 pacemakers but in none of the last 40, which had improved electronic components. Atrial tracking pacing is feasible in pediatric and young adult patients. PMID:3558979

  19. Tachycardia-induced silencing of subcellular Ca2+ signaling in atrial myocytes

    PubMed Central

    Greiser, Maura; Kerfant, Benoît-Gilles; Williams, George S.B.; Voigt, Niels; Harks, Erik; Dibb, Katharine M.; Giese, Anne; Meszaros, Janos; Verheule, Sander; Ravens, Ursula; Allessie, Maurits A.; Gammie, James S.; van der Velden, Jolanda; Lederer, W. Jonathan; Dobrev, Dobromir; Schotten, Ulrich

    2014-01-01

    Atrial fibrillation (AF) is characterized by sustained high atrial activation rates and arrhythmogenic cellular Ca2+ signaling instability; however, it is not clear how a high atrial rate and Ca2+ instability may be related. Here, we characterized subcellular Ca2+ signaling after 5 days of high atrial rates in a rabbit model. While some changes were similar to those in persistent AF, we identified a distinct pattern of stabilized subcellular Ca2+ signaling. Ca2+ sparks, arrhythmogenic Ca2+ waves, sarcoplasmic reticulum (SR) Ca2+ leak, and SR Ca2+ content were largely unaltered. Based on computational analysis, these findings were consistent with a higher Ca2+ leak due to PKA-dependent phosphorylation of SR Ca2+ channels (RyR2s), fewer RyR2s, and smaller RyR2 clusters in the SR. We determined that less Ca2+ release per [Ca2+]i transient, increased Ca2+ buffering strength, shortened action potentials, and reduced L-type Ca2+ current contribute to a stunning reduction of intracellular Na+ concentration following rapid atrial pacing. In both patients with AF and in our rabbit model, this silencing led to failed propagation of the [Ca2+]i signal to the myocyte center. We conclude that sustained high atrial rates alone silence Ca2+ signaling and do not produce Ca2+ signaling instability, consistent with an adaptive molecular and cellular response to atrial tachycardia. PMID:25329692

  20. Influence of resting tension on immunoreactive atrial natriuretic peptide secretion by rat atria superfused in vitro

    SciTech Connect

    Schiebinger, R.J.; Linden, J.

    1986-07-01

    Atrial natriuretic peptide is a potent diuretic hormone secreted by the atria in response to volume expansion. We examined the effect of resting tension on atrial natriuretic peptide secretion by rat atria superfused in vitro. Left atria were hooked between an electrode and force transducer and superfused with medium 199. The atria were studied at a pacing frequency of 0 or 3 Hz. Atrial natriuretic peptide content of the superfusate was measured by radioimmunoassay. In nonpaced and paced atria, increasing resting tension three- to five-fold caused immunoreactive atrial natriuretic peptide secretion to increase by 35 +/- 5% (mean +/- SEM, n = 6, p less than 0.01) and 30 +/- 3% (n = 4, p less than 0.01), respectively. Lowering resting tension by 50% in nonpaced and paced atria lowered immunoreactive atrial natriuretic peptide secretion by 30 +/- 3% (n = 7, p less than 0.01) and 24 +/- 3% (n = 6, p less than 0.01), respectively. To exclude the possibility that release of norepinephrine or acetylcholine from endogenous nerve endings was mediating this effect, the atria were superfused with the combination of propranolol 0.1 microM, phentolamine 1.0 microM, and atropine 10 microM. These concentrations of the antagonists were 125-fold or higher than their Kd for binding to their respective receptors. The antagonists did not block the rise in immunoreactive atrial natriuretic peptide secretion; neither did they inhibit an established rise in immunoreactive atrial natriuretic peptide secretion induced by increasing the resting tension.

  1. Wall-motion based analysis of global and regional left atrial mechanics.

    PubMed

    Moyer, Christian B; Helm, Patrick A; Clarke, Christopher J; Budge, Loren P; Kramer, Christopher M; Ferguson, John D; Norton, Patrick T; Holmes, Jeffrey W

    2013-10-01

    Atrial fibrillation is an increasingly prevalent cardiovascular disease; changes in atrial structure and function induced by atrial fibrillation and its treatments are often spatially heterogeneous. However, spatial heterogeneity of function is difficult to assess with standard imaging techniques. This paper describes a method to assess global and regional mechanical function by combining cardiac magnetic resonance imaging and finite-element surface fitting. We used this fitted surface to derive measures of left atrial volume, regional motion, and spatial heterogeneity of motion in 23 subjects, including healthy volunteers and atrial fibrillation patients. We fit the surfaces using a Newton optimization scheme in under 1 min on a standard laptop, with a root mean square error of 2.3 ± 0.5 mm, less than 9% of the mean fitted radius, and an inter-operator variability of less than 10%. Fitted surfaces showed clear definition of the phases of left atrial motion (filling, passive emptying, active contraction) in both volume-time and regional radius-time curves. Averaged surfaces of healthy volunteers and atrial fibrillation patients provided evidence of substantial regional variation in both amount and timing of regional motion, indicating spatial heterogeneity of function, even in healthy adults. PMID:23708788

  2. [Atrial fibrillation: anticoagulation or antiaggregation. Is there still a controversy?].

    PubMed

    Bonhorst, D

    1995-04-01

    Unlike what happened regarding rheumatic atrial fibrillation, there was no consensus until few years ago about the indication for antithrombotic therapy in nonrheumatic atrial fibrillation. Nevertheless, as it was noticed a high prevalence of stroke in this last situation, several clinical trials were accomplished to clarify the role of those drugs. It was reviewed the five initial big trials, which in spite of having different dimensions, endpoints and design, were remarkably consistent in their results, showing in those patients taking varfarine a 60% reduction in ischemic stroke and systemic embolism. Those results were obtained with an acceptable risk of hemorrhage, which was related to anticoagulation intensity. An European trial showed similar results in secondary prevention, in patients with higher risk, all of them with a previous minor stroke. In some of those trials antiplatelet therapy was also evaluated but only one (SPAF I), showed a significant reduction of stroke with aspirin; the reductions of risk was meanwhile much smaller than with varfarine. As there were a high number of patients with indication for anticoagulants one tried to find thromboembolic risk factors, to identify the population potentially more prone to benefit from that therapy. It was possible in SPAF I trial to find some clinical and echocardiographic risk factors. SPAF II trial directly compare aspirine with varfarine, showing the superiority of the last one but also its greater haemorrhagic risk. That study permitted a better understanding of the indications of those two therapies, according to embolic and haemorrhagic risk of each patient. PMID:7612283

  3. Rat atrial responses to Bothrops jararacussu (jararacuçu) snake venom.

    PubMed

    Rodrigues, Mariana A P; Dias, Lourdes; Rennó, André L; Sousa, Norma C; Smaal, Adriana; da Silva, Delano A; Hyslop, Stephen

    2014-09-01

    Envenoming by the pitviper Bothrops jararacussu produces cardiovascular alterations, including coagulopathy, systemic hemorrhage, hypotension, circulatory shock and renal failure. In this work, we examined the activity of this venom in rat isolated right atria. Incubation with venom (0.025, 0.05, 0.1 and 0.2mg/ml) caused concentration-dependent muscle contracture that was not reversed by washing. Muscle damage was seen histologically and confirmed by quantification of creatine kinase-MB (CK-MB) release. Heating and preincubation of venom with p-bromophenacyl bromide (a phospholipase A2 inhibitor) abolished the venom-induced contracture and muscle damage. In contrast, indomethacin, a non-selective inhibitor of cyclooxygenase, and verapamil, a voltage-gated Ca(2+) channel blocker, did not affect the responses to venom. Preincubation of venom with Bothrops or Bothrops/Crotalus antivenom or the addition of antivenom soon after venom attenuated the venom-induced changes in atrial function and tissue damage. These results indicate that B. jararacussu venom adversely affected rat atrial contractile activity and muscle organization through the action of venom PLA2; these venom-induced alterations were attenuated by antivenom. PMID:24973630

  4. Multifractal analysis for grading complex fractionated electrograms in atrial fibrillation.

    PubMed

    Orozco-Duque, A; Novak, D; Kremen, V; Bustamante, J

    2015-11-01

    Complex fractionated atrial electrograms provide an important tool for identifying arrhythmogenic substrates that can be used to guide catheter ablation for atrial fibrillation (AF). However, fractionation is a phenomenon that remains unclear. This paper aims to evaluate the multifractal properties of electrograms in AF in order to propose a method based on multifractal analysis able to discriminate between different levels of fractionation. We introduce a new method, the h-fluctuation index (hFI), where h is the generalised Hurst exponent, to extract information from the shape of the multifractal spectrum. Two multifractal frameworks are evaluated: multifractal detrended fluctuation analysis and wavelet transform modulus maxima. hFI is exemplified through its application in synthetic signals, and it is evaluated in a database of electrograms labeled on the basis of four degrees of fractionation. We compare the performance of hFI with other indexes, and find that hFI outperforms them. The results of the study provide evidence that multifractal analysis is useful for studying fractionation phenomena in AF electrograms, and indicate that hFI can be proposed as a tool for grade fractionation associated with the detection of target sites for ablation in AF. PMID:26450345

  5. New technologies in treatment of atrial fibrillation in cardiosurgical patients

    NASA Astrophysics Data System (ADS)

    Evtushenko, A. V.; Evtushenko, V. V.; Bykov, A. N.; Sergeev, V. S.; Syryamkin, V. I.; Kistenev, Yu. V.; Anfinogenova, Ya. D.; Smyshlyaev, K. A.; Kurlov, I. O.

    2015-11-01

    The article is devoted to the evaluation of the results of clinical application of penetrating radiofrequency ablation techniques on atrial myocardium. Total operated on 241 patients with valvular heart disease and coronary heart disease complicated with atrial fibrillation. All operations were performed under cardiopulmonary bypass and cardioplegia. The main group consists of 141 patients which were operated using penetrating technique radiofrequency exposure. The control group consisted of 100 patients who underwent surgery with the use of "classical" monopolar RF-ablation technique. Both groups were not significantly different on all counts before surgery. Patients with previous heart surgery were excluded during the selection of candidates for the procedure, due to the presence of adhesions in the pericardium, that do not allow good visualization of left atrium, sufficient to perform this procedure. Penetrating technique has significantly higher efficiency compared to the "classic" technique in the early and long-term postoperative periods. In the early postoperative period, its efficiency is 93%, and in the long term is 88%. The efficacy of "classical" monopolar procedure is below: 86% and 68% respectively.

  6. Long non-coding RNA expression profile in atrial fibrillation

    PubMed Central

    Ruan, Zhongbao; Sun, Xiaohua; Sheng, Haihui; Zhu, Li

    2015-01-01

    To investigate the expression profiles of long non-coding RNAs (lncRNAs) in atrial fibrillation (AF), atrial tissues from 3 AF patients and 3 non-AF patients that were collected for lncRNA expression microarray analyses to explore the role of lncRNA in the pathogenesis of AF. Gene Ontology (GO) categories and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed to identify the main functions of the differentially expressed genes and AF-related pathways. A total of 219 lncRNAs was found to be differentially expressed between AFs and controls. Among them, 156 were upregulated and 63 were downregulated. Eight out of 10 dysregulated lncRNAs such as uc001eqh.1 were validated by quantitative real-time PCR. GO categories, pathway analyses, and interaction network showed a consistent result that differentially expressed genes contribute to the pathogenesis of AF. In conclusion, the findings of our study provide a perspective on lncRNA in AF and the foundation for further study of the biological functions of lncRNAs in AF. PMID:26339410

  7. Genetic mechanisms of atrial fibrillation: impact on response to treatment

    PubMed Central

    Darbar, Dawood; Roden, Dan M.

    2013-01-01

    Atrial fibrillation (AF) is the most-common sustained arrhythmia observed in clinical practice, but response to therapy is highly variable between patients. Current drug therapies to suppress AF are incompletely and unpredictably effective and carry substantial risk of proarrhythmia and noncardiac toxicities. The limited success of therapy for AF is partially the result of heterogeneity of the underlying substrate, interindividual differences in disease mechanisms, and our inability to predict response to therapies in individual patients. In this Review, we discuss the evidence that variability in response to drug therapy is also conditioned by the underlying genetic substrate for AF. Increased susceptibility to AF is mediated through diverse genetic mechanisms, including modulation of the atrial action-potential duration, conduction slowing, and impaired cell-to-cell communication, as well as novel mechanisms, such as regulation of signalling proteins important in the pathogenesis of AF. However, the translation of genetic data to the care of the patients with AF has been limited because of poor understanding of the underlying mechanisms associated with common AF-susceptibility loci, a dearth of prospective, adequately powered studies, and the challenges associated with determining efficacy of antiarrhythmic drugs. What is apparent, however, is the need for appropriately designed, genotype-directed clinical trials. PMID:23591267

  8. Management of Atrial Fibrillation in Critically Ill Patients

    PubMed Central

    Arrigo, Mattia

    2014-01-01

    Atrial fibrillation (AF) is common in ICU patients and is associated with a two- to fivefold increase in mortality. This paper provides a reappraisal of the management of AF with a special focus on critically ill patients with haemodynamic instability. AF can cause hypotension and heart failure with subsequent organ dysfunction. The underlying mechanisms are the loss of atrial contraction and the high ventricular rate. In unstable patients, sinus rhythm must be rapidly restored by synchronised electrical cardioversion (ECV). If pharmacological treatment is indicated, clinicians can choose between the rate control and the rhythm control strategy. The optimal substance should be selected depending on its potential adverse effects. A beta-1 antagonist with a very short half-life (e.g., esmolol) is an advantage for ICU patients because the effect of beta-blockade on cardiovascular stability is unpredictable in those patients. Amiodarone is commonly used in the ICU setting but has potentially severe cardiac and noncardiac side effects. Digoxin controls the ventricular response at rest, but its benefit decreases in the presence of adrenergic stress. Vernakalant converts new-onset AF to sinus rhythm in approximately 50% of patients, but data on its efficacy and safety in critically ill patients are lacking. PMID:24527212

  9. Automatic detection of atrial fibrillation in cardiac vibration signals.

    PubMed

    Brueser, C; Diesel, J; Zink, M D H; Winter, S; Schauerte, P; Leonhardt, S

    2013-01-01

    We present a study on the feasibility of the automatic detection of atrial fibrillation (AF) from cardiac vibration signals (ballistocardiograms/BCGs) recorded by unobtrusive bedmounted sensors. The proposed system is intended as a screening and monitoring tool in home-healthcare applications and not as a replacement for ECG-based methods used in clinical environments. Based on BCG data recorded in a study with 10 AF patients, we evaluate and rank seven popular machine learning algorithms (naive Bayes, linear and quadratic discriminant analysis, support vector machines, random forests as well as bagged and boosted trees) for their performance in separating 30 s long BCG epochs into one of three classes: sinus rhythm, atrial fibrillation, and artifact. For each algorithm, feature subsets of a set of statistical time-frequency-domain and time-domain features were selected based on the mutual information between features and class labels as well as first- and second-order interactions among features. The classifiers were evaluated on a set of 856 epochs by means of 10-fold cross-validation. The best algorithm (random forests) achieved a Matthews correlation coefficient, mean sensitivity, and mean specificity of 0.921, 0.938, and 0.982, respectively. PMID:23086532

  10. Pharmacologic Atrial Natriuretic Peptide Reduces Human Leg Capillary Filtration

    NASA Technical Reports Server (NTRS)

    Watenpaugh, Donald E.; Vissing, Susanne F.; Lane, Lynda D.; Buckey, Jay C.; Firth, Brian G.; Erdman, William; Hargens, Alan R.; Blomqvist, C. Gunnar

    1995-01-01

    Atrial natriuretic peptide (ANP) is produced and secreted by atrial cells. We measured calf capillary filtration rate with prolonged venous-occlusion plethys-mography of supine health male subjects during pharmacologic infusion of ANP (48 pmol/kg/min for 15 min; n equals 6) and during placebo infusion (n equals 7). Results during infusions were compared to prior control measurements. ANP infusion increased plasma (ANP) from 30 plus or minus 4 to 2,568 plus or minus 595 pmol/L. Systemic hemoconcentration occurred during ANP infusion; mean hematocrit and plasma colloid osmotic pressure increased 4.6 and 11.3 percent respectively, relative to pre-infusion baseline values (p is less than 0.05). Mean calf filtration, however was significantly reduced from 0.15 to 0.08 ml/100 ml/min with ANP. Heart rate increased 20 percent with ANP infusion, wheras blood pressure was unchanged. Calf conductance (blood flow/arterial pressure) and venous compliance were unaffected by ANP infusion. Placebo infusion had no effect relative to prior baseline control measurements. Although ANP induced systemic capillary filtration, in the calf, filtration was reduced with ANP. Therefore, phamacologic ANP infusion enhances capillary filtration from the systemic circulation, perhaps at upper body or splanchic sites or both, while having the opposite effect in the leg.

  11. Pharmacologic Atrial Natriuretic Peptide Reduces Human Leg Capillary Filtration

    NASA Technical Reports Server (NTRS)

    Watenpaugh, Donald E.; Vissing, Susanne F.; Lane, Lynda D.; Buckey, Jay C.; Firth, Brian G.; Erdman, William; Hargens, Alan R.; Blomqvist, C. Gunnar

    1995-01-01

    Atrial natriuretic peptide (ANP) is produced and secreted by atrial cells. We measured calf capillary filtration rate with prolonged venous-occlusion plethysmography of supine healthy male subjects during pharmacologic infusion of ANP (48 pmol/kg/min for 15 min; n = 6) and during placebo infusion (n = 7). Results during infusions were compared to prior control measurements. ANP infusion increased plasma (ANP) from 30 +/- 4 to 2,568 +/- 595 pmol/L. Systemic hemoconcentration occurred during ANP infusion: mean hematocrit and plasma colloid osmotic pressure increased 4.6 and 11.3%, respectively, relative to preinfusion baseline values (p less than 0.05). Mean calf filtration, however, was significantly reduced from 0.15 to 0.08 ml/100 ml/min with ANP. Heart rate increased 20% with ANP infusion, whereas blood pressure was unchanged. Calf conductance (blood flow/ arterial pressure) and venous compliance were unaffected by ANP infusion. Placebo infusion had no effect relative to prior baseline control measurements. Although ANP induced systemic capillary filtration, in the calf, filtration was reduced with ANP. Therefore, pharmacologic ANP infusion enhances capillary filtration from the systemic circulation, perhaps at upper body or splanchnic sites or both, while having the opposite effect in the leg.

  12. Anatomical features and clinical importance of left atrial diverticula: MDCT findings.

    PubMed

    Genç, Berhan; Solak, Aynur; Kantarci, Mecit; Bayraktutan, Ummügülsüm; Ogul, Hayri; Yüceler, Zeynep; Oztürk, Ali; Kizrak, Ye?im

    2014-07-01

    To assess the anatomical features and clinical importance of left atrial diverticula and atrial accessory appendages in patients undergoing cardiac computed tomography with multidetector computed tomography. A total of 1305 consecutive patients (385 female, 29.5%; 920 male, 70.5%) were assessed using electrocardiogram-gated computed tomography between May 2010 and June 2013. The anatomical features and the prevalences of left atrial diverticula and left atrial accessory appendages were retrospectively assessed by four radiologists. The relationships between the prevalence and size of the diverticula and the age and gender of the patients were assessed. Among the 1305 patients, 610 (46.7%) exhibited 708 left atrial diverticula, and 62 (4.8%) exhibited left atrial accessory appendages. The most common locations of the left atrial diverticula were the right anterior superior wall (n?=?328, 46.3%) and the lateral superior wall (n?=?96, 13.5%). In addition to classical cystic and tubular diverticula, 49 (3.7%) of the patients exhibited mixed (cystic-tubular), conical, or hook-shaped diverticula and diverticular forms containing mural calcifications. There was no significant relationship between the prevalence of diverticula and the age and gender of the patients (P?>?0.05). In addition to tubular and cystic diverticula, the left atrial wall can host different diverticular forms (such as mixed, conical, calcific, and hook shaped). It could be beneficial to assess the left atrium using MDCT to determine the source of emboli in cryptogenic embolism and to reduce complications associated with interventional procedures performed for left atrial arrhythmias. PMID:24214737

  13. Body surface localization of left and right atrial high-frequency rotors in atrial fibrillation patients: A clinical-computational study

    PubMed Central

    Rodrigo, Miguel; Guillem, María S.; Climent, Andreu M.; Pedrón-Torrecilla, Jorge; Liberos, Alejandro; Millet, José; Fernández-Avilés, Francisco; Atienza, Felipe; Berenfeld, Omer

    2014-01-01

    BACKGROUND Ablation is an effective therapy in patients with atrial fibrillation (AF) in which an electrical driver can be identified. OBJECTIVE The aim of this study was to present and discuss a novel and strictly noninvasive approach to map and identify atrial regions responsible for AF perpetuation. METHODS Surface potential recordings of 14 patients with AF were recorded using a 67-lead recording system. Singularity points (SPs) were identified in surface phase maps after band-pass filtering at the highest dominant frequency (HDF). Mathematical models of combined atria and torso were constructed and used to investigate the ability of surface phase maps to estimate rotor activity in the atrial wall. RESULTS The simulations show that surface SPs originate at atrial SPs, but not all atrial SPs are reflected at the surface. Stable SPs were found in AF signals during 8.3% ± 5.7% vs 73.1% ± 16.8% of the time in unfiltered vs HDF-filtered patient data, respectively (P < .01). The average duration of each rotational pattern was also lower in unfiltered than in HDF-filtered AF signals (160 ± 43 ms vs 342 ± 138 ms; P < .01), resulting in 2.8 ± 0.7 rotations per rotor. Band-pass filtering reduced the apparent meandering of surface HDF rotors by reducing the effect of the atrial electrical activity occurring at different frequencies. Torso surface SPs representing HDF rotors during AF were reflected at specific areas corresponding to the fastest atrial location. CONCLUSION Phase analysis of surface potential signals after HDF filtering during AF shows reentrant drivers localized to either the left atrium or the right atrium, helping in localizing ablation targets. PMID:24846374

  14. Percutaneous transhepatic stenting of a restrictive atrial septal communication in hypoplastic left heart syndrome.

    PubMed

    Al Senaidi, Khalfan; Al Mesned, Abdulrahman; Coe, James Y

    2014-06-01

    The postnatal survival of patients with congenital cardiac defects such as hypoplastic left heart syndrome (HLHS) is dependent on the patency of the ductus arteriosus and the presence of an unrestrictive atrial septal defect (ASD). We report a six week old infant with HLHS and tricuspid valve regurgitation with restrictive ASD. Transfemoral balloon atrial septostomy provided temporary relief but further attempts were not possible. A transhepatic venous approach to stent the atrial communication was technically successful. This approach may be the only access for certain infant cardiac catheterization interventions, permitting the use of a large delivery system (? 8 Fr). PMID:24532371

  15. Cardiac resonant oscillations in terms of finite-dimensional group representation in atrial parasystole.

    PubMed

    Izumi, K; Izumi, S

    1995-01-01

    In order to understand the variation of the atrial parasystolic cycle lengths and mutual interactions of sinus node and atrial parasystolic pacemakers, a representation theory for finite groups of invertible linear transformation on a vector space is considered. A quantitative description of manifest atrial parasystolic cycles can be provided by the mapping in the group multiplication with the use of numerical factors of 2, 4 square root of 2 pi, 2/ 4 square root of 2 pi and 2 4 square root of 2 pi. These represent operators of a linear transformation in matrix multiplication of the similarity transformation representing an isomorphism. PMID:8935146

  16. Predictors of atrial fibrillation recurrence after cryoballoon ablation

    PubMed Central

    Aksu, Tolga; Baysal, Erkan; Guler, Tümer Erdem; Golcuk, Sukriye Ebru; Erden, ?smail; Ozcan, Kazim Serhan

    2015-01-01

    Objective Cryoballoon ablation (CA) is a safe and efficient method for pulmonary vein isolation in the treatment of paroxysmal atrial fibrillation (AF). There are conflicting results about the predictors of AF recurrence. The aim of this study is to evaluate the role of hematological indices to predict AF recurrence after CA. Methods A total of 49 patients (mean age 58.3±12.2 years, 51.02% female) with symptomatic paroxysmal AF underwent CA procedure. One hundred and sixty-eight pulmonary veins were used for pulmonary vein isolation with the second-generation cryoballoon. The hematological samples were obtained before and 24 hours after ablation. Results At a mean follow-up of 10.2±2.4 months, the probability of being arrhythmia-free after a single procedure was 86%. Patients with AF recurrence had higher red cell distribution width levels (16.10%±1.44% vs 14.87%±0.48%, P=0.035). The neutrophil/lymphocyte ratio, erythrocyte sedimentation rate, and C-reactive protein levels were detected in the patients with or without recurrence. Left atrial diameter (46.28±4.30 mm vs 41.02±4.10 mm, P=0.002), duration of AF (6.71±4.57 years vs 3.59±1.72 years, P=0.003), and age (65.01±15.39 years vs 54.29±11.32 years, P=0.033) were the other independent predictors of clinical recurrence after CA. Multiple regression analysis revealed that left atrial diameter was the only independent predictor for AF recurrence (P=0.012). Conclusion In this study of patients with paroxysmal AF undergoing cryoablation, increased preablation red cell distribution width levels, and not C-reactive protein or erythrocyte sedimentation rate, was associated with a higher rate of AF recurrence. Our results support the role of a preablation, proinflammatory, and pro-oxidant environment in the development of AF recurrence after ablation therapy but suggest that other factors are also important. PMID:26170730

  17. Improved frequency resolution for characterization of complex fractionated atrial electrograms

    PubMed Central

    2012-01-01

    Background The dominant frequency of the Fourier power spectrum is useful to analyze complex fractionated atrial electrograms (CFAE), but spectral resolution is limited and uniform from DC to the Nyquist frequency. Herein the spectral resolution of a recently described and relatively new spectral estimation technique is compared to the Fourier radix-2 implementation. Methods In 10 paroxysmal and 10 persistent atrial fibrillation patients, 216 CFAE were acquired from the pulmonary vein ostia and left atrial free wall (977?Hz sampling rate, 8192 sample points, 8.4?s duration). With these parameter values, in the physiologic range of 3–10?Hz, two frequency components can theoretically be resolved at 0.24?Hz using Fourier analysis and at 0.10?Hz on average using the new technique. For testing, two closely-spaced periodic components were synthesized from two different CFAE recordings, and combined with two other CFAE recordings magnified 2×, that served as interference signals. The ability to resolve synthesized frequency components in the range 3–4?Hz, 4–5?Hz, …, 9–10?Hz was determined for 15 trials each (105 total). Results With the added interference, frequency resolution averaged 0.29?±?0.22?Hz for Fourier versus 0.16?±?0.10?Hz for the new method (p?

  18. Percutaneous left atrial appendage closure: Technical aspects and prevention of periprocedural complications with the watchman device

    PubMed Central

    Möbius-Winkler, Sven; Majunke, Nicolas; Sandri, Marcus; Mangner, Norman; Linke, Axel; Stone, Gregg W; Dähnert, Ingo; Schuler, Gerhard; Sick, Peter B

    2015-01-01

    Transcatheter closure of the left atrial appendage has been developed as an alternative to chronic oral anticoagulation for stroke prevention in patients with atrial fibrillation, and as a primary therapy for patients with contraindications to chronic oral anticoagulation. The promise of this new intervention compared with warfarin has been supported by several, small studies and two pivotal randomized trial with the Watchman Device. The results regarding risk reduction for stroke have been favourable although acute complications were not infrequent. Procedural complications, which are mainly related to transseptal puncture and device implantation, include air embolism, pericardial effusions/tamponade and device embolization. Knowledge of nature, management and prevention of complications should minimize the risk of complications and allow transcatheter left atrial appendage closure to emerge as a therapeutic option for patients with atrial fibrillation at risk for cardioembolic stroke. PMID:25717354

  19. 78 FR 11207 - Clinical Study Designs for Surgical Ablation Devices for Treatment of Atrial Fibrillation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-15

    ... September 14, 2009 (74 FR 46996), FDA announced the availability of the draft guidance document. Interested.... Background Atrial fibrillation (AF) is a complex arrhythmia of the heart. This guidance describes elements...

  20. Real-Time Tracking and Shape Analysis of Atrial Septal Defects in 3D Echocardiography1

    E-print Network

    heart procedures. Our application assists pediatric atrial septal defect (ASD) closure techniques using.G.L.); Department of Engi- neering, University of Cambridge, Cambridge, UK (A.K.); Department of Cardiology (G

  1. Digoxin: A systematic review in atrial fibrillation, congestive heart failure and post myocardial infarction

    PubMed Central

    Virgadamo, Sebastiano; Charnigo, Richard; Darrat, Yousef; Morales, Gustavo; Elayi, Claude S

    2015-01-01

    AIM: To review digoxin use in systolic congestive heart failure, atrial fibrillation, and after myocardial infarction. METHODS: A comprehensive PubMed search was performed using the key words “digoxin and congestive heart failure”, “digoxin and atrial fibrillation”, “digoxin, atrial fibrillation and systolic congestive heart failure”, and “digoxin and myocardial infarction”. Only articles written in English were included in this study. We retained studies originating from randomized controlled trials, registries and included at least 500 patients. The studies included patients with atrial fibrillation or heart failure or myocardial infarction and had a significant proportion of patients (at least 5%) on digoxin. A table reviewing the different hazard ratios was developed based on the articles selected. Our primary endpoint was the overall mortality in the patients on digoxin vs those without digoxin, among patients with atrial fibrillation and also among patients with atrial fibrillation and systolic heart failure. We reviewed the most recent international guidelines to discuss current recommendations. RESULTS: A total of 18 studies were found that evaluated digoxin and overall mortality in different clinical settings including systolic congestive heart failure and normal sinus rhythm (n = 5), atrial fibrillation with and without systolic congestive heart failure (n = 9), and myocardial infarction (n = 4). Overall, patients with systolic congestive heart failure with normal sinus rhythm, digoxin appears to have a neutral effect on mortality especially if close digoxin level monitoring is employed. However, most of the observational studies evaluating digoxin use in atrial fibrillation without systolic congestive heart failure showed an increase in overall mortality when taking digoxin. In the studies evaluated in this systematic review, the data among patients with atrial fibrillation and systolic congestive heart failure, as well as post myocardial infarction were more controversial. The extent to which discrepancies among studies are based on statistical methods is currently unclear, as these studies’ findings are generated by retrospective analyses that employed different techniques to address confounding. CONCLUSION: Based on the potential risks and benefits, as well as the presence of alternative drugs, there is a limited role for digoxin in the management of patients with normal sinus rhythm and congestive heart failure. Based on the retrospective studies reviewed there is a growing volume of data showing increased mortality in those with only atrial fibrillation. The proper role of digoxin is, however, less certain in other subgroups of patients, such as those with both atrial fibrillation and systolic congestive heart failure or after a myocardial infarction. Further studies may provide helpful information for such subgroups of patients. PMID:26635929

  2. Effects of Low-Intensity Autonomic Nerve Stimulation on Atrial Electrophysiology

    PubMed Central

    Cho, Youngjin; Cha, Myung-Jin; Choi, Eue-Keun; Oh, Il-Young

    2014-01-01

    Background and Objectives The cardiac autonomic nervous system is an emerging target for therapeutic control of atrial fibrillation (AF). We evaluated the effects of low-intensity autonomic nerve stimulation (LI-ANS) on atrial electrophysiology, AF vulnerability, and neural remodeling. Subjects and Methods Fourteen dogs were subjected to 3 hours rapid atrial pacing (RAP, 5 Hz) and concomitant high frequency LI-ANS (20 Hz, at voltages 40% below the threshold) as follows: no autonomic stimulation (control, n=3); or right cervical vagus nerve (RVN, n=6), anterior right ganglionated plexi (ARGP, n=3), and superior left ganglionated plexi (SLGP, n=2) stimulation. Programmed and burst atrial pacing were performed at baseline and at the end of each hour to determine atrial effective refractory period (ERP), window of vulnerability (WOV), and inducibility of sustained AF. Results Atrial ERP was significantly shortened by 3 hours RAP (in control group, ?ERP=-47.9±8.9%, p=0.032), and RAP-induced ERP shortening was attenuated by LI-ANS (in LI-ANS group, ?ERP=-15.4±5.9%, p=0.019; vs. control, p=0.035). Neither WOV for AF nor AF inducibility changed significantly during 3 hours RAP with simultaneous LI-ANS. There was no significant difference between the control and LI-ANS group in nerve density and sprouting evaluated by anti-tyrosine hydroxylase and anti-growth associated protein-43 staining. Among the various sites for LI-ANS, the ARGP-stimulation group showed marginally lower ?WOV (p=0.077) and lower nerve sprouting (p=0.065) compared to the RVN-stimulation group. Conclusion Low-intensity autonomic nerve stimulation significantly attenuated the shortening of atrial ERP caused by RAP. ARGP may be a better target for LI-ANS than RVN for the purpose of suppressing atrial remodeling in AF. PMID:25089136

  3. Hypertension Is Associated With Preamyloid Oligomers in Human Atrium: A Missing Link in Atrial Pathophysiology?

    PubMed Central

    Sidorova, Tatiana N.; Mace, Lisa C.; Wells, K. Sam; Yermalitskaya, Liudmila V.; Su, Pei?Fang; Shyr, Yu; Atkinson, James B.; Fogo, Agnes B.; Prinsen, Joseph K.; Byrne, John G.; Petracek, Michael R.; Greelish, James P.; Hoff, Steven J.; Ball, Stephen K.; Glabe, Charles G.; Brown, Nancy J.; Barnett, Joey V.; Murray, Katherine T.

    2014-01-01

    Background Increasing evidence indicates that proteotoxicity plays a pathophysiologic role in experimental and human cardiomyopathy. In organ?specific amyloidoses, soluble protein oligomers are the primary cytotoxic species in the process of protein aggregation. While isolated atrial amyloidosis can develop with aging, the presence of preamyloid oligomers (PAOs) in atrial tissue has not been previously investigated. Methods and Results Atrial samples were collected during elective cardiac surgery in patients without a history of atrial arrhythmias, congestive heart failure, cardiomyopathy, or amyloidosis. Immunohistochemistry was performed for PAOs using a conformation?specific antibody, as well as for candidate proteins identified previously in isolated atrial amyloidosis. Using a myocardium?specific marker, the fraction of myocardium colocalizing with PAOs (PAO burden) was quantified (green/red ratio). Atrial samples were obtained from 92 patients, with a mean age of 61.7±13.8 years. Most patients (62%) were male, 23% had diabetes, 72% had hypertension, and 42% had coronary artery disease. A majority (n=62) underwent aortic valve replacement, with fewer undergoing coronary artery bypass grafting (n=34) or mitral valve replacement/repair (n=24). Immunostaining detected intracellular PAOs in a majority of atrial samples, with a heterogeneous distribution throughout the myocardium. Mean green/red ratio value for the samples was 0.11±0.1 (range 0.03 to 0.77), with a value ?0.05 in 74 patients. Atrial natriuretic peptide colocalized with PAOs in myocardium, whereas transthyretin was located in the interstitium. Adjusting for multiple covariates, PAO burden was independently associated with the presence of hypertension. Conclusion PAOs are frequently detected in human atrium, where their presence is associated with clinical hypertension. PMID:25468655

  4. Non-Traumatic Spontaneous Spinal Subdural Hematoma in a Patient with Non-Valvular Atrial Fibrillation During Treatment with Rivaroxaban

    PubMed Central

    Castillo, Jessica M.; Afanador, Hayley F.; Manjarrez, Efren; Morales, Ximena A.

    2015-01-01

    Patient: Male, 69 Final Diagnosis: Spontaneous spinal subdural hematoma Symptoms: Paraplegia Medication: Rivaroxaban Clinical Procedure: — Specialty: General Internal Medicine • Hospital Medicine • Cardiology • Hematology • Neurology Objective: Diagnostic/therapeutic accidents Background: Spontaneous spinal subdural hematoma (SSDH) is a rare but disabling condition, accounting for only 4.1% of all intraspinal hematomas. Risk factors include arteriovenous malformations, coagulopathy, therapeutic anticoagulation, underlying neoplasms, or following spinal puncture. Vitamin K antagonists, antiplatelet agents, and heparinoids have been associated with SSDHs in prior reports. To the best of our knowledge, no cases have reported this association with the factor Xa inhibitor, rivaroxaban, and SSDHs. Case Report: We report the case of a 69-year-old Honduran man with a 5-year history of symptomatic palpitations due to non-valvular atrial fibrillation. He was initially refractory to pharmacologic therapy. He underwent cardioversion in February 2014. After cardioversion, he remained asymptomatic on flecainide. He was anticoagulated on rivaroxaban 20 mg daily without incident since early 2013 until presentation in August 2014. He presented with sudden onset of excruciating upper and lower back pain after minimal movement. This was immediately followed by bilateral lower extremity paresis rapidly progressing to paraplegia with bowel and bladder dysfunction over 15 minutes. Magnetic resonance imaging demonstrated an acute spinal subdural hematoma extending from T3 inferiorly to the conus medullaris. Six months after undergoing cervical and lumbar drainage procedures, he has not recovered bowel, bladder, or lower extremity neurologic function. Conclusions: Non-traumatic spontaneous spinal subdural hematoma is a rare neurological emergency that may occur during the use of rivaroxaban in patients with non-valvular atrial fibrillation. Physicians should suspect SSDH in patients on rivaroxaban with acute onset of severe back pain and neurologic symptoms to improve the odds of a favorable outcome. PMID:26090890

  5. Purification and subunit composition of atrial natriuretic peptide receptor

    SciTech Connect

    Schenk, D.B.; Phelps, M.N.; Porter, J.G.; Fuller, F.; Cordell, B.; Lewicki, J.A.

    1987-03-01

    A receptor for atrial natriuretic peptide (ANP) was purified 2700-fold, to apparent homogeneity, from cultured bovine aortic smooth muscle cells by affinity chromatography. The native ANP receptor has a molecular weight of 125,000 as determined by both metrizamide gradient centrifugation and nonreducing NaDodSO/sub 4//polyacrylamide gel electrophoresis. With /sup 125/I-labeled ANP as ligand, the purified receptor bound a maximum of 5.70 nmol of ligand per mg of protein and the dissociation constant was 4.0 X 10(-10)M. Upon treatment with 10 mM dithiothreitol, the purified receptor migrated as a single band at Mr 60,500 in NaDodSO/sub 4//polyacrylamide gel electrophoresis. These findings show that the holoreceptor for ANP in vascular tissue is composed of two subunits of identical apparent molecular weight, presumably linked by a disulfide bridge(s).

  6. [New frontiers for an ancient disease: genetics of atrial fibrillation].

    PubMed

    Disertori, Marcello; Mazzola, Silvia; Quintarelli, Silvia; Arbustini, Eloisa

    2013-01-01

    Atrial fibrillation (AF) is the commonest sustained arrhythmia in clinical practice, but its treatment is still a challenge for modern cardiology. During the last decade new insights regarding AF genetic background have been achieved. Familial aggregation suggesting a potential heritability was well known in the pre-molecular era. Now, research on the molecular basis of the disease is providing evidence that familial AF is mostly autosomal, both dominant and recessive, and genetically heterogeneous. Mutations in several disease genes with different functional effects may be associated with AF. Early results encourage family studies and monitoring. In addition, genome-wide association studies have recently identified common polymorphisms associated with an increased risk of AF in different large populations. These studies are contributing to provide early answers, but also raise new questions. In this review we analyze existing knowledge on genetics of AF and related potential clinical impact. PMID:23258204

  7. Personalizing oral anticoagulant treatment in patients with atrial fibrillation.

    PubMed

    Capranzano, Piera; Miccichè, Eligio; D'Urso, Lucia; Privitera, Fiorella; Tamburino, Corrado

    2013-08-01

    For decades, warfarin has remained the standard oral anticoagulation for stroke prevention in atrial fibrillation (AF). Three novel oral anticoagulants (NOACs) have been recently approved for stroke prevention in non-valvular AF: dabigatran, rivaroxaban and apixaban. Better pharmacological and clinical profiles make these newcomers a preferable alternative over warfarin. Current AF guidelines do not endorse NOACs over warfarin, or one NOAC over another. Indeed, choice of the anticoagulation regimen should be personalized based on the relative efficacy and safety of different agents across subgroups stratified by thrombotic and bleeding risk, as well as on other clinical factors, including anticoagulation control on warfarin, drug interactions, compliance and need for coagulation monitoring. This review appraises i) the randomized evidence on approved NOACs versus warfarin in AF across subgroups stratified by risk factors of stroke and bleeding and by the anticoagulation level reached on warfarin; and ii) clinical factors impacting on the anticoagulation regimen selection. PMID:23957907

  8. Reactive oxygen species-targeted therapeutic interventions for atrial fibrillation

    PubMed Central

    Sovari, Ali A.; Dudley, Samuel C.

    2012-01-01

    Atrial fibrillation (AF) is the most common arrhythmia that requires medical attention, and its incidence is increasing. Current ion channel blockade therapies and catheter ablation have significant limitations in treatment of AF, mainly because they do not address the underlying pathophysiology of the disease. Oxidative stress has been implicated as a major underlying pathology that promotes AF; however, conventional antioxidants have not shown impressive therapeutic effects. A more careful design of antioxidant therapies and better selection of patients likely are required to treat effectively AF with antioxidant agents. Current evidence suggest inhibition of prominent cardiac sources of reactive oxygen species (ROS) such as nicotinamide adenine dinucleotide phosphate (NADPH) oxidase and targeting subcellular compartments with the highest levels of ROS may prove to be effective therapies for AF. Increased serum markers of oxidative stress may be an important guide in selecting the AF patients who will most likely respond to antioxidant therapy. PMID:22934062

  9. Epidemiology, diagnosis, and management of atrial fibrillation in women

    PubMed Central

    Poli, Daniela; Antonucci, Emilia

    2015-01-01

    Atrial fibrillation (AF) is the most common arrhythmia and has become a serious public health problem. Moreover, epidemiological data demonstrate that incidence and prevalence of AF are increasing. Several differences in epidemiological patterns, clinical manifestations, and incidence of stroke have been reported between AF in women and in men, particularly in elderly women. Elderly women have higher blood pressure than men and a higher prevalence of heart failure with preserved ejection fraction, both independent risk factors for stroke. On the basis of the evidence on the higher stroke risk among AF in women, recently, female sex has been accepted as a risk factor for stroke and adopted to stratify patients, especially if they are not at high risk for stroke. This review focuses on available evidence on sex differences in AF patients, and examines factors contributing to different stroke risk, diagnosis, and prognosis of arrhythmia in women, with the aim to provide an analysis of the available evidence. PMID:26089706

  10. Physician's Fear of Anticoagulant Therapy in Nonvalvular Atrial Fibrillation

    PubMed Central

    Dahlberg, Katherine Willett

    2014-01-01

    Abstract: Despite the availability of predictive tools and treatment guidelines, anticoagulant therapies are underprescribed and many patients are undertreated for conditions that predispose to thromboembolic complications, including stroke. This review explores reasons for which physicians fear that the risks of anticoagulation may be greater than the potential benefit. The results of numerous clinical trials confirm that patients benefit from judiciously managed anticoagulation and that physicians can take various approaches to minimize risk. Use of stratification scores for patient selection and accurate estimation of stroke risk may improve outcomes; bleeding risk is less important than stroke risk. Adoption of newer anticoagulants with simpler regimens may help physicians allay their fears of anticoagulant use in patients with atrial fibrillation. These fears, although not groundless, should not overtake caution and hinder the delivery of appropriate evidence-based care. PMID:25285512

  11. An N-terminal pro-atrial natriuretic peptide (NT-proANP) 'aggregation-prone' segment involved in isolated atrial amyloidosis.

    PubMed

    Louros, Nikolaos N; Iconomidou, Vassiliki A; Tsiolaki, Paraskevi L; Chrysina, Evangelia D; Baltatzis, Georgios E; Patsouris, Efstratios S; Hamodrakas, Stavros J

    2014-01-01

    Isolated atrial amyloidosis (IAA) is a common localized form of amyloid deposition within the atria of the aging heart. The main constituents of amyloid fibrils are atrial natriuretic peptide (ANP) and the N-terminal part of its precursor form (NT-proANP). An 'aggregation-prone' heptapeptide ((114)KLRALLT(120)) was located within the NT-proANP sequence. This peptide self-assembles into amyloid-like fibrils in vitro, as electron microscopy, X-ray fiber diffraction, ATR FT-IR spectroscopy and Congo red staining studies reveal. Consequently, remedies/drugs designed to inhibit the aggregation tendency of this 'aggregation-prone' segment of NT-proANP may assist in prevention/treatment of IAA, congestive heart failure (CHF) or atrial fibrillation (AF). PMID:24220659

  12. The morphology and location of atrial specific granules and the demonstration of atrial natriuretic factor in porcine, lapine and bovine heart by immunoelectronmicroscopy.

    PubMed

    Castagnaro, M; Guarda, F; Lucchi, M L; Bortolami, R

    1991-01-01

    The atrial specific granules (ASGs) were studied in samples collected from the right and left auricles of conventionally slaughtered cows (10), pigs (16) and rabbits (8). In addition, the presence of atrial natriuretic factor (ANF) was detected by immunocytochemistry. Mature ASGs, characterized by the presence of highly osmiophilic and electron-dense material surrounded by a membrane, were present in all atrial myoendocrine cells and their diameters ranged from 100 to 470 nm in pigs, from 100 to 235 nm in cattle, and from 125 to 275 nm in rabbits. Immunoelectronmicroscopical studies revealed the presence of ANF in the ASGs of pigs and cattle, whereas anti-ANF polyclonal serum failed to detect any significative reaction in lapine ASGs. The ultrastructural features of the ASGs of pigs, cattle and rabbits described may be useful in comparing the morphological picture of several cardiac endocrine pathological conditions. PMID:1837636

  13. The Role of Magnetic Resonance Imaging and Cardiac Computed Tomography in the Assessment of Left Atrial Anatomy, Size, and Function

    PubMed Central

    Kuchynka, Petr; Podzimkova, Jana; Masek, Martin; Lambert, Lukas; Cerny, Vladimir; Danek, Barbara; Palecek, Tomas

    2015-01-01

    In the last decade, there has been increasing evidence that comprehensive evaluation of the left atrium is of utmost importance. Numerous studies have clearly demonstrated the prognostic value of left atrial volume for long-term outcome. Furthermore, advances in catheter ablation procedures used for the treatment of drug-refractory atrial fibrillation require the need for detailed knowledge of left atrial and pulmonary venous morphology as well of atrial wall characteristics. This review article discusses the role of cardiac magnetic resonance and computed tomography in assessment of left atrial size, its normal and abnormal morphology, and function. Special interest is paid to the utility of these rapidly involving noninvasive imaging methods before and after atrial fibrillation ablation. PMID:26221583

  14. Atrial Fibrillation and Stroke: The Evolving Role of Rhythm Control

    PubMed Central

    Patel, Taral K.; Passman, Rod S.

    2013-01-01

    Opinion statement Atrial fibrillation (AF) remains a major risk factor for stroke. Unfortunately, clinical trials have failed to demonstrate that a strategy of rhythm control—therapy to maintain normal sinus rhythm (NSR)—reduces stroke risk. The apparent lack of benefit of rhythm control likely reflects the difficulty in maintaining NSR using currently available therapies. However, there are signals from several trials that the presence of NSR is indeed beneficial and associated with better outcomes related to stroke and mortality. Most electrophysiologists feel that as rhythm control strategies continue to improve, the crucial link between rhythm control and stroke reduction will finally be demonstrated. Therefore, AF specialists tend to be aggressive in their attempts to maintain NSR, especially in patients who have symptomatic AF. A step-wise approach from antiarrhythmic drugs to catheter ablation to cardiac surgery is generally used. In select patients, catheter ablation or cardiac surgery may supersede antiarrhythmic drugs. The choice depends on the type of AF, concurrent heart disease, drug toxicity profiles, procedural risks, and patient preferences. Regardless of strategy, given the limited effectiveness of currently available rhythm control therapies, oral anticoagulation is still recommended for stroke prophylaxis in AF patients with other stroke risk factors. Major challenges in atrial fibrillation management include selecting patients most likely to benefit from rhythm control, choosing specific antiarrhythmic drugs or procedures to achieve rhythm control, long-term monitoring to gauge the efficacy of rhythm control, and determining which (if any) patients may safely discontinue anticoagulation if long-term NSR is achieved. PMID:23397289

  15. Intracardiac Echocardiography Evaluation in Secundum Atrial Septal Defect Transcatheter Closure

    SciTech Connect

    Zanchetta, Mario; Pedon, Luigi; Rigatelli, Gianluca; Carrozza, Antonio; Zennaro, Marco; Di Martino, Roberta; Onorato, Eustaquio; Maiolino, Pietro

    2003-02-15

    Purpose: This study was designed to assess the balloon sizing maneuvers and deployment of an Amplatzer Septal Occluder (ASO). In addition, intraprocedural balloon sizing was compared with off-line intracardiac echocardiographic measurements. Methods: The intracardiac echocardiography (ICE) measurements were: maximum transverse and longitudinal atrial septal defect (ASD) diameters in the aortic valve and four-chamber planes;area of the ASD and its equivalent circle diameter. Thirteen consecutive patients underwent transcatheter implantation of an ASO device using ICE guidance under local anesthesia. The device matching the balloon sizing diameter of the defect was implanted. Qualitative ICE assessment of the ASO devices implanted was performed off line. Results: The mean equivalent circle diameter predicted by ICE was 24.40 {+-} 5.61 mm and was significantly higher(p 0.027) than the ASD measured by balloonsizing (21.38 {+-} 5.28 mm). Unlike previous studies we did not find any correlation between the two measurements (correlation coefficient = 0.47). Only four of the 13 patients had optimal device positioning as shown by the qualitative ICE evaluation, whereas the remaining nine patients had inadequate device placement. This resulted in a waist diameter that was an average 26.1% undersized in seven patients and 12.7% oversized in two patients. Five of the seven patients with an undersized device had ASO-atrial septum misalignment with leftward device deviation. Conclusion: The ICE images allowed careful measurement of the dimensions of the ASD and accurately displayed the spatial relations of the ASO astride the ASD.Moreover, use of the ICE measurement led to selection of a different size of device in comparison with those of balloon sizing. The clinical benefit of this new approach needs to be rigorously tested.

  16. A fully adaptive multiresolution algorithm for atrial arrhythmia simulation on anatomically realistic unstructured meshes.

    PubMed

    Cristoforetti, Alessandro; Mase, Michela; Ravelli, Flavia

    2013-09-01

    Biophysically detailed and anatomically realistic atrial models are emerging as a valuable tool in the study of atrial arrhythmias, nevertheless clinical use of these models would be favored by a reduction of computational times. This paper introduces a novel adaptive mesh algorithm, based on multiresolution representation (MR), for the efficient integration of cardiac ordinary differential equation (ODE)-partial differential equation (PDE) systems on unstructured triangle meshes. The algorithm applies a dynamically adapted node-centered finite volume method (FVM) scheme for integration of diffusion. The method accuracy and efficiency were evaluated by simulating propagation scenarios of increasing complexity levels (pacing, stable spirals, atrial fibrillation) on tomography-derived three-dimensional monolayer atrial models, based on a monodomain reaction-diffusion formulation coupled with the Courtemanche atrial ionic model. All simulated propagation patterns were accurately reproduced with substantially reduced computational times (10%-30% of the full-resolution simulation time). The proposed algorithm, combining the MR computational efficiency with the geometrical flexibility of unstructured meshes, may favor the development of patient-specific multiscale models of atrial arrhythmias and their application in the clinical setting. PMID:23674407

  17. Role of the autonomic nervous system in atrial fibrillation: pathophysiology and therapy.

    PubMed

    Chen, Peng-Sheng; Chen, Lan S; Fishbein, Michael C; Lin, Shien-Fong; Nattel, Stanley

    2014-04-25

    Autonomic nervous system activation can induce significant and heterogeneous changes of atrial electrophysiology and induce atrial tachyarrhythmias, including atrial tachycardia and atrial fibrillation (AF). The importance of the autonomic nervous system in atrial arrhythmogenesis is also supported by circadian variation in the incidence of symptomatic AF in humans. Methods that reduce autonomic innervation or outflow have been shown to reduce the incidence of spontaneous or induced atrial arrhythmias, suggesting that neuromodulation may be helpful in controlling AF. In this review, we focus on the relationship between the autonomic nervous system and the pathophysiology of AF and the potential benefit and limitations of neuromodulation in the management of this arrhythmia. We conclude that autonomic nerve activity plays an important role in the initiation and maintenance of AF, and modulating autonomic nerve function may contribute to AF control. Potential therapeutic applications include ganglionated plexus ablation, renal sympathetic denervation, cervical vagal nerve stimulation, baroreflex stimulation, cutaneous stimulation, novel drug approaches, and biological therapies. Although the role of the autonomic nervous system has long been recognized, new science and new technologies promise exciting prospects for the future. PMID:24763467

  18. Modified radial v/s biatrial maze for atrial fibrillation in rheumatic valvular heart surgery

    PubMed Central

    Sayed, Sajid A.; Katewa, Ashish; Srivastava, Vivek; Jana, Sujit; Patwardhan, Anil M.

    2014-01-01

    Background Atrial fibrillation (AF) is commonest sustained atrial arrhythmia producing high morbidity. Although Cox's Maze III procedure cures AF in majority, reduced atrial transport function (ATF) is a concern. Radial approach with ablation lines radial from sinus node towards atrioventricular annulii and parallel to atrial coronary arteries, has shown better ATF. Methods Single blind open randomized prospective study of 80 patients was undertaken in two groups (40 each) of modified Cox's maze III and modified radial approach, to evaluate conversion to normal sinus rhythm (NSR) and ATF. Patients undergoing surgery for rheumatic valvular heart disease with continuous AF were prospectively randomized. Ablation lines were created with radiofrequency (RF) bipolar coagulation with cryoablation for the isthmal lesions and coronary sinus. Results were compared at 6 months and ATF was evaluated by atrial filling fraction (AFF) and A/E ratio on echocardiography. Results The rate of conversion to NSR in both groups was statistically insignificant by Fisher's exact test (p > 0.05). ATF was better in modified radial approach compared to modified Cox's Maze III (A/E compared by unpaired t test:0.52 ± 0.08 v/s 0.36 ± 0.10; p < 0.05. AFF compared using Mann Whitney U test: median AFF for radial group was 23 v/s 20 for biatrial group; p < 0.05). Discussion In patients with AF undergoing rheumatic valvular surgery, radiofrequency radial approach is as effective as modified Cox's maze III for conversion to NSR with better atrial transport function. PMID:25443604

  19. Mathematical Approaches to Understanding and Imaging Atrial Fibrillation: Significance for Mechanisms and Management

    PubMed Central

    Trayanova, Natalia A

    2014-01-01

    Atrial fibrillation (AF) is the most common sustained arrhythmia in humans. The mechanisms that govern AF initiation and persistence are highly complex, of dynamic nature, and involve interactions across multiple temporal and spatial scales in the atria. This articles aims to review the mathematical modeling and computer simulation approaches to understanding AF mechanisms and aiding in its management. Various atrial modeling approaches are presented, with descriptions of the methodological basis and advancements in both lower-dimensional and realistic geometry models. A review of the most significant mechanistic insights made by atrial simulations is provided. The article showcases the contributions that atrial modeling and simulation have made not only to our understanding of the pathophysiology of atrial arrhythmias, but also to the development of AF management approaches. A summary of the future developments envisioned for the field of atrial simulation and modeling is also presented. The review contends that computational models of the atria assembled with data from clinical imaging modalities that incorporate electrophysiological and structural remodeling could become a first line of screening for new AF therapies and approaches, new diagnostic developments, and new methods for arrhythmia prevention. PMID:24763468

  20. Incidence of new onset atrial fibrillation in patients with permanent pacemakers and the relation to the pacing mode

    PubMed Central

    Said, Sarmad; Alkhateeb, Haider; Cooper, Chad J.; Gosavi, Sucheta; Dwivedi, Alok; Paez, David; Abedin, Zainul

    2014-01-01

    Background Atrial fibrillation is a relatively common arrhythmia often seen in patients with permanent pacemakers. In this study we aimed to assess the incidence of atrial fibrillation in patients whose pacemakers were programmed to pace in the right ventricle (VVI) and compared it with patients whose pacemakers were programmed in non-VVI mode(i.e. AAI or DDD). Material/Methods Records of the patients with permanent pacemaker or implantable-cardioverter-defibrillator were evaluated and analyzed. These patients had regular periodic follow-up evaluation over the last 10 years. (January 1, 2002 to December 31, 2012). Patient demographic, pacemaker data, pacing mode, review and analysis of arrhythmia log for occurrence of new atrial fibrillation and echocardiographic findings for left atrial size, mitral regurgitation, were analyzed and recorded. Left atrial size was classified as mild, moderate or severe enlargement, depending on the left atrial dimension. Results Average age was 68 years. There was no gender predominance (51% male). Mean follow-up duration was 6 years and 3 months. Hispanic population represented the majority of the patients (65.4%). Majority of the devices (80.0%) were programmed as DDD pacing mode. Fifty-five patients (52.8%) did not develop atrial fibrillation. 85.7% of the patients paced in VVI-mode had atrial fibrillation while atrial fibrillation occurred in 37.4% among patients paced in non-VVI-mode. This difference was statistically significant (P<0.0001). Conclusions Right ventricular pacing in a VVI mode was associated with higher incidence of atrial fibrillation, mitral regurgitation and left atrial enlargement. Non-VVI based pacing demonstrated lower incidence of new onset atrial fibrillation. PMID:24535068

  1. Reduction of radiation exposure in catheter ablation of atrial fibrillation: Lesson learned.

    PubMed

    De Ponti, Roberto

    2015-08-26

    Over the last decades, the concern for the radiation injury hazard to the patients and the professional staff has increased in the medical community. Since there is no magnitude of radiation exposure that is known to be completely safe, the use of ionizing radiation during medical diagnostic or interventional procedures should be as low as reasonably achievable (ALARA principle). Nevertheless, in cardiovascular medicine, radiation exposure for coronary percutaneous interventions or catheter ablation of cardiac arrhythmias may be high: for ablation of a complex arrhythmia, such as atrial fibrillation, the mean dose can be > 15 mSv and in some cases > 50 mSv. In interventional electrophysiology, although fluoroscopy has been widely used since the beginning to navigate catheters in the heart and the vessels and to monitor their position, the procedure is not based on fluoroscopic imaging. Therefore, non-fluoroscopic three-dimensional systems can be used to navigate electrophysiology catheters in the heart with no or minimal use of fluoroscopy. Although zero-fluoroscopy procedures are feasible in limited series, there may be difficulties in using no fluoroscopy on a routine basis. Currently, a significant reduction in radiation exposure towards near zero-fluoroscopy procedures seems a simpler task to achieve, especially in ablation of complex arrhythmias, such as atrial fibrillation. The data reported in the literature suggest the following three considerations. First, the use of the non-fluoroscopic systems is associated with a consistent reduction in radiation exposure in multiple centers: the more sophisticated and reliable this technology is, the higher the reduction in radiation exposure. Second, the use of these systems does not automatically lead to reduction of radiation exposure, but an optimized workflow should be developed and adopted for a safe non-fluoroscopic navigation of catheters. Third, at any level of expertise, there is a specific learning curve for the operators in the non-fluoroscopic manipulation of catheters; however, the learning curve is shorter for more experienced operators compared to less experienced operators. PMID:26322183

  2. Left atrial-oesophageal fistula: a very rare, potentially fatal complication of radiofrequency ablation for atrial fibrillation

    PubMed Central

    Garala, Kanai; Gunarathne, Ashan; Jarvis, Martin; Stafford, Peter

    2013-01-01

    A 56-year-old man underwent radiofrequency ablation for atrial fibrillation. Four weeks later he presented with sepsis and neurological symptoms. Urine analysis demonstrated the presence of blood and protein. A CT scan showed pockets of air in the left atrium. An MRI brain scan revealed multiple cerebral abscesses. The patient developed a third heart sound and splinter haemorrhages. He was subsequently referred to cardiology for transoesophageal echocardiography after starting a course of intravenous meropenem. The cardiology team noted that this individual presented with a triad of infections, neurological sequelae and air in the left atrium after an ablation procedure and diagnosed atrio-oesophageal fistula. A decision to operate was made 9?days after admission. At surgery an area of caseous ulceration was found on the posterior wall of the left atrium overlying the oesophagus. PCR analysis revealed Mycoplasma salivarium, part of the oral flora. PMID:24259529

  3. Percutaneous trans-jugular vein closure of atrial septal defect with steerable introducer under echocardiographic guidance

    PubMed Central

    Fang, Jian; Ma, Lunchao; Kuang, Suhua; Lu, Guoliang; Zhang, Yingyuan; Liao, Shengjie

    2015-01-01

    Background The aim of this study is to discuss a novel surgical approach of percutaneous trans-jugular vein closure of atrial septal defect (ASD) with steerable introducer under echocardiographic guidance. Methods From January 2015 to June 2015, ten ASD patients underwent percutaneous trans-jugular vein ASD closure, the occluder placement could be perpendicular to the plane of ASD using the steerable introducer. Results All cases succeeded. The average procedure time was 27.4±5.6 minutes; and the average intracardiac operation time was 6.7±5.2 minutes. No patient showed the residual shunt after the procedure. There was no clinical death, no arrhythmia, no hemolysis, no infection, no jugular vein damage or occlusion during patients’ hospitalization. The post-operation follow up after one month of the operation showed that there was no residual shunt, no falling off or detachment of occluders or other complications. Conclusions It is a new surgical method with easy operation, mild damage and wider indication. Compared with the traditional percutaneous and transthoracic closure of ASD, it has obvious advantages. PMID:26623109

  4. Transient cerebral ischemia in an elderly patient with patent foramen ovale and atrial septal aneurysm

    PubMed Central

    Merante, Alfonso; Gareri, Pietro; Castagna, Alberto; Marigliano, Norma Maria; Candigliota, Mafalda; Ferraro, Alessandro; Ruotolo, Giovanni

    2015-01-01

    Cerebrovascular disease is one of the most common causes of cerebrovascular morbidity and mortality in developed countries; up to 40% of acute ischemic strokes in young adults are cryptogenic in nature – that is, no cause is determined. However, in more than half of these patients, patent foramen ovale (PFO) is seen along with an increased incidence of atrial septal aneurysm (ASA). The following is a report of an interesting case: a 68-year-old man with ASA and transient cerebral ischemia. Transesophageal echocardiography (TEE) showed the presence of ASA; a test with microbubbles derived from a mixture of air and saline or colloids pointed out a shunt on the foramen ovale following Valsalva’s maneuver. The patient underwent percutaneous transcatheter closure of the interatrial communication by an interventional cardiologist. TEE and transcranial Doppler or TEE with the microbubbles test are the recommended methods for detecting and quantifying intracardiac shunts, both at rest and following Valsalva’s maneuver. In patients following the first event of transient ischemic attack, and without clinical and anatomical risk factors (such as the presence of ASA, PFO, and basal shunt), pharmacological treatment with antiplatelets or anticoagulants is closely recommended. On the contrary, in patients following the first event of transient ischemic attack, or a recurrent event during antiplatelet treatment, the percutaneous closure of PFO is recommended. PMID:26379429

  5. Automatic planning of atrial fibrillation ablation lines using landmark-constrained nonrigid registration

    PubMed Central

    Koch, Martin; Brost, Alexander; Bourier, Felix; Hornegger, Joachim; Strobel, Norbert

    2014-01-01

    Abstract. Catheter ablation is a common treatment option for drug-refractory atrial fibrillation. In many cases, pulmonary vein isolation is the treatment of choice. With current fluoro overlay methods or electroanatomic mapping systems, it is possible to visualize three-dimensional (3-D) anatomy as well as target ablation lines to provide additional context information. Today, however, these lines need to be set manually before the procedure by the physician, which may interrupt the clinical workflow. As a solution, we present an automatic approach for the planning of ablation target lines. Our method works on surface models extracted from 3-D images. To propose suitable ablation lines, a reference model annotated with reference ablation lines is nonrigidly registered to the model segmented from a new patient’s 3-D data. After registration, the reference plan is transferred from the reference anatomy to the individual patient anatomy. Due to the high anatomical variations observed in clinical practice, additional landmark constraints are employed in the registration process to increase the robustness of our approach. We evaluated our method on 43 clinical datasets by benchmarking it against professionally planned ablation lines and achieved an average error over all datasets of 2.7±2.0??mm. A qualitative evaluation of the ablation planning lines matched clinical expectations. PMID:26158027

  6. [Cardiac extension of a non-Hodgkin lymphoma revealed by an atrial flutter].

    PubMed

    Mioulet, D; Braem, L; Heno, P; Paule, P; Peloni, J-M; Bonnet, D; Fourcade, L

    2009-04-01

    Primary or secondary cardiac lymphomas are not frequent. Their clinical expression is unusual and the diagnosis is rarely made during the patient's life. Our case report, which is a slow atrial flutter with a pericardial effusion, is an uncommon discovery mode for a malignant lymphoma. Their diagnosis and the mechanism of the arythmia were allowed by non-invasive cardiac imagery (transesophageal echography and magnetic resonance imaging), which showed a tumour-like infiltration of the right atrium, of the right ventricle posterior wall, and of the atrioventricular junction. The diagnosis of a high grade B cell malignant non-hodgkin lymphoma, involving the bone marrow, the liver and the kidneys was made by biopsies of lymph nodes, histological analysis of the bone marrow, and a body CT scan. Throughout the first chemotherapy sequence, we observed a spontaneous return to a sinusal rhythm, and the cardiac MRI showed a regression of the myocardial infiltration and of the pericardial effusion; moreover, the patient's state improved and the peripheral lymph nodes shrank back to a normal size. However, the patient passed away, due to neurological complications 13 months after the diagnosis of lymphoma, without recurrence of cardiac involvement. PMID:18657797

  7. Circulating fibrosis biomarkers and risk of atrial fibrillation: The Cardiovascular Health Study (CHS)

    PubMed Central

    Rosenberg, Michael A.; Maziarz, Marlena; Tan, Alex Y.; Glazer, Nicole L.; Zieman, Susan J.; Kizer, Jorge R.; Ix, Joachim H.; Djousse, Luc; Siscovick, David S.; Heckbert, Susan R.; Mukamal, Kenneth J.

    2014-01-01

    Background Cardiac fibrosis is thought to play a central role in the pathogenesis of atrial fibrillation (AF). Retrospective studies have suggested that circulating fibrosis biomarkers are associated with AF, but prospective studies are limited. Methods We measured circulating levels of 2 fibrosis biomarkers, procollagen type III, N-terminal propeptide (PIIINP) and transforming growth factor ?1 among participants of the CHS, a population-based study of older Americans. We used Cox proportional hazards and competing risks models to examine adjusted risk of incident AF over a median follow-up of 8.8 years. Results Levels of PIIINP were assessed in 2,935 participants, of whom 767 developed AF. Compared with the median PIIINP level (4.45 ?g/L), adjusted hazard ratios (95% CIs) were 0.85 (0.72–1.00) at the 10th percentile, 0.93 (0.88–0.99) at the 25th percentile, 1.04 (0.95–1.04) at the 75th percentile, and 1.07 (0.90–1.26) at the 90th. Transforming growth factor ?1 levels, assessed in 1,538 participants with 408 cases of incident AF, were not associated with AF risk. Conclusion In older adults, PIIINP levels were associated with risk of incident AF in a complex manner, with an association that appeared to be positive up to median levels but with little relationship beyond that. Further studies are required to confirm and possibly delineate the mechanism for this relationship. PMID:24766983

  8. Analysis on Differential Gene Expression Data for Prediction of New Biological Features in Permanent Atrial Fibrillation

    PubMed Central

    Ou, Feng; Rao, Nini; Jiang, Xudong; Qian, Mengyao; Feng, Wei; Yin, Lixue; Chen, Xu

    2013-01-01

    Permanent Atrial fibrillation (pmAF) has largely remained incurable since the existing information for explaining precise mechanisms underlying pmAF is not sufficient. Microarray analysis offers a broader and unbiased approach to identify and predict new biological features of pmAF. By considering the unbalanced sample numbers in most microarray data of case - control, we designed an asymmetric principal component analysis algorithm and applied it to re - analyze differential gene expression data of pmAF patients and control samples for predicting new biological features. Finally, we identified 51 differentially expressed genes using the proposed method, in which 42 differentially expressed genes are new findings compared with two related works on the same data and the existing studies. The enrichment analysis illustrated the reliability of identified differentially expressed genes. Moreover, we predicted three new pmAF – related signaling pathways using the identified differentially expressed genes via the KO-Based Annotation System. Our analysis and the existing studies supported that the predicted signaling pathways may promote the pmAF progression. The results above are worthy to do further experimental studies. This work provides some new insights into molecular features of pmAF. It has also the potentially important implications for improved understanding of the molecular mechanisms of pmAF. PMID:24204599

  9. Chocolate Consumption and Risk of Atrial Fibrillation (from the Physicians' Health Study).

    PubMed

    Khawaja, Owais; Petrone, Andrew B; Kanjwal, Yousuf; Gaziano, John M; Djoussé, Luc

    2015-08-15

    Chocolate consumption has been shown to protect against various cardiovascular end points; however, little is known about the association between chocolate consumption and incident atrial fibrillation (AF). Therefore, we prospectively examined the association between chocolate consumption and incident AF in a cohort of 18,819 US male physicians. Chocolate consumption was ascertained from 1999 to 2002 through a self-administered food frequency questionnaire. Incident AF was ascertained through yearly follow-up questionnaires. Cox regression was used to estimate relative risks of AF. The average age at baseline was 66 years (±9.1). During a mean follow-up of 9.0 years (±3.0), 2,092 cases of AF occurred. Using <1 per month of chocolate consumption as the reference group, multivariable adjusted hazard ratios (95% confidence interval) for AF were 1.04 (0.93 to 1.18), 1.10 (0.96 to 1.25), 1.14 (0.99 to 1.31), and 1.05 (0.89 to 1.25) for chocolate intake of 1 to 3 per month and 1, 2 to 4, and ?5 per week (p for trend 0.25), respectively. In a secondary analysis, there was no evidence of effect modification by adiposity (p interaction = 0.71) or age (p interaction = 0.26). In conclusion, our data did not support an association between chocolate consumption and risk of AF in US male physicians. PMID:26076989

  10. Infantile Systemic Hyalinosis Complicated with Right Atrial Thrombus and Pericardial Effusion in an Infant.

    PubMed

    Mohamed, Sarar; Ahmed, Wafa; Al-Jurayyan, Nasir; Faqeih, Eisa; Al-Nemri, Abdulrahman; Al-Ghamdi, Mohamed

    2014-11-21

    Infantile systemic hyalinosis (ISH) is a rare multisystem fatal autosomal recessive disorder that involves widespread deposition of hyaline on connective tissues and certain internal organs. The major manifestations include painful articular contractures, hyperpigmentation, subcutaneous nodules, gingival hypertrophy, failure to thrive secondary to protein-losing enteropathy, and osteolytic bone lesions. In this paper, we report a 12-month-old girl with ISH presenting with recurrent diarrhea, failure to thrive, and refractory infections. A molecular study identified a homozygous missense mutation, c.134T > C; p.L45P, in exon 1 of the anthrax toxin receptor 2 (ANTRX2) gene. Our patient passed through an eventful course that included septic shock, central line infections, right atrial thrombosis, and pericardial effusion. She incurred acute bronchiolitis due to respiratory syncytial virus infection, which led to her death. In conclusion, this case report highlights that severe and life-threatening morbidities and complications can be encountered in ISH, to which some management options can be applied. PMID:25458638

  11. The Association between Job Strain and Atrial Fibrillation: Results from the Swedish WOLF Study

    PubMed Central

    Fransson, Eleonor I.; Stadin, Magdalena; Nordin, Maria; Malm, Dan; Knutsson, Anders; Alfredsson, Lars; Westerholm, Peter J. M.

    2015-01-01

    Introduction. Atrial fibrillation (AF) is a common heart rhythm disorder. Several life-style factors have been identified as risk factors for AF, but less is known about the impact of work-related stress. This study aims to evaluate the association between work-related stress, defined as job strain, and risk of AF. Methods. Data from the Swedish WOLF study was used, comprising 10,121 working men and women. Job strain was measured by the demand-control model. Information on incident AF was derived from national registers. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between job strain and AF risk. Results. In total, 253 incident AF cases were identified during a total follow-up time of 132,387 person-years. Job strain was associated with AF risk in a time-dependent manner, with stronger association after 10.7 years of follow-up (HR 1.93, 95% CI 1.10–3.36 after 10.7 years, versus HR 1.11, 95% CI 0.67–1.83 before 10.7 years). The results pointed towards a dose-response relationship when taking accumulated exposure to job strain over time into account. Conclusion. This study provides support to the hypothesis that work-related stress defined as job strain is linked to an increased risk of AF. PMID:26557661

  12. Aorto-right atrial fistula secondary to rupture of an occluded old saphenous venous graft to right coronary artery.

    PubMed

    Balestrini, Carlos Sebastian; Saaibi, José Federico; Ortiz, Santiago Navas

    2014-09-01

    We report a case of an acquired aorta-right atrial fistula, secondary to a ruptured proximal anastomosis of an old saphenous vein graft 12 years after a coronary artery bypass surgery, in a 57 year old patient with multiple cardiovascular risk factors. On admission, he presented with congestive heart failure and on examination a continuous murmur was detected on the right parasternal border. Catheterization showed a fistula from the proximal anastomosis of an occluded right coronary artery saphenous vein graft draining to the right atrium with a large left to right shunt. The fistula was successfully occluded by a percutaneous approach with a Life Tech duct occluder with complete resolution of heart failure. The patient was discharged one week afterwards. After a two-year follow-up, the fistula remained occluded. PMID:23404794

  13. Sinus Venosus Atrial Septal Defect as a Cause of Palpitations and Dyspnea in an Adult: A Diagnostic Imaging Challenge

    PubMed Central

    Donovan, Michael S.; Kassop, David; Liotta, Robert A.; Hulten, Edward A.

    2015-01-01

    Sinus venosus atrial septal defects (SV-ASD) have nonspecific clinical presentations and represent a diagnostic imaging challenge. Transthoracic echocardiography (TTE) remains the initial diagnostic imaging modality. However, detection rates have been as low as 12%. Transesophageal echocardiography (TEE) improves diagnostic accuracy though it may not detect commonly associated partial anomalous pulmonary venous return (PAPVR). Cardiac magnetic resonance (CMR) imaging provides a noninvasive, highly sensitive and specific imaging modality of SV-ASD. We describe a case of an adult male with exercise-induced, paroxysmal supraventricular tachycardia who presented with palpitations and dyspnea. Despite nondiagnostic imaging results on TTE, CMR proved to be instrumental in visualizing a hemodynamically significant SV-ASD with PAPVR that ultimately led to surgical correction. PMID:25705227

  14. Brain Abscess Associated with Isolated Left Superior Vena Cava Draining into the Left Atrium in the Absence of Coronary Sinus and Atrial Septal Defect

    SciTech Connect

    Erol, Ilknur Cetin, I. Ilker; Alehan, Fuesun; Varan, Birguel; Ozkan, Sueleyman; Agildere, A. Muhtesem; Tokel, Kursad

    2006-06-15

    A previously healthy 12-year-old girl presented with severe headache for 2 weeks. On physical examination, there was finger clubbing without apparent cyanosis. Neurological examination revealed only papiledema without focal neurologic signs. Cerebral magnetic resonance imaging showed the characteristic features of brain abscess in the left frontal lobe. Cardiologic workup to exclude a right-to-left shunt showed an abnormality of the systemic venous drainage: presence of isolated left superior vena cava draining into the left atrium in the absence of coronary sinus and atrial septal defect. This anomaly is rare, because only a few other cases have been reported.

  15. Myocardial glucose and lactate metabolism during rest and atrial pacing in humans.

    PubMed

    Bergman, Bryan C; Tsvetkova, Tatiana; Lowes, Brian; Wolfel, Eugene E

    2009-05-01

    There is minimal in vivo data in humans evaluating myocardial substrate utilization during increased heart work. This study was performed to determine the balance of myocardial glucose and lactate metabolism during rest and increased heart work induced by atrial pacing in seven healthy men and women (age, 49.7 +/- 3.9 years; body mass index, 23.4 +/- 1.1 kg m(-2), maximum oxygen consumption, 35.5 +/- 3.0 ml kg(-1) min(-1), ejection fraction, 68 +/- 3%). After 3 days of dietary control, catheters were placed in coronary sinus, femoral arterial and venous, and peripheral venous blood vessels. Subjects received a primed continuous infusion of [3,3,3-(2)H]lactate and [6,6-(2)H]glucose throughout the study. Arterial and coronary sinus blood sampling and measurements of coronary sinus blood flow were made during rest and atrial pacing at approximately 111 beats min(-1). Myocardial oxygen consumption increased (P = 0.04) from rest to atrial pacing. Net glucose uptake increased (P = 0.04) from rest to atrial pacing with unchanged fractional extraction (rest: 9.1 +/- 2.7%, atrial pacing 9.8 +/- 2.9%). The percentage of whole body glucose disposal from myocardial uptake also increased from rest to atrial pacing. Isotopically measured lactate uptake also increased significantly from rest to atrial pacing with no significant differences in fractional extraction. The myocardium released lactate throughout the experiment, which increased significantly from rest and atrial pacing (P < 0.05). The heart accounted for a significantly greater percentage of whole body lactate disposal during atrial pacing (15.0 +/- 4.4%) compared to rest (4.9 +/- 0.9%, P = 0.03). These data suggest: (1) in the absence of ischaemia the myocardium is constantly taking up and releasing lactate at rest which increases during atrial pacing, and (2) when arterial substrate delivery is unchanged, increased myocardial work is accomplished with similar proportions of glucose and lactate utilization in healthy humans in vivo. PMID:19289551

  16. Nebivolol in preventing atrial fibrillation following coronary surgery in patients over 60 years of age

    PubMed Central

    Erdil, Nevzat; Kaynak, Murat; Dönmez, Köksal; Disli, Olcay Murat; Battaloglu, Bektas

    2014-01-01

    Objective Postoperative atrial fibrillation is a common complication after cardiac surgery, with an incidence as high as 20-50%. Increased age is associated with a significant increase in postoperative atrial fibrillation risk. This common complication is associated with higher morbidity and mortality rates. The aim of this study was to assess the efficacy of nebivolol in preventing atrial fibrillation following coronary artery bypass surgery in patients over 60 years of age. Methods In this prospective randomized study, 200 patients who were candidates for elective coronary artery bypass surgery were divided into two groups. The first group was administered with nebivolol and the second group was administered with metoprolol. Treatment was initiated four days prior to surgery, and patients were monitored for atrial fibrillation until discharge. Forty-one patients recieved 50 mg metoprolol succinate daily, which was initiated minimum 4 days before surgery. Results Demographic data were similar in both groups. The incidence of postoperative atrial fibrillation in both groups was similar, with no significant difference being identified [n=20 (20%); n=18 (18%), P=0.718; respectively]. There were not any mortality at both groups during study. Inotropic agent requirement at ICU was similar for both groups [n=12 (12%), n=18 (18%), P=0.32]. Conclusion We compared the effectiveness of nebivolol and metoprolol in decreasing the incidence of postoperative atrial fibrillation, and determined that nebivolol was as effective as metoprolol in preventing postoperative atrial fibrillation at patients. Nebivolol may be the drug of choice due to its effects, especially after elective coronary artery bypass surgery. PMID:25714213

  17. Connexin40 and connexin43 determine gating properties of atrial gap junction channels.

    PubMed

    Lin, Xianming; Gemel, Joanna; Glass, Aaron; Zemlin, Christian W; Beyer, Eric C; Veenstra, Richard D

    2010-01-01

    While ventricular gap junctions contain only Cx43, atrial gap junctions contain both Cx40 and Cx43; yet the functional consequences of this co-expression remain poorly understood. We quantitated the expression of Cx40 and Cx43 and their contributions to atrial gap junctional conductance (g(j)). Neonatal murine atrial myocytes showed similar abundances of Cx40 and Cx43 proteins, while ventricular myocytes contained at least 20 times more Cx43 than Cx40. Since Cx40 gap junction channels are blocked by 2 mM spermine while Cx43 channels are unaffected, we used spermine block as a functional dual whole cell patch clamp assay to determine Cx40 contributions to cardiac g(j). Slightly more than half of atrial g(j) and atrial g(j) was reduced to <20%. Compared to ventricular gap junctions, the transjunctional voltage (V(j))-dependent inactivation of atrial g(j) was reduced and kinetically slowed, while the V(j)-dependence of fast and slow inactivation was unchanged. We conclude that Cx40 and Cx43 are equally abundant in atrium and make similar contributions to atrial g(j). Co-expression of Cx40 accounts for most, but not all, of the differences in the V(j)-dependent gating properties between atrium and ventricle that may play a role in the genesis of slow myocardial conduction and arrhythmias. PMID:19486903

  18. Association between aldosterone synthase (CYP11B2) -344C/T polymorphism and atrial fibrillation among Han and Kazak residents of the Xinjiang region

    PubMed Central

    Lu, Wu-Hong; Bayike, Maerjiaen; Liu, Ji-Wen; Wang, Shanshan; Xie, Xiang; Yang, Yu-Chun; Liu, Fen; Li, Na; Liu, Zhi-Qiang; He, Peng-Yi; Muhuyati

    2015-01-01

    Objectives: Atrial fibrillation (AF) is one the most common and complex types of clinical arrhythmia syndromes. In recent years, an association between CYP11B2 gene polymorphisms and atrial myocardial fibrosis has received a significant amount of attention. This study explores the relationship between CYP11B2 gene-344C/T polymorphism and AF among Kazak and Han residents in the Xinjiang region and further clarifies the molecular mechanisms of atrial fibrillation. Methods: The study is a case-control study using traditional methods. We selected 156 Kazak and 203 Han patient cases in the Xinjiang region who had non-valvular atrial fibrillation as well as 307 Kazak and 418 Han cases of non-AF patients as a control group. Blood samples were collected, and DNA was extracted from the peripheral blood samples. The presence of the CYP11B2 gene-344C/T polymorphism was determined using polymerase chain reaction-restriction enzyme fragment length polymorphism (PCR-RFLP). Differences in the genotypes and allele distributions among the 2 groups were compared using Statistical Package for Social Science (SPSS) 17.0 statistical software. Student’s t test, the chi-squared test and logistic regression methods were used for the data analysis. Results: The genotypes of both ethnic groups followed a Hardy-Weinberg genetic equilibrium distribution. The 2 patient groups, compared with their respective control groups, showed significant dominant models in CYP11B2 gene-344C/T polymorphism genotype frequency and B1 allele frequency (P<0.05). The frequencies of the CYP11B2 gene-344C/T polymorphism in the Kazak patient group were higher compared with the control groups (P<0.05). The frequencies of the CYP11B2 gene-344C/T polymorphisms in the Han patient group was also higher compared with the control group (P<0.05). Logistic regression analysis showed that the frequencies of the CYP11B2 gene-344C/T genotypes were significantly different between the Kazak and Han patient groups and the control groups. Conclusion: CYP11B2 gene -344C/T polymorphism is associated with AF. PMID:26131131

  19. Comparison of Prolonged Atrial Electromechanical Delays with Different Definitions in the Discrimination of Patients with Non-Valvular Paroxysmal Atrial Fibrillation

    PubMed Central

    Lee, Dong Hyun; Choi, Sun Young; Seo, Jeong-Min; Choi, Jae-Hyuk; Cho, Young-Rak; Park, Kyungil; Kim, Moo Hyun; Kim, Young-Dae

    2015-01-01

    Background and Objectives Previous studies have evaluated atrial electromechanical delays (AEMDs) with a number of different definitions to discriminate patients with paroxysmal atrial fibrillation (PAF) from controls without PAF. However, their discriminative values for PAF have not previously been directly compared. Subjects and Methods A total of 65 PAF patients and 130 control subjects matched for age, sex, history of hypertension, and diabetes mellitus were selected. The AEMDi and AEMDp were defined as the time intervals from the initiation of the P wave on the surface electrocardiogram to the initiation and peak of the late diastolic transmitral inflow on pulsed wave Doppler images, respectively. The AEMDim and AEMDpm were defined as the time intervals from the initiation of the P wave on the surface electrocardiogram to the initiation and peak of the late diastolic lateral mitral annular motion on tissue Doppler images, respectively. Results There were no significant differences in the clinical characteristics between the two groups. All 4 AEMDs were consistently longer in the PAF group, and proven effective to differentiate the PAF patients from the controls. The AEMDi measurement had a larger area under the curve (AUC) than the other AEMDs, left atrial volume index, and P wave amplitude. However, the AEMDp, AEMDim, and AEMDpm measurements had AUCs similar to those of the left atrial volume index and P wave amplitude. Conclusion The findings suggest that the AEMDi is better than the other AEMDs for the discrimination of PAF patients from the controls. PMID:26617650

  20. Natriuretic peptides for the detection of paroxysmal atrial fibrillation

    PubMed Central

    Seegers, Joachim; Zabel, Markus; Grüter, Timo; Ammermann, Antje; Weber-Krüger, Mark; Edelmann, Frank; Gelbrich, Götz; Binder, Lutz; Herrmann-Lingen, Christoph; Gröschel, Klaus; Hasenfuß, Gerd; Feltgen, Nicolas; Pieske, Burkert; Wachter, Rolf

    2015-01-01

    Background and purpose Silent atrial fibrillation (AF) and tachycardia (AT) are considered precursors of ischaemic stroke. Therefore, detection of paroxysmal atrial rhythm disorders is highly relevant, but is clinically challenging. We aimed to evaluate the diagnostic value of natriuretic peptide levels in the detection of paroxysmal AT/AF in a pilot study. Methods Natriuretic peptide levels were analysed in two independent patient cohorts (162 patients with arterial hypertension or other cardiovascular risk factors and 82 patients with retinal vessel disease). N-terminal-pro-brain natriuretic peptide (NT-proBNP) and BNP were measured before the start of a 7-day Holter monitoring period carefully screened for AT/AF. Results 244 patients were included; 16 had paroxysmal AT/AF. After excluding patients with a history of AT/AF (n=5), 14 patients had newly diagnosed AT/AF (5.8%) NT-proBNP and BNP levels were higher in patients with paroxysmal AT/AF in both cohorts: (1) 154.4 (IQR 41.7; 303.6) versus 52.8 (30.4; 178.0)?pg/mL and 70.0 (31.9; 142.4) versus 43.9 (16.3; 95.2) and (2) 216.9 (201.4; 277.1) versus 90.8 (42.3–141.7) and 96.0 (54.7; 108.2) versus 29.1 (12.0; 58.1). For the detection of AT/AF episodes, NT-proBNP and BNP had an area under the curve in receiver operating characteristic analysis of 0.76 (95% CI, 0.64 to 0.88; p=0.002) and 0.75 (0.61 to 0.89; p=0.004), respectively. Conclusions NT-proBNP and BNP levels are elevated in patients with silent AT/AF as compared with sinus rhythm. Thus, screening for undiagnosed paroxysmal AF using natriuretic peptide level initiated Holter monitoring may be a useful strategy in prevention of stroke or systemic embolism. PMID:26288739

  1. Atrial natriuretic peptide: a new factor in blood pressure control.

    PubMed

    Lang, R E; Unger, T; Ganten, D

    1987-06-01

    The hypothesis of a natriuretic factor-originally an intriguing possibility and now an experimentally documented reality-has occupied the minds of scientists for more than 30 years. It has attracted not only experts in salt and water metabolism but also those interested in hypertension, because of the well known link between sodium homeostasis and blood pressure regulation. There are at least two distinct types of natriuretic substances: one is an inhibitor of the Na+K+ATPase and has been proposed to contribute to a rise in blood pressure; the other, now isolated from atrial tissue, is vasodilatory, natriuretic, diuretic, and has been demonstrated to decrease blood pressure. Our knowledge of regulation and function of this ANP has increased rapidly since its detection. Its role in blood pressure regulation is now fairly well understood. As depicted in Fig. 1, both synthesis and release of ANP are induced by atrial and ventricular wall stretch. In hypertension, distension of the left atrium and ventricle may be of particular importance for ANP release. The endocrine function of myocardial cells is stimulated in response to wall stretch in the ventricle. ANP is synthesized and stored as a 126 amino acid prohormone. Enzymatic processing of this prohormone to the circulating forms ANP 1-98 and ANP 99-126 takes place within the myoendocrine cells. The biological effects of ANP 1-98 are as yet unknown. ANP 99-126 acts at multiple sites to reduce blood pressure. One may distinguish between acute and more chronic effects. The acute effects include shift of fluid to the extravascular compartment and vasorelaxation. This shift is indicated by the rapidly developing rise in haematocrit, which is observed in intact as well as in nephrectomized rats and therefore not due to diuresis alone. The reduction of blood volume in addition to an increase in venous capacitance may be responsible for the reduced cardiac output. The latter may cause a reflex activation of the sympathetic nervous system and an increase in peripheral resistance, thereby overriding the vasodilator effects of the peptide. ANP appears to have a 'de-pressor' effect rather than a direct vasodilator effect. A lowering of peripheral resistance in response to ANP is not observed in normotensives, but is readily seen in at least certain forms of hypertension associated with an increased vascular tone. This most likely explains the discrepancy in the haemodynamic responses to ANP in normotensives and hypertensives.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2956321

  2. Atrial Septal Defect Closure: Comparison of Vertical Axillary Minithoracotomy and Median Sternotomy

    PubMed Central

    Poyrazoglu, Huseyin Hakan; Avsar, Mustafa Kemal; Karakaya, Zeynep; Güler, Tayfun; Tor, Funda

    2013-01-01

    Background This study aims to evaluate whether or not the method of right vertical axillary minithoracotomy (RVAM) is preferable to and as reliable as conventional sternotomy surgery, and also assesses its cosmetic results. Methods Thirty-three patients (7 males, 26 females) with atrial septal defect were admitted to the Cardiovascular Surgery Clinic of Cukurova University from December 2005 until January 2010. The patients' ages ranged from 3 to 22. Patients who underwent vertical axillary minithracotomy were assigned to group I, and those undergoing conventional sternotomy, to group II. Group I and group II were compared with regard to the preoperative, perioperative and postoperative variables. Group I included 12 females and 4 males with an average age of 16.5±9.7. Group II comprised 14 female and 3 male patients with an average age of 18.5±9.8 showing similar features and pathologies. The cases were in Class I-II according to the New York Heart Association (NYHA) Classification, and patients with other cardiac and systemic problems were not included in the study. The ratio of the systemic blood flow to the pulmonary blood flow (Qp/Qs) was 1.8±0.2. The average pulmonary artery pressure was 35±10 mmHg. Following the diagnosis, performing elective surgery was planned. Results No significant difference was detected in the average time of the patients' extraportal circulation, cross-clamp and surgery (p>0.05). In the early postoperative period of the cases, the duration of mechanical ventilator support, the drainage volume in the first 24 hours, and the hospitalization time in the intensive care unit were similar (p>0.05). Postoperative pains were evaluated together with narcotic analgesics taken intravenously or orally. While 7 cases (43.7%) in group I needed postoperative analgesics, 12 cases (70.6%) in group II needed them. No mortality or major morbidity has occurred in the patients. The incision style and sizes in all of the patients undergoing RVAM were preserved as they were at the beginning. Furthermore, the patients of group I were mobilized more quickly than the patients of group II. The patients of group I were quite pleased with the psychological and cosmetic results. No residual defects have been found in the early postoperative period and after the end of the follow-up periods. All of the patients achieved functional capacity per NYHA. No deformation of breast growth has been detected during 18 months of follow-up for the group I patients, who underwent RVAM. Conclusion To conclude, the repair of atrial septal defect by RVAM, apart from the limited working zone for the surgeon in these pathologies as compared to sternotomymay be considered in terms of the outcomes, and early and late complications. And this has accounted for less need of analgesics and better cosmetic results in recent years. PMID:24175268

  3. Atrial fibrillation screening in pharmacies using an iPhone ECG: a qualitative review of implementation.

    PubMed

    Lowres, Nicole; Krass, Ines; Neubeck, Lis; Redfern, Julie; McLachlan, Andrew J; Bennett, Alexandra A; Freedman, S Ben

    2015-12-01

    Background Atrial fibrillation guidelines advocate screening to identify undiagnosed atrial fibrillation. Community pharmacies may provide an opportunistic venue for such screening. Objective To explore the experience of implementing an atrial fibrillation screening service from the pharmacist's perspective including: the process of study implementation; the perceived benefits; the barriers and enablers; and the challenges for future sustainability of atrial fibrillation screening within pharmacies. Setting Interviews were conducted face-to-face in the pharmacy or via telephone, according to pharmacist preference. Method The 'SEARCH-AF study' screened 1000 pharmacy customers aged ?65 years using an iPhone electrocardiogram, identifying 1.5 % with undiagnosed atrial fibrillation. Nine pharmacists took part in semi-structured interviews. Interviews were transcribed in full and thematically analysed. Main outcome measure Qualitative analysis of the experience of implementing an AF screening service from the pharmacist's perspective. Results Four broad themes relating to service provision were identified: (1) interest and engagement in atrial fibrillation screening by pharmacists, customers, and doctors with the novel, easy-to-use electrocardiogram technology serving as an incentive to undergo screening and an education tool for pharmacists to use with customers; (2) perceived benefits to the pharmacist including increased job satisfaction, improvement in customer relations and pharmacy profile by fostering enhanced customer care and the educational role of pharmacists; (3) implementation barriers including managing workflow, and enablers such as personal approaches for recruitment, and allocating time to discuss screening process and fears; and, (4) potential for sustainable future implementation including remuneration linked to government or pharmacy incentives, combined cardiovascular screening, and automating sections of risk-assessments using touch-screen technology. Conclusion Atrial fibrillation screening in pharmacies is well accepted by pharmacists and customers. Many pharmacists combined atrial fibrillation screening with other health screens reporting improved time-efficiency and greater customer satisfaction. Widespread implementation of atrial fibrillation screening requires longterm funding, which could be provided for a combined cardiovascular screening service. Further research could focus on feasibility and cost-effectiveness of combined cardiovascular screening in pharmacies. PMID:26202627

  4. Metabolomics and Incidence of Atrial Fibrillation in African Americans: The Atherosclerosis Risk in Communities (ARIC) Study

    PubMed Central

    Alonso, Alvaro; Yu, Bing; Qureshi, Waqas T.; Grams, Morgan E.; Selvin, Elizabeth; Soliman, Elsayed Z.; Loehr, Laura R.; Chen, Lin Y.; Agarwal, Sunil K.; Alexander, Danny; Boerwinkle, Eric

    2015-01-01

    Background Atrial fibrillation (AF) is a common arrhythmia. Application of metabolomic approaches, which may identify novel pathways and biomarkers of disease risk, to a longitudinal epidemiologic study of AF has been limited. Methods We determined the prospective association of 118 serum metabolites identified through untargeted metabolomics profiling with the incidence of newly-diagnosed AF in 1919 African-American men and women from the Atherosclerosis Risk in Communities study without AF at baseline (1987–1989). Incident AF cases through 2011 were ascertained from study electrocardiograms, hospital discharge codes, and death certificates. Results During a median follow-up of 22 years, we identified 183 incident AF cases. In Cox proportional hazards models adjusted for age, sex, smoking, body mass index, systolic blood pressure, use of antihypertensive medication, diabetes, prevalent heart failure, prevalent coronary heart disease, and kidney function, two conjugated bile acids (glycolithocholate sulfate and glycocholenate sulfate) were significantly associated with AF risk after correcting for multiple comparisons (p<0.0004). Multivariable-adjusted hazard ratios (95% confidence intervals) of AF were 1.22 (1.12–1.32) for glycolithocholate sulfate and 1.22 (1.10–1.35) for glycocholenate sulfate per 1-standard deviation higher levels. Associations were not appreciably different after additional adjustment for alcohol consumption or concentrations of circulating albumin and liver enzymes. Conclusion We found an association of higher levels of two bile acids with an increased risk of AF, pointing to a potential novel pathway in AF pathogenesis. Replication of results in independent studies is warranted. PMID:26544570

  5. Transcatheter closure of the left atrial appendage: initial experience with the WATCHMAN device

    PubMed Central

    Ding, Jiandong; Zhu, Jian; Lu, Jing; Ding, Xiuxia; Zhang, Xiaoli; Lu, Wenbin; Ao, Mingqiang; Ma, Genshan

    2015-01-01

    Background: Atrial fibrillation (AF) is the most commonly encountered clinical arrhythmia, accounting for approximately one third of hospitalizations for cardiac rhythm disturbance. In patients with non-valvular AF, approximately 90% of thrombi are thought to arise from the left atrial appendage (LAA). Anticoagulation with warfarin has been the mainstay of therapy to reduce stroke risk in these patients; however, it is not without its complications including bleeding and drug interactions. Percutaneous left atrial appendage closure can be an alternative to warfarin treatment in patients with AF at high risk for thromboembolic events and/or bleeding complications. Methods: Patients with atrial fibrillation and CHADSVASc score ? 2, not eligible for anticoagulation, were submitted to left atrial appendage closure using the WATCHMAN device. The procedure was performed under general anaesthesia, and was guided by fluoroscopy and transoesophageal echocardiography. Results: Percutaneous LAA closure with the WATCHMAN device was performed in all patients. At 45-day follow-up no recurrent major adverse events and especially no thromboembolic events occurred. Conclusions: Transcatheter closure of the LAA with the WATCHMAN device is generally safe and feasible. Long-term follow-up will further reveal the risk and benefits of this therapy. PMID:26629008

  6. Patient-specific left atrial wall-thickness measurement and visualization for radiofrequency ablation

    NASA Astrophysics Data System (ADS)

    Inoue, Jiro; Skanes, Allan C.; White, James A.; Rajchl, Martin; Drangova, Maria

    2014-03-01

    INTRODUCTION: For radiofrequency (RF) catheter ablation of the left atrium, safe and effective dosing of RF energy requires transmural left atrium ablation without injury to extra-cardiac structures. The thickness of the left atrial wall may be a key parameter in determining the appropriate amount of energy to deliver. While left atrial wall-thickness is known to exhibit inter- and intra-patient variation, this is not taken into account in the current clinical workflow. Our goal is to develop a tool for presenting patient-specific left atrial thickness information to the clinician in order to assist in the determination of the proper RF energy dose. METHODS: We use an interactive segmentation method with manual correction to segment the left atrial blood pool and heart wall from contrast-enhanced cardiac CT images. We then create a mesh from the segmented blood pool and determine the wall thickness, on a per-vertex basis, orthogonal to the mesh surface. The thickness measurement is visualized by assigning colors to the vertices of the blood pool mesh. We applied our method to 5 contrast-enhanced cardiac CT images. RESULTS: Left atrial wall-thickness measurements were generally consistent with published thickness ranges. Variations were found to exist between patients, and between regions within each patient. CONCLUSION: It is possible to visually determine areas of thick vs. thin heart wall with high resolution in a patient-specific manner.

  7. Atrial electromechanical cycle length mapping in paced canine hearts in vivo.

    PubMed

    Costet, Alexandre; Bunting, Ethan; Grondin, Julien; Gambhir, Alok; Konofagou, Elisa E

    2015-07-01

    Atrial arrhythmias affect millions of people worldwide. Characterization and study of arrhythmias in the atria in the clinic is currently performed point by point using mapping catheters capable of generating maps of the electrical activation rate or cycle length. In this paper, we describe a new ultrasound-based mapping technique called electromechanical cycle length mapping (ECLM) capable of estimating the electromechanical activation rate, or cycle length, i.e., the rate of the mechanical activation of the myocardium which follows the electrical activation. ECLM relies on frequency analysis of the incremental strain within the atria and can be performed in a single acquisition. ECLM was validated in a canine model paced from the left atrial appendage, against pacing rates within the reported range of cycle lengths previously measured during atrial arrhythmias such as atrial fibrillation. Correlation between the global estimated electromechanical cycle lengths and pacing rates was shown to be excellent (slope = 0.983, intercept = 3.91, r(2) = 0.9999). The effect of the number of cardiac cycles on the performance of ECLM was also investigated and the reproducibility of ECLM was demonstrated (error between consecutive acquisitions for all pacing rates: 6.3 ± 4.3%). These findings indicate the potential of ECLM for noninvasively characterizing atrial arrhythmias and provide feedback on the treatment planning of catheter ablation procedures in the clinic. PMID:26168174

  8. Melanocyte-like cells in the heart and pulmonary veins contribute to atrial arrhythmia triggers

    PubMed Central

    Levin, Mark D.; Lu, Min Min; Petrenko, Nataliya B.; Hawkins, Brian J.; Gupta, Tara H.; Lang, Deborah; Buckley, Peter T.; Jochems, Jeanine; Liu, Fang; Spurney, Christopher F.; Yuan, Li J.; Jacobson, Jason T.; Brown, Christopher B.; Huang, Li; Beermann, Friedrich; Margulies, Kenneth B.; Madesh, Muniswamy; Eberwine, James H.; Epstein, Jonathan A.; Patel, Vickas V.

    2009-01-01

    Atrial fibrillation is the most common clinical cardiac arrhythmia. It is often initiated by ectopic beats arising from the pulmonary veins and atrium, but the source and mechanism of these beats remains unclear. The melanin synthesis enzyme dopachrome tautomerase (DCT) is involved in intracellular calcium and reactive species regulation in melanocytes. Given that dysregulation of intracellular calcium and reactive species has been described in patients with atrial fibrillation, we investigated the role of DCT in this process. Here, we characterize a unique DCT-expressing cell population within murine and human hearts that populated the pulmonary veins, atria, and atrioventricular canal. Expression profiling demonstrated that this population expressed adrenergic and muscarinic receptors and displayed transcriptional profiles distinct from dermal melanocytes. Adult mice lacking DCT displayed normal cardiac development but an increased susceptibility to atrial arrhythmias. Cultured primary cardiac melanocyte-like cells were excitable, and those lacking DCT displayed prolonged repolarization with early afterdepolarizations. Furthermore, mice with mutations in the tyrosine kinase receptor Kit lacked cardiac melanocyte-like cells and did not develop atrial arrhythmias in the absence of DCT. These data suggest that dysfunction of melanocyte-like cells in the atrium and pulmonary veins may contribute to atrial arrhythmias. PMID:19855129

  9. Human Atrial Cell Models to Analyse Haemodialysis-Related Effects on Cardiac Electrophysiology: Work in Progress

    PubMed Central

    2014-01-01

    During haemodialysis (HD) sessions, patients undergo alterations in the extracellular environment, mostly concerning plasma electrolyte concentrations, pH, and volume, together with a modification of sympathovagal balance. All these changes affect cardiac electrophysiology, possibly leading to an increased arrhythmic risk. Computational modeling may help to investigate the impact of HD-related changes on atrial electrophysiology. However, many different human atrial action potential (AP) models are currently available, all validated only with the standard electrolyte concentrations used in experiments. Therefore, they may respond in different ways to the same environmental changes. After an overview on how the computational approach has been used in the past to investigate the effect of HD therapy on cardiac electrophysiology, the aim of this work has been to assess the current state of the art in human atrial AP models, with respect to the HD context. All the published human atrial AP models have been considered and tested for electrolytes, volume changes, and different acetylcholine concentrations. Most of them proved to be reliable for single modifications, but all of them showed some drawbacks. Therefore, there is room for a new human atrial AP model, hopefully able to physiologically reproduce all the HD-related effects. At the moment, work is still in progress in this specific field. PMID:25587348

  10. Detailed Anatomical and Electrophysiological Models of Human Atria and Torso for the Simulation of Atrial Activation

    PubMed Central

    Ferrer, Ana; Sebastián, Rafael; Sánchez-Quintana, Damián; Rodríguez, José F.; Godoy, Eduardo J.; Martínez, Laura; Saiz, Javier

    2015-01-01

    Atrial arrhythmias, and specifically atrial fibrillation (AF), induce rapid and irregular activation patterns that appear on the torso surface as abnormal P-waves in electrocardiograms and body surface potential maps (BSPM). In recent years both P-waves and the BSPM have been used to identify the mechanisms underlying AF, such as localizing ectopic foci or high-frequency rotors. However, the relationship between the activation of the different areas of the atria and the characteristics of the BSPM and P-wave signals are still far from being completely understood. In this work we developed a multi-scale framework, which combines a highly-detailed 3D atrial model and a torso model to study the relationship between atrial activation and surface signals in sinus rhythm. Using this multi scale model, it was revealed that the best places for recording P-waves are the frontal upper right and the frontal and rear left quadrants of the torso. Our results also suggest that only nine regions (of the twenty-one structures in which the atrial surface was divided) make a significant contribution to the BSPM and determine the main P-wave characteristics. PMID:26523732

  11. Safety and efficacy of vernakalant for acute cardioversion of atrial fibrillation: an update

    PubMed Central

    Tsuji, Yukiomi; Dobrev, Dobromir

    2013-01-01

    Intravenous vernakalant has recently been approved in Europe as an atrial-selective antiarrhythmic drug for the conversion of recent-onset atrial fibrillation (AF). It inhibits atrial-selective K+ currents (IK,ACh and IKur) and causes rate-dependent atrial-predominant Na+ channel block, with only a small inhibitory effect on the rapid delayed rectifier K+ current (IKr) in the ventricle. Due to its atrial-selective properties, vernakalant prolongs the effective refractory period of the atria with minimal effects on the ventricles, being associated with a low proarrhythmic risk for torsades de pointes arrhythmias. Five pivotal clinical trials consistently demonstrated that vernakalant rapidly terminates AF with stable maintenance of sinus rhythm for up to 24 hours. A head-to-head comparative trial showed that the 90-minute conversion rate of vernakalant was substantially higher than that of amiodarone. Initially, a longer-acting oral formulation of vernakalant was shown to be effective and safe in preventing AF recurrence after cardioversion in a Phase IIb study. However, the clinical studies testing oral vernakalant for maintenance of sinus rhythm after AF cardioversion were prematurely halted for undisclosed reasons. This review article provides an update on the safety and efficacy of intravenous vernakalant for the rapid cardioversion of AF. PMID:23637539

  12. Comparative transcriptome analysis of atrial septal defect identifies dysregulated genes during heart septum morphogenesis.

    PubMed

    Wang, Wenju; Niu, Zhaoyi; Wang, Yi; Li, Yaxiong; Zou, Honglin; Yang, Li; Meng, Mingyao; Wei, Chuanyu; Li, Qinrui; Duan, Le; Xie, Yanhua; Zhang, Yayong; Cao, Yu; Han, Shen; Hou, Zongliu; Jiang, Lihong

    2016-01-10

    Congenital heart disease (CHD) is one of most common birth defects, causing fetal loss and death in newborn all over the world. Atrial and ventricular septal defects were the most common CHD subtypes in most districts. During the past decades, several genes were identified to control atrial septum formation, and mutations of these genes can cause cardiac septation defects. However, the pathogenic mechanism of ASD on transcriptional levels has not been well elucidated yet. Herein, we performed comparative transcriptome analysis between normal and atrial septal defect (ASD) patients by Illumina RNA sequencing (RNA-seq). Advanced bioinformatic analyses were employed to identify dysregulated genes in ASD. The results indicated that cardiac specific transcriptional factors (GATA4 and NKX2-5), extracellular signal molecules (VEGFA and BMP10) and cardiac sarcomeric proteins (MYL2, MYL3, MYH7, TNNT1 and TNNT3) were downregulated in ASD which may affect heart atrial septum formation, cardiomyocyte proliferation and cardiac muscle development. Importantly, cell cycle was dominant pathway among downregulated genes, and decreased expression of the proteins included in cell cycle may disturb cardiomyocyte growth and differentiation during atrial septum formation. Our study provided evidences of understanding pathogenic mechanism of ASD and resource for validation of CHD genomic studies. PMID:26375510

  13. A MicroRNA-Transcription Factor Blueprint for Early Atrial Arrhythmogenic Remodeling

    PubMed Central

    Torrado, Mario; Franco, Diego; Lozano-Velasco, Estefanía; Hernández-Torres, Francisco; Calviño, Ramón; Aldama, Guillermo; Centeno, Alberto; Castro-Beiras, Alfonso; Mikhailov, Alexander

    2015-01-01

    Spontaneous self-terminating atrial fibrillation (AF) is one of the most common heart rhythm disorders, yet the regulatory molecular mechanisms underlying this syndrome are rather unclear. MicroRNA (miRNA) transcriptome and expression of candidate transcription factors (TFs) with potential roles in arrhythmogenesis, such as Pitx2, Tbx5, and myocardin (Myocd), were analyzed by microarray, qRT-PCR, and Western blotting in left atrial (LA) samples from pigs with transitory AF established by right atrial tachypacing. Induced ectopic tachyarrhythmia caused rapid and substantial miRNA remodeling associated with a marked downregulation of Pitx2, Tbx5, and Myocd expression in atrial myocardium. The downregulation of Pitx2, Tbx5, and Myocd was inversely correlated with upregulation of the corresponding targeting miRNAs (miR-21, miR-10a/10b, and miR-1, resp.) in the LA of paced animals. Through in vitro transient transfections of HL-1 atrial myocytes, we further showed that upregulation of miR-21 did result in downregulation of Pitx2 in cardiomyocyte background. The results suggest that immediate-early miRNA remodeling coupled with deregulation of TF expression underlies the onset of AF. PMID:26221584

  14. Bisphenol A decreases atrial contractility involving NO-dependent G-cyclase signaling pathway.

    PubMed

    Pant, Jayanti; Ranjan, Pratibha; Deshpande, Shripad B

    2011-10-01

    Bisphenol A (BPA) is used in manufacturing plastics. Even though BPA is reported to produce reproductive and behavioral toxicity in experimental animals, the direct effect of BPA on the cardiovascular system is not known. The present study was therefore undertaken to evaluate the effect of BPA, on spontaneously beating rat right atrial preparations. In this study, in vitro isometric contractions of right atria were recorded. Cumulative concentration-response of BPA on atrial contractions was obtained in the absence or presence of antagonists. BPA (0.1-100?? m) decreased the rate and the force of atrial contractions in a concentration-dependent manner. At 100?? m, the decreases were >90%. The BPA-induced changes were not blocked by atropine (muscarinic receptor blocker). However, pretreatment with N-?-nitro-L-arginine methyl ester (L-NAME, a nitric oxide synthase inhibitor) or methylene blue (a guanylyl cyclase inhibitor) blocked the BPA-induced changes in rate and force. Nitroglycerine, an NO-donor, decreased the rate and force of atrial contractions. Further, the BPA-induced changes were not due to the solvent (ethanol) used to dissolve it. The present study therefore indicates that BPA decreases the atrial contractility involving NO-dependent G-cyclase signaling mechanisms. PMID:21351110

  15. Effects of Sterile Pericarditis on Connexins 40 and 43 in the Atria Correlation with Abnormal Conduction and Atrial

    E-print Network

    Effects of Sterile Pericarditis on Connexins 40 and 43 in the Atria ­ Correlation with Abnormal Heart, Lung, and Blood Institute, Bethesda, Maryland. Running Title: Effects of atrial sterile by the American Physiological Society. #12;Effects of atrial sterile pericarditis on Cx40 and Cx43 Ryu et al. 2

  16. Efficacy of Oral Anticoagulation in Stroke Prevention among Sinus-Rhythm Patients Who Lack Left Atrial Mechanical Contraction after Cryoablation

    PubMed Central

    Gualis, Javier; Marcos-Vidal, José Miguel; Buber, Jonnatan; Martín, Carlos Esteban; Gomez-Plana, Jesús; Rodríguez, Miguel Angel; Iglesias-Garriz, Ignacio; Alonso, David; Soria, Carlos; Miguélez, Eva Higuera; Castaño, Mario

    2015-01-01

    The customary recommendation is that oral anticoagulation be withdrawn a few months after cryoablation for atrial fibrillation, independently of left atrial mechanical contraction in patients in sinus rhythm. Recently, a 5-fold increase in stroke has been described in sinus-rhythm patients who lack atrial mechanical contraction. One aim of this study was to evaluate the efficacy of oral anticoagulation in preventing postoperative stroke in such patients. This prospective study divided 154 sinus-rhythm patients into 2 groups, depending on the presence (108 patients) or absence (46 patients) of left atrial mechanical contraction at 6 months after surgery, and monitored them annually for 5 years. Those without left atrial contraction were maintained on acenocumarol. The primary endpoint was the occurrence of ischemic stroke. The median follow-up period was 29 ± 16 months; 4 patients (2.5%), all belonging to the group with preserved atrial contraction, had ischemic stroke; the group of patients without left atrial contraction had no episodes of stroke during follow-up. Logistic binary regression analyses showed no evidence of factors independently predictive of stroke. Among anticoagulated patients in sinus rhythm without left atrial contraction, we found the incidence of stroke to be zero. In a small, nonrandomized group such as this, we cannot discount the element of chance, yet we suggest that maintaining anticoagulation might lower the incidence of stroke in this population. PMID:26504435

  17. Ablation of Complex Fractionated Atrial Electrograms in Catheter Ablation for AF; Where have we been and where are we going?

    PubMed Central

    Caldwell, Jane; Redfearn, Damian

    2012-01-01

    Catheter ablation for persistent AF remains a challenge to the ablator as the disease is now outside the veins and cannot be tackled by pulmonary vein isolation alone. In this article we describe targeting complex fractionated atrial electrograms (CFAE) as a method to guide atrial substrate modification. PMID:22920481

  18. Predicting Postoperative Atrial Fibrillation from Independent ECG Components Chih-Chun Chia, James Blum, Zahi Karam, Satinder Singh, Zeeshan Syed

    E-print Network

    Baveja, Satinder Singh

    Predicting Postoperative Atrial Fibrillation from Independent ECG Components Chih-Chun Chia, James of novel electrocardio- graphic (ECG) markers to identify patients at risk of PAF. As a first step, we explore an eigen-decomposition approach that partitions ECG signals into atrial and ven- tricular

  19. A Comparison of Atrial Fibrillation Monitoring Strategies After Cryptogenic Stroke (from the Cryptogenic Stroke and Underlying AF Trial).

    PubMed

    Choe, William C; Passman, Rod S; Brachmann, Johannes; Morillo, Carlos A; Sanna, Tommaso; Bernstein, Richard A; Di Lazzaro, Vincenzo; Diener, Hans-Christoph; Rymer, Marilyn M; Beckers, Frank; Koehler, Jodi; Ziegler, Paul D

    2015-09-15

    Ischemic stroke cause remains undetermined in 30% of cases, leading to a diagnosis of cryptogenic stroke. Paroxysmal atrial fibrillation (AF) is a major cause of ischemic stroke but may go undetected with short periods of ECG monitoring. The Cryptogenic Stroke and Underlying Atrial Fibrillation trial (CRYSTAL AF) demonstrated that long-term electrocardiographic monitoring with insertable cardiac monitors (ICM) is superior to conventional follow-up in detecting AF in the population with cryptogenic stroke. We evaluated the sensitivity and negative predictive value (NPV) of various external monitoring techniques within a cryptogenic stroke cohort. Simulated intermittent monitoring strategies were compared to continuous rhythm monitoring in 168 ICM patients of the CRYSTAL AF trial. Short-term monitoring included a single 24-hour, 48-hour, and 7-day Holter and 21-day and 30-day event recorders. Periodic monitoring consisted of quarterly monitoring through 24-hour, 48-hour, and 7-day Holters and monthly 24-hour Holters. For a single monitoring period, the sensitivity for AF diagnosis was lowest with a 24-hour Holter (1.3%) and highest with a 30-day event recorder (22.8%). The NPV ranged from 82.3% to 85.6% for all single external monitoring strategies. Quarterly monitoring with 24-hour Holters had a sensitivity of 3.1%, whereas quarterly 7-day monitors increased the sensitivity to 20.8%. The NPVs for repetitive periodic monitoring strategies were similar at 82.6% to 85.3%. Long-term continuous monitoring was superior in detecting AF compared to all intermittent monitoring strategies evaluated (p <0.001). Long-term continuous electrocardiographic monitoring with ICMs is significantly more effective than any of the simulated intermittent monitoring strategies for identifying AF in patients with previous cryptogenic stroke. PMID:26183793

  20. Measurement of ventricular function by ECG gating during atrial fibrillation

    SciTech Connect

    Bacharach, S.L.; Green, M.V.; Bonow, R.O.; Findley, S.L.; Ostrow, H.G.; Johnston, G.S.

    1981-03-01

    The assumptions necessary to perform ECG-gated cardiac studies are seemingly not valid for patients in atrial fibrillation (AF). To evaluate the effect of AF on equilibrium gated scintigraphy, beat-by-beat measurements of left-ventricular function were made on seven subjects in AF (mean heart rate 64 bpm), using a high-efficiency nonimaging detector. The parameters evaluated were ejection fraction (EF), time to end-systole (TES), peak rates of ejection and filling (PER,PFR), and their times of occurrence (TPER, TPFR). By averaging together single-beat values of EF, PER, etc., it was possible to determine the true mean values of these parameters. The single-beam mean values were compared with the corresponding parameters calculated from one ECG-gated time-activity curve (TAC) obtained by superimposing all the single-beat TACs irrespective of their length. For this population with slow heart rates, we find that the values for EF, etc., produced from ECG-gated time-activity curves, are very similar to those obtained from the single-beat data. Thus use of ECG gating at low heart rates may allow reliable estimation of average cardiac function even in subjects with AF.

  1. Atrial fibrillation in heart failure: what should we do?

    PubMed Central

    Kotecha, Dipak; Piccini, Jonathan P.

    2015-01-01

    Heart failure (HF) and atrial fibrillation (AF) are two conditions that are likely to dominate the next 50 years of cardiovascular (CV) care. Both are increasingly prevalent and associated with high morbidity, mortality, and healthcare cost. They are closely inter-related with similar risk factors and shared pathophysiology. Patients with concomitant HF and AF suffer from even worse symptoms and poorer prognosis, yet evidence-based evaluation and management of this group of patients is lacking. In this review, we evaluate the common mechanisms for the development of AF in HF patients and vice versa, focusing on the evidence for potential treatment strategies. Recent data have suggested that these patients may respond differently than those with HF or AF alone. These results highlight the clear clinical need to identify and treat according to best evidence, in order to prevent adverse outcomes and reduce the huge burden that HF and AF are expected to have on global healthcare systems in the future. We propose an easy-to-use clinical mnemonic to aid the initial management of newly discovered concomitant HF and AF, the CAN-TREAT HFrEF + AF algorithm (Cardioversion if compromised; Anticoagulation unless contraindication; Normalize fluid balance; Target initial heart rate <110 b.p.m.; Renin–angiotensin–aldosterone modification; Early consideration of rhythm control; Advanced HF therapies; Treatment of other CV disease). PMID:26419625

  2. Current perspectives in percutaneous atrial septal defect closure devices

    PubMed Central

    Bissessor, N

    2015-01-01

    In the last decade, percutaneous atrial septal defect (ASD) closure has become the treatment of choice in most clinical presentations of ASD. Percutaneous ASD closure has established procedural safety through operator experience and improved device structure and deliverability. There have also been advances in diagnostic capabilities. Devices have evolved from large bulky meshes to repositionable, minimal residual mesh content that easily endothelializes and conforms well to surrounding structures. Biodegradable technology has been introduced and will be closely watched as a future option. The evolution of ASD closure device usage in the last four decades incorporates development that minimizes a wide range of serious side effects that have been reported over the years. Complications reported in the literature include thrombus formation, air embolization, device embolization, erosions, residual shunts, and nickel hypersensitivity. Modern devices have intermediate to long term data with outcomes that have been favorable. Devices are available in multiple sizes with improved delivery mechanisms to recapture, reposition, and safely close simple and complex ASDs amenable to percutaneous closure. In this review, commonly used devices and deployment procedures are discussed together with a look at devices that show promise for the future. PMID:26203289

  3. Novel biomarkers in cardiology: MicroRNAs in atrial fibrillation.

    PubMed

    Orenes-Piñero, Esteban; Quintana-Giner, Miriam; Romero-Aniorte, Ana I; Valdés, Mariano; Marín, Francisco

    2015-01-01

    Atrial fibrillation (AF) is the most common sustained chronic cardiac arrhythmia in clinical practice, which increases the risk of stroke and thromboembolism and is an independent predictor of mortality. The underlying mechanisms involved in the development of AF have yet to be fully elucidated. However, once initiated, AF tends to self-perpetuate, owing to structural and electrical remodeling in the atria. MicroRNAs (miRNAs) represent a sizable sub-group of small non-coding RNAs, which degrades or inhibits the translation of their target mRNAs, thus regulating gene expression and playing an important role in a wide range of biologic processes. Clinically, there is increasing evidence of the potential diagnostic role of miRNAs as biomarkers, representing a novel therapeutic target in AF. The aim of this review is to provide an exhaustive overview of the role of miRNAs in AF and to discuss the diagnostic and therapeutic potential of miRNAs in this arrhythmia. PMID:25957926

  4. Metabolic syndrome, atrial fibrillation, and stroke: Tackling an emerging epidemic.

    PubMed

    Hajhosseiny, Reza; Matthews, Gareth K; Lip, Gregory Y H

    2015-11-01

    The prevalence of atrial fibrillation (AF) and AF-related stroke is set to increase dramatically in coming decades, with developing regions such as Latin America experiencing the greatest impact. These trends are primarily driven by aging populations and by the increasing prevalence of the metabolic syndrome. The metabolic syndrome describes an association between diabetes, hypertension, obesity, and dyslipidemia and an increased risk of cardiovascular disease. It is in large part the result of unbalanced diet and sedentary lifestyle. These essentially modifiable risk factors are becoming more prevalent with the widespread adoption of so-called Western lifestyles. This review examines the physiology underlying the link between the metabolic syndrome and AF. Next, it highlights the importance of addressing lifestyle-related risk factors to mitigate the trend toward increasing AF prevalence. It then goes on to discuss the importance of stroke prevention therapy in patients with established AF, focusing on the relative merits of various available options for anticoagulation. Given the recent availability of comprehensive data on the 4 currently available non-vitamin K antagonist oral anticoagulant drugs, this review concludes by discussing the relative merits of specific agents in individual patient groups. PMID:26142297

  5. Ionic currents in single isolated bullfrog atrial cells

    PubMed Central

    1983-01-01

    Enzymatic dispersion has been used to yield single cells from segments of bullfrog atrium. Previous data (Hume and Giles, 1981) have shown that these individual cells are quiescent and have normal resting potentials and action potentials. The minimum DC space constant is approximately 920 microns. The major goals of the present study were: (a) to develop and refine techniques for making quantitative measurements of the transmembrane ionic currents, and (b) to identify the individual components of ionic current which generate different phases of the action potential. Initial voltage-clamp experiments made using a conventional two-microelectrode technique revealed a small tetrodotoxin (TTX)-insensitive inward current. The small size of this current (2.5-3.0 X 10(-10)A) and the technical difficulty of the two- microelectrode experiments prompted the development of a one- microelectrode voltage-clamp technique which requires impalements using a low-resistance (0.5-2 M omega) micropipette. Voltage-clamp experiments using this new technique in isolated single atrial cells reveal five distinct ionic currents: (a) a conventional transient Na+ current, (b) a TTX-resistant transient inward current, carried mainly by Ca++, (c) a component of persistent inward current, (d) a slowly developing outward K+ current, and (e) an inwardly rectifying time- independent background current. The single suction micropipette technique appears well-suited for use in the quantitative study of ionic currents in these cardiac cells, and in other small cells having similar electrophysiological properties. PMID:6302197

  6. Specific binding of atrial natriuretic factor in brain microvessels

    SciTech Connect

    Chabrier, P.E.; Roubert, P.; Braquet, P.

    1987-04-01

    Cerebral capillaries constitute the blood-brain barrier. Studies of specific receptors (neurotransmitters or hormones) located on this structure can be performed by means of radioligand-binding techniques on isolated brain microvessels. The authors examined on pure bovine cerebral microvessel preparations the binding of atrial natriuretic factor (ANF), using /sup 125/I-labeled ANF. Saturation and competition experiments demonstrated the presence of a single class of ANF-binding sites with high affinity and with a binding capacity of 58 fmol/mg of protein. The binding of /sup 125/I-labeled ANF to brain microvessels is specific, reversible, and time dependent, as is shown by association-dissociation experiments. The demonstration of specific ANF-binding sites on brain microvessels supposes a physiological role of ANF on brain microvasculature. The coexistence of ANF and angiotensin II receptors on this cerebrovascular tissue suggests that the two circulating peptides may act as mutual antagonists in the regulation of brain microcirculation and/or blood-brain barrier function.

  7. Atrial natriuretic polypeptide-like material in rat lung

    SciTech Connect

    Chang, J.K.; Chang, D.; Xie, C.W.; Song, D.L.; Li, X.R.; Zhang, S.X.; Wang, T.L.; Tang, J.

    1986-03-05

    Atrial natriuretic polypeptide-like immunoreactive material (ANP-IR) was found in rat lung by radioimmunoassay, with the concentration ranging from 0.6-1.2 pmol/g of tissue in each lobe. PAP-immunohistochemical study demonstrated that specific staining of granules for ..cap alpha..-human ANP are mainly located in the muscular layer of the pulmonary vein. Fractionation of lung extract by gel filtration and reserve phase HPLC revealed the presence of multiple forms of ANP-IR, which possibly possessed molecular structure partially different from rat ANP, atriopeptin I and III. Intravenous injection of lung extract induced potent diuresis and natriuresis in rats. These responses could be abolished when the lung extract was preincubated with antiserum for ..cap alpha..-human ANP. Specific binding sites for /sup 125/I-labeled rat ANP were also found in lung membrane preparation by radioreceptor assay. Incubation of synthetic atriopeptin III (10/sup -9/ to 10/sup -6/M) with lung tissue induced 1-28 fold increase in lung cGMP content. The results suggest that ANP-IR and its receptors existing in rat lung may be involved in the regulation of pulmonary function and have a synergic effect with ANP of cardiac origin in the control of water-electrolytes balance.

  8. Specific Binding of Atrial Natriuretic Factor in Brain Microvessels

    NASA Astrophysics Data System (ADS)

    Chabrier, Pierre E.; Roubert, Pierre; Braquet, Pierre

    1987-04-01

    Cerebral capillaries constitute the blood--brain barrier. Studies of specific receptors (neurotransmitters or hormones) located on this structure can be performed by means of radioligand-binding techniques on isolated brain microvessels. We examined on pure bovine cerebral microvessel preparations the binding of atrial natriuretic factor (ANF), using 125I-labeled ANF. Saturation and competition experiments demonstrated the presence of a single class of ANF-binding sites with high affinity (dissociation constant, ? 10-10 M) and with a binding capacity of 58 fmol/mg of protein. The binding of 125I-labeled ANF to brain microvessels is specific, reversible, and time dependent, as is shown by association-dissociation experiments. The demonstration of specific ANF-binding sites on brain microvessels supposes a physiological role of ANF on brain microvasculature. The coexistence of ANF and angiotensin II receptors on this cerebrovascular tissue suggests that the two circulating peptides may act as mutual antagonists in the regulation of brain microcirculation and/or blood--brain barrier function.

  9. Atrial natriuretic factor binding sites in the jejunum

    SciTech Connect

    Bianchi, C.; Thibault, G.; De Lean, A.; Genest, J.; Cantin, M.

    1989-02-01

    We have studied the localization and the characterization of atrial natriuretic factor (ANF) binding sites by radioautographic techniques. Quantitative in vitro radioautography with a computerized microdensitometer demonstrated the presence of high-affinity, low-capacity /sup 125/I-ANF-(99-126) binding sites (Kd, 48 pM; Bmax, 63 fmol/mg protein) mainly in the villi of 20-microns slide-mounted transverse sections of the rat jejunum. Competition curves showed 50% inhibitory concentrations of 55 and 1,560 pM for ANF-(99-126) and ANF-(103-123), respectively. In vivo electron microscope radioautography showed that 80% of the silver grains were localized on the lamina propria fibroblast-like cells, 18% on mature enterocytes, and 2% on capillaries. Bradykinin and adrenocorticotropin did not compete with ANF binding. These results demonstrate that ANF binding sites in the rat jejunum possess the pharmacological characteristics of functional ANF receptors encountered in other rat tissues, and ultrastructural radioautographs show their cellular distribution. Taken together, these results demonstrate the presence and the localization of specific binding sites for ANF in the jejunal villi of the rat small intestine.

  10. Atrial natriuretic factor receptor heterogeneity in rat tissues

    SciTech Connect

    Andresen, J.W.; Kuno, T.; Kamisaki, Y.; Leitman, D.C.; Murad, F.

    1986-03-01

    Rat /sup 125/I-atrial natriuretic factor (ANF, 8-33) was used to identify ANF receptors in membrane preparations from rat adrenal gland and lung. When solubilized with Lubrol-PX, the receptors retained a binding profile and properties that correspond to the high affinity and specificity found in crude membranes. Single peaks of binding activity were observed in gel permeation HPLC and density gradient centrifugation analysis of the solubilized preparations. However, when membranes and solubilized preparations were labeled with /sup 125/I-ANF, treated with crosslinking reagent (disuccinimidyl suberate), and analyzed by SDS gel electrophoresis several specifically labeled bands (120,000, 70,000, and 60,000 daltons) were identified by autoradiography. The relative distribution of the specifically labeled proteins varied significantly between rat adrenal gland and lung. In adrenal glands the 120K dalton band was the most prominent specifically labeled protein, while the 60K and 70K dalton proteins were labeled to a lesser degree. In lung membranes the lower molecular weight proteins were more prominent. These results suggest the presence of multiple ANF receptor subtypes, the distribution of which varies among tissues. Chromatographic separation and further characterization of these receptors are currently in progress, and preliminary purification studies support this hypothesis.

  11. Molecular characteristics of receptors for atrial natriuretic factor

    SciTech Connect

    Vandlen, R.L.; Arcuri, K.E.; Hupe, L.; Keegan, M.E.; Napier, M.A.

    1986-08-01

    Specific, high-affinity receptors for atrial natriuretic factor (ANF) have been identified on membranes from a variety of tissues and cultured cells. By affinity labeling procedures, radioactivity from /sup 125/I-labeled ANF was specifically incorporated into three different polypeptides of ca. 120,000, 70,000, and 60,000 daltons, which may represent the binding subunits of ANF receptors. These polypeptides were present in varying amounts in different target tissues. In rat adrenal membranes, the 120,000- and 70,000-dalton peptides were specifically labeled whereas in A10 rat smooth muscle cells, only the 60,000-dalton peptide was labeled. Membranes from rat kidney and rabbit aorta contain all three peptides. Gel filtration chromatography of solubilized receptors suggested that intact ANF receptors are large molecular complexes with apparent molecular masses in the range of 250,000-350,000 daltons. The differential labeling pattern observed with the various tissues suggested that there might be at least two different receptors composed of unique ANF-binding polypeptides.

  12. Atrial natriuretic factor binding sites in experimental congestive heart failure

    SciTech Connect

    Bianchi, C.; Thibault, G.; Wrobel-Konrad, E.; De Lean, A.; Genest, J.; Cantin, M. )

    1989-10-01

    A quantitative in vitro autoradiographic study was performed on the aorta, renal glomeruli, and adrenal cortex of cardiomyopathic hamsters in various stages of heart failure and correlated, in some instances, with in vivo autoradiography. The results indicate virtually no correlation between the degree of congestive heart failure and the density of 125I-labeled atrial natriuretic factor ((Ser99, Tyr126)ANF) binding sites (Bmax) in the tissues examined. Whereas the Bmax was increased in the thoracic aorta in moderate and severe heart failure, there were no significant changes in the zona glomerulosa. The renal glomeruli Bmax was lower in mild and moderate heart failure compared with control and severe heart failure. The proportion of ANF B- and C-receptors was also evaluated in sections of the aorta, adrenal, and kidney of control and cardiomyopathic hamsters with severe heart failure. (Arg102, Cys121)ANF (des-(Gln113, Ser114, Gly115, Leu116, Gly117) NH2) (C-ANF) at 10(-6) M displaced approximately 505 of (Ser99, Tyr126)125I-ANF bound in the aorta and renal glomeruli and approximately 20% in the adrenal zona glomerulosa in both series of animals. These results suggest that ANF may exert a buffering effect on the vasoconstriction of heart failure and to a certain extent may inhibit aldosterone secretion. The impairment of renal sodium excretion does not appear to be related to glomerular ANF binding sites at any stage of the disease.

  13. Atrial natriuretic peptide prevents cancer metastasis through vascular endothelial cells.

    PubMed

    Nojiri, Takashi; Hosoda, Hiroshi; Tokudome, Takeshi; Miura, Koichi; Ishikane, Shin; Otani, Kentaro; Kishimoto, Ichiro; Shintani, Yasushi; Inoue, Masayoshi; Kimura, Toru; Sawabata, Noriyoshi; Minami, Masato; Nakagiri, Tomoyuki; Funaki, Soichiro; Takeuchi, Yukiyasu; Maeda, Hajime; Kidoya, Hiroyasu; Kiyonari, Hiroshi; Shioi, Go; Arai, Yuji; Hasegawa, Takeshi; Takakura, Nobuyuki; Hori, Megumi; Ohno, Yuko; Miyazato, Mikiya; Mochizuki, Naoki; Okumura, Meinoshin; Kangawa, Kenji

    2015-03-31

    Most patients suffering from cancer die of metastatic disease. Surgical removal of solid tumors is performed as an initial attempt to cure patients; however, surgery is often accompanied with trauma, which can promote early recurrence by provoking detachment of tumor cells into the blood stream or inducing systemic inflammation or both. We have previously reported that administration of atrial natriuretic peptide (ANP) during the perioperative period reduces inflammatory response and has a prophylactic effect on postoperative cardiopulmonary complications in lung cancer surgery. Here we demonstrate that cancer recurrence after curative surgery was significantly lower in ANP-treated patients than in control patients (surgery alone). ANP is known to bind specifically to NPR1 [also called guanylyl cyclase-A (GC-A) receptor]. In mouse models, we found that metastasis of GC-A-nonexpressing tumor cells (i.e., B16 mouse melanoma cells) to the lung was increased in vascular endothelium-specific GC-A knockout mice and decreased in vascular endothelium-specific GC-A transgenic mice compared with control mice. We examined the effect of ANP on tumor metastasis in mice treated with lipopolysaccharide, which mimics systemic inflammation induced by surgical stress. ANP inhibited the adhesion of cancer cells to pulmonary arterial and micro-vascular endothelial cells by suppressing the E-selectin expression that is promoted by inflammation. These results suggest that ANP prevents cancer metastasis by inhibiting the adhesion of tumor cells to inflamed endothelial cells. PMID:25775533

  14. Diabetes and atrial fibrillation: stratification and prevention of stroke risks

    PubMed Central

    2014-01-01

    Background Although evidence is not very clear, diabetes is assumed to be an independent risk factor for atrial fibrillation (AF). One reason for the lack of evidence could be that AF often is not detected due to its paroxysmal or asymptomatic character. A better understanding of the relationship between both diseases and improved detection of AF is necessary since the combination of both diseases dramatically increase the risk of strokes if not treated properly. Methods Available literature about diabetes as an independent risk factor for AF has been evaluated, and limitations of studies are discussed. Results Results from different trials and registers are contradictory concerning diabetes as an independent risk factor for AF. Reasons for these differences can be found in different study designs and neglecting patients with unknown AF. Conclusions Due to the increasing burden of disease of diabetes and AF as common risk factors for stroke, a systematic screening for AF in diabetes patients could provide a better understanding of their correlation and personalized prevention strategies. PMID:25302085

  15. Role of neural modulation in the pathophysiology of atrial fibrillation.

    PubMed

    Male, Shailesh; Scherlag, Benjamin J

    2014-04-01

    Atrial-fibrillation (AF) is the most common clinically encountered arrhythmia affecting over 1 per cent of population in the United States and its prevalence seems to be moving only in forward direction. A recent systemic review estimates global prevalence of AF to be 596.2 and 373.1 per 100,000 population in males and females respectively. Multiple mechanisms have been put forward in the pathogenesis of AF, however; multiple wavelet hypothesis is the most accepted theory so far. Similar to the conduction system of the heart, a neural network exists which surrounds the heart and plays an important role in formation of the substrate of AF and when a trigger is originated, usually from pulmonary vein sleeves, AF occurs. This neural network includes ganglionated plexi (GP) located adjacent to pulmonary vein ostia which are under control of higher centers in normal people. When these GP become hyperactive owing to loss of inhibition from higher centers e.g. in elderly, AF can occur. We can control these hyperactive GP either by stimulating higher centers and their connections, e.g. vagus nerve stimulation or simply by ablating these GP. This review provides detailed information about the different proposed mechanisms underlying AF, the exact role of autonomic neural tone in the pathogenesis of AF and the possible role of neural modulation in the treatment of AF. PMID:24927337

  16. Osteoprotegerin and TRAIL in Acute Onset of Atrial Fibrillation

    PubMed Central

    Rewiuk, Krzysztof; Grodzicki, Tomasz

    2015-01-01

    Background. There is a growing amount of evidence that inflammatory processes are involved in the development of atrial fibrillation (AF) and its complications. We decided to investigate the behavior of osteoprotegerin (OPG) and TNF-related apoptosis inducing ligand (TRAIL) in terms of acute onset of AF. Methods and Results. We included 60 patients with acute onset of AF, candidates for pharmacological cardioversion. The presence of cardiovascular comorbidities was connected with higher concentration of OPG and lower level of TRAIL right from the first hours of AF paroxysm. The initial TRAIL level correlated also positively with left ventricle ejection fraction and negatively with left atrium diameter. We found subsequent increase of OPG in subgroups selected on the basis of CHA2DS2-VASc scoring. Although basal concentrations of studied markers did not allow prediction of the restoration of sinus rhythm, we observed important increase of TRAIL concentration in subgroup with sinus rhythm maintenance (94.11 ± 29.46 versus 111.39 ± 30.23?pg/mL; p = 0.002). Conclusions. OPG and TRAIL are associated with the underlying cardiovascular damage in AF, but their balance is modulated by the fact of sinus rhythm restoration. Determining the suitability of OPG and TRAIL as predictive markers in AF requires further prospective studies. PMID:26504794

  17. Left Atrial Function in Patients with Chronic Chagasic Cardiomyopathy

    PubMed Central

    Fragata, Claudia da Silva; Matsumoto, Afonso Y.; Ramires, Felix J. A.; Fernandes, Fabio; Buck, Paula de Cássia; Salemi, Vera Maria C.; Nastari, Luciano; Mady, Charles; Ianni, Barbara Maria

    2015-01-01

    Background Chagas disease is a cause of dilated cardiomyopathy, and information about left atrial (LA) function in this disease still lacks. Objective To assess the different LA functions (reservoir, conduit and pump functions) and their correlation with the echocardiographic parameters of left ventricular (LV) systolic and diastolic functions. Methods 10 control subjects (CG), and patients with Chagas disease as follows: 26 with the indeterminate form (GI); 30 with ECG alterations (GII); and 19 with LV dysfunction (GIII). All patients underwent M-mode and two-dimensional echocardiography, pulsed-wave Doppler and tissue Doppler imaging. Results Reservoir function (Total Emptying Fraction: TEF): (p <0.0001), lower in GIII as compared to CG (p = 0.003), GI (p <0.001) and GII (p <0.001). Conduit function (Passive Emptying Fraction: PEF): (p = 0.004), lower in GIII (GIII and CG, p = 0.06; GI and GII, p = 0.06; and GII and GIII, p = 0.07). Pump function (Active Emptying Fraction: AEF): (p = 0.0001), lower in GIII as compared to CG (p = 0.05), GI (p<0.0001) and GII (p = 0.002). There was a negative correlation of E/e’average with the reservoir and pump functions (TEF and AEF), and a positive correlation of e’average with s’ wave (both septal and lateral walls) and the reservoir, conduit and pump LA functions. Conclusion An impairment of LA functions in Chagas cardiomyopathy was observed. PMID:25993486

  18. Atrial natriuretic factor in maternal and fetal sheep

    SciTech Connect

    Cheung, C.Y.; Gibbs, D.M.; Brace, R.A.

    1987-02-01

    To determine atrial natriuretic factor (ANF) concentrations in the circulation and body fluids of adult pregnant sheep and their fetuses, pregnant ewes were anesthetized with pentobarbital sodium, and the fetuses were exteriorized for sampling. ANF concentration, as measured by radioimmunoassay, was 47 +/- 6 (SE) pg/ml in maternal plasma, which was significantly higher than the 15 +/- 3 pg/ml in maternal urine. In the fetus, plasma ANF concentration was 265 +/- 49 pg/ml, 5.6 times that in maternal plasma. No umbilical arterial and venous difference in ANF concentration was observed. Fetal urine ANF concentration was significantly lower than that in fetal plasma, and was similar to that measured in amniotic and allantoic fluid. In chronically catheterized maternal and fetal sheep, fetal plasma ANF was again 5.1 times that in maternal plasma, and these levels were not different from those measured in acutely anesthetized animals. These results demonstrate that immunoreactive ANF is present in the fetal circulation at levels higher than those found in the mother. The low concentration of ANF in fetal urine suggests that ANF is probably metabolized and/or reabsorbed by the fetal kidney.

  19. Atrial fibrillation in heart failure: what should we do?

    PubMed

    Kotecha, Dipak; Piccini, Jonathan P

    2015-12-01

    Heart failure (HF) and atrial fibrillation (AF) are two conditions that are likely to dominate the next 50 years of cardiovascular (CV) care. Both are increasingly prevalent and associated with high morbidity, mortality, and healthcare cost. They are closely inter-related with similar risk factors and shared pathophysiology. Patients with concomitant HF and AF suffer from even worse symptoms and poorer prognosis, yet evidence-based evaluation and management of this group of patients is lacking. In this review, we evaluate the common mechanisms for the development of AF in HF patients and vice versa, focusing on the evidence for potential treatment strategies. Recent data have suggested that these patients may respond differently than those with HF or AF alone. These results highlight the clear clinical need to identify and treat according to best evidence, in order to prevent adverse outcomes and reduce the huge burden that HF and AF are expected to have on global healthcare systems in the future. We propose an easy-to-use clinical mnemonic to aid the initial management of newly discovered concomitant HF and AF, the CAN-TREAT HFrEF + AF algorithm (Cardioversion if compromised; Anticoagulation unless contraindication; Normalize fluid balance; Target initial heart rate <110 b.p.m.; Renin-angiotensin-aldosterone modification; Early consideration of rhythm control; Advanced HF therapies; Treatment of other CV disease). PMID:26419625

  20. Atrial Fibrillation and Non-cardiovascular Diseases: A Systematic Review

    PubMed Central

    Ferreira, Cátia; Providência, Rui; Ferreira, Maria João; Gonçalves, Lino Manuel

    2015-01-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with an unfavorable prognosis, increasing the risk of stroke and death. Although traditionally associated with cardiovascular diseases, there is increasing evidence of high incidence of AF in patients with highly prevalent noncardiovascular diseases, such as cancer, sepsis, chronic obstructive pulmonary disease, obstructive sleep apnea and chronic kidney disease. Therefore, considerable number of patients has been affected by these comorbidities, leading to an increased risk of adverse outcomes. The authors performed a systematic review of the literature aiming to better elucidate the interaction between these conditions. Several mechanisms seem to contribute to the concomitant presence of AF and noncardiovascular diseases. Comorbidities, advanced age, autonomic dysfunction, electrolyte disturbance and inflammation are common to these conditions and may predispose to AF. The treatment of AF in these patients represents a clinical challenge, especially in terms of antithrombotic therapy, since the scores for stratification of thromboembolic risk, such as the CHADS2 and CHA2DS2VASc scores, and the scores for hemorrhagic risk, like the HAS-BLED score have limitations when applied in these conditions. The evidence in this area is still scarce and further investigations to elucidate aspects like epidemiology, pathogenesis, prevention and treatment of AF in noncardiovascular diseases are still needed. PMID:26577719

  1. The efficacy of rivaroxaban in patients with atrial fibrillation.

    PubMed

    Carag, Michael R; Arora, Rohit R

    2014-01-01

    Atrial fibrillation (AF), the most common form of cardiac arrhythmia, is a major risk factor for cardioembolic stroke. Dose-adjusted warfarin has been the gold standard for stroke prophylaxis in moderate- to high-risk patients with AF. However, the use of warfarin therapy is greatly limited by its narrow therapeutic window, numerous dietary restrictions, and drug-drug interactions, and an increased risk of hemorrhage. As a result, great emphasis has been placed on developing a new anticoagulant agent with fewer risks and limitations. Current data suggest that the oral direct factor Xa inhibitor rivaroxaban is a safe and effective alternative to warfarin. Furthermore, rivaroxaban does not require routine coagulation monitoring, which may improve patient compliance to anticoagulant therapy. The ROCKET AF trial demonstrated that 20-mg oral rivaroxaban taken once daily was noninferior to dose-adjusted warfarin in the prevention of stroke and non-central nervous system systemic embolism and had a comparable risk of bleeding. Based primarily on the ROCKET AF trial results, the US Food and Drug Administration recently approved the use of rivaroxaban for stroke prophylaxis in patients with nonvalvular AF. However, additional postmarketing studies on its safety and cost effectiveness are needed before it can be widely accepted as a sound alternative to warfarin. PMID:22487774

  2. Atrial natriuretic peptide increases resistance to venous return in rats

    SciTech Connect

    Chien, Y.W.; Frohlich, E.D.; Trippodo, N.C.

    1987-05-01

    To examine mechanisms by which administration of atrial natriuretic peptide (ANP) decreases venous return, the authors compared the hemodynamic effects of ANP furosemide (FU), and hexamethonium (HEX) with those of vehicle (VE) in anesthetized rats. Compared with VE, ANP reduced mean arterial pressure, central venous pressure, and cardiac index and increased calculated resistance to venous return. /sup 141/Ce-labeled microspheres were used to determine cardiac output. Mean circulatory filling pressure, distribution of blood flow between splanchnic organs and skeletal muscles, and total peripheral resistance remained unchanged. FU increased urine output similar to that of ANP, yet produced no hemodynamic changes, dissociating diuresis, and decreased cardiac output. HEX lowered arterial pressure through a reduction in total peripheral resistance without altering cardiac output or resistance to venous return. The results confirm previous findings that ANP decreases cardiac output through a reduction in venous return and suggest that this results partly from increased resistance to venous return and not from venodilation or distribution of blood flow.

  3. Simple Model for Identifying Critical Regions in Atrial Fibrillation

    NASA Astrophysics Data System (ADS)

    Christensen, Kim; Manani, Kishan A.; Peters, Nicholas S.

    2015-01-01

    Atrial fibrillation (AF) is the most common abnormal heart rhythm and the single biggest cause of stroke. Ablation, destroying regions of the atria, is applied largely empirically and can be curative but with a disappointing clinical success rate. We design a simple model of activation wave front propagation on an anisotropic structure mimicking the branching network of heart muscle cells. This integration of phenomenological dynamics and pertinent structure shows how AF emerges spontaneously when the transverse cell-to-cell coupling decreases, as occurs with age, beyond a threshold value. We identify critical regions responsible for the initiation and maintenance of AF, the ablation of which terminates AF. The simplicity of the model allows us to calculate analytically the risk of arrhythmia and express the threshold value of transversal cell-to-cell coupling as a function of the model parameters. This threshold value decreases with increasing refractory period by reducing the number of critical regions which can initiate and sustain microreentrant circuits. These biologically testable predictions might inform ablation therapies and arrhythmic risk assessment.

  4. Atrial natriuretic peptide prevents cancer metastasis through vascular endothelial cells

    PubMed Central

    Nojiri, Takashi; Hosoda, Hiroshi; Tokudome, Takeshi; Miura, Koichi; Ishikane, Shin; Otani, Kentaro; Kishimoto, Ichiro; Shintani, Yasushi; Inoue, Masayoshi; Kimura, Toru; Sawabata, Noriyoshi; Minami, Masato; Nakagiri, Tomoyuki; Funaki, Soichiro; Takeuchi, Yukiyasu; Maeda, Hajime; Kidoya, Hiroyasu; Kiyonari, Hiroshi; Shioi, Go; Arai, Yuji; Hasegawa, Takeshi; Takakura, Nobuyuki; Hori, Megumi; Ohno, Yuko; Miyazato, Mikiya; Mochizuki, Naoki; Okumura, Meinoshin; Kangawa, Kenji

    2015-01-01

    Most patients suffering from cancer die of metastatic disease. Surgical removal of solid tumors is performed as an initial attempt to cure patients; however, surgery is often accompanied with trauma, which can promote early recurrence by provoking detachment of tumor cells into the blood stream or inducing systemic inflammation or both. We have previously reported that administration of atrial natriuretic peptide (ANP) during the perioperative period reduces inflammatory response and has a prophylactic effect on postoperative cardiopulmonary complications in lung cancer surgery. Here we demonstrate that cancer recurrence after curative surgery was significantly lower in ANP-treated patients than in control patients (surgery alone). ANP is known to bind specifically to NPR1 [also called guanylyl cyclase-A (GC-A) receptor]. In mouse models, we found that metastasis of GC-A–nonexpressing tumor cells (i.e., B16 mouse melanoma cells) to the lung was increased in vascular endothelium-specific GC-A knockout mice and decreased in vascular endothelium-specific GC-A transgenic mice compared with control mice. We examined the effect of ANP on tumor metastasis in mice treated with lipopolysaccharide, which mimics systemic inflammation induced by surgical stress. ANP inhibited the adhesion of cancer cells to pulmonary arterial and micro-vascular endothelial cells by suppressing the E-selectin expression that is promoted by inflammation. These results suggest that ANP prevents cancer metastasis by inhibiting the adhesion of tumor cells to inflamed endothelial cells. PMID:25775533

  5. In vivo porcine left atrial wall stress: Computational model.

    PubMed

    Di Martino, Elena S; Bellini, Chiara; Schwartzman, David S

    2011-10-13

    Most computational models of the heart have so far concentrated on the study of the left ventricle, mainly using simplified geometries. The same approach cannot be adopted to model the left atrium, whose irregular shape does not allow morphological simplifications. In addition, the deformation of the left atrium during the cardiac cycle strongly depends on the interaction with its surrounding structures. We present a procedure to generate a comprehensive computational model of the left atrium, including physiological loads (blood pressure), boundary conditions (pericardium, pulmonary veins and mitral valve annulus movement) and mechanical properties based on planar biaxial experiments. The model was able to accurately reproduce the in vivo dynamics of the left atrium during the passive portion of the cardiac cycle. A shift in time between the peak pressure and the maximum displacement of the mitral valve annulus allows the appendage to inflate and bend towards the ventricle before the pulling effect associated with the ventricle contraction takes place. The ventricular systole creates room for further expansion of the appendage, which gets in close contact with the pericardium. The temporal evolution of the volume in the atrial cavity as predicted by the finite element simulation matches the volume changes obtained from CT scans. The stress field computed at each time point shows remarkable spatial heterogeneity. In particular, high stress concentration occurs along the appendage rim and in the region surrounding the pulmonary veins. PMID:21907340

  6. Role of neural modulation in the pathophysiology of atrial fibrillation

    PubMed Central

    Male, Shailesh; Scherlag, Benjamin J.

    2014-01-01

    Atrial-fibrillation (AF) is the most common clinically encountered arrhythmia affecting over 1 per cent of population in the United States and its prevalence seems to be moving only in forward direction. A recent systemic review estimates global prevalence of AF to be 596.2 and 373.1 per 100,000 population in males and females respectively. Multiple mechanisms have been put forward in the pathogenesis of AF, however; multiple wavelet hypothesis is the most accepted theory so far. Similar to the conduction system of the heart, a neural network exists which surrounds the heart and plays an important role in formation of the substrate of AF and when a trigger is originated, usually from pulmonary vein sleeves, AF occurs. This neural network includes ganglionated plexi (GP) located adjacent to pulmonary vein ostia which are under control of higher centers in normal people. When these GP become hyperactive owing to loss of inhibition from higher centers e.g. in elderly, AF can occur. We can control these hyperactive GP either by stimulating higher centers and their connections, e.g. vagus nerve stimulation or simply by ablating these GP. This review provides detailed information about the different proposed mechanisms underlying AF, the exact role of autonomic neural tone in the pathogenesis of AF and the possible role of neural modulation in the treatment of AF. PMID:24927337

  7. Characterization of Electrograms from Multipolar Diagnostic Catheters during Atrial Fibrillation

    PubMed Central

    Ganesan, Prasanth; Cherry, Elizabeth M.; Pertsov, Arkady M.; Ghoraani, Behnaz

    2015-01-01

    Atrial fibrillation (AF) is the most common arrhythmia in USA with more than 2.3 million people affected annually. Catheter ablation procedure is a method for treatment of AF, which involves 3D electroanatomic mapping of the patient's left atrium (LA) by maneuvering a conventional multipolar diagnostic catheter (MPDC) along the LA endocardial surface after which pulmonary vein (PV) isolation is performed, thus eliminating the AF triggers originating from the PVs. However, it remains unclear how to effectively utilize the information provided by the MPDC to locate the AF-sustaining sites, known as sustained rotor-like activities (RotAs). In this study, we use computer modeling to investigate the variations in the characteristics of the MPDC electrograms, namely, total conduction delay (TCD) and average cycle length (CL), as the MPDC moves towards a RotA source. Subsequently, a study with a human subject was performed in order to verify the predictions of the simulation study. The conclusions from this study may be used to iteratively direct an MPDC towards RotA sources thus allowing the RotAs to be localized for customized and improved AF ablation. PMID:26581316

  8. Alcohol concentration determines the type of atrial arrhythmia induced in a porcine model of acute alcoholic intoxication.

    PubMed

    Anadon, M J; Almendral, J; González, P; Zaballos, M; Delcan, J L; De Guevara, J L

    1996-11-01

    Alcohol abuse has long been suspected clinically to cause paroxysmal atrial tachyarrhythmias. However, such a relationship has never been conclusively proven, partly due to the lack of experimental evidence. Although atrial fibrillation (AF) is the most common atrial arrhythmia attributed to acute alcoholic ingestion, atrial flutter has occasionally been noted. We analyzed the possible role of alcohol in initiation and/or maintenance of a variety of atrial tachyarrhythmias in a closed-chest porcine model. Nine pigs underwent nine endocardial right atrial stimulation protocols (RASP) at baseline and 17 RASPs after increasing doses of ethanol (first infusion 1,230 mg/kg, second infusion 870 mg/kg) by means of one multipolar catheter advanced under heavy sedation from the femoral vein. Each RASP included 1, 2, and 3 extrastimuli, and rapid pacing at 5 times diastolic threshold. Venous ethanol concentrations were measured (HPGC method) every 10 minutes and at the time of arrhythmia induction. Atrial tachyarrhythmias were induced in 4 of 9 baseline RASPs, and lasted for a mean of 21 seconds, and in 16 of 17 RASPs after alcohol lasting for a mean of 357 seconds. Only fibrillation was observed at the baseline RASP. The atrial tachyarrhythmias induced after alcohol were AF in 11 RASPs and atrial flutter in 5 RASPs (in 5 animals). The mean venous ethanol concentration at the time of the longest arrhythmia induced for each RASP were 200 +/- 89 mg/dL for RASP inducing fibrillation and 292 +/- 40 mg/dL for RASP inducing flutter (P < 0.05). Flutter tended to be sustained (> 1 minute in duration) more often than fibrillation (4 of 5 flutter vs 2 of 11 fibrillation P < 0.05). In three experiments, atrial flutter persisted for > 10 minutes and was terminated by overdrive atrial pacing. We concluded: (1) in this closed-chest porcine model, an ethanol infusion facilitates a variety of atrial arrhythmias related to the ethanol concentration; (2) flutter tended to be sustained, and its termination by overdrive pacing suggests the possibility of an alcohol induced reentrant mechanism; and (3) the higher concentration required for atrial flutter, exceeding that usually seen in humans, may help to explain the rarity of atrial flutter in clinical alcohol intoxication. PMID:8945078

  9. Carney Complex

    MedlinePLUS

    ... Ephelides (freckles) LAMB syndrome – Lentigines, Atrial Myxoma, and Blue nevi What causes Carney complex? Carney complex is ... melanotic schwannoma, meaning tumors that grow on nerves Blue nevi, which are blue-black moles Osteochondromyxoma (bone ...

  10. Binding sites of atrial natriuretic peptide in tree shrew adrenal gland

    SciTech Connect

    Fuchs, E.; Shigematsu, K.; Saavedra, J.M.

    1986-09-01

    Adrenal gland binding sites for atrial natriuretic peptide-(99-126) (ANP) were quantitated in tree shrew (Tupaia belangeri) by incubation of adrenal sections with (3-(/sup 125/I)-iodotyrosyl28) atrial natriuretic peptide-(99-126), followed by autoradiography with computerized microdensitometry. In the adrenal glands, there are three types of ANP binding sites. One is located in the zona glomerulosa (BMax 84 +/- 6 fmol/mg protein; Kd 122 +/- 9 pM); the second in the zona fasciculata and reticularis (BMax 29 +/- 2 fmol/mg protein; Kd 153 +/- 6 pM) and the third in the adrenal medulla (BMax 179 +/- 1 fmol/mg protein; Kd 70 +/- 2 pM). Besides the influence of ANP on the regulation of adrenocortical mineralcorticoid and glucocorticoid secretion our findings raise the possibility for a local site of action of atrial natriuretic peptide in the regulation of adrenomedullary catecholamines in the tree shrew, primates and man.

  11. Geometric analysis on the unidirectionality of the pulmonary veins for atrial reentry

    E-print Network

    Chun, Sehun

    2013-01-01

    It is widely believed that the pulmonary veins (PVs) of the atrium play the central role in the generation of atrial reentry leading to atrial fibrillation, but its mechanism has not been analytically explained. In order to improve the current clinical procedures for atrial reentry by understanding its mechanism, geometrical analysis is proposed on the conditions of conduction failure at the PVs and is validated by various computational modeling. To achieve this, a new analytic approach is proposed by adapting the geometric relative acceleration analysis from spacetime physics on the hypothesis that a large relative acceleration can translate to a dramatic increase in the curvature of the wavefront and subsequently to conduction failure. This analytic method is applied to a simplified model of the PV to reveal the strong dependency of the propagational direction and the magnitude of anisotropy for conduction failure. The unidirectionality of the PVs follows directly and is validated by computational tests in ...

  12. Inotropic effects of ethanol and dihydropyridines on the guinea pig heart atrial muscle

    SciTech Connect

    Salvatici, R.P. ); Gallardo-Carpentier, A.; Carpentier, R.G. ); Isaacson, R.L. )

    1990-01-01

    The effects of ethanol and/or dihydropyridines (DHPs) on force of contraction of atrial muscle were studied. Guinea pig atrial strips superfused with Tyrode's solution were driven while recording muscle tension. Bay K 8644 (BAYK) increased, while nimodipine or ethanol reduced, the peak tension developed and the maximum velocity of development of tension. The effects of ethanol were readily reversible, but those of the DHPs were not. The combined actions of ethanol and DHPs were the result of the synergism or antagonism of the drugs tested. The shorter duration of the action of ethanol resulted in the effect of DHPs being still evident well after the exposure to the drugs ended. In summary, ethanol and nimodipine exerted depressant actions on atrial contractile force, while BAYK had opposite effects. The different mechanisms of action may explain the different duration of the effects of ethanol and DHPs.

  13. Increased atrial arrhythmia susceptibility induced by intense endurance exercise in mice requires TNF?.

    PubMed

    Aschar-Sobbi, Roozbeh; Izaddoustdar, Farzad; Korogyi, Adam S; Wang, Qiongling; Farman, Gerrie P; Yang, FengHua; Yang, Wallace; Dorian, David; Simpson, Jeremy A; Tuomi, Jari M; Jones, Douglas L; Nanthakumar, Kumaraswamy; Cox, Brian; Wehrens, Xander H T; Dorian, Paul; Backx, Peter H

    2015-01-01

    Atrial fibrillation (AF) is the most common supraventricular arrhythmia that, for unknown reasons, is linked to intense endurance exercise. Our studies reveal that 6 weeks of swimming or treadmill exercise improves heart pump function and reduces heart-rates. Exercise also increases vulnerability to AF in association with inflammation, fibrosis, increased vagal tone, slowed conduction velocity, prolonged cardiomyocyte action potentials and RyR2 phosphorylation (CamKII-dependent S2814) in the atria, without corresponding alterations in the ventricles. Microarray results suggest the involvement of the inflammatory cytokine, TNF?, in exercised-induced atrial remodelling. Accordingly, exercise induces TNF?-dependent activation of both NF?B and p38MAPK, while TNF? inhibition (with etanercept), TNF? gene ablation, or p38 inhibition, prevents atrial structural remodelling and AF vulnerability in response to exercise, without affecting the beneficial physiological changes. Our results identify TNF? as a key factor in the pathology of intense exercise-induced AF. PMID:25598495

  14. Role of Calcium-activated Potassium Channels in Atrial Fibrillation Pathophysiology and Therapy.

    PubMed

    Diness, Jonas G; Bentzen, Bo H; Sørensen, Ulrik S; Grunnet, Morten

    2015-11-01

    Small-conductance Ca-activated potassium (SK) channels are relative newcomers within the field of cardiac electrophysiology. In recent years, an increased focus has been given to these channels because they might constitute a relatively atrial-selective target. This review will give a general introduction to SK channels followed by their proposed function in the heart under normal and pathophysiological conditions. It is revealed how antiarrhythmic effects can be obtained by SK channel inhibition in a number of species in situations of atrial fibrillation. On the contrary, the beneficial effects of SK channel inhibition in situations of heart failure are questionable and still needs investigation. The understanding of cardiac SK channels is rapidly increasing these years, and it is hoped that this will clarify whether SK channel inhibition has potential as a new anti-atrial fibrillation principle. PMID:25830485

  15. Atrial ganglionated plexi stimulation may be an effective therapeutic tool for the treatment of heart failure.

    PubMed

    He, Bo; Lu, Zhibing; Jiang, Hong

    2013-11-01

    An autonomic imbalance, i.e., increased sympathetic tone and/or decreased parasympathetic tone is a critical characteristic of heart failure, which is associated with progressive ventricular remodeling, ventricular arrhythmia generation and disease progression. Increasing cardiac parasympathetic tone by vagus nerve stimulation has been shown to significantly improve heart failure symptoms, hemodynamics, left ventricular function and quality of life. However, cervical surgery is needed to position vagal stimulation electrode and vagus nerve stimulation may also cause some undesired side effects. Our recent studies showed that ablation of the main atrial ganglionated plexi (GP) facilitated the occurrence of ventricular arrhythmias in acute myocardial ischemic heart while low-intensity atrial GP stimulation inhibited the occurrence of ventricular arrhythmias during acute myocardial ischemia and ischemia reperfusion. Based on these results, we hypothesize that atrial GP stimulation may ameliorate autonomic dysfunction in heart failure, inhibit heart failure progression and improve heart failure prognosis. PMID:24018286

  16. Tetralogy of Fallot and atrial septal defect in a white Bengal Tiger cub (Panthera tigris tigris)

    PubMed Central

    2014-01-01

    A 3-week-old female white Bengal Tiger cub (Panthera tigris tigris) presented with acute onset tachypnoea, cyanosis and hypothermia. The cub was severely hypoxaemic with a mixed acid–base disturbance. Echocardiography revealed severe pulmonic stenosis, right ventricular hypertrophy, high membranous ventricular septal defect and an overriding aorta. Additionally, an atrial septal defect was found on necropsy, resulting in the final diagnosis of Tetralogy of Fallot with an atrial septal defect (a subclass of Pentalogy of Fallot). This report is the first to encompass arterial blood gas analysis, thoracic radiographs, echocardiography and necropsy findings in a white Bengal Tiger cub diagnosed with Tetralogy of Fallot with an atrial septal defect. PMID:24594084

  17. Exercise response before and after termination of atrial tachycardia after congenital heart disease surgery.

    PubMed

    Wessel, H U; Benson, D W; Braunlin, E A; Dunnigan, A; Paul, M H

    1989-07-01

    We studied exercise performance before and after conversion of atrial tachycardia to sinus rhythm, atrial bradycardia, or junctional rhythm in 10 patients 9-25 years of age 8-20 years after congenital heart disease surgery (complete transposition of the great arteries, seven of 10 patients). The same maximal cycle (five of 10 patients) or treadmill (five of 10 patients) exercise protocol was performed in atrial tachycardia and sinus rhythm 1-232 days after atrial tachycardia (mean, 34 days). Electrocardiogram, heart rate, and pulmonary gas exchange were recorded. Sinus rhythm exercise increased peak VO2 (mean, 28.7 [sinus rhythm] vs. 24.7 [atrial tachycardia], p less than 0.01), exercise time (p less than 0.01), and O2 pulse at rest (p less than 0.01) and at peak exercise (NS). Mean resting heart rate decreased from 109 to 70 beats/min (p less than 0.01). In atrial tachycardia, peak exercise heart rate was low (80-163 beats/min) because of fixed conduction (six of 10 patients) or high as conduction approached 1:1 (176-252 beats/min) (four of 10 patients). In sinus rhythm, rest to peak exercise heart rate increased in six of 10 patients (p less than 0.05). The data show improved exercise performance in sinus rhythm primarily because of improved heart rate adaptation to exercise, by either permitting increased heart rate response or eliminating excessively high heart rate with inadequate diastolic filling. PMID:2736742

  18. Effects of Intrinsic and Extrinsic Cardiac Nerves on Atrial Arrhythmia in Experimental Pulmonary Artery Hypertension.

    PubMed

    Zhao, Qingyan; Deng, Hongping; Jiang, Xuejun; Dai, Zixuan; Wang, Xiaozhan; Wang, Xule; Guo, Zongwen; Hu, Wei; Yu, Shengbo; Yang, Bo; Tang, Yanhong; Huang, Congxin

    2015-11-01

    Atrial arrhythmia, which includes atrial fibrillation (AF) and atrial flutter (AFL), is common in patients with pulmonary arterial hypertension (PAH), who often have increased sympathetic nerve activity. Here, we tested the hypothesis that autonomic nerves play important roles in vulnerability to AF/AFL in PAH. The atrial effective refractory period and AF/AFL inducibility at baseline and after anterior right ganglionated plexi ablation were determined during left stellate ganglion stimulation or left renal sympathetic nerve stimulation in beagle dogs with or without PAH. Then, sympathetic nerve, ?-adrenergic receptor densities and connexin 43 expression in atrial tissues were assessed. The sum of the window of vulnerability to AF/AFL was increased in the right atrium compared with the left atrium at baseline in the PAH dogs but not in the controls. The atrial effective refractory period dispersion was increased in the control dogs, but not in the PAH dogs, during left stellate ganglion stimulation. The voltage thresholds for inducing AF/AFL during anterior right ganglionated plexi stimulation were lower in the PAH dogs than in the controls. The AF/AFL inducibility was suppressed after ablation of the anterior right ganglionated plexi in the PAH dogs. The PAH dogs had higher sympathetic nerve and ?1-adrenergic receptor densities, increased levels of nonphosphorylated connexin 43, and heterogeneous connexin 43 expression in the right atrium when compared with the control dogs. The anterior right ganglionated plexi play important roles in the induction of AF/AFL. AF/AFL induction was associated with right atrium substrate remodeling in dogs with PAH. PMID:26418021

  19. Applying Harmonic Optical Microscopy for Spatial Alignment of Atrial Collagen Fibers

    PubMed Central

    Tsai, Ming-Rung; Chang, Yi-Chung; Hsu, Rong-Bin; Yu, Hsu-Yu; Sun, Chi-Kuang; Ho, Yi-Lwun

    2010-01-01

    Background Atrial fibrosis creates a vulnerable tissue for atrial fibrillation (AF), but the spatial disarray of collagen fibers underlying atrial fibrosis is not fully elucidated. Objective This study hypothesizes that harmonics optical microscopy can illuminate the spatial mal-alignment of collagen fibers in AF via a layer-by-layer approach. Patients and Methods Atrial tissues taken from patients who underwent open-heart surgery were examined by harmonics optical microscopy. Using the two-dimensional Fourier transformation method, a spectral-energy description of image texture was constituted and its entropy was used to quantify the mal-alignment of collagen fibers. The amount of collagen fiber was derived from its area ratio to total atrial tissue in each image. Serum C-terminal pro-collagen pro-peptide (CICP), pro-matrix metalloproteinase-1 (pro-MMP-1), and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) were also evaluated. Results 46 patients were evaluated, including 20 with normal sinus rhythm and 26 with AF. The entropy of spectral-energy distribution of collagen alignment was significantly higher in AF than that in sinus rhythm (3.97±0.33 vs. 2.80±0.18, p<0.005). This difference was more significant in the permanent AF group. The amount of collagen was also significantly higher in AF patients (0.39±0.13 vs. 0.18±0.06, p<0.005) but serum markers of cardiac fibrosis were not significantly different between the two groups. Conclusions Harmonics optical microscopy can quantify the spatial mal-alignment of collagen fibers in AF. The entropy of spectral-energy distribution of collagen alignment is a potential tool for research in atrial remodeling. PMID:21085489

  20. Quantitative Analysis of Localized Sources Identified by Focal Impulse and Rotor Modulation Mapping in Atrial Fibrillation

    PubMed Central

    Benharash, Peyman; Buch, Eric; Frank, Paul; Share, Michael; Tung, Roderick; Shivkumar, Kalyanam; Mandapati, Ravi

    2015-01-01

    Background New approaches to ablation of atrial fibrillation (AF) include focal impulse and rotor modulation (FIRM) mapping, and initial results reported with this technique have been favorable. We sought to independently evaluate the approach by analyzing quantitative characteristics of atrial electrograms used to identify rotors and describe acute procedural outcomes of FIRM-guided ablation. Methods and Results All FIRM-guided ablation procedures (n=24; 50% paroxysmal) at University of California, Los Angeles Medical Center were included for analysis. During AF, unipolar atrial electrograms collected from a 64-pole basket catheter were used to construct phase maps and identify putative AF sources. These sites were targeted for ablation, in conjunction with pulmonary vein isolation in most patients (n=19; 79%). All patients had rotors identified (mean, 2.3±0.9 per patient; 72% in left atrium). Prespecified acute procedural end point was achieved in 12 of 24 (50%) patients: AF termination (n=1), organization (n=3), or >10% slowing of AF cycle length (n=8). Basket electrodes were within 1 cm of 54% of left atrial surface area, and a mean of 31 electrodes per patient showed interpretable atrial electrograms. Offline analysis revealed no differences between rotor and distant sites in dominant frequency or Shannon entropy. Electroanatomic mapping showed no rotational activation at FIRM-identified rotor sites in 23 of 24 patients (96%). Conclusions FIRM-identified rotor sites did not exhibit quantitative atrial electrogram characteristics expected from rotors and did not differ quantitatively from surrounding tissue. Catheter ablation at these sites, in conjunction with pulmonary vein isolation, resulted in AF termination or organization in a minority of patients (4/24; 17%). Further validation of this approach is necessary. PMID:25873718

  1. The role of gap junctions in stretch-induced atrial fibrillation

    PubMed Central

    Ueda, Norihiro; Yamamoto, Mitsuru; Honjo, Haruo; Kodama, Itsuo; Kamiya, Kaichiro

    2014-01-01

    Aims The aim of this study was to investigate the role of gap junctions in atrial fibrillation (AF) by analysing the effects of a gap junction enhancer and blocker on AF vulnerability and electrophysiological properties of isolated hearts. Methods and results The acute atrial stretch model of AF in the isolated rabbit heart was used. Sustained AF (SAF) was induced by a burst of high-frequency stimulation of the Bachmann's bundle. The effective refractory period (ERP) was measured, and the total conduction time (TCT) and the pattern of conduction of the anterior surface of the left atrium were monitored by using an optical mapping system. The effect of enhancing gap junction function by 100–1000 nM rotigaptide (ZP123) and block by 30 ?M carbenoxolone on these parameters was measured. SAF inducibility was increased with an elevation of intra-atrial pressure. Enhanced gap junction conductance induced by treatment with 100–1000 nM rotigaptide reduced SAF inducibility, and the gap junction blocker carbenoxolone increased SAF inducibility. In the absence of gap junction enhancer or blocker, normal conduction was observed at 0 cmH2O. When intra-atrial pressure was raised to 12 cmH2O, the conduction pattern was changed to a heterogeneous zig-zag pattern and TCT was prolonged. Conduction pattern was not affected by either agent. Rotigaptide shortened TCT, whereas carbenoxolone prolonged TCT. ERP was significantly shortened with an increase in intra-atrial pressure, but ERP was unaffected by either agent. Conclusion Gap junction modulators changed AF inducibility through their effects on atrial conduction, not by altering ERP. PMID:25183791

  2. Fluid dynamics of heart valves during atrial fibrillation: a lumped parameter-based approach

    E-print Network

    Scarsoglio, Stefania; Guala, Andrea; Ridolfi, Luca

    2015-01-01

    Atrial fibrillation (AF) consequences on the heart valve dynamics are usually studied along with a valvular disfunction or disease, since in medical monitoring the two pathologies are often concomitant. Aim of the present work is to study, through a stochastic lumped-parameter approach, the basic fluid dynamics variations of heart valves, when only paroxysmal AF is present with respect to the normal sinus rhythm (NSR) in absence of any valvular pathology. Among the most common parameters interpreting the valvular function, the most useful turns out to be the regurgitant volume. During AF both atrial valves do not seem to worsen their performance, while the ventricular efficiency is remarkably reduced.

  3. Pleiotropic Effects of Antiarrhythmic Agents: Dronedarone in the Treatment of Atrial Fibrillation

    PubMed Central

    Heijman, Jordi; Heusch, Gerd; Dobrev, Dobromir

    2013-01-01

    Atrial fibrillation remains the most common arrhythmia in clinical practice. Dronedarone is an antiarrhythmic drug for the maintenance of sinus rhythm in patients with atrial fibrillation. Dronedarone is an amiodarone derivative developed to reduce the number of extracardiovascular side effects. Dronedarone has undergone extensive experimental and clinical testing during the last decade. On the aggregate, these studies have highlighted a complex set of pleiotropic actions that may contribute to dronedarone’s antiarrhythmic effects. In this review, we summarize the clinical studies that have evaluated dronedarone and provide an overview of dronedarone’s electrophysiological and nonelectrophysiological pleiotropic actions. PMID:23997577

  4. Late endocarditis of Amplatzer atrial septal occluder device in a child

    PubMed Central

    Jha, Neerod K; Kiraly, Laszlo; Murala, John SK; Tamas, Csaba; Talo, Haitham; El Badaoui, Hazem; Tofeig, Magdi; Mendonca, Malaika; Sajwani, Sameer; Thomas, Mary A; Al Doory, Sura Ahmed; Khan, Mohammad D

    2015-01-01

    Bacterial endocarditis following atrial septal defect closure using Amplatzer device in a child is extremely rare. We report a 10-year-old girl who developed late bacterial endocarditis, 6 years after placement of an Amplatzer atrial septal occluder device. Successful explantation of the device and repair of the resultant septal defect was carried out using a homograft patch. The rare occurrence of this entity prompted us to highlight the importance of long-term follow up, review the management and explore preventive strategies for similar patients who have multiple co-morbidities and a cardiac device. A high index of suspicion is warranted particularly in pediatric patients. PMID:26516426

  5. Integrated approach to treatment-resistant atrial fibrillation: additional value of acupuncture

    PubMed Central

    Jonkman, F A M; Jonkman-Buidin, M L

    2013-01-01

    A 62-year-old patient with chronic bronchitis had treatment-resistant atrial fibrillation. Electrical cardioversion was performed, but sinus rhythm (SR) lasted only for some minutes. Administration of amiodarone was withheld in favour of a course of acupuncture treatment in order to increase the success rate of a second attempt of electrical cardioversion. After two acupuncture treatments, spontaneous conversion to SR occurred. Relapses into atrial fibrillation in the following five winters, associated with attacks of bronchitis, also responded to acupuncture. The mechanisms of action of the acupuncture treatment and the value of this integrated approach to treatment are discussed. PMID:23884291

  6. The Surgical Treatment for Atrial Fibrillation: Ablation Technology and Surgical Approaches

    PubMed Central

    Henry, Linda; Ad, Niv

    2013-01-01

    The Cox maze procedure developed originally in 1987 by Dr James Cox has evolved from a “cut and sew” surgical procedure, where the maze was applied using multiple surgical cuts, to an extensive use of surgical ablation technology where ablation lesions are placed with alternative energy sources (radiofrequency, cryothermy, microwave, and high-frequency ultrasound). Furthermore, the procedure has changed from a median sternotomy approach only to one that can be performed minimally invasively and robotically. The purpose of this paper is to review the current available technology for the ablation of atrial fibrillation as well as the different procedural approaches for the surgical ablation of atrial fibrillation. PMID:23908871

  7. The impact of yoga on atrial fibrillation: A review of The Yoga My Heart Study

    PubMed Central

    Deutsch, Steven Brent; Krivitsky, Eric Lawrence

    2015-01-01

    Atrial fibrillation is a common arrhythmia affecting thousands of individuals worldwide. It is a conduction disorder that causes the heart to beat irregularly and rapidly. There are a few medical approaches to manage this costly health care burden: antiarrhythmics to maintain normal sinus rhythm, beta blockers to achieve rate control while allowing atrial fibrillation to persist, and electro-physiologic intervention for rate and rhythm control. These treatments can be costly and are not without side effects. Yoga, an intervention that is available to people worldwide, has shown some promise in combating this widespread heart disorder. PMID:26702311

  8. Managing atrial fibrillation in the very elderly patient: challenges and solutions

    PubMed Central

    Karamichalakis, Nikolaos; Letsas, Konstantinos P; Vlachos, Konstantinos; Georgopoulos, Stamatis; Bakalakos, Athanasios; Efremidis, Michael; Sideris, Antonios

    2015-01-01

    Atrial fibrillation (AF) is the most common arrhythmia affecting elderly patients. Management and treatment of AF in this rapidly growing population of older patients involve a comprehensive assessment that includes comorbidities, functional, and social status. The cornerstone in therapy of AF is thromboembolic protection. Anticoagulation therapy has evolved, using conventional or newer medications. Percutaneous left atrial appendage closure is a new invasive procedure evolving as an alternative to systematic anticoagulation therapy. Rate or rhythm control leads to relief in symptoms, fewer hospitalizations, and an improvement in quality of life. Invasive methods, such as catheter ablation, are the new frontier of treatment in maintaining an even sinus rhythm in this particular population. PMID:26604772

  9. Plasma Phospholipid Saturated Fatty Acids and Incident Atrial Fibrillation: The Cardiovascular Health Study

    PubMed Central

    Fretts, Amanda M.; Mozaffarian, Dariush; Siscovick, David S.; Djousse, Luc; Heckbert, Susan R.; King, Irena B.; McKnight, Barbara; Sitlani, Colleen; Sacks, Frank M.; Song, Xiaoling; Sotoodehnia, Nona; Spiegelman, Donna; Wallace, Erin R.; Lemaitre, Rozenn N.

    2014-01-01

    Background Prior studies suggest that circulating fatty acids may influence the risk of atrial fibrillation (AF), but little is known about the associations of circulating saturated fatty acids with risk of AF. Methods and Results The study population included 2899 participants from the Cardiovascular Health Study, a community?based longitudinal cohort of adults aged 65 years or older in the United States who were free of prevalent coronary heart disease and AF in 1992. Cox regression was used to assess the association of all the long?chain saturated fatty acids—palmitic acid (16:0), stearic acid (18:0), arachidic acid (20:0), behenic acid (22:0), and lignoceric acid (24:0)—with incident AF. During a median of 11.2 years of follow?up, 707 cases of incident AF occurred. After adjustment for other AF risk factors, higher levels of circulating 16:0 were associated with a higher risk of AF (hazard ratio comparing highest and lowest quartiles: 1.48; 95% CI: 1.18, 1.86). In contrast, higher levels of circulating 18:0, 20:0, 22:0, and 24:0 were each associated with a lower risk of AF. The hazard ratios (95% CI) for AF in the top and bottom quartiles were 0.76 (95% CI: 0.61, 0.95) for 18:0; 0.78 (95% CI: 0.63, 0.97) for 20:0; 0.62 (95% CI: 0.50, 0.78) for 22:0; and 0.68 (95% CI: 0.55, 0.85) for 24:0. Conclusions Results from this prospective cohort study of older adults demonstrate divergent associations of circulating 16:0 versus longer?chain saturated fatty acids with incident AF, highlighting the need to investigate both determinants of these levels and potential pathways of the observed differential risk. PMID:24970268

  10. Aspirin Use and Risk of Atrial Fibrillation in the Physicians' Health Study

    PubMed Central

    Ofman, Peter; Petrone, Andrew B.; Peralta, Adelqui; Hoffmeister, Peter; Albert, Christine M.; Djousse, Luc; Gaziano, J. Michael; Rahilly?Tierney, Catherine R.

    2014-01-01

    Background Inflammatory processes have been associated with an increased risk of atrial fibrillation (AF), potentially allowing for preventive therapy by anti?inflammatory agents such as aspirin. However, the effect of chronic aspirin on the incidence of AF has not been evaluated in a prospective cohort followed for an extended period. Methods and Results This study was comprised of a prospective cohort of 23 480 male participants of the Physicians' Health Study. Aspirin intake and covariates were estimated using self?reported questionnaires. Incident AF was ascertained through yearly follow?up questionnaires. Cox's regression, with adjustment for multiple covariates, was used to estimate relative risk of AF. Average age at baseline was 65.1±8.9 years. During a mean follow?up of 10.0 years, 2820 cases of AF were reported. Age?standardized incidence rates were 12.6, 11.1, 12.7, 11.3, 15.8, and 13.8/1000 person?years for people reporting baseline aspirin intake of 0, <14 days per year, 14 to 30 days per year, 30 to 120 days per year, 121 to 180 days per year, and >180 days per year, respectively. Multivariable adjusted hazard ratios (95% confidence interval) for incident AF were 1.00 (reference), 0.88 (0.76 to 1.02), 0.93 (0.76 to 1.14), 0.96 (0.80 to 1.14), 1.07 (0.80 to 1.14), and 1.04 (0.94 to 1.15) across consecutive categories of aspirin intake. Analysis of the data using time?varying Cox's regression model to update aspirin intake over time showed similar results. Conclusions In a large cohort of males followed for a long period, we did not find any association between aspirin use and incident AF. PMID:24980132

  11. The Italian START-Register on Anticoagulation with Focus on Atrial Fibrillation

    PubMed Central

    2015-01-01

    START-Register – Survey on anTicoagulated pAtients RegisTer – is an independent, inception-cohort, observational, collaborative database aimed at recording prospectively the clinical history of adult patients starting anticoagulant treatment for any reason and using whatever drug. In this article we present the START-Register and give cross section baseline data focusing on non valvular atrial fibrillation (NVAF). Participants are asked to insert prospectively consecutive patients recorded as electronic file on the web-site of the registry. Required data are: demographic and clinical characteristics of patients, associated risk factors for stroke and bleeding, laboratory routine data, clinical indication for treatment, expected therapeutic range (in cases of treatment with vitamin K antagonists -VKAs). The follow-up is carried out to record: quality of treatment (for patients on VKAs), bleeding complications, thrombotic events, and the onset of any type of associated disease. To date 5252 patients have been enrolled; 97.6% were on VKAs because direct oral anticoagulants (DOAC) have been available in Italy only recently. The median age was 74 years [interquartile range (IQR) 64-80]; males 53.7%. This analysis is focused on the 3209 (61.1%) NVAF patients. Mean CHADS2 score was 2.1±1.1, CHADSVASc score was 3.1±1.3;median age was 76 years (IQR 70-81); 168 patients (5.3%) had severe renal failure [Creatinine clearance (CrCl) <30 ml/min]. Moderate renal failure (CrCl 30-59 ml/min) was found in 1265 patients (39.5%). The analysis of the START-Register data shows that two-third of patients who started chronic anticoagulant treatment had NVAF, one-third of them was > 80 years with high prevalence of renal failure. PMID:26001109

  12. Is Atrial Fibrillation a Risk Factor for Gastroesophageal Reflux Disease Occurrence?

    PubMed

    Hwang, Jae Jin; Lee, Dong Ho; Yoon, Hyuk; Shin, Cheol Min; Park, Young Soo; Kim, Nayoung

    2015-10-01

    Recent studies have reported an association between gastroesophageal reflux disease (GERD) and atrial fibrillation (AF). The objective of the present study was to evaluate whether AF is one of the risk factors for GERD occurrence.In this hospital-based, retrospective, case-control study, the patients were classified into 2 groups. The patients diagnosed with new AF were assigned to the AF group (n?=?1612); those diagnosed without AF and GERD were assigned to the control group (n?=?1612). The subjects in the control group were selected from outpatients of total healthcare center without a history of AF or GERD, and matched for age and gender. We evaluated the incidence of GERD and risk factors for GERD occurrence between the 2 groups.The number of patients experiencing occurrence of GERD during the follow-up period was significantly higher in the AF group than those in the control group, respectively (129 patients vs 98 subjects, P?=?0.037). The incidence of GERD was significantly higher in the AF group than in the control group by Kaplan-Meier analysis with log-rank test (P?=?0.008). The AF group's adjusted hazard ratio of GERD occurrence against that of the control group was 1.37 (95% confidence interval [CI]: 1.16-1.57; P?=?0.009) according to Cox's proportional hazard model.The presence of AF appears to increase the incidence of GERD and may be considered a risk factor for the development of GERD. Further, large prospective and cohort studies will be required to better establish the correlation of GERD with AF. PMID:26512618

  13. Relation of Physical Activity and Incident Atrial Fibrillation (from the Multi-Ethnic Study of Atherosclerosis).

    PubMed

    Bapat, Aneesh; Zhang, Yiyi; Post, Wendy S; Guallar, Eliseo; Soliman, Elsayed Z; Heckbert, Susan R; Lima, Joao; Bertoni, Alain G; Alonso, Alvaro; Nazarian, Saman

    2015-09-15

    Previous studies have raised the question of whether an association exists between physical activity and atrial fibrillation (AF). We used the Multi-Ethnic Study of Atherosclerosis (MESA) database to examine the association between physical activity and AF in a diverse population without clinically recognized cardiovascular disease (CVD). MESA participants (n = 5,793) with complete baseline physical activity and covariate data were included. Cox proportional hazards models were used to calculate hazard ratios (HRs) for incident AF by levels of total intentional exercise and vigorous physical activity, independently and in combination. Multivariate models were adjusted for demographics and CVD risk factors. During a mean follow-up of 7.7 ± 1.9 years, 199 AF cases occurred. In the overall MESA population, neither vigorous physical activity nor total intentional exercise was independently associated with incident AF after adjusting for covariates. However, within the group that reported any vigorous physical activity, there was a statistically significant inverse association between total intentional exercise (modeled as a continuous variable) and incident AF. In those who reported any vigorous physical activity, the top tertile of total intentional exercise was associated with a significantly lower risk of incident AF compared with the group with no total intentional exercise in the fully adjusted model (HR 0.46, 95% confidence interval 0.22 to 0.98). In conclusion, neither total intentional exercise nor vigorous physical activity alone was associated with incident AF, but greater total intentional exercise was associated with a lower risk of incident AF in those who participated in any vigorous physical activity. As importantly, no subgroup of participants demonstrated an increased risk of incident AF with greater physical activity. The results re-emphasize the beneficial role of physical activity for cardiovascular health. PMID:26189040

  14. A new LMS algorithm for analysis of atrial fibrillation signals

    PubMed Central

    2012-01-01

    Background A biomedical signal can be defined by its extrinsic features (x-axis and y-axis shift and scale) and intrinsic features (shape after normalization of extrinsic features). In this study, an LMS algorithm utilizing the method of differential steepest descent is developed, and is tested by normalization of extrinsic features in complex fractionated atrial electrograms (CFAE). Method Equations for normalization of x-axis and y-axis shift and scale are first derived. The algorithm is implemented for real-time analysis of CFAE acquired during atrial fibrillation (AF). Data was acquired at a 977?Hz sampling rate from 10 paroxysmal and 10 persistent AF patients undergoing clinical electrophysiologic study and catheter ablation therapy. Over 24 trials, normalization characteristics using the new algorithm with four weights were compared to the Widrow-Hoff LMS algorithm with four tapped delays. The time for convergence, and the mean squared error (MSE) after convergence, were compared. The new LMS algorithm was also applied to lead aVF of the electrocardiogram in one patient with longstanding persistent AF, to enhance the F wave and to monitor extrinsic changes in signal shape. The average waveform over a 25?s interval was used as a prototypical reference signal for matching with the aVF lead. Results Based on the derivation equations, the y-shift and y-scale adjustments of the new LMS algorithm were shown to be equivalent to the scalar form of the Widrow-Hoff LMS algorithm. For x-shift and x-scale adjustments, rather than implementing a long tapped delay as in Widrow-Hoff LMS, the new method uses only two weights. After convergence, the MSE for matching paroxysmal CFAE averaged 0.46?±?0.49?V2/sample for the new LMS algorithm versus 0.72?±?0.35?V2/sample for Widrow-Hoff LMS. The MSE for matching persistent CFAE averaged 0.55?±?0.95?V2/sample for the new LMS algorithm versus 0.62?±?0.55?V2/sample for Widrow-Hoff LMS. There were no significant differences in estimation error for paroxysmal versus persistent data. From all trials, the mean convergence time was approximately 1 second for both algorithms. The new LMS algorithm was useful to enhance the electrocardiogram F wave by subtraction of an adaptively weighted prototypical reference signal from the aVF lead. The extrinsic weighting over 25?s demonstrated that time-varying functions such as patient respiration could be identified and monitored. Conclusions A new LMS algorithm was derived and used for normalization of the extrinsic features in CFAE and for electrocardiogram monitoring. The weighting at convergence provides an estimate of the degree of similarity between two signals in terms of x-axis and y-axis shift and scale. The algorithm is computationally efficient with low estimation error. Based on the results, proposed applications include monitoring of extrinsic and intrinsic features of repetitive patterns in CFAE, enhancement of the electrocardiogram F wave and monitoring of time-varying signal properties, and to quantitatively characterize mechanistic differences in paroxysmal versus persistent AF. PMID:22449196

  15. Can we predict the occurrence of atrial fibrillation?

    PubMed

    Schnabel, Renate B

    2012-01-01

    Atrial fibrillation (AF) is a complex disease with increasing prevalence in an aging population and longer survival with cardiovascular diseases. Whereas most clinical efforts have been aimed at predicting risk of AF sequelae such as stroke and heart failure, little is known on primary prevention. AF risk assessment is complicated by the existence of distinct subtypes of AF, such as lone AF or postoperative AF, in contrast to common AF in the elderly. Due to its often intermittent nature, diagnosing AF can be a challenge. Risk prediction becomes reasonable when specific interventions arise. Due to our limited understanding of AF pathophysiology and substantial lack of specific preventive strategies in the population, modification of the general cardiovascular risk profile has largely remained the only option. Initial attempts at combining established risk factors for AF such as age, sex, hypertension, body mass index, electrocardiographic characteristics, and cardiovascular disease in a risk-prediction instrument have produced a robust algorithm. However, known risk factors only explain a fraction of the population-attributable risk of AF, and the search for novel risk indicators is ongoing. More efficient monitoring for electrocardiographic precursors of AF and the field of genomics are evolving areas of AF risk factor research. A better understanding of the underlying substrate of AF will provide targets for prevention. In the future, clinical trials will be needed to establish risk categories, interventions, and their efficacy. Despite a relevant public-health impact, knowledge on risk prediction and primary prevention of AF is still limited today. There are no conflicts of interest to disclose. PMID:22246951

  16. MRI evaluation of RF ablation scarring for atrial fibrillation treatment

    NASA Astrophysics Data System (ADS)

    Ishihara, Yuri; Nazafat, Reza; Wylie, John V.; Linguraru, Marius G.; Josephson, Mark E.; Howe, Robert D.; Manning, Warren J.; Peters, Dana C.

    2007-03-01

    This study presents a multi-modality image registration method that evaluates left atrial scarring after radiofrequency (RF) ablation for pulmonary vein (PV) isolation. Our group has recently developed a delayed enhancement magnetic resonance imaging (DE-MRI) method with the potential to visualize and monitor non-invasively post-ablation scarring in the left atrium and the PV ostia. We wished to compare the 3D configuration of scarring in the DE-MRI image and the ablation points recorded by electroanatomical mapping (EAM) system, hypothesizing that scarring detected by DE-MRI overlaps with ablation points recorded by the EAM system used in the procedure. Methods and Results: Three data sets, DE-MRI images and pulmonary vein MR angiography (PV-MRA) images, and EAM data (CARTO-XP, Biosense-Webster, Inc., Diamond Bar, CA) from a patient who underwent PV ablation, were used for the multi-modal image registration. Contrast-enhanced MR imaging was performed 38 days after the ablation procedure. PV-MRA and DE-MRI were fused by intensity-based rigid registration. Scar tissue was extracted from the DE-MRI images using multiple threshold values. EAM data was further fused with segmented PV-MRA by the iterative closest point algorithm (ICP). After registration, the distance from PV-MRA to the scar was 2.6 +/- 2.1 mm, and from ablation points to the surface of the scar was 2.5 +/- 2.3 mm. The fused image demonstrates the 3D relationship between the PV ostia, the scar and the EAM recording of ablation points. Conclusion: Multimodal data fusion indicated that the scar tissue lesion after PV isolation showed good overlap with the ablation points.

  17. Functional atrial natriuretic peptide receptor in human adrenal tumor

    SciTech Connect

    Shionoiri, H.; Hirawa, N.; Takasaki, I.; Ishikawa, Y.; Oda, H.; Minamisawa, K.; Sugimoto, K.; Matsukawa, T.; Ueda, S.; Miyajima, E.

    1989-01-01

    The effects of synthetic human atrial natriuretic peptide (ANP) on the release of catecholamines, aldosterone, or cortisol were observed in human adrenal tumors obtained surgically from patients with pheochromocytoma, primary aldosteronism, or Cushing's syndrome, respectively. Each tumor tissue or adjacent normal cortical tissue was sectioned into slices, which were incubated in medium-199 in the presence or absence of adrenocorticotrophin (ACTH) and ANP. The amounts of epinephrine, norepinephrine, aldosterone, or cortisol released into the medium were measured. Existence of ANP receptors on the adrenal tissues was examined by binding assays, affinity labeling, and immunohistochemistry. Release of catecholamines from pheochromocytoma tissues was inhibited by ANP, and the presence of the ANP receptor on pheochromocytoma was further demonstrated by both binding assays and affinity labeling; Scatchard analysis revealed a single class of binding sites for ANP with a Kd of 1.0 nM and a Bmax of 0.4 pmol/mg of protein and the molecular size was estimated as 140 and a 70 kDa under nonreducing and reducing conditions, respectively. The presence of ANP receptors in pheochromocytoma was demonstrated by immunohistochemistry. ANP inhibited both basal and ACTH-stimulated aldosterone secretion in the slices of normal cortex, and localization of ANP receptors in zona glomerulosa cells was also demonstrated. However, ANP did not inhibit basal and ACTH-stimulated aldosterone and cortisol secretion in both tissue slices from aldosteronoma and Cushing's adenoma. Consistent with these observations, the absence of ANP receptors in adenoma tissues was determined by binding assays, affinity labeling, and immunohistochemistry.

  18. Regulation of atrial natriuretic peptide receptors in the rat brain

    SciTech Connect

    Saavedra, J.M.

    1987-06-01

    We have studied the localization, kinetics, and regulation of receptors for the circulating form of the atrial natriuretic peptide (ANP; 99-126) in the rat brain. Quantitative autoradiographic techniques and a /sup 125/I-labeled ligand, /sup 125/I-ANP (99-126), were employed. After in vitro autoradiography, quantification was achieved by computerized microdensitometry followed by comparison with /sup 125/I-standards. ANP receptors were discretely localized in the rat brain, with the highest concentrations in circumventricular organs, the choroid plexus, and selected hypothalamic nuclei involved in the production of the antidiuretic hormone vasopressin and in blood-pressure control. Spontaneously (genetic) hypertensive rats showed much lower numbers of ANP receptors than normotensive controls in the subfornical organ, the area postrema, the nucleus of the solitary tract, and the choroid plexus. These changes are in contrast to those observed for receptors of angiotensin II, another circulating peptide with actions opposite to those of ANP. Under conditions of acute dehydration after water deprivation, as well as under conditions of chronic dehydration such as those present in homozygous Brattleboro rats, there was an up-regulation of ANP receptors in the subfornical organ. Our results indicate that in the brain, circumventricular organs contain ANP receptors which could respond to variations in the concentration of circulating ANP. In addition, brain areas inside the blood-brain barrier contain ANP receptors probably related to the endogenous, central ANP system. The localization of ANP receptors and the alterations in their regulation present in genetically hypertensive rats and after dehydration indicate that brain ANP receptors are probably related to fluid regulation, including the secretion of vasopressin, and to cardiovascular function.

  19. The changing characteristics of atrial fibrillation patients treated with warfarin.

    PubMed

    Putnam, Andrew; Gu, Xiaokui; Haymart, Brian; Kline-Rogers, Eva; Almany, Steve; Kozlowski, Jay; Krol, Gregory D; Kaatz, Scott; Froehlich, James B; Barnes, Geoffrey D

    2015-11-01

    It has been suggested that direct oral anticoagulants are being preferentially used in low risk atrial fibrillation (AF) patients. Understanding the changing risk profile of new AF patients treated with warfarin is important for interpreting the quality of warfarin delivery through an anticoagulation clinic. Six anticoagulation clinics participating in the Michigan Anticoagulation Quality Improvement Initiative enrolled 1293 AF patients between 2010 and 2014 as an inception cohort. Abstracted data included demographics, comorbidities, medication use and all INR values. Risk scores including CHADS2, CHA2DS2-VASc, HAS-BLED, SAMe-TT2R2, and Charlson comorbidity index (CCI) were calculated for each patient at the time of warfarin initiation. The quality of anticoagulation was assessed using the Rosendaal time in the therapeutic range (TTR) during the first 6 months of treatment. Between 2010 and 2014, patients initiating warfarin therapy for AF had an increasing mean CHADS2 (2.0 ± 1.1 to 2.2 ± 1.4, p = 0.02) and CCI (4.7 ± 1.8 to 5.1 ± 2.0, p = 0.03), and a trend towards increasing mean CHA2DS2-VASc, HAS-BLED, and SAMe-TT2R2 scores. The actual TTR remained unchanged over the study period (62.6 ± 18.2 to 62.7 ± 17.0, p = 0.98), and the number of INR checks did not change (18.9 ± 5.2 to 18.5 ± 5.1, p = 0.06). Between 2010 and 2014, AF patients newly starting warfarin had mild increases in risk for stroke and death with sustained quality of warfarin therapy. PMID:26130229

  20. Preferences for anticoagulation therapy in atrial fibrillation: the patients' view.

    PubMed

    Böttger, Björn; Thate-Waschke, Inga-Marion; Bauersachs, Rupert; Kohlmann, Thomas; Wilke, Thomas

    2015-11-01

    Since the introduction of new oral anticoagulants (NOACs), besides vitamin-K antagonists, an additional option for stroke prevention of patients with atrial fibrillation (AF) is available. The objective of this study was to assess AF patients' preferences with regard to the attributes of these different treatment options. We conducted a multicenter study among randomly selected physicians. Preferences were assessed by computer-assisted telephone interviews. We used a discrete-choice-experiment (DCE) with four convenience-related treatment dependent attributes (need of bridging: yes/no, interactions with food/nutrition: yes/no, need of INR controls/dose adjustment: yes/no; frequency of intake: once/twice daily) and one comparator attribute (distance to practitioner: <1 km/>15 km). Preferences measured in the interviews were analyzed descriptively and based on a conditional logit regression model. A total of 486 AF patients (age: 73.9 ± 8.2 years; 43.2 % female; mean CHA2DS2-VASc: 3.7 ± 1.6; current medication: 48.1 % rivaroxaban, 51.9 % VKA) could be interviewed. Regardless of type of medication, patients significantly preferred the attribute levels (in order of patients' importance) "once daily intake" (Level: once = 1 vs. twice = 0; Coefficient = 0.615; p < 0.001), "bridging necessary" (yes = 1 vs. no = 0; -0.558; p < 0.001), "distance to practitioner of ?1 km (>15 km = 0 vs. ?1 km = 1; 0.494; p < 0.001), "interactions with food/nutrition" (yes = 1 vs. no = 0; -0.332; p < 0.001) and "need of INR controls/dose adjustment" (yes = 1 vs. no = 0; -0.127; p < 0.001). In our analyses, "once daily frequency of intake" was the most important OAC-attribute for patients' choice followed by "no bridging necessary" and "no interactions with food/nutrition". Thus, patients with AF seem to prefer treatment options which are easier to administer. PMID:26260625

  1. Atrial Fibrillation and Colonic Neoplasia in African Americans

    PubMed Central

    Nouraie, Mehdi; Kansal, Vandana; Belfonte, Cassius; Ghazvini, Mohammad; Haidari, Tahmineh; Shahnazi, Anahita; Brim, Hassan; Soliman, Elsayed Z.; Ashktorab, Hassan

    2015-01-01

    Background Colorectal cancer (CRC) and atrial fibrillation/flutter (AF) share several risk factors including increasing age and obesity. However, the association between CRC and AF has not been thoroughly examined, especially in African Americans. In this study we aimed to assess the prevalence of AF and its risk factors in colorectal neoplasia in an African American. Methods We reviewed records of 527 African American patients diagnosed with CRC and 1008 patients diagnosed with benign colonic lesions at Howard University Hospital from January 2000 to December 2012. A control group of 731 hospitalized patients without any cancer or colonic lesion were randomly selected from the same time and age range, excluding patients who had diagnosis of both CRC and/or adenoma. The presence or absence of AF was based upon ICD-9 code documentation. The prevalence of AF in these three groups was compared by multivariate logistic regression. Results The prevalence of AF was highest among CRC patients (10%) followed by adenoma patients (7.2%) then the control group (5.4%, P for trend = 0.002). In the three groups of participants, older age (P<0.008) and heart failure (P<0.001) were significantly associated with higher risk of AF. After adjusting for these risk factors, CRC (OR: 1.4(95%CI):0.9–2.2, P = 0.2) and adenoma (OR: 1.1(95%CI):0.7–1.6, P = 0.7) were not significantly associated AF compared to control group. Conclusions AF is highly prevalent among CRC patients; 1 in 10 patients had AF in our study. The predictors of AF in CRC was similar to that in adenoma and other patients after adjustment for potential confounders suggesting that the increased AF risk in CRC is explained by higher prevalence of AF risk factors. PMID:26317627

  2. Relation of Vigorous Exercise to Risk of Atrial Fibrillation

    PubMed Central

    Aizer, Anthony; Gaziano, J. Michael; Cook, Nancy R.; Manson, JoAnn E.; Buring, Julie E.; Albert, Christine M.

    2009-01-01

    Limited data suggest that athletes may have a higher risk of developing atrial fibrillation (AF); however there has been no large prospective assessment of the relationship between vigorous exercise and AF. Logistic regression analyses stratified by time were utilized to assess the association between frequency of vigorous exercise and risk of developing AF among 16,921 apparently healthy men in the Physicians’ Health Study. During 12 years of follow-up, 1,661 men reported developing AF. With increasing frequency of vigorous exercise (0, <1, 1?2, 3?4, 5?7 days per week), the multivariate relative risks for the full cohort were 1.0 (referent), 0.90, 1.09, 1.04, 1.20 (p=0.04). This risk was not significantly elevated when exercise habits were updated or in models excluding variables that may be in the biologic pathway through which exercise influences AF risk. In sub-group analyses, this elevated risk was observed only in men below age 50 [1.0, 0.94, 1.20, 1.05, 1.74 (p<0.01)] and joggers [1.0, 0.91, 1.03, 1.30, 1.53 (p<0.01)], where risks remained elevated in all analyses. In conclusion, frequency of vigorous exercise was associated with an increased risk of developing AF among young men and joggers. This risk diminished as the population aged and was offset by known beneficial effects of vigorous exercise on other AF risk factors. PMID:19463518

  3. "Torsade de pointes" in patients with structural heart disease and atrial fibrillation treated with amiodarone, beta-blockers, and digitalis.

    PubMed

    Schrickel, Jan W; Schwab, Joerg O; Yang, Alexander; Bitzen, Alexander; Lüderitz, Berndt; Lewalter, Thorsten

    2006-04-01

    Amiodarone is one of the most efficient and safe antiarrhythmic drugs in the treatment of atrial fibrillation (AF). Yet, though rare, proarrhythmic effects remain a clinical problem. We present three cases of amiodarone-associated "Torsade de pointes" tachycardia (Tdp) in patients treated concomitantly with heart rate controlling medication for AF. Amiodarone loading therapy was started for the treatment of tachyarrhythmic AF in all the three patients. All presented with a history of coronary heart disease, resulting in a severely reduced left ventricular ejection fraction in two patients. One received oral amiodarone loading, in the others, amiodarone was administered intravenously because of hemodynamically relevant AF episodes. Amiodarone therapy was combined with a heart rate controlling medication including a beta-blocking agent and digitalis in all the cases. All the subjects suffered from clinically relevant Tdp in the early run after initiation of amiodarone loading (max. 48 hours). The mean QTc in all patients before induction of Tdp was prolonged. The present case reports imply that amiodarone in combination with beta-blocker/digitalis therapy may be associated with an elevated proarrhythmic risk in selected patients with structural heart disease and AF. PMID:16650263

  4. One-Year Outcomes of Emergency Department Patients With Atrial Fibrillation: A Prospective, Multicenter Registry in China.

    PubMed

    Yang, Yan-Min; Shao, Xing-Hui; Zhu, Jun; Zhang, Han; Liu, Yao; Gao, Xin; Yu, Li-Tian; Liu, Li-Sheng; Zhao, Li; Yu, Peng-Fei; Zhang, Hua; He, Qing; Gu, Xiao-Dan

    2015-09-01

    There is lack of data about patient characteristics, practice patterns, and long-term adverse outcomes in patients with atrial fibrillation (AF) attending emergency departments (EDs) in China. A total of 2016 patients from 20 representative EDs were included. During 1 year, all-cause mortality was 291 (14.6%) cases, stroke/noncentral nervous system systemic embolism rate was 159 (8.0%) cases, and major bleeding was 26 (1.3%) cases. Heart failure, the major cause of mortality, accounted for 43.0% of deaths. Of 375 (18.6%) patients who used warfarin at baseline, only 217 (57.9%) patients were still on anticoagulation therapy during 1-year follow-up. Compared with the patients who continued on warfarin, the mortality rate was higher in those who did not continue (15.9% vs 5.5%, P < .001). Patients seen in ED with AF appear to have a high incidence rate of long-term all-cause mortality and inadequate anticoagulation rate. PMID:25344528

  5. Localisation of atrial natriuretic peptide immunoreactivity in the ventricular myocardium and conduction system of the human fetal and adult heart.

    PubMed Central

    Wharton, J; Anderson, R H; Springall, D; Power, R F; Rose, M; Smith, A; Espejo, R; Khaghani, A; Wallwork, J; Yacoub, M H

    1988-01-01

    Atrial natriuretic peptide immunoreactivity was found in ventricular and atrial tissues with specific antisera raised to the amino and carboxy terminal regions of the precursor molecule. In 13 developing human hearts (7-24 weeks' gestation) the immunoreactivity was concentrated in the atrial myocardium and ventricular conduction system but it was also detected in the early fetal ventricular myocardium. Immunoreactivity in five normal adults was largely confined to the atrial myocardium although it was also found in the ventricular conduction tissues of hearts removed from 10 patients who were undergoing cardiac transplantation. The ventricular conduction system is an extra-atrial site for the synthesis of atrial natriuretic peptide. In the failing heart this synthesis may be further supplemented by expression of the gene in the ventricular myocardium. It is possible that ventricular production of the peptide contributes to the raised circulating concentrations of atrial natriuretic peptide immunoreactivity found in severe congestive heart disease, particularly in patients with dilated cardiomyopathy. Images Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 PMID:2973340

  6. Detection of occult atrial fibrillation in patients with embolic stroke of uncertain source: a work in progress

    PubMed Central

    Andrade, Jason G.; Field, Thalia; Khairy, Paul

    2015-01-01

    Atrial fibrillation accounts for a substantial proportion of ischemic strokes of known etiology and may be responsible for an additional subset of the 25–40% of strokes of unknown cause (so-called cryptogenic). Oral anticoagulation is significantly more effective than antiplatelet therapy in the secondary prevention of atrial fibrillation-related strokes, providing justification for developing more sensitive approaches to detecting occult paroxysms of atrial fibrillation. In this article, we summarize the current state of knowledge regarding the value of in-hospital and out-patient monitoring for detecting atrial fibrillation in the context of cryptogenic stroke. We review the evidence for and against screening with standard Holter monitors, external loop recorders, the newer real-time continuous attended cardiac monitoring systems, cardiac implantable electronic devices, and insertable loop recorders. We review key questions regarding prolonged cardiac arrhythmia monitoring, including the relationship between duration of the atrial fibrillation episode and risk of thromboembolism, frequency of monitoring and its impact on the diagnostic yield in detecting occult or subclinical atrial fibrillation, and the temporal proximity of device-detected atrial fibrillation to stroke events. We conclude by proposing avenues for further research. PMID:25883570

  7. Evaluating The Hatch Score For Predicting Progression To Sustained Atrial Fibrillation In ED Patients With New Atrial Fibrillation

    PubMed Central

    Barrett, Tyler W.; Self, Wesley H.; Wasserman, Brian S.; McNaughton, Candace D.; Darbar, Dawood

    2013-01-01

    Objectives Atrial fibrillation (AF) is often first detected in the emergency department (ED). Not all AF patients progress to sustained AF (i.e., episodes lasting > 7 days), which is associated with increased morbidity. The HATCH score stratifies patients with paroxysmal AF according to their risk for progression to sustained AF within 1-year. The HATCH score has previously never been tested in ED patients. Weevaluated the accuracy of the HATCH score to predict progression to sustained AF within 1-year of initial AF diagnosis in the ED. Methods We conducted a retrospective cohort study of 253 ED patients with new onset AF and known rhythm status for 1-year following the initial AF detection. The exposure variable was the HATCH score at initial ED evaluation. The primary outcome was rhythm status at1-year following initial AF diagnosis. We constructed a receiver operating characteristic (ROC) curve and calculated the area under the curve (AUC) to estimate the HATCH score’s accuracy of predicting progression to sustained AF. Results Overall, 61/253 (24%) of patients progressed to sustained AF within1-year of initial detection, and the HATCH score ROC AUC was 0.62 (95% CI: 0.54 to 0.70). Conclusions Among ED patients with new onset AF, the HATCH score was a modest predictor of progression to sustained AF. Because only 2 patients had a HATCH > 5, this previously recommended cut-point was not useful in identifying high-risk patients in this cohort. Refinement of this decision aid is needed to improve its prognostic accuracy in the ED population. PMID:23478104

  8. Prognostic Implications of Right and Left Atrial Enlargement after Radiofrequency Catheter Ablation in Patients with Nonvalvular Atrial Fibrillation

    PubMed Central

    Moon, Jeonggeun; Lee, Hye-Jeong; Kim, Jong-Youn; Pak, Hui-Nam; Lee, Moon-Hyoung; Kim, Young Jin

    2015-01-01

    Background and Objectives The prognostic role of the right atrium (RA) compared with that of the left atrium (LA) is unclear in patients with atrial fibrillation (AF). We assessed structural changes in both atria and determined their association with recurrence of AF after radiofrequency catheter ablation (RFCA). Subjects and Methods All 111 patients with nonvalvular AF (87 men; mean age, 57±11 years; 68 with paroxysmal AF) who underwent RFCA were enrolled consecutively. Three-dimensional volumes of both atria measured from computed tomography images were compared between subjects with and without recurrence of AF during the follow-up. Results Early (<3 months), 6-month, and 1-year recurrence was documented in 26 (24%), 30 (27%), and 36 (32%) patients, respectively. Significantly larger RA and LA volume indices (RAVI and LAVI) were observed in the early, 6-month, and 1-year recurrence groups (p<0.05 for all). In multivariate analysis, Early recurrence was independently associated with RAVI (for each 10 mL/m2 increase; odds ratio [OR], 1.31; 95% confidence interval [CI], 1.03-1.66, p= 0.03), but not with LAVI. However, both RAVI and LAVI failed to predict 6-month outcomes independently. LAVI was the only independent predictor of 1-year recurrence (for each 10 mL/m2 increase; OR, 1.36; 95% CI, 1.08-1.71, p=0.009). Conclusion RA enlargement was more closely related to early recurrence of AF after RFCA than LA size. However, LA size, rather than RA volume, was a determinant of long-term AF prognosis after RFCA. These findings suggest a temporal pattern in the prognostic implication of enlargement in each atrium that switches over time after RFCA for AF. PMID:26240584

  9. Relation between Left Atrial Remodeling in Young Patients with Cryptogenic Stroke and Normal Inter-atrial Anatomy

    PubMed Central

    Vural, Mustafa Gökhan; Cetin, Suha; Yilmaz, Murat; Akdemir, Ramazan; Gunduz, Huseyin

    2015-01-01

    Background and Purpose To investigate an association between left atrial (LA) structural and P wave dispersion (PWD) during sinus rhythm, and electrical remodeling in cryptogenic stroke (CS) patients. Methods Forty CS patients and 40 age- and sex-matched healthy controls were enrolled. P wave calculations were based on 12-lead electrocardiography (ECG) at a 50-mm/s-paper speed with an amplitude of 10 mm/mV. Difference between the maximum and minimum P wave duration was the P wave dispersion (PWD=Pmax-Pmin). LA deformation was evaluated by speckle tracking echocardiography within 3 days of the acute event. Results PWD was 30.1±7.0 ms and 27.4±3.5 ms in CS and control group (P=0.02), whereas LA maximum volume index [LAVImax] was 20.4±4.5 mL/m2 and 19.9±2.4 mL/m2 in CS and control group, respectively (P = 0.04). While global peak LA strain was [pLA-S] (LA reservoir function) 41.4 ± 6.3% and 44.5 ± 7.1% in CS and control group, (P = 0.04), global peak late diastolic strain rate values [pLA-SRa] (LA pump function) were 2.5 ± 0.4% and 2.9 ± 0.5% in CS and control group, respectively (P = 0.001). A mild and a strong negative correlation between global pLA-S and LAVImax (r=-0.49; P<0.01), and between PWD and global pLA-S (r = -0.52; P < 0.01), respectively, was observed in CS. Conclusions Increased PWD is associated with impaired LA mechanical functions and enlargement, and involved in the pathophysiology of AF or an AF-like physiology in CS. PMID:26437996

  10. Stroke Risk Factors Beyond the CHA2DS2-VASc Score: Can We Improve Our Identification of "High Stroke Risk" Patients With Atrial Fibrillation?

    PubMed

    Szymanski, Filip M; Lip, Gregory Y H; Filipiak, Krzysztof J; Platek, Anna E; Hrynkiewicz-Szymanska, Anna; Opolski, Grzegorz

    2015-12-01

    The prevention of stroke and other thromboembolic events plays a crucial role in the management of patients with atrial fibrillation. Not all patients with atrial fibrillation are equal in terms of thromboembolic risk; therefore, not all will benefit from oral anticoagulation treatment. The general principle is that the expected benefit of anticoagulation in reduction of thromboembolic risk must exceed the expected harm caused by possible bleeding. Some guidelines have focused on a categorical approach to stroke prevention, with a focus on identifying patients at high risk for oral anticoagulation. Various current guidelines recommend assessment of stroke risk using the CHADS2 or CHA2DS2-VASc scores to initially detect patients at low risk who require no antithrombotic therapy. However, the scores do not incorporate all possible risk factors causing a high thromboembolic risk. Factors such as impaired renal function, obstructive sleep apnea, and echocardiographic and biochemical or coagulation parameters can also predict adverse thromboembolic events. The present review aims to describe biomarkers whether blood, urine, imaging (cardiac or cerebral), or clinical that go beyond the CHA2DS2-VASc score and potentially aid stroke risk assessment. Although useful in some cases, the presented parameters should be perhaps used to further refine initial identification of patients at low risk, after which effective stroke prevention can be offered to those with ?1 additional stroke risk factors. PMID:26434516

  11. Clinical utility of rivaroxaban in stroke prevention associated with nonvalvular atrial fibrillation – patient considerations

    PubMed Central

    Ahrens, Ingo; Bode, Christoph

    2014-01-01

    The direct factor Xa inhibitor rivaroxaban was the first within the group of orally available direct factor Xa inhibitors to gain clinical approval for oral anticoagulation in patients with nonvalvular atrial fibrillation in 2011. The –xabans, as drugs from the group of oral direct factor Xa inhibitors are often referred to, comprise currently three drugs (apixaban, edoxaban, and rivaroxaban) with clinical approval for a variety of clinical indications that require oral anticoagulation therapy. The number of patients with nonvalvular atrial fibrillation requiring long-term oral anticoagulation therapy for the prevention of stroke and systemic embolism is predicted to increase up to five times by 2050. Many of these patients will be within the elderly and aging population that is at a higher risk of stroke and also at a higher risk for bleeding events. This requires novel options for efficient and safe oral anticoagulation, and rivaroxaban is one of the novel oral anticoagulants that have been shown to be at least as effective as vitamin K antagonists in patients with nonvalvular atrial fibrillation. Furthermore, like all of the novel oral anticoagulants, rivaroxaban provides a significant reduction in intracerebral hemorrhage compared with vitamin K antagonists such as warfarin. The clinical utility of oral anticoagulation with rivaroxaban in patients with nonvalvular atrial fibrillation is discussed here, along with special patient considerations, including impaired renal function, switching from a vitamin K antagonist, and patients with concomitant acute coronary syndrome. PMID:24591854

  12. The European Network for Translational Research in Atrial Fibrillation (EUTRAF): objectives and initial results.

    PubMed

    Schotten, Ulrich; Hatem, Stephane; Ravens, Ursula; Jaïs, Pierre; Müller, Frank-Ulrich; Goette, Andres; Rohr, Stephan; Antoons, Gudrun; Pieske, Burkert; Scherr, Daniel; Oto, Ali; Casadei, Barbara; Verheule, Sander; Cartlidge, David; Steinmeyer, Klaus; Götsche, Thorsten; Dobrev, Dobromir; Kockskämper, Jens; Lendeckel, Uwe; Fabritz, Larissa; Kirchhof, Paulus; Camm, A John

    2015-10-01

    Atrial fibrillation (AF) is the most common sustained arrhythmia in the general population. As an age-related arrhythmia AF is becoming a huge socio-economic burden for European healthcare systems. Despite significant progress in our understanding of the pathophysiology of AF, therapeutic strategies for AF have not changed substantially and the major challenges in the management of AF are still unmet. This lack of progress may be related to the multifactorial pathogenesis of atrial remodelling and AF that hampers the identification of causative pathophysiological alterations in individual patients. Also, again new mechanisms have been identified and the relative contribution of these mechanisms still has to be established. In November 2010, the European Union launched the large collaborative project EUTRAF (European Network of Translational Research in Atrial Fibrillation) to address these challenges. The main aims of EUTRAF are to study the main mechanisms of initiation and perpetuation of AF, to identify the molecular alterations underlying atrial remodelling, to develop markers allowing to monitor this processes, and suggest strategies to treat AF based on insights in newly defined disease mechanisms. This article reports on the objectives, the structure, and initial results of this network. PMID:26364316

  13. Separation and Characterization of Amines from Individual Atrial Gland Vesicles of Aplysia

    E-print Network

    ¨teborg University, SE-413 90, Go¨teborg, Sweden Several amine-containing components of individual vesicles from-containing components were detected with laser-induced fluorescence (LIF). Amino acids, including taurine, that had neuromodulatory activity. The bioactive peptides, well-known to be in atrial gland vesicles, were detected

  14. Recurrence of atrial fibrillation after switching from brand to generic atenolol.

    PubMed

    Gallelli, Luca; Maida, Francesca; Staltari, Orietta; Rende, Pierandrea; Russo, Emilio; Caroleo, Benedetto; De Sarro, Giovambattista

    2015-01-01

    Beta blockers are the initial treatment for rate control of supraventricular tachyarrhythmia in patients without a history of myocardial infarction or left ventricular dysfunction. In this article we report the recurrence of atrial fibrillation after switching to the generic formulation of atenolol. PMID:25709353

  15. [Paroxysmal atrial fibrillation in community medicine: management intentions and cost estimates].

    PubMed

    Jeantet, M; Losay, J; Cassinat, G; Andral, J; Guize, L; de Pouvourville, G

    2001-10-01

    This study was undertaken to describe the declared management of atrial fibrillation in community medicine in France for patients between 50 and 80 years of age, and to estimate the total cost of treatment for Society in the year 2000. A questionnaire was sent to a sample of 306 private sector cardiologists, representative for their geographic location: 100 replies were received. Only 10% of cardiologists prescribed a treatment in patients without cardiovascular precedents who had a single regressive episode of atrial fibrillation and three quarters of them advised follow-up. This management cost an average between 228 and 296 Euros/year. When the episode of fibrillation was persistent at the time of consultation, 82% of practitioners prescribed antiarrhythmic reduction (amiodarone) after antithrombotic treatment (oral anticoagulants) followed by an antiarrhythmic therapy (class lc mainly) with an average cost of 659 to 783 Euros/year. In patients with previous cardiovascular disease, when a first episode of atrial fibrillation was present at the time of consultation, 92% of cardiologists prescribed pharmacological reduction with amiodarone, followed by long-term therapy when successful for an average cost of 755 to 1,092 Euros/year. All cardiologists requested systematic blood tests to search for thyroid complications of amiodarone with an average cost of 59 Euros/year. The costs were high, especially in chronic and recurrent pathology: the cost of treatment of the first two episodes of atrial fibrillation in the over 65 age group was 305 million Euros/year. PMID:11725717

  16. Effects of antiarrhythmic drug therapy on atrioventricular nodal function during atrial

    E-print Network

    Glass, Leon

    and Medicine, McGill University, McIntyre Medical Sciences Building, 3655 Promenade Sir William Osler, Montreal One of the major medical problems facing cardiol- ogists is the treatment of paroxysmal and chronic activity during atrial fibrillation (AF) in post-surgical patients, and to develop and use a mathematical

  17. A review on atrioventricular junction ablation and pacing for heart rate control of atrial fibrillation

    PubMed Central

    Vlachos, Konstantinos; Letsas, Konstantinos P; Korantzopoulos, Panagiotis; Liu, Tong; Efremidis, Michael; Sideris, Antonios

    2015-01-01

    Atrioventricular junction ablation with permanent pacemaker implantation is a highly effective treatment approach in patients with atrial fibrillation and high ventricular rates resistant to other treatment modalities, especially in the elderly or those with severe comorbidities. Compared with pharmacological therapy alone, the so-called “ablate and pace” approach offers the potential for more robust control of ventricular rate. Atrioventricular junction ablation and pacing strategy is associated with improvement in symptoms, quality of life, and exercise capacity. Given the close relationship between atrial fibrillation and heart failure, there is a particular benefit of such a rate control in patients with atrial fibrillation and reduced systolic function. There is increasing evidence that cardiac resynchronization therapy devices may be beneficial in selected populations after atrioventricular junction ablation. The present review article focuses on the current recommendations for atrioventricular junction ablation and pacing for heart rate control in patients with atrial fibrillation. The technique, the optimal implantation time, and the proper device selection after atrioventricular junction ablation are also discussed. PMID:26512247

  18. [Design and application of cardiac stimulator for rapid atrial pacing animal model].

    PubMed

    Qin, Yong; Yu, Jiahui; Zhou, Zhen; Wei, Hongming

    2014-01-01

    A cardiac stimulator for rapid atrial pacing animal model was designed in this paper. According to the needs of clinical research, output pulse parameters of the cardiac stimulator can be designed. The cardiac stimulator will be controlled through magnet. Efficiency of the cardiac stimulator was validated by animal experiments. PMID:24839845

  19. The Current Role of Omega-3 Fatty Acids in the Management of Atrial Fibrillation

    PubMed Central

    Christou, Georgios A.; Christou, Konstantinos A.; Korantzopoulos, Panagiotis; Rizos, Evangelos C.; Nikas, Dimitrios N.; Goudevenos, John A.

    2015-01-01

    Background: The main dietary source of omega-3 polyunsaturated fatty acids (n-3 PUFA) is fish, which contains eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). In the present manuscript, we aimed to review the current evidence regarding the clinical role of n-3 PUFA in the prevention of atrial fibrillation (AF) and the possible underlying mechanisms. Methods: A literature search based on PubMed listings was performed using “Omega-3 fatty acids” and “atrial fibrilation” as key search terms. Results: n-3 PUFA have been shown to attenuate structural atrial remodeling, prolong atrial effective refractory period through the prevention of reentry and suppress ectopic firing from pulmonary veins. Dietary fish intake has been found to have no effect on the incidence of AF in the majority of studies. Circulating DHA has been consistently reported to be inversely associated with AF risk, whereas EPA has no such effect. The majority of studies investigating the impact of n-3 PUFA supplementation on the incidence of AF following cardiac surgery reported no benefit, though most of them did not use n-3 PUFA pretreatment for adequate duration. Studies using adequate four-week pretreatment with n-3 PUFA before cardioversion of AF showed a reduction of the AF incidence. Conclusions: Although n-3 PUFA have antiarrhythmogenic properties, their clinical efficacy on the prevention of AF is not consistently supported. Further well-designed studies are needed to overcome the limitations of the existing studies and provide robust conclusions. PMID:26402674

  20. Nervous activity of afferent cardiac sympathetic fibres with atrial and ventricular endings

    PubMed Central

    Malliani, A.; Recordati, G.; Schwartz, P. J.

    1973-01-01

    1. We recorded the electrical activity of single afferent cardiac fibres isolated from the third and fourth left thoracic sympathetic rami communicantes of anaesthetized cats. Their conduction velocities ranged from 12 to 32 m/sec. 2. The endings of each fibre were localized to one cardiac chamber by mechanical probing of the opened heart performed at the end of the experiment. 3. The impulse activity was spontaneous and, in fibres with atrial or ventricular endings, it was in phase with a particular atrial or ventricular event. 4. This nervous activity increased during increases in pressure occurring in the chamber where the endings were located. Conversely, decreases in pressure were accompanied by decreased nervous discharge. 5. In some experiments the left coronary artery was perfused at different flows and pressures. Brief decreases or increases in coronary flow and pressure decreased or increased, respectively, the discharge of fibres with atrial or ventricular endings. Fibres were excited by intracoronary injections of veratridine. 6. Cessation of coronary pump flow increased the discharge of fibres with atrial or ventricular endings only when myocardial ischaemia was accompanied by signs of heart failure. 7. These afferent cardiac sympathetic fibres which provide the spinal cord with continuous specific information on cardiac events are likely to contribute to the neural control of circulation. PMID:4724832