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1

[Mitral valve repair in a patient with giant left atrial myxoma;report of a case].  

PubMed

In patients with left atrial myxoma, mitral valve regurgitation is often encountered. However, preoperative assessment of the mitral valve is difficult in cases with giant left atrial myxoma occupying the left atrial cavity. We experienced a patient with giant left atrial myxoma who underwent tumor excision and mitral valve repair. A 40-year-old woman was transferred to the emergency room due to respiratory failure. On admission, her hemodynamic status was unstable and percutaneous cardiopulmonary support was immediately started. Transesophageal echocardiography was performed, which showed giant left atrial tumor with the pedicle on the atrial septum with mitral valve regurgitation, but the severity of regurgitation was unclear. After excision of left atrial myxoma with atrial septum, the mitral valve was examined. The anterior leaflet( A3 scallop) prolapse due to a torn chordae was found. The mitral valve was repaired with leaflet resection and prosthetic ring annuloplasty. Postoperative course was uneventful and postoperative echocardiography showed no residual mitral valve regurgitation. The mitral valve should be carefully inspected intraoperatively after resection of left atrial myxoma, especially when the tumor is gigantic. PMID:25201370

Iizuka, Hirofumi; Aoki, Atushi; Omoto, Tadashi; Maruta, Kazuto; Sakurai, Sigeru; Kawaura, Hiromasa

2014-09-01

2

Aspergillus infection in pulmonary cavitating lesions with right atrial myxoma.  

PubMed

Cardiac myxomas are rare primary tumors with varied clinical presentations that may pose a diagnostic challenge. Here, we describe the case of a 21-year-old man with multiple cavitating lung lesions with aspergillosis and underlying right atrial myxoma, who presented with hemoptysis and weight loss. He was successfully treated with right atrial myxoma resection and antifungal agents, with no recurrence or complications after one year of follow-up. PMID:24887845

Sharma, Divyesh; Dorgan, Eileen; Douglas, Hannah; Trouton, Tom; McMullan, Ronan; Parissis, Haralabos

2014-11-01

3

Right atrial myxoma with a large tumor embolus in the left pulmonary artery  

PubMed Central

Cardiac myxoma, the most common primary cardiac tumor, usually develops in the left atrium. Right atrial myxomas are rare, especially those accompanied by pulmonary tumor embolism. We describe a case of a right atrial myxoma with a large tumor embolus in the left pulmonary artery. A 74-year-old man was referred to our hospital for the treatment of a right atrial tumor. Upon echocardiography, the right atrial tumor was revealed to have a mobile and tail-like surface projection. In addition, computed tomography showed that an embolus was wedged into the left pulmonary artery. We performed an emergency surgery to remove both the right atrial tumor and the pulmonary embolus. Histopathological examination revealed them both to be myxoma. Right atrial myxoma with a large pulmonary tumor embolus is a serious condition and emergency surgery to remove both cardiac tumors and pulmonary emboli should be performed to avoid the risk of sudden death. PMID:25352579

Ikeda, Akihiko; Tsukada, Toru; Konishi, Taisuke; Matsuzaki, Kanji; Jikuya, Tomoaki; Hiramatsu, Yuji

2014-01-01

4

Right atrial myxoma with a large tumor embolus in the left pulmonary artery.  

PubMed

Cardiac myxoma, the most common primary cardiac tumor, usually develops in the left atrium. Right atrial myxomas are rare, especially those accompanied by pulmonary tumor embolism. We describe a case of a right atrial myxoma with a large tumor embolus in the left pulmonary artery. A 74-year-old man was referred to our hospital for the treatment of a right atrial tumor. Upon echocardiography, the right atrial tumor was revealed to have a mobile and tail-like surface projection. In addition, computed tomography showed that an embolus was wedged into the left pulmonary artery. We performed an emergency surgery to remove both the right atrial tumor and the pulmonary embolus. Histopathological examination revealed them both to be myxoma. Right atrial myxoma with a large pulmonary tumor embolus is a serious condition and emergency surgery to remove both cardiac tumors and pulmonary emboli should be performed to avoid the risk of sudden death. PMID:25352579

Ikeda, Akihiko; Tsukada, Toru; Konishi, Taisuke; Matsuzaki, Kanji; Jikuya, Tomoaki; Hiramatsu, Yuji

2014-01-01

5

Atrial myxoma masquerading as Takayasu’s arteritis  

PubMed Central

Lesson We describe the case of a 48-year-old woman whose atrial myxoma was mistaken for vasculitis. The case report highlights the reasons why these two disorders may become confused, the dangers of initiating the wrong treatment and a simple means of avoiding misdiagnosis.

Fung, Kenneth; Edmondson, Stephen

2014-01-01

6

Right atrial myxoma as a possible cause of hemorrhagic stroke and sudden death  

PubMed Central

Right atrial myxomas are rare primary tumors of the heart. They may remain asymptomatic or eventually cause constitutional signs and symptoms. Less frequently, obstruction of the tricuspid valve occurs, resulting in exertional dyspnea, syncope, or sudden death. Neurological manifestation as initial presentation of atrial myxomas is rarely, if ever, associated with right atrial myxomas and may be secondary to cerebral infarction, cerebral hemorrhage and, more rarely subarachnoid hemorrhage. We review the case of a previously unknown, middle-aged Nigerian man who presented to hospital with severe headache and sudden loss of consciousness. A clinical diagnosis of hypertensive hemorrhagic cerebrovascular accident was made. The patient died suddenly a few hours after presentation. Post-mortem examination revealed a small intracerebral hemorrhage in the left superior temporal lobe as well as a large right atrial myxoma, a ventricular septal defect in the muscular septum, and right ventricular hypertrophy. The liver showed fatty change while the kidneys showed evidence of benign nephrosclerosis. Right atrial myxomas may, therefore, be remotely considered as a cause of intracranial hemorrhage, especially in the presence of predisposing cardiac anomalies such as a ventricular septal defect. Similarly, being a known cause of right heart failure, sudden death, and other constitutional derangements, it may contribute significantly to disease outcome. Hence, it should be given due consideration in the differential diagnosis of cerebrovascular accidents. PMID:23271855

Sabageh, Donatus; Odujoko, Oluwole Olaniyi; Komolafe, Akinwumi Oluwole

2012-01-01

7

Tricuspid valve obstruction and right heart failure due to a giant right atrial myxoma arising from the superior vena cava  

PubMed Central

Myxomas are the most common primary cardiac tumors. The cardiac myxomas are mostly diagnosed within the atria, and only a few such tumors are reported to have arisen from atrioventricular valves or pulmonary vessels. The authors here present a case of 59-year-old Chinese woman who was hospitalized for exacerbating symptoms of tricuspid stenosis and right heart failure. Echocardiography revealed a giant right atrial myxoma arising from an extremely rare site, the anterior wall of the superior vena cava. With the aid of transesophageal echocardiography, the surgical resection was performed successfully with the patient achieving complete recovery. PMID:24172033

2013-01-01

8

[Simultaneous occurrence and treatment of right atrial myxoma and extensive colonic polyposis causing recurrent intestinal hemorrhages].  

PubMed

The authors describe the case history of 68 year old man. Right atrial myxoma had been diagnosed two years prior to this present observation, however surgical intervention has been contraindicated due to high operative risk. Later the patient was referred to a cardiological evaluation because of chronic atrial fibrillation before a cataract surgery in a symptom free condition. The right atrial myxoma caused inflow obstruction and tricuspid regurgitation was removed before the eye surgery. In addition, tricuspid valve replacement and revascularization of three coronary arteries has been performed. The patient receiving chronic anticoagulant therapy experienced severe gastrointestinal bleeding the source of which turned out to be a partially malignant colon polyposis. The polyps were successfully removed by coloscopy and intra operative coloscopy. No gastrointestinal bleeding has been observed afterwards in spite of the continued anticoagulation. After review of the literature the authors observed that according to their knowledge the common occurrence of the right atrial myxoma and the colon polyposis had not been described before. PMID:9019703

Jánosi, A; Moravcsik, E; Faller, J; Adám, Z; Bodó, M

1996-07-28

9

Cerebral embolism associated with left atrial myxoma that was treated with thrombolytic therapy.  

PubMed

We present a case of cerebral embolism associated with a left atrial myxoma that was treated with intravenous thrombolytic therapy. A 79-year-old right-handed man with no history of neurological or psychiatric illnesses was referred to our hospital because of confusion. He had been self-supported in the activity of daily living and could enjoy gardening until just before his admission. He had aphasia, left conjugate deviation, right hemiparesis, and right pathological reflexes. His NIHSS score was 24. Cranial DWI showed hyperintense lesions in the left middle cerebral artery territory, and MRA revealed left middle cerebral artery occlusion. We started treatment with the recombinant tissue plasminogen activator alteplase intravenously 3 h after the onset. However, the therapy was ineffective, and the NIHSS score was 25 on the second day. A transthoracic echocardiogram and heart MRI showed a left atrial myxoma. However, surgery was contraindicated because of the patient's poor general condition. Although intravenous recombinant tissue plasminogen activator is a reasonable treatment for stroke patients, even with a cardiac myxoma, we cannot always expect good effects, especially if the emboli are parts of the tumor itself. In this case, we could not perform an endovascular mechanical embolectomy; however, we speculate that mechanical embolus retrieval in cerebral ischemia might be effective in such cases. PMID:22545036

Kohno, Naoto; Kawakami, Yuko; Hamada, Chizuko; Toyoda, Genya; Bokura, Hirokazu; Yamaguchi, Shuhei

2012-01-01

10

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

PubMed

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

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

2014-09-01

11

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

PubMed Central

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

Habbab, Louay; Alfaraidi, Haifa; Lamy, Andre

2014-01-01

12

Rare association of acromegaly with left atrial myxoma in Carney's complex due to novel PRKAR1A mutation  

PubMed Central

Summary Carney complex (CNC) is a rare autosomal dominant syndrome characterized by pigmented lesions of the skin and mucosae along with cardiac, endocrine, cutaneous, and neural myxomatous tumors. Mutations in the PRKAR1A gene have been identified in ?70% of the CNC cases reported worldwide. A 30-year-old male was referred to the endocrinology clinic with suspected acromegaly. He had a history of recurrent atrial myxoma for the past 8 years for which he underwent repeated surgeries. Presently, he complained of having headache, excessive snoring, sweating, and also noticed increase in his shoe size. Evaluation for acromegaly revealed elevated levels of GH in random as well as in suppressed condition. Magnetic resonance imaging scan revealed enlarged sella with microadenoma in the left anterior pituitary. Screening of PRKAR1A gene was carried out for the patient, his parents and siblings who were available and willing to undergo the test. The patient was diagnosed to have the rare CNC syndrome characterized by recurrent atrial myxoma and acromegaly due to a novel 22?bp insertion mutation in PRKAR1A which was predicted to be deleterious by in silico analysis. Screening the available family members revealed the absence of this mutation in them except the elder brother who also tested positive for this mutation. The present study reports on a novel PRKAR1A insertion mutation in a patient with acromegaly and left atrial myxoma in CNC. Learning points Identification of a novel deleterious PRKAR1A insertion mutation causing CNC.It is important that patients with cardiac myxoma be investigated for presence of endocrine overactivity suggestive of CNC. PRKAR1A mutation analysis should be undertaken in such cases to confirm the diagnosis in the patients as well as first degree relatives.This case highlights an important aspect of diagnosis, clinical course, and management of this rare condition.

Birla, Shweta; Aggarwal, Sameer; Tandon, Nikhil

2014-01-01

13

Recurrence of nonfamilial cardiac myxoma in the left ventricle: A case report.  

PubMed

A left atrial myxoma was found and removed in a 47-year-old woman admitted for acute ischemic cerebrovascular disease, without family history of cardiac tumor. Follow-up echocardiography, 15 months later, demonstrated a new myxoma in the left ventricle. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42:576-577, 2014. PMID:24797084

Song, Xiaole; Tang, Li; Yang, Jun; Li, Nan

2014-11-12

14

Complicated Sporadic Cardiac Myxomas: A Second Recurrence and Myxomatous Cerebral Aneurysms in One Patient  

PubMed Central

A second recurrence of an excised nonfamilial cardiac myxoma is rare. Myxomatous cerebral aneurysms as a complication of cardiac myxomas are equally rare. A unique case of a patient with a total of 4 myxomas over a 20-year interval is presented. Her most recent presentation was a second recurrence of a left atrial myxoma, a de novo right atrial myxoma, and multiple cerebral myxomatous aneurysms. The challenging reconstruction of the normal anatomy was achieved with the use of porcine extracellular matrix patches. A diagnostic cerebral angiogram was later performed, and the aneurysms will be monitored for growth and possible intervention. PMID:24455387

Iskandar, Mazen E.; Dimitrova, Kamellia; Geller, Charles M.; Hoffman, Darryl M.; Tranbaugh, Robert F.

2013-01-01

15

Atrial myxoma: a rare cause of cardioembolic stroke  

PubMed Central

The authors present the case of a 45-year-old lady who presented to the emergency department with sudden onset of right hemiparesis, numbness, dysarthria, dysmetria, left upper motor neuron facial palsy and left extensor plantar. Initial laboratory investigations, ECG and MR angiography were normal. MRI brain revealed multiple ischaemic strokes in middle cerebral artery and posterior cerebral artery territory. Transthoracic echocardiography revealed large mobile mass in left atrium which was resected and the patient remained well postoperatively. Anticoagulants do not play any protective role making resection as the only effective treatment. PMID:22962389

Akhtar, Junaid; Wasay, Mohammad; Rauf, Javeria

2012-01-01

16

Pathology Case Study: Multiple Myxomas and Thyroid Cancer  

NSDL National Science Digital Library

This is a endocrine pathology case study presented by the University of Pittsburgh Department of Pathology in which a 36-year-old white female has multiple myxomas and thyroid cancer. Visitors are given examination and laboratory data and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with diagnosis. It is also a helpful site for educators to use to introduce or test student learning in endocrine pathology.

Virji, Mohamed; Wang, Jianzhou

2008-04-08

17

Intramural hematoma and oozing rupture of left atrium after resection of wide-based left atrial myxoma.  

PubMed

We describe a rare complication after the resection of the left atrial (LA) myxoma. After tumor resection, a large defect of the endocardium was reinforced with an autologous pericardial patch. Transesophageal echocardiography demonstrated a hematoma and pulsatile flow beneath the patch, without patch perforation or detachment. Bleeding increased after closure of the sternum. Intramural hematoma and oozing rupture of the LA were diagnosed. A small intramural vessel of the LA was identified as the main causative site of bleeding. The pericardial patch was repositioned with fibrin glue. Fibrin sheets and glue were applied for reinforcement of the LA from outside. PMID:25046973

Ohira, Suguru; Doi, Kiyoshi; Maeda, Sachiko; Yaku, Hitoshi

2014-10-01

18

Surgical management of odontogenic myxoma: a case report and review of the literature  

PubMed Central

Background Odontogenic myxoma is a benign odontogenic tumor with locally aggressive behavior, and is relatively rare in the oral cavity. There are currently no clear surgical management guidelines for odontogenic myxoma, and a variety of approaches may be used. This study evaluated the literature concerning the surgical management of odontogenic myxoma, and reports the long-term outcome of a case managed by using a more conservative surgical approach. Case presentation We managed a 40-year-old Japanese man with odontogenic myxoma in the right mandible by enucleation and curettage, a relatively conservative approach that has proved to have been justified by a lack of recurrence over 10 years. Our strategy was compared with others reported in the literature, which was identified by a PubMed search using the term “odontogenic myxoma”. Articles without full text or with missing data were excluded. The age and sex of patients, the tumor location (maxilla/mandible), treatment (conservative/radical), recurrence, and follow-up period were compared in the reported cases that we evaluated. From the initial 211 studies identified, 20 studies qualified as mandibular cases of odontogenic myxoma. Recurrence was reported in three cases that had been treated with a more conservative surgical approach. Conclusions Enucleation and curettage has proved an effective approach in several cases in ours there has been no recurrence more than 10 years after surgery but the risk of recurrence appears to be higher. We discuss the important factors that must be considered when determining the correct management approach to odontogenic myxoma. PMID:24708884

2014-01-01

19

Infiltrative odontogenic myxoma of the posterior maxilla: Report of a case  

PubMed Central

Myxomas of the head and neck are rare tumors of uncertain histogenesis. Odontogenic myxomas in maxilla are less common but behave more aggressively, as it spreads through maxillary antrum. It therefore reaches considerable size before being detected. The current case arouses particular interest due to the rapid growth and infiltrating nature of the lesion in a 25-year-old female patient, who denied any leading symptoms, even with the lesion involving extensively. Radiographic and microscopic similarities to a number of entities make diagnostic interpretation of odontogenic myxoma challenging. Therefore sound knowledge of clinical, radiographic and histopathologic features is important to establish an appropriate treatment aimed at a good clinical course and patient cure. PMID:24082760

Arul, A. Sri Kennath J.; Verma, Sonika; Arul, A. Sri Sennath J.; Verma, Rashmika

2013-01-01

20

Report of a Rare Case of an Odontogenic Myxoma of the Maxilla and Review of Literature  

PubMed Central

Odontogenic myxoma (OM) is a mesenchymal tissue benign neoplasia, being relatively rare which is almost exclusively seen in tooth-bearing areas. OM commonly occurs in the 2nd and 3rd decade and the mandible is involved more commonly than the maxilla. The lesion often grows without symptoms and presents as a painless swelling. Radiographically, the myxoma appears as a unilocular or multilocular radiolucency. This article presents a rare case of OM occurring in the maxilla of a 28-year-old female patient with a brief review of the literature. PMID:25031907

Manjunath, SM; Gupta, AA; Swetha, P; Moon, NJ; Singh, S; Singh, A

2014-01-01

21

Myxoma in childhood  

Microsoft Academic Search

Purpose: The object of this study was to present a series of myxoma in children and to evaluate possible differences between young and adults patients.Materials and Methods: All tumors of patients under 16 years of age (10 cases), were separated from the 80 myxomas found in the Oral Pathology Laboratory, Faculty of Odontology, Buenos Aires University, and were analyzed in

A. Keszler; F. V. Dominguez; G. Giannunzio

1995-01-01

22

Odontogenic myxoma of the maxilla: a case report.  

PubMed

A 38-year-old male presented with a slowly progressive and painful swelling in the right cheek. On palpation, a firm, fixed and tender mass was detected over the right maxilla, with normal overlying skin. Endoscopic examination revealed a submucosal mass protruding into the right nasal cavity along the lateral wall, extending from the vestibule to the sphenoid sinus. Computed tomography showed a well-defined, 4x4 cm mass with cystic compartments, obliterating the right maxillary sinus, with destruction to the medial wall and extension into the nasal cavity. Magnetic resonance imaging showed similar findings of extension. A transnasal biopsy yielded a diagnosis of myxoma. En bloc resection of the mass was performed through a medial maxillectomy. No clinical or radiological recurrences were noted during a follow-up period of 24 months. PMID:18187991

Saylam, Güleser; Dursun, Engin; Albayrak, Levent; Akmansu, Halit; Korkmaz, Hakan; Eryilmaz, Adil

2007-01-01

23

A large odontogenic myxoma of the bilateral maxillae: A case report  

PubMed Central

Odontogenic myxomas (OMs) are benign mesenchymal locally aggressive neoplasms of the jaw bone. Although OMs predominantly involve the mandible, maxillary tumors are usually more aggressive than mandibular tumors. The present study describes the case of a 37-year-old male with a large odontogenic myxoma of the bilateral maxillae, which caused a defect in the right skull base bone. The tumor was successfully removed through radical resection of the hard tissue and local resection around the envelope of the soft tissue. The tumor exhibited no recurrence. However, the current methods for bilateral maxillary reconstruction to restore the maxillary buttress and achieve an optimal aesthetic appearance are complicated due to the lack of suitable conditions for oral rehabilitation with good dentition. PMID:25120718

LIU, YING; HAN, BO; YU, TAO; LI, LONGJIANG

2014-01-01

24

Case Note Lightning induced atrial ?brillation  

E-print Network

Atrial ?brillation (AF) is a common arrhythmia that occurs in paroxysmal and persistent forms. It occurs in varied situations but lightning induced AF is extremely rare. Here is a case which reverted to sinus rhythm spontaneously. This 37-year-old man without any underlying heart disease had new onset AF after being struck by a lightning. Oral Metoprolol alone was given to control ventricular rate. Spontaneous reversion to sinus rhythm within 36 hours is in favor of new onset lightning induced AF. Key words: Lightning injuries, atrial ?brillation, ECG changes Lightning produces manifold systemic effects of varying severity. Notable amongst them are neurological and cardiovascular ones1. Transient and persistent atrial ?brillation, which has its many causes, can result from lightning mainly due to its effect on autonomic nervous system. Due to its hemodynamic effects and other serious cardiovascular injuries, patients struck by lightning should be evaluated completely to

Dronacharya L; Poudel R

25

Odontogenic Myxoma of Maxilla in an Atypical Location: A Case Report  

PubMed Central

Odontogenic myxoma is a rare and locally invasive benign neoplasm found exclusively in jaws. It presents local invasiveness and tendency to recurrence. According to the World Health Organization (WHO), the odontogenic myxoma is classified as an odontogenic tumor of ectomesenchymal origin. The odontogenic myxoma is a rare entity found in both jaws while the mandible is involved more commonly than the maxilla. We present a kind of odontogenic myxoma in a 24-year old male that was found in an unusual location. PMID:24724116

Ghalayani, P; Jahanshahi, GR; Mohagheghiyan, HR

2013-01-01

26

Multiple cerebral aneurysms as manifestations of cardiac myxoma: Brain imaging, digital subtraction angiography, and echocardiography  

Microsoft Academic Search

We report a patient with left side atrial myxoma who initially presented with neurological symptoms. Cerebral magnetic resonance imaging and angiography revealed multiple aneurysms with enhancement leading to the final diagnosis of cardiac myxoma. We showed distinctive findings from brain magnetic resonance imaging, digital subtraction angiography, and cardiac echography and the final pathological appearance of cardiac myxoma in this patient.

Kuo-Hsien Chiang; Hua-Ming Cheng; Bee-Song Chang; Cheng-Hui Chiu; Pao-Sheng Yen

2011-01-01

27

[Primary left atrial myxofibrosarcoma; report of a case].  

PubMed

We herein report a very rare case of a primary left atrial myxofibrosarcoma. A 61-year-old female presented with dyspnea and a wet cough. Chest X-ray film showed cardiomegaly and pulmonary congestion. Echocardiography and computed tomography revealed a left atrial tumor obstructing blood flow to the left ventricle. She was diagnosed with acute congestive heart failure due to functional mitralstenosis secondary to a left atrial tumor, and an emergency operation was performed. The tumor, which occupied left atrium, attached to the posterior wall of the left atrium and to the mitral valve, but had not invaded the left atrial wall. The tumor was removed from the left atrial wall, preserving the mitral valve and valve leaflets. The patient's post operative course was uneventful. The pathological diagnosis was myxofibrosarcoma, which rarely develops in the heart. PMID:24322362

Sato, Hisashi; Yoshikai, Masaru; Miho, Takahiro; Nakanishi, Harumi; Irie, Koji

2013-12-01

28

Cardiac Hemangioma: A Case Report  

PubMed Central

Hemangioma of the heart, presenting as a primary cardiac tumor is extremely rare; it accounts for approximately 2% of all primary resected heart tumors. In our patient, the tumor was located in the orifice of the right lower pulmonary vein. Few cases of cardiac hemangiomas have been reported to arise from the left atrial (LA) wall. Left atrial hemangiomas, especially those attached to the LA wall, may be erroneously diagnosed as myxomas. Cardiac hemangioma is a rare disease; furthermore, a tumor arising from the LA wall and misconceived as a myxoma is extremely rare. We removed a mass misdiagnosed as a myxoma; it was pathologically confirmed to be a cardiac capillary hemangioma. Therefore, we report a rare case of a cardiac hemangioma misconceived as a myxoma; the tumor was removed successfully. PMID:24782967

Hong, Sung-Yong; Park, Kyung-Taek; Lee, Yang-Haeng; Cho, Kwang-Hyun; Seo, Jeong-Sook

2014-01-01

29

A case of paroxysmal atrial fibrillation following low voltage electrocution  

PubMed Central

Background Electrical injury may result in arrhythmias, however atrial fibrillation following low voltage electrocution is not a common occurrence. Case presentation A 70-year-old South-Asian woman with no prior history of cardiovascular disease presented following an accidental low voltage electrocution with loss of consciousness. On initial assessment she was found to be in atrial fibrillation with a moderate to rapid ventricular rate. Troponin I and 2D echo were normal. Transient rise in markers of muscle damage were noted. The arrhythmia resolved spontaneously without active intervention. Conclusion Loss of consciousness and the path of electrical conduction involving the heart may herald cardiac involvement following electrocution. Low voltage electrocution may cause cardiac insult. Conservative management may suffice in management of atrial fibrillation without cardiovascular compromise. PMID:24070318

2013-01-01

30

Intramuscular myxoma of the nasal vestibule.  

PubMed

Intramuscular myxoma is an uncommon benign soft tissue neoplasm and a distinct histopathological entity within the heterogeneous group of myxomas. The most common localizations are the gluteal muscles and the muscles of the thigh. We report on a case of a myxoma within the mimetic muscles of the nasal and mouth region in a 52-year-old man. The tumor was surgically removed and the patient is free of recurrence or complications 8 months after treatment. The clinical and pathologic features of this lesion are presented. The head and neck region is an uncommon site of presentation for intramuscular myxoma with only 13 documented cases in the available literature. To the very best of our knowledge, there is no report of this neoplasm located within the nasal and oral mimetic muscles. PMID:19414229

Patsiaoura, Kalliopi; Anagnostou, Eleftherios; Benis, Nikolaos

2010-02-01

31

Juxta-articular myxoma: an unusual benign mesenchymal lesion, readily mistaken for malignancy.  

PubMed

Myxomas are benign tumours of mesenchymal origin. We describe the first reported case of paraspinal juxta-articular myxoma. Juxta-articular myxomas show increased cellularity and distinction from cellular myxoma is required. The differential also includes malignant myxofibrosarcoma. For patient prognosis and management it is essential to separate these entities. Complete surgical excision is the mainstay of treatment as local recurrences may occur. PMID:25226717

Beggan, C; Davies, K; Leader, M

2014-01-01

32

Ventriculoatrial conduction: a cause of atrial malpacing in AV universal pacemakers. A report of two cases.  

PubMed

Retrograde atrial activation during ventricular pacing has often been a cause of intermittent or persistent arrhythmias (pacemaker-mediated tachycardia) in AV universal pacemakers. We recently encountered two cases in which VA conduction was responsible for atrial malpacing in patients with an implanted AV universal pacemaker, one programmed in DDD and one in DVI mode. Atrial malpacing was induced by the atrial refractoriness due to retrograde activation. In the first patient, it was observed when the pacemaker was programmed to a rate of 110 ppm (lower rate) and an AV interval of 200 ms in order to check crosstalk. In the second patient, it was observed after ventricular premature contractions. PMID:2578641

van Gelder, L M; El Gamal, M I

1985-01-01

33

Robotic assisted excision of a left ventricular myxoma  

PubMed Central

We present a rare case of left ventricular myxoma discovered incidentally in an asymptomatic 16-year old male. The patient underwent the appropriate work-up and a robotic-assisted excision of the mass. The patient had an uneventful recovery and was discharged home at postoperative day 3. To our knowledge, this is the first case of robotic-assisted left ventricular myxoma excision in the literature. Robotic-assisted surgery of left ventricular myxomas is a safe and feasible method of excision. PMID:22108931

Hassan, Mohammed; Smith, J. Michael

2012-01-01

34

Robotic assisted excision of a left ventricular myxoma.  

PubMed

We present a rare case of left ventricular myxoma discovered incidentally in an asymptomatic 16-year old male. The patient underwent the appropriate work-up and a robotic-assisted excision of the mass. The patient had an uneventful recovery and was discharged home at postoperative day 3. To our knowledge, this is the first case of robotic-assisted left ventricular myxoma excision in the literature. Robotic-assisted surgery of left ventricular myxomas is a safe and feasible method of excision. PMID:22108931

Hassan, Mohammed; Smith, J Michael

2012-01-01

35

A rare case of obstructive right atrial lipoma.  

PubMed

Benign cardiac tumours are rare and cardiac lipomas account only for a small fraction among those. Most of these tumours differ in terms of clinical manifestation, diagnosis, morphology and size, and are therefore not diagnosed easily unless they become symptomatic. We report the case of a 71-year-old Caucasian woman with recurrent episodes of shortness of breath presenting with an acute exacerbation of dyspnoea and hypertensive crisis. Diagnosis of a right atrial lipoma with a coexisting patent foramen ovale was established on echocardiography and computed tomography, and the patient was evaluated for elective surgery. Comprising the entire free wall of the right atrium, the tumour was removed during open heart surgery on cardiopulmonary bypass. The right atrium and the orifices of both the superior and inferior vena cava were reconstructed with bovine pericardium. No evidence of tumour relapse was observed during successive follow-up visits. PMID:25245725

Habertheuer, A; Andreas, M; Wiedemann, D; Rath, C; Kocher, A

2014-10-01

36

Giant ventricular myxoma obstructing right ventricular outflow tract.  

PubMed

Intracardiac myxoma is predominantly located in the left atrium but their location in the right ventricle is quite unusual. We present a case in which successful excision of the tumor was done through bicameral approach. PMID:22358285

Gajjar, Trushar P; Shah, Gaurang B; Desai, Neelam B

2011-01-01

37

A butterfly shaped mobile biatrial cardiac mass: myxoma or something else.  

PubMed

Primary cardiac tumors are rare with a reported prevalence of 0.01-0.02% based on pooled autopsy series. Although most mobile cardiac tumors arising from the interatrial septum and extending into the atria are thought to be benign myxomas, this may often not be true. Myxoid fibrosarcomas which in contrast to myxomas are malignant cardiac tumors often mimic the clinical and echocardiographic picture of atrial myxomas. We describe a rare entity of biatrial low-grade myxoid fibrosarcoma presenting in an adult patient as a butterfly shaped mass, with progressive shortness of breath and prolonged PR interval on the ECG that was pre-operatively thought to be a cardiac myxoma. The distinguishing echocardiographic features of the two entities are discussed. PMID:24973849

Gupta, Pallav; Kapoor, Aditya; Jain, Manoj; Kumar, Sudeep; Agarwal, Surendra K; Pande, Shantanu

2014-01-01

38

A butterfly shaped mobile biatrial cardiac mass: Myxoma or something else  

PubMed Central

Primary cardiac tumors are rare with a reported prevalence of 0.01–0.02% based on pooled autopsy series. Although most mobile cardiac tumors arising from the interatrial septum and extending into the atria are thought to be benign myxomas, this may often not be true. Myxoid fibrosarcomas which in contrast to myxomas are malignant cardiac tumors often mimic the clinical and echocardiographic picture of atrial myxomas. We describe a rare entity of biatrial low-grade myxoid fibrosarcoma presenting in an adult patient as a butterfly shaped mass, with progressive shortness of breath and prolonged PR interval on the ECG that was pre-operatively thought to be a cardiac myxoma. The distinguishing echocardiographic features of the two entities are discussed. PMID:24973849

Gupta, Pallav; Kapoor, Aditya; Jain, Manoj; Kumar, Sudeep; Agarwal, Surendra K.; Pande, Shantanu

2014-01-01

39

Left atrial thrombosis in an anticoagulated patient after bioprosthetic valve replacement: Report of a case.  

PubMed

We present the case of a 74 year old woman suffering from severe mitral valve incompetence and rapid atrial fibrillation. After an appropriate vitamin K antagonist (VKA) therapy, the patient underwent mitral valve replacement by bioprosthesis. Then, the patient was re-hospitalized for jaundice. Suspecting hepatotoxicity, VKA was discontinued and fondaparinux was started. During this treatment, the patient developed a symptomatic atrial thrombus. After exclusion of a hepatic disease, VKA was re-established with hemodynamic and liver enzymes normalization and atrial thrombus resolution. Caution has to be used when considering fondaparinux as an alternative strategy to VKA in patients with multiple thrombotic risk factors. PMID:24527429

Rosa, Gian Marco; Parodi, Antonello; Dorighi, Ulrico; Carbone, Federico; Mach, François; Quercioli, Alessandra; Montecucco, Fabrizio; Vuilleumier, Nicolas; Balbi, Manrico; Brunelli, Claudio

2014-01-16

40

Left atrial thrombosis in an anticoagulated patient after bioprosthetic valve replacement: Report of a case  

PubMed Central

We present the case of a 74 year old woman suffering from severe mitral valve incompetence and rapid atrial fibrillation. After an appropriate vitamin K antagonist (VKA) therapy, the patient underwent mitral valve replacement by bioprosthesis. Then, the patient was re-hospitalized for jaundice. Suspecting hepatotoxicity, VKA was discontinued and fondaparinux was started. During this treatment, the patient developed a symptomatic atrial thrombus. After exclusion of a hepatic disease, VKA was re-established with hemodynamic and liver enzymes normalization and atrial thrombus resolution. Caution has to be used when considering fondaparinux as an alternative strategy to VKA in patients with multiple thrombotic risk factors. PMID:24527429

Rosa, Gian Marco; Parodi, Antonello; Dorighi, Ulrico; Carbone, Federico; Mach, Francois; Quercioli, Alessandra; Montecucco, Fabrizio; Vuilleumier, Nicolas; Balbi, Manrico; Brunelli, Claudio

2014-01-01

41

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...

42

Atrium of stone: A case of confined left atrial calcification without hemodynamic compromise  

PubMed Central

Dystrophic cardiac calcification is often associated with conditions causing systemic inflammation and when present, is usually extensive, often encompassing multiple cardiac chambers and valves. We present an unusual case of dystrophic left atrial calcification in the setting of end stage renal disease on hemodialysis diagnosed by echocardiography and computed tomography. Significant calcium deposition is confined within the walls of the left atrium with no involvement of the mitral valve, and no hemodynamic effects. PMID:24868514

Jones, Christopher; Lodhi, Aadil Mubeen; Cao, Long Bao; Chagarlamudi, Arjun Kumar; Movahed, Assad

2014-01-01

43

Acute paradoxical embolic cerebral ischemia secondary to possible May-Thurner syndrome and an atrial septal defect: a case report  

PubMed Central

Introduction May-Thurner syndrome is an anatomic abnormality that predisposes patients to increased risk of paradoxical embolism and stroke. It consists of chronic compression of the left common iliac vein by the overlying right common iliac artery which may predispose to local thrombus formation, which in turn may be the nidus of a paradoxical embolus leading to cerebral ischemia in patients with a right-to-left shunt secondary to an atrial septal defect or patent foramen ovale. Case presentation We report the case of an embolic cerebral ischemic event in a 53-year-old Caucasian woman whose investigations revealed findings suggestive of possible May-Thurner syndrome coupled with an atrial septal defect. Her atrial septal defect was closed, she was placed on aspirin therapy, and has not had any recurrent events. Conclusion May-Thurner syndrome is an important consideration in patients with paradoxical embolic cerebral ischemia and atrial septal defects. PMID:23822806

2013-01-01

44

[Robot assisted tumor resection of an asymptomatic right atrial intracardiac lipoma; report of a case].  

PubMed

Primary cardiac tumors are relatively rare. No therapeutic guidelines have been established for the surgical indications of such cases. This creates therapeutic dilemmas, especially when the patient is asymptomatic. We describe the robot-assisted resection of an asymptomatic right atrial lipoma. A 63-year-old female was diagnosed to have a round mobile lipoma, measuring 27 mm in diameter in the right atrium near the junction with the inferior vena cava (IVC). Although she was asymptomatic, a surgical resection was indicated since the lipoma could cause an embolism or IVC obstruction due to its morbidity and potential to enlarge. Surgery was performed using the da Vinci Surgical System. A right-sided approach was used through 4 ports. The tumor was resected with a small portion of the right atrial wall. The total operation time was 214 minutes, and the total pump time was 84 minutes. The operation was performed while the heart was beating. PMID:21682051

Seguchi, Ryuta; Yashiki, Noriyoshi; Kato, Hiroki; Yamaguchi, Shojiro; Ishikawa, Norihiko; Tomita, Shigeyuki; Otake, Hiroshi; Watanabe, Go

2011-06-01

45

Cellular myxoma of the lumbar spine  

PubMed Central

Background: Cellular myxoma is a histopathologically distinctive benign neoplasm, which has often been categorized among the broad category of benign mesenchymal tumors with myxoid stroma and fibroblast- and/or myofibroblast-like cells. These tumors can arise in any of the large muscles and are usually found in the thigh, shoulder, buttocks, and upper arm, and more rarely in the head and neck or in small muscles of the hand. Case Description: Here we illustrate the case of a 57-year-old female with a spinal lesion, who initially presented with complaints of vague pelvic discomfort but no focal neurological deficits. Imaging revealed a sharply demarcated paraspinal lesion concerning for a tumorous growth. The lesion was excised in toto and a detailed immuno-histopathological analysis was performed revealing the diagnosis of a cellular myxoma. Postoperative imaging showed a gross total resection and the patient is under clinical surveillance since, with no signs of recurrence after 42 months. Conclusion: Although very rare, this entity should be considered in the differential diagnosis of any spinal and paraspinal mass to allow for adequate treatment, which requires wide excision with clean margins to avoid any local recurrence. PMID:23869282

Ohla, Victoria; Ciarlini, Pedro D.S.C; Goldsmith, Jeffrey D.; Kasper, Ekkehard M.

2013-01-01

46

[Stroke prevention after stroke in patients with atrial fibrillation: A case-based review].  

PubMed

Non-valvular atrial fibrillation is one of the most important risk factor for embolic cerebral infarcts. Besides vitamin K antagonists, recently developed novel oral anticoagulants are gaining an increasing role in its treatment. Dabigatran, rivaroxaban and apixaban are novel oral anticoagulants available in the routine clinical practice. This review summarizes their use and the corresponding guidelines in the secondary prevention of ischemic stroke, by answering questions raised in relation of a hypothetical case report. Orv. Hetil., 2014, 155(42), 1655-1660. PMID:25305723

Kovács, Tibor

2014-10-01

47

Pathology Case Sstudy: A 59-Year-Old Female with a Right Atrial Mass  

NSDL National Science Digital Library

This is a cardiovascular pathology case study presented by the University of Pittsburgh Department of Pathology in which a 59-year-old black female has diffuse large cell lymphoma (i.e. right atrial mass). Visitors are given both the microscopic and gross descriptions, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose. It is also a helpful site for educators to use to introduce or test student learning in cardiovascular pathology.

Schubert, Eric

2007-12-14

48

Incidental finding of a giant asymptomatic right atrial tumor  

PubMed Central

Primary cardiac tumors are very rare, atrial myxoma being the most common benign tumor of the heart. They may present with a great variety of incidental asymptomatic masses to severe life-threatening cardiovascular complications necessitating emergency surgery. Here we report the diagnostic evaluation and successful surgical resection of such a giant cardiac tumor which was found on a routine medical check-up in a 62-year-old patient. Histology confirmed diagnosis of unusually huge myxoma. This article demonstrates it’s necessary to include cardiac tumors in the differential diagnosis of subtle and non-specific cardiothoracic symptoms. PMID:25120848

Strecker, Thomas; Agaimy, Abbas; Zelzer, Peter; Weyand, Michael; Wachter, David Lukas

2014-01-01

49

[Thoracoscopic Ex-Maze III procedure and radiofrequency catheter ablation - a hybrid therapy for permanent atrial fibrillation. A case report].  

PubMed

We desribe a case of a 57-year-old patient with persistent longstanding atrial fibrillation (AF) in whom paracardioscopic Ex-Maze III procedure converted AF to typical counterclockwise atrial flutter. Subsequent catheter RF ablation of cavo-tricuspid isthmus restored sinus rhythm. We propose that the hybrid therapy including thoracoscopic maze procedure and catheter RF ablation of flutter isthmus might be effective in some patients with permanent AF. To the best of our knowledge this approach was never published before. Lelako. PMID:19838966

Majewski, Jacek; Bartu?, Krzysztof; Kapelak, Bogus?aw; My?, Jacek; Sadowski, Jerzy; Lelakowski, Jacek

2009-09-01

50

Double trouble - a case report of mobile right atrial thrombus in the setting of acute pulmonary thromboembolism.  

PubMed

We report the case of a 51 year-old woman who, six weeks post hysterectomy, developed an acute on chronic pulmonary thromboembolism. On transthoracic echocardiography a mobile right atrial thrombus was detected at the entry of the coronary sinus into the right atrium. A 64 slice spiral CT angiogram confirmed the left sided superior vena cava and bilateral extensive thrombus in the proximal pulmonary arteries. Bilateral pulmonary endarterectomy, removal of atrial thrombus and ligation of the persistent left superior vena cava was performed which markedly improved the haemodynamic and functional status of the patient. The presence of right atrial thrombus in the setting of acute pulmonary embolism presents a unique therapeutic challenge which needs to be individualised based on a number of concomitant clinical factors. PMID:24998796

Lohrmann, Graham M; Peters, Ferande; van Riet, Sonja; Essop, Mohammed R

2014-10-01

51

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

SciTech Connect

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.

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

1986-08-01

52

[Left ventricular myxoma - an unexpected cause of dyspnoea and fever in a young patient].  

PubMed

Primary cardiac tumours are rare. In 75% of cases, these are benign, mainly myxomas. The present case study describes a patient with an impressive epidemiological history, examined at a department of infectious diseases for progressing dyspnoea and subfebrile states. As part of differential diagnosis, the patient was sent for cardiological examination. Echocardiography unexpectedly revealed tumour of the left ventricle that explained patients symptomatology. The tumour was then quickly removed using right minithoracotomy and histology confirmed myxoma. The patient was, also due to the mini-invasive nature of the intervention, discharged from the hospital to home care on the 4th day of hospitalization with practically no complaints. PMID:23256836

Sattran, T; Toušek, F; Pešl, L; Mokrá?ek, A

2012-11-01

53

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

PubMed Central

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

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

54

MitraClip® via direct right atrial access in case of a missing inferior vena cava.  

PubMed

The presence of mitral regurgitation (MR) in patients with heart failure represents an independent predictor of mortality. Until now, the standard therapy for severe MR has been cardiac surgery in order to perform mitral valve replacement or mitral valve repair. With the introduction of the MitraClip® system (Abbott Vascular - Structural Heart, Menlo Park, CA, USA) in 2008, there is now an alternative percutaneous treatment option available for high-risk patients. We report on an 84-year-old male patient who was admitted to the emergency room with increasing shortness of breath due to severe functional MR, at stage NYHA III. In the following days the patient developed cardiogenic shock due to failure of the diuretic medication. The case first described here demonstrates an alternative transseptal route of access via a direct atrial puncture of the RA in a patient with absent inferior vena cava. This approach was successfully used to perform a MitraClip® procedure in this patient with functional MR and cardiogenic shock. It was possible to treat mitral regurgitation and the consecutive cardiogenic shock by implanting two MitraClips®. PMID:23482326

Frerker, Christian; Meincke, Felix; Seibert, Hans-Peter; Alessandrini, Hannes; Kreidel, Felix; Caspary, Michael; Busse, Cord; Schäfer, Ulrich; Kuck, Karl-Heinz

2013-09-01

55

Surgical management of left ventricular myxoma with embolization to the right coronary artery.  

PubMed Central

We report a rare case of left ventricular myxoma with embolization to the right coronary artery, presenting as an acute myocardial infarction. The tumor was excised from the left ventricle, and the tumor embolus was removed from the right coronary artery. Saphenous vein bypass grafting was also performed successfully. Images PMID:8885108

Saldanha, R; Srikrishna, S V; Shetty, N; Shenthar, J; Nayak, P P

1996-01-01

56

Non-steroidal anti-inflammatory drug use and risk of atrial fibrillation or flutter: population based case-control study  

Microsoft Academic Search

Objectives To examine the risk of atrial fibrillation or flutter associated with use of non-selective non-steroidal anti-inflammatory drugs (NSAIDs) or selective cyclo-oxygenase (COX) 2 inhibitors.Design Population based case-control study using data from medical databases.Setting Northern Denmark (population 1.7 million).Participants 32 602 patients with a first inpatient or outpatient hospital diagnosis of atrial fibrillation or flutter between 1999 and 2008; 325

Morten Schmidt; Christian F Christiansen; Frank Mehnert; Kenneth J Rothman; Henrik Toft Sørensen

2011-01-01

57

Intramuscular myxoma of the soleus muscle: A rare tumor in an unusual location  

PubMed Central

Patient: Female, 52 Final Diagnosis: Myxoma Symptoms: — Medication: — Clinical Procedure: — Specialty: Oncology Objective: Challenging differential diagnosis Background: Intramuscular myxoma is a benign intramuscular neoplasm. However, sometimes it is difficult to distinguish it from soft-tissue sarcomas that underwent myxomatous degeneration. To the best of our knowledge, only 2 cases of intramuscular myxoma in the soleus muscle have been previously reported. Case Report: We present the case of a 52-year-old Caucasian woman who was referred to our tertiary anticancer hospital for magnetic resonance imaging (MRI) diagnosis for suspicion of mesenchymal tumor. Percutaneous core biopsy revealed an intramuscular myxoma (IM). Despite the benign nature of the lesion, the patient desired that the tumor be removed. She underwent wide local excision. The final histopathologic diagnosis was IM. She is doing well 3 years after the operation. Conclusions: Percutaneous core biopsy is the procedure of choice for providing preoperative tissue diagnosis. The treatment of choice is wide local excision. IM does not usually recur after surgical removal. PMID:24516691

Gavriilidis, Paschalis; Balis, Georgios; Giannouli, Angeliki; Nikolaidou, Anastasia

2014-01-01

58

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

PubMed

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

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

59

Unusual presentation of atrial fibrillation.  

PubMed

A case is reported of atrial fibrillation in a young healthy man after head injury and the possible causes are discussed. The atrial fibrillation reverted spontaneously to normal rhythm in two days. The authors are not aware of a similar report in the literature. PMID:12533391

Muthu, P; Oduro, G; Sakr, M; Esberger, D A

2003-01-01

60

Migraine symptoms related to the percutaneous closure of an ostium secundum atrial septal defect: report of four paediatric cases and review of the literature.  

PubMed

Several publications have recently suggested that atrial septal defect may be associated with the physiopathology of headache with migraine-type characteristics. We describe four previously asymptomatic paediatric patients with atrial septal defect who underwent percutaneous Amplatzer septal occluder device implantation and who subsequently developed symptoms compatible with migraine headache. The cases had normal echocardiograms after the intervention and a benign course with headache improvement after several weeks or months. There are paediatric patients with atrial septal defect who may dramatically develop migraine symptoms with or without aura following percutaneous correction of their defect. Large paediatric studies are needed to offer accurate prognoses for children and their families. The possibility of using clopidogrel to treat this type of headache is subject to debate. PMID:17459082

Fernández-Mayoralas, D M; Fernández-Jaén, A; Muñoz-Jareño, N; Gutiérrez-Larraya, F; Calleja-Pérez, B; San Antonio Arce, V

2007-06-01

61

An alternative transseptal intracardiac echocardiography strategy to guide left atrial appendage closure: the first described case.  

PubMed

Transesophageal echocardiography (TEE) is the standard imaging technique to guide device implantation for left atrial appendage (LAA) closure. Unfortunately, TEE was contraindicated in this patient due to the high risk of variceal hemorrhage. Critical information about the exact anatomic characteristics of the LAA can be obtained using intracardiac echocardiography (ICE). However, standard right-side views do not allow a complete visualization of the LAA: in particular, a reliable left circumflex coronary artery short axis view, relevant for device positioning, is not always achievable. Transseptal views of the LAA with ICE might be used in planning an appropriate intervention strategy for patients who are not suitable for TEE imaging. PMID:24964221

Fassini, Gaetano; Dello Russo, Antonio; Conti, Sergio; Tondo, Claudio

2014-11-01

62

Unusual Case of a Free-floating Ball Thrombus with Preserved Attachment to the Left Atrial Appendage Causing Recurrent Obstruction of the Left Ventricular Outflow Tract  

PubMed Central

Few cases of a left atrial thrombus without mitral valve disease have been reported. We present an unusual case in which a patient presented to the emergency department with syncope and acute cerebral ischemia caused by a ball thrombus originating from the left atrium (LA). An emergency bedside echocardiogram showed the LA ball thrombus intermittently obstructing the mitral orifice and, at times, compromising the left ventricular outflow tract. This thrombus was determined to be the source of cerebral embolization resulting in acute ischemia. Surgical excision of the mass was performed. At operation, the thrombus was found to be tethered to the left atrial appendage. This tethering was not apparent on the echocardiographic images, where the thrombus appeared to be free floating. This case demonstrates the utility of transthoracic echocardiography in establishing the etiology of emergent conditions seemingly unrelated to acute cardiac disease, in this situation a neurologic presentation with syncope and cerebral ischemia. PMID:25392701

Alushi, Brunilda; Hoffmeier, Andreas; Sindermann, Jurgen; Bose, Dirk; Garvey, J Lee; Breuckmann, Frank

2014-01-01

63

Mazabraud's syndrome: case report and literature review  

PubMed Central

Mazabraud's syndrome is a rare disorder characterized by the association of single or multiple intramuscular myxomas with fibrous dysplasia. Here, we present the first case of Mazabraud's syndrome visualized on 18F-FDG PET/CT with histopathological confirmation of the myxoma. Our case demonstrates a slightly increased FDG uptake (SUVmax 2.1) within the myxomas and a moderately to highly increased tracer uptake (SUVmax 7.0) within the fibrous dysplastic lesions. The typical histological appearance of the intramuscular myxoma confirmed the radiological diagnosis. Further, we discuss the imaging findings and the histopathological features of this rare case with a review of the related literature. PMID:24198959

Munksgaard, Peter Svenssen; Salkus, Giedrius; Iyer, Victor V; Fisker, Rune Vincents

2013-01-01

64

Burden of comorbidities among Japanese patients with atrial fibrillation: a case study of dyspepsia  

PubMed Central

Background The aim of this study was to investigate the link between atrial fibrillation (AF) and dyspepsia, as well as the contribution of dyspepsia to the overall burden of AF. Methods The 2008, 2009, and 2010 Japan National Health and Wellness Survey (NHWS) datasets were used in this study. The NHWS is an Internet-based survey administered to the adult population in Japan using a random stratified sampling framework to ensure demographic representativeness. The presence of dyspepsia was compared between those with and without AF. Among those with AF, the effect of dyspepsia on health status, work productivity, and activity impairment was examined, along with health care resource use using multivariable regression modeling and controlling for baseline differences. Results Among patients with AF (n = 565), the three most commonly reported comorbidities were hypertension (38.76%), dyspepsia (37.35%), and overactive bladder (28.72%). Patients with AF had 48.59% greater odds of reporting dyspepsia than those without AF (P < 0.05). Patients with dyspepsia used more AF medications (2.05 versus 1.54) and had been diagnosed more recently (9.97 versus 10.58 years). Dyspepsia was associated with significantly worse physical health status (P < 0.05) and significantly more absenteeism, overall work impairment, activity impairment, physician visits, and emergency room visits (all P < 0.05). Conclusion Patients with AF in Japan experience a number of comorbidities, with dyspepsia being the most common noncardiovascular comorbidity. Given the prevalence and additional burden of this comorbidity across both humanistic and economic outcomes, the management of dyspepsia among patients with AF should be an area of greater focus. PMID:23717048

Kinoshita, Yoshikazu; DiBonaventura, Marco; Rossi, Bruno; Iwamoto, Kazuya; Wang, Edward C Y; Briere, Jean-Baptiste

2013-01-01

65

Aligning health care policy with evidence-based medicine: the case for funding direct oral anticoagulants in atrial fibrillation.  

PubMed

Misalignment between evidence-informed clinical care guideline recommendations and reimbursement policy has created care gaps that lead to suboptimal outcomes for patients denied access to guideline-based therapies. The purpose of this article is to make the case for addressing this growing access barrier to optimal care. Stroke prevention in atrial fibrillation (AF) is discussed as an example. Stroke is an extremely costly disease, imposing a significant human, societal, and economic burden. Stroke in the setting of AF carries an 80% probability of death or disability. Although two-thirds of these strokes are preventable with appropriate anticoagulation, this has historically been underprescribed and poorly managed. National and international guidelines endorse the direct oral anticoagulants as first-line therapy for this indication. However, no Canadian province has provided these agents with an unrestricted listing. These decisions appear to be founded on silo-based cost assessment-the drug costs rather than the total system costs-and thus overlook several important cost-drivers in stroke. The discordance between best scientific evidence and public policy requires health care providers to use a potentially suboptimal therapy in contravention of guideline recommendations. It represents a significant obstacle for knowledge translation efforts that aim to increase the appropriate anticoagulation of Canadians with AF. As health care professionals, we have a responsibility to our patients to engage with policy-makers in addressing and resolving this barrier to optimal patient care. PMID:25262864

Stone, James A; Earl, Karen M; O'Neill, Blair J; Sharma, Mukul; Huynh, Thao; Leblanc, Kori; Ward, Richard; Teal, Philip A; Cox, Jafna L

2014-10-01

66

Massive Purulent Pericardial Effusion Presenting as Atrial Fibrillation with Rapid Rate: Case Report and Review of the Literature  

PubMed Central

Patient: Male, 59 Final Diagnosis: Pleural and pericardial effusion from a Streptococcus pneumonia Symptoms: Chest pain • chills • cough • fever • shortness of breath Medication: — Clinical Procedure: Pericardiocentesis • pericardial window Specialty: Cardiology Objective: Rare disease Background: Although pericardial effusion with afib is not rare, the combination of purulent pericardial effusion presenting as afib is not a common occurrence particularly in the developing world. The more common symptoms associated with purulent pericardial effusion are fever, dyspenia, and tachycardia. Without prompt recognition followed by antibiotics and surgical drainage, tamponade, and shock can potentially lead to death. Case Report: A 59-year-old male was transferred to our hospital for evaluation of afib with rapid rate associated with cough and dyspenia. He reported fevers, chills, cough and sputum for 1 week. Complaints included chest pain with relief upon lying down. Patient was afebrile with a pulse of 101 and blood pressure of 119/89. WBC 39,200 cells/ml. Chest X-RAY showed right lower lobe pneumonia and EKG revealed afib, rapid ventricular response, and secondary ST changes inferolaterally. Pericardial effusion and thickened pericardium were eveident on echo. Patient was treated for community acquired pneumonia, along with heparin and IV amiodarone. Both sputum cultures and pericardiocentesis revealed S. Pneumoniae. Cardioversion reestablished sinus mechanism. Intially pericardial effusion resolved, but later reaccumulated at which point it was decided to perform a subxiphoid pericardial window. Follow up showed no effusion and patient was asymptomatic. Conclusions: Purulent pericardial effusion with atrial fibrillation and rapid ventricular rate needs to be recognized promptly. Because friction fub and chest pain are not present in every case, prompt management in the setting of pneumonia and minor hemodynamic derangements can aid in the treatment of this potentially life threating disease. PMID:25407956

Kathrotia, Amit; Hindupur, Mohan R.

2014-01-01

67

Massive purulent pericardial effusion presenting as atrial fibrillation with rapid rate: case report and review of the literature.  

PubMed

Background Although pericardial effusion with afib is not rare, the combination of purulent pericardial effusion presenting as afib is not a common occurrence particularly in the developing world.The more common symptoms associated with purulent pericardial effusion are fever, dyspenia, and tachycardia. Without prompt recognition followed by antibiotics and surgical drainage, tamponade, and shock can potentially lead to death. Case Report A 59-year-old male was transferred to our hospital for evaluation of afib with rapid rate associated with cough and dyspenia. He reported fevers, chills, cough and sputum for 1 week. Complaints included chest pain with relief upon lying down. Patient was afebrile with a pulse of 101 and blood pressure of 119/89. WBC 39,200 cells/ml. Chest X-RAY showed right lower lobe pneumonia and EKG revealed afib, rapid ventricular response, and secondary ST changes inferolaterally. Pericardial effusion and thickened pericardium were eveident on echo. Patient was treated for community acquired pneumonia, along with heparin and IV amiodarone. Both sputum cultures and pericardiocentesis revealed S. Pneumoniae. Cardioversion reestablished sinus mechanism. Intially pericardial effusion resolved, but later reaccumulated at which point it was decided to perform a subxiphoid pericardial window. Follow up showed no effusion and patient was asymptomatic. Conclusions Purulent pericardial effusion with atrial fibrillation and rapid ventricular rate needs to be recognized promptly. Because friction fub and chest pain are not present in every case, prompt management in the setting of pneumonia and minor hemodynamic derangements can aid in the treatment of this potentially life threating disease. PMID:25407956

Kathrotia, Amit; Hindupur, Mohan R

2014-01-01

68

Right atrial angiosarcoma with severe biventricular dysfunction and massive pericardial effusion.  

PubMed

This paper presents the case of a 35 year-old woman with symptoms of heart failure from the last month. A physical examination at admission showed paleness, dyspnea, peripheral edema and fatigue. In a two-dimensional echocardiography and transesophageal echocardiography, normal thickness but severe left and right ventricular dysfunction with severe pericardial effusion and thickened pericardium were found. In the enlarged right atrium, an oval-shaped structure was found with features of continuity with lateral right atrial wall and also a bulging of the structure through the orifice of the tricuspid valve to the right ventricle. In the echocardiography, we did not saw any blocking of the tricuspid valve or the inflow from inferior vena cava (IVC) or superior vena cava (SVC) or coronary sinus. On the basis of the echocardiography examination and clinical presentation, tentative diagnosis of the right atrium myxoma was made. A coronary angiography revealed normal coronary arteries and no feeding of tumor by branch of right coronary artery (RCA). Surgical removal of the tumor was performed without complication. The histopathological examination confirmed the diagnosis of angiosarcoma. In the follow-up echocardiography carried out after three months, severe left ventricular (LV) and right ventricular (RV) dysfunction continued and was demonstrated. Magnetic resonance imaging revealed no lymphadenopathy or re-growth of the tumor in the mediastinum or pericardium. PMID:23585321

Sabzi, Feridoun; Dadkhah, Heidar; Shojaei, Sharam; Mahdavi, Masoume; Poormotaabed, Alireza; Javid, Nasrin; Dabiri, Samsam

2013-01-01

69

Efficacy of ticlopidine for preventing migraine after transcatheter closure of atrial septal defect with Amplatzer septal occluder: a case report.  

PubMed

Transcatheter closure of an atrial septal defect using the Amplatzer septal occluder is a current treatment option in Japan, but is occasionally associated with transient exacerbation or new onset migraine. Clopidogrel is effective in such a situation, but the efficacy of ticlopidine, an analog of clopidogrel, on migraine remains unclear. A 15-year-old girl presented with typical migraine attacks with aura 11 days after transcatheter closure of an atrial septal defect with an Amplatzer septal occluder. All examinations excluded thromboembolic origin of the migrain. Her symptoms disappeared completely after medication with ticlopidine. PMID:17633574

Tomita, Hideshi; Hatakeyama, Kinya; Soda, Wataru; Kobayashi, Toshiki

2007-06-01

70

Localized reentrant tachycardia in the aorta contiguity region mimicking perimitral atrial flutter in the context of atrial fibrillation ablation.  

PubMed

We describe a case with a focal atrial tachycardia (AT) masquerading as perimitral atrial flutter revealed after circumferential pulmonary vein antral isolation for atrial fibrillation. It was successfully terminated and became noninducible by a point ablation on the left atrial anterior wall (LAAW) near the mitral annulus in contact with the aortic root and on the left superior pulmonary vein-left atrial appendage ridge, without any linear ablation, using electroanatomical mapping and conventional precise mapping with a maximum amplified gain within the low-voltage area. The AT revealed in our case was an LAAW-aorta contiguity area-related AT. PMID:23080286

Ejima, Koichiro; Shoda, Morio; Miyazaki, Shinsuke; Yashiro, Bun; Wakisaka, Osamu; Manaka, Tetsuyuki; Hagiwara, Nobuhisa

2013-07-01

71

Chemical and histochemical characterization of mucopolysaccharides in a jaw myxoma  

PubMed Central

Chemical and histochemical analyses, including testicular and staphylococcal hyaluronidase digestion, have been made of a jaw myxoma and the results show the presence of two acid mucopolysaccharides. Of the total mucopolysaccharide present 80% was hyaluronic acid and 20% chondroitin sulphate. The high content of non-sulphated mucopolysaccharide would seem to explain the paucity of fibres characteristic of the myxoma. It is suggested that myxomas generally probably have a similar high hyaluronic acid content. It is considered that the cell concerned is a mesenchymal cell elaborating non-sulphated mucopolysaccharide and may be called a `myxoblast'; it is metabolically different from the sulphated-mucopolysaccharide-collagen-producing fibroblast. The high hyaluronic acid content is much greater than that found in embryonic connective tissue and may be a significant factor in the neoplastic behaviour of the myxomatous tissue. The aggressive behaviour of the myxoma is against a simple reversion to embryonic mesenchyme. It is concluded that the myxoblast is an active mucopolysaccharide-secreting cell and that mucin in the myxoma is not a sign of cell degeneration of preexisting fibroblasts or collagen. Images PMID:4235175

Hodson, J. J.; Prout, R. E. S.

1968-01-01

72

Atrial fibrillation in healthy adolescents after highly caffeinated beverage consumption: two case reports  

Microsoft Academic Search

INTRODUCTION: Energy drinks and highly caffeinated drinks comprise some of the fastest growing products of the beverage industry, often targeting teenagers and young adults. Cardiac arrhythmias in children related to high caffeine consumption have not been well described in the literature. This case series describes the possible association between the consumption of highly caffeinated drinks and the subsequent development of

Jennifer R Di Rocco; Peter J Morelli; Marybeth Heyden; Thomas A Biancaniello

2011-01-01

73

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

PubMed Central

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

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

2013-01-01

74

Oncolytic Myxoma Virus: The path to clinic  

PubMed Central

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

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

2013-01-01

75

Atrial Fibrillation During an Exploration Class Mission  

NASA Technical Reports Server (NTRS)

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.

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

2011-01-01

76

Host-specificity of myxoma virus: Pathogenesis of South American and North American strains of myxoma virus in two North American lagomorph species  

Microsoft Academic Search

The pathogenesis of South American and North American myxoma viruses was examined in two species of North American lagomorphs, Sylvilagus nuttallii (mountain cottontail) and Sylvilagus audubonii (desert cottontail) both of which have been shown to have the potential to transmit the South American type of myxoma virus. Following infection with the South American strain (Lausanne, Lu), S. nuttallii developed both

L. Silvers; D. Barnard; F. Knowlton; B. Inglis; A. Labudovic; M. K. Holland; P. A. Janssens; B. H. van Leeuwen; P. J. Kerr

2010-01-01

77

Electrical dissociation within the left atrium and left atrial appendage diagnosed with transesophageal echocardiography.  

PubMed

The authors describe the case of a 79-year-old man with prior mitral valve repair and a maze procedure who developed recurrent atrial fibrillation, in whom transesophageal echocardiography revealed an accessory lobe of the left atrial appendage in sinus rhythm when the remaining body of the left atrial appendage was in atrial fibrillation or flutter. Electrophysiology confirmed dissociated rhythm within the left atrium. This case emphasizes the need for careful Doppler interrogation of the left atrial appendage and its lobes to look for dissociated atrial rhythm. PMID:20434878

Naqvi, Tasneem Z; Rafie, Reza; Cesario, David

2010-10-01

78

Aorto-left atrial tunnel: a rare entity.  

PubMed

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

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

2013-05-01

79

Atrial septal defect (ASD)  

MedlinePLUS

... a number of problems, including: Arrhythmias , particularly atrial fibrillation Heart failure Heart infections (endocarditis) High blood pressure in the arteries of the lungs ( pulmonary hypertension ) Stroke

80

Brain Embolism Secondary to Cardiac Myxoma in Fifteen Chinese Patients  

PubMed Central

Background. Heart myxoma-related embolisms commonly involve the central nervous system, but data are lacking in Chinese patients. Methods. 27 patients diagnosed with myxoma were reviewed retrospectively. Results. Among 27 patients, fourteen (51.9%) patients were women. Fifteen (55.6%) patients had brain embolisms. Rarely, patients were misdiagnosed with central nervous system vasculitis (n = 2), moyamoya disease (n = 1), and neuromyelitis optica (n = 1). We found positive associations between mRS (>3) and female gender (r = 0.873, P < 0.0001), infection (r = 0.722, P = 0.002), severe complications (r = 0.722, P = 0.002), systolic blood pressure (SBP) of <120?mmHg (r = 0.6, P = 0.018), WBC count of >10 × 109/L (r = 0.722, P = 0.002), tumour size (r = 0.866, P < 0.0001), bilateral brain lesions (r = 0.60, P = 0.018), and total anterior circulation infarction (TACI) (r = 0.667, P = 0.007). The independent relationships among these factors and outcomes could not be confirmed (P > 0.05). Conclusions. Neurologic manifestations in Chinese patients with cardiac myxoma-related stroke were complicated and multifarious. Female gender, infection, other severe complications, low SBP, tumour size, bilateral brain lesions, TACI, and high WBC counts could be associated with a poor prognosis. PMID:24737987

Long, Youming; Gao, Cong

2014-01-01

81

Left Atrial-Esophageal Fistula Repair after Radiofrequency Catheter Ablation for Atrial Fibrillation  

PubMed Central

Left atrial-esophageal fistula (LAEF) is a rare complication of radiofrequency ablation (RFA) procedures undertaken for atrial fibrillation (AF). This complication is associated with significant morbidity and mortality. Currently, there is no clear consensus on the appropriate management strategy. We report a case of a LAEF that developed in a patient 2 weeks after RFA for medication refractory AF. The patient underwent successful repair of the fistula through a left posterolateral thoracotomy, wherein the esophageal and atrial lesions were repaired primarily with an intercostal muscle flap and bovine pericardial patch to reinforce and prevent recurrence.

Velotta, Jeffrey B.; Vasquez, Charles R.; Bolman, Ralph M.; Dasilva, Marcelo C.

2013-01-01

82

Atrial fibrillation: Catheter ablation  

Microsoft Academic Search

Catheter ablation of atrial fibrillation (AF) has evolved dramatically over the last several years. The initial efforts in the catheter-based management of AF targeted the atrial substrate in an effort to mimic the maze procedure. After the pulmonary veins (PV) were shown to be critical in the initiation and perpetuation of AF, the focus then shifted to a trigger approach

Aman Chugh; Fred Morady

2006-01-01

83

A case of thrombosis of intra-atrial extracardiac conduit and left pulmonary artery due to infective endocarditis after modified Fontan operation.  

PubMed

Previous studies have reported that the extracardiac Fontan procedure has excellent outcomes and a lower incidence of postoperative complications than the lateral tunnel procedure. However, thromboembolic events that occur after the Fontan procedure are a well-known cause of morbidity. We experienced a case of thrombosis of intra-atrial extracardiac conduit and the left pulmonary artery 2 years after a modified Fontan operation due to infective endocarditis (IE) despite prophylactic antiplatelet therapy. The patient underwent reoperation. The conduit in the right atrium (RA) was excised, and the thrombus in the vessels was removed. Because the fibrous tissue in the RA around the conduit was firm, the tissue was used as the "tunnel" for the Fontan route between the IVC and the ePTFE graft outside the RA instead of replacement using another alien graft. He was discharged on postoperative day 45 and was medicated with coumadin and aspirin. He is now being followed in our outpatient clinic and is still without any sign of infection. PMID:24881585

Oka, Norihiko; Yoshii, Takeshi; Shibata, Miyuki; Hayashi, Hidenori; Kitamura, Tadashi; Horai, Tetsuya; Itatani, Keiichi; Miyaji, Kagami

2014-01-01

84

Multifocal atrial tachycardia  

MedlinePLUS

... atrial tachycardia (MAT), many locations in the atria fire signals at the same time. Too many signals ... of oxygen in the blood. These conditions include: Bacterial pneumonia Chronic obstructive pulmonary disease (COPD) Congestive heart ...

85

Atrial Fibrillation (AF or AFib)  

MedlinePLUS

... Failure Heart Valve Disease High Blood Pressure Peripheral Artery Disease By clicking submit below you agree to the Terms and Conditions Atrial Fibrillation • Introduction • What is Atrial Fibrillation? • Why AFib Matters • ...

86

Successful treatment of left atrial disk thrombus on an Amplatzer atrial septal defect occluder with abciximab and heparin  

PubMed Central

Acute device thrombosis is a rare but important complication after transcatheter atrial septal defect closure. In this case a mobile thrombus was noted on the left side of an Amplatzer atrial septal occluder after device release in a 12 year old boy with an uncomplicated atrial septal defect. The thrombus was successfully treated with an infusion of heparin and the glycoprotein IIa/IIIb receptor antagonist abciximab. Transoesophageal ultrasound performed the following day showed complete resolution of the clot. There are no reports to guide treatment of acute thrombosis in this setting. This combination of treatments was effective without complication in this case. PMID:15084578

Willcoxson, F E; Thomson, J D R; Gibbs, J L

2004-01-01

87

Myxoma virus combined with rapamycin treatment enhances adoptive T cell therapy for murine melanoma brain tumors  

Microsoft Academic Search

Adoptive transfer of tumor-specific T cells has shown some success for treating metastatic melanoma. We evaluated a novel\\u000a strategy to improve adoptive therapy by administering both T cells and oncolytic myxoma virus to mice with syngeneic B16.SIY\\u000a melanoma brain tumors. Adoptive transfer of activated CD8+ 2C T cells that recognize SIY peptide doubled survival time, but SIY-negative tumors recurred. Myxoma

Diana L. Thomas; Rosalinda Doty; Vesna Tosic; Jia Liu; David M. Kranz; Grant McFadden; Amy L. MacNeill; Edward J. Roy

88

Interrupted inferior vena cava and partial anomalous pulmonary venous return with atrial septal defect in a 38-year-old adult: a case report  

PubMed Central

We present a woman having congenital anomalies of the inferior vena cava and partial anomalous pulmonary venous return from the right lung with atrial septal defect in a 38-year-old. Congenital anomalies of inferior vena cava are rare. They are seen more often in young males. If there are not other anomalies, they are latent for a long time. Peripheral venous thrombosis, chronic venous insufficiency, dyspnea and fatigue are often the first symptoms of these anomalies. Surgical repair of atrial septal defect with partial anomalous pulmonary venous return include provision of durably unobstructed systemic and pulmonary venous pathways, closure of the atrial septal defect, and avoidance of arrhythmias. The diagnosis has been determined by compression ultrasonography with color doppler assessment, multidetector computed tomography angiography and echocardiography. PMID:19829946

Rahman, Ali; Kocaturk, Hasan; Bayram, Ednan; Kocakoc, Ercan

2009-01-01

89

Dual-energy cardiac computed tomography for differentiating cardiac myxoma from thrombus.  

PubMed

Although intra-cardiac masses are rare, diagnosis and refined characterization of these masses are important because of the different therapeutic strategies used to treat these lesions. The purpose of this study was to evaluate the diagnostic value of dual-energy cardiac computed tomography (CCT) for differentiating cardiac myxomas from thrombi. Our institutional review board approved this study, and patients provided informed consent. We prospectively enrolled 37 patients who had an intra-cardiac mass on echocardiography or computed tomography (CT). All patients underwent dual-energy CCT. For quantitative analysis, the CT attenuation density and iodine concentration of the intra-cardiac mass were measured on CT images. The Mann-Whitney test was used to evaluate differences in the mean CT attenuation density and the mean iodine concentrations between the cardiac myxoma and thrombus groups. Pathological results or follow-up with echocardiography was used to make the final diagnosis. There were a total of 17 cardiac myxomas and 20 thrombi. On CT, the mean CT numbers were not significantly different between cardiac myxomas and cardiac thrombi (91.7 ± 11.6 HU vs. 85.2 ± 10.9 HU, respectively, P = 0.241), whereas, the mean iodine concentration (mg/ml) was significantly different between cardiac myxomas and cardiac thrombi (3.53 ± 0.72 vs. 1.37 ± 0.31, respectively, P < 0.001). Dual-energy CCT using a quantitative analytic methodology can be used to differentiate between cardiac myxomas and thrombi. PMID:25011535

Hong, Yoo Jin; Hur, Jin; Kim, Young Jin; Lee, Hye-Jeong; Hong, Sae Rom; Suh, Young Joo; Kim, Hee Yeong; Lee, Ji Won; Choi, Byoung Wook

2014-12-01

90

Left atrial isomerism: biventricular repair  

Microsoft Academic Search

Objective: Biventricular repair of hearts with left atrial isomerism often necessitates complex atrial and ventricular baffle procedures. We analysed our experience with an accent on baffle techniques. Methods: From 1997 until 2008, 12 patients (four male) with left atrial isomerism received biventricular repair. Their median age at surgery was 9 (range: 1–24) months. Four patients had dextrocardia. Nine patients presented

Janez Vodiskar; Sally-Ann Clur; Jarda Hruda; Regina Bokenkamp; Mark Gerard Hazekamp

2010-01-01

91

Atrial selectivity of antiarrhythmic drugs  

PubMed Central

New antiarrhythmic drugs for treatment of atrial fibrillation should ideally be atrial selective in order to avoid pro-arrhythmic effects in the ventricles. Currently recognized atrial selective targets include atrial Nav1.5 channels, Kv1.5 channels and constitutively active Kir3.1/3.4 channels, each of which confers atrial selectivity by different mechanisms. Na+ channel blockers with potential- and frequency-dependent action preferentially suppress atrial fibrillation because of the high excitation rate and less negative atrial resting potential, which promote drug binding in atria. Kv1.5 channels are truly atrial selective because they do not conduct repolarizing current IKur in ventricles. Constitutively active IK,ACh is predominantly observed in remodelled atria from patients in permanent atrial fibrillation (AF). A lot of effort has been invested to detect compounds which will selectively block Kir3.1/Kir3.4 in their remodelled constitutively active form. Novel drugs which have been and are being developed aim at atrial-selective targets. Vernakalant and ranolazine which mainly block atrial Na+ channels are clinically effective. Newly designed selective IKur blockers and IK,ACh blockers are effective in animal models; however, clinical benefit in converting AF into sinus rhythm (SR) or reducing AF burden remains to be demonstrated. In conclusion, atrial-selective antiarrhythmic agents have a lot of potential, but a long way to go. PMID:23732646

Ravens, Ursula; Poulet, Claire; Wettwer, Erich; Knaut, Michael

2013-01-01

92

Large right atrial thrombosis. Rare complication during permanent transvenous endocardial pacing.  

PubMed Central

Right atrial thrombosis is a rare complication of permanent endocardial pacing. We report two cases with large right atrial thrombi which occurred during permanent endocardial electrical stimulation. Both patients were women, aged 83 and 89 years, who died suddenly, respectively, one month and 24 days after pacemaker implantation. At the time of death the two patients were in severe persistent refractory congestive heart failure despite appropriate medical treatment. At necropsy large mobile right atrial thrombi were found in both cases. Images PMID:7362712

Nicolosi, G L; Charmet, P A; Zanuttini, D

1980-01-01

93

Rivaroxaban in atrial fibrillation  

PubMed Central

Warfarin is the traditional therapeutic option available to manage thromboembolic risk in atrial fibrillation. The hemorrhagic risk with warfarin depends mainly on the international normalized ratio (INR). Data from randomized controlled trials show that patients have a therapeutic INR (2.00–3.00) only 61%–68% of the time while taking warfarin, and this target is sometimes hard to establish. Many compounds have been developed in order to optimize the profile of oral anticoagulants. We focus on one of them, rivaroxaban, comparing it with novel alternatives, ie, dabigatran and apixaban. The indication for rivaroxaban in nonvalvular atrial fibrillation was evaluated in ROCKET-AF (Rivaroxaban-once daily, Oral, direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation). In this trial, rivaroxaban was associated with a 12% reduction in the incidence of the primary endpoint compared with warfarin (hazard ratio 0.88; 95% confidence interval [CI] 0.74–1.03; P < 0.001 for noninferiority and P = 0.12 for superiority). However, patients remained in the therapeutic range for INR only 55% of the time, which is less than that in RE-LY (the Randomized Evaluation of Long-Term Anticoagulation Therapy, 64%) and in the ARISTOTLE trial (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation, 66%). This shorter time spent in the therapeutic range has been one of the main criticisms of the ROCKET-AF trial, but could actually reflect what happens in real life. In addition, rivaroxaban exhibits good pharmacokinetic and pharmacoeconomic properties. Novel anticoagulants are a viable and commercially available alternative to vitamin K antagonists nowadays for the prevention of thromboembolic complications in atrial fibrillation. Rivaroxaban is an attractive alternative, but the true picture of this novel compound in atrial fibrillation will only become available with more widespread use. PMID:22973107

Giorgi, Mariano A; Miguel, Lucas San

2012-01-01

94

Management of Atrial Tachycardia in the Newborn With Enterovirus Myocarditis  

PubMed Central

Neonatal enterovirus myocarditis is a rare but serious infection that is often an underrecognized cause of cardiovascular collapse. Enterovirus myocarditis in patients with such collapse should be suspected when signs of congestive heart failure and tachyarrhythmia are present. The majority of reported electrical disturbances associated with enterovirus myocarditis are ventricular in origin, but the infection can present as atrial tachyarrhythmia. Atrial tachyarrhythmias associated with enterovirus myocarditis are difficult to manage because of their resistance to conventional antiarrhythmic therapy. We present 2 cases of neonates with atrial tachycardia associated with enterovirus myocarditis who responded to a combination of amiodarone and flecainide. PMID:22778684

Petroni, Daniel H.; Yang, Song G.; Kattash, Mudar M.; Snyder, Christopher S.

2012-01-01

95

Typical atrial flutter in an atypical patient.  

PubMed

Arrhythmias in adult congenital heart disease (ACHD) pose unique procedural challenges, especially with intravascular access. We report a unique case of ablation via a left-sided hepatic vein approach in a patient with situs inversus totalis. A 28-year-old woman with situs inversus totalis, ventriculoseptal defect, and dextro-transposition of the great arteries underwent ablation for documented narrow-complex tachycardia. Because of bilateral iliac venous occlusions, the coronary sinus (CS) was accessed through the left internal jugular vein. Rapid atrial pacing resulted in a tachycardia with an atrial cycle length of 225 msec and 2:1 atrioventricular association. Entrainment from the proximal and distal CS was consistent with typical atrial flutter around the left-sided tricuspid valve. Because of the iliac vein occlusions, access for ablation was obtained via a left-sided hepatic vein (Figure 1). Resetting from the cavotricuspid isthmus and three-dimensional electroanatomic mapping (Figure 2) confirmed typical atrial flutter, which, given the dextrocardia, occurred in a clockwise fashion around the tricuspid valve. Ablation was performed at the cavotricuspid isthmus resulting in arrhythmia termination and isthmus block. This case highlights the many unusual challenges that patients with ACHD can pose to the proceduralist, including atypical cardiac anatomy and difficult intravascular access. Unusual and creative approaches are often necessary to treat these patients successfully. PMID:21702889

Bargas, Royce L; Sauer, William H; Lowery, Christopher M

2011-01-01

96

Bilateral renal infarction following atrial fibrillation and thromboembolism and presenting as acute abdominal pain: a case report  

PubMed Central

Introduction Renal infarct is rare and often misdiagnosed because the symptoms are misleading. The mechanisms are various, mainly thrombotic and embolic. Case presentation In this review, we report the case of a 61-year-old Tunisian woman presented to the emergency unit with a 4-hour history of abdominal pain diffused at both flanks, ultrasounds was performed to remove a surgical emergency, showed a peri-renal fluid collection with heterogeneous parenchyma. We followed by a CT scan, which confirmed the diagnosis of renal infarct. The patient was treated by heparin at a curative dose, and the outcome was favorable. Conclusion Diagnosis is difficult and should be considered in patients with inexplicable flank or abdominal pain and with risk factors to this disease. Our purpose is to raise clinician’s awareness for this condition so that they will be more likely to diagnose it. This will facilitate prompt diagnosis and treatment. A review of the literature was performed and the case is discussed in the context of the current knowledge of this condition. PMID:22691187

2012-01-01

97

Exploiting periodicity to extract the atrial activity in atrial arrhythmias  

NASA Astrophysics Data System (ADS)

Atrial fibrillation disorders are one of the main arrhythmias of the elderly. The atrial and ventricular activities are decoupled during an atrial fibrillation episode, and very rapid and irregular waves replace the usual atrial P-wave in a normal sinus rhythm electrocardiogram (ECG). The estimation of these wavelets is a must for clinical analysis. We propose a new approach to this problem focused on the quasiperiodicity of these wavelets. Atrial activity is characterized by a main atrial rhythm in the interval 3-12 Hz. It enables us to establish the problem as the separation of the original sources from the instantaneous linear combination of them recorded in the ECG or the extraction of only the atrial component exploiting the quasiperiodic feature of the atrial signal. This methodology implies the previous estimation of such main atrial period. We present two algorithms that separate and extract the atrial rhythm starting from a prior estimation of the main atrial frequency. The first one is an algebraic method based on the maximization of a cost function that measures the periodicity. The other one is an adaptive algorithm that exploits the decorrelation of the atrial and other signals diagonalizing the correlation matrices at multiple lags of the period of atrial activity. The algorithms are applied successfully to synthetic and real data. In simulated ECGs, the average correlation index obtained was 0.811 and 0.847, respectively. In real ECGs, the accuracy of the results was validated using spectral and temporal parameters. The average peak frequency and spectral concentration obtained were 5.550 and 5.554 Hz and 56.3 and 54.4%, respectively, and the kurtosis was 0.266 and 0.695. For validation purposes, we compared the proposed algorithms with established methods, obtaining better results for simulated and real registers.

Llinares, Raul; Igual, Jorge

2011-12-01

98

Alterations in atrial perfusion during atrial fibrillation.  

PubMed

Left atrial (LA) perfusion during disease states has been a topic of much interest, because the clinical implications and detrimental effects of lack of blood flow to the atria are numerous. In the chronic setting, changes in perfusion may lead to LA ischaemia and structural remodelling, a factor implicated in the self-perpetuation of chronic atrial fibrillation (AF). The association between AF and altered LA perfusion has been studied, but a direct causal association between perfusion changes and AF has not been established. A comprehensive literature search of Medline, Embase and Google Scholar databases was conducted from 1960 to February 2014. We systematically analysed reference lists of physiological articles and reviews for other possibly relevant studies. The aim of this review is to provide a comprehensive discussion of the AF-mediated changes in LA perfusion and the potential mechanisms underlying the alterations in coronary flow to the LA in this setting. In addition, we discuss the clinical contexts in which changes in LA perfusion may be relevant. Finally, this article highlights the need for longitudinal studies of AF that would elucidate the changes in LA perfusion resulting from chronic AF and lead to advancements in effective treatments to prevent progression of this disease. PMID:25063838

Pacchia, Christina F; Dosdall, Derek J; Ranjan, Ravi; DiBella, Edward

2014-10-01

99

Surgical ablation for atrial fibrillation.  

PubMed

This paper reviews the history of surgical procedures developed for eradication of atrial fibrillation (AF) during cardiac surgery for structural heart disease, and in patients with AF without other indication for cardiac surgery. Current evidence indicates that, despite their proven efficacy, the Cox-Maze procedure and its modifications require cardiopulmonary bypass and cannot be easily justified in the case of AF without other indication for cardiac surgery. In patients undergoing cardiac surgery for mitral valve disease, concomitant ablation techniques using modifications of the Maze and alternative energy sources appear to be safe and effective in treating AF, especially in non-rheumatic disease. Minimally invasive epicardial ablation has been recently developed and can be performed on a beating heart through small access incision ports. Various techniques combining pulmonary vein isolation, ganglionated plexi ablation, and left atrial lines have been tried. Initial results are promising but further clinical experience is required to establish ideal lesion sets, appropriate energy sources, and the benefit-risk ratio of such an approach in patients without other indication for cardiac surgery. The role of surgical ablation in the current management of AF is under investigation. PMID:22490369

Fragakis, Nikolaos; Pantos, Ioannis; Younis, Jenan; Hadjipavlou, Marios; Katritsis, Demosthenes G

2012-11-01

100

Pharmacogenomics of atrial fibrillation  

Microsoft Academic Search

Atrial fibrillation (AF) is the commonest arrhythmia requiring intervention; we report here analyses of 2 ongoing studies of AF from the Pharmacogenomics of Arrhythmia Therapy (PAT) group.(1) ACE polymorphism and drug response: The Angiotensin Converting Enzyme (ACE) DD genotype increases plasma ACE, is presumed to thereby increase tissue angiotensin II, and has been linked to adverse outcomes in cardiovascular disease.

B. S. Donahue; D. Darbar; A GEORGEJR; C. Li; N. J. Brown; M. Ritchie; D. M. Roden

2005-01-01

101

Percutaneous balloon mitral valvulotomy and coexisting left atrial hemangioma: case report and long-term follow-up.  

PubMed

Hemangiomas of the heart are extremely rare. The prognosis is quite variable, because this benign tumor may grow, involute, or stop growing; therefore, resection is usually the treatment of choice. In patients with tumors of the left atrium, percutaneous balloon mitral valvulotomy is generally contraindicated. Yet for patients with moderate-to-severe mitral valve stenosis, balloon valvulotomy is an established therapy. Herein, we present the case of a 73-year-old woman who was referred to our department in 1995 with severe mitral valve stenosis. Echocardiography showed a valve orifice area of 0.9 cm2, according to Gorlin's formula, and a mean pressure gradient of 11 mmHg. Surgical therapy was declined by the patient. There were no signs of coronary artery disease. The injection of contrast medium into the left coronary artery showed a hemangioma at the posterior wall of the left atrium. Magnetic resonance imaging and transesophageal echocardiography confirmed the diagnosis. Despite the increased risk posed by the hemangioma, we performed successful percutaneous balloon mitral valvulotomy with an Inoue balloon. We saw the patient in 2001, and again in 2008 when she was 86 years of age. She was in excellent condition, with no signs of relevant dyspnea. Magnetic resonance imaging showed the size of the hemangioma to be stable. By use of echocardiography, we were able to confirm a good long-term result of the balloon valvulotomy. In this patient, a nonsurgical approach was adequate because of the lack of growth of the hemangioma in the left atrium. PMID:20200640

van Buuren, Frank; Langer, Christoph; Faber, Lothar; Butz, Thomas; Schmidt, Henning Karl; Esdorn, Hermann; Bogunovic, Nikola; Mellwig, Klaus Peter; Scholtz, Werner; Horstkotte, Dieter

2010-01-01

102

Host-specificity of myxoma virus: Pathogenesis of South American and North American strains of myxoma virus in two North American lagomorph species.  

PubMed

The pathogenesis of South American and North American myxoma viruses was examined in two species of North American lagomorphs, Sylvilagus nuttallii (mountain cottontail) and Sylvilagus audubonii (desert cottontail) both of which have been shown to have the potential to transmit the South American type of myxoma virus. Following infection with the South American strain (Lausanne, Lu), S. nuttallii developed both a local lesion and secondary lesions on the skin. They did not develop the classical myxomatosis seen in European rabbits (Oryctolagus cuniculus). The infection at the inoculation site did not resolve during the 20-day time course of the trial and contained transmissible virus titres at all times. In contrast, S. audubonii infected with Lu had very few signs of disseminated infection and partially controlled virus replication at the inoculation site. The prototype Californian strain of myxoma virus (MSW) was able to replicate at the inoculation site of both species but did not induce clinical signs of a disseminated infection. In S. audubonii, there was a rapid response to MSW characterised by a massive T lymphocyte infiltration of the inoculation site by day 5. MSW did not reach transmissible titres at the inoculation site in either species. This might explain why the Californian myxoma virus has not expanded its host-range in North America. PMID:19836172

Silvers, L; Barnard, D; Knowlton, F; Inglis, B; Labudovic, A; Holland, M K; Janssens, P A; van Leeuwen, B H; Kerr, P J

2010-03-24

103

Thrombolytic treatment of cardiac myxoma-induced ischemic stroke: a review.  

PubMed

Primary cardiac tumors are uncommon, with an autopsy frequency of 0.001%-0.28%: 75% of them are benign, and 50-75% of these are myxomas. Often the first neurological manifestations of a cardiac myxoma include transient ischemic attacks and ischemic strokes. Although thrombolytic therapy represents the gold standard for acute ischemic stroke treatment, its safety and effectiveness in stroke patients with myxoma is unknown. From the analysis of the literature on thrombolysis in ischemic stroke patients with myxoma we report clinical evidence supporting the use of thrombolytics, and the application of thrombolysis in this setting of patients. 23 previous reports presented patients with acute ischemic stroke and associated cardiac myxoma treated with thrombolytic therapy: 16 patients were treated with intravenous thrombolysis, 4 patients with intra-arterial thrombolysis and 3 patients were treated with bridging therapy (intravenous alteplase followed by local mechanical thrombolysis). Our review showed that the possible risk of major bleeding in these patients resulted in limited and small hemorrhages; furthermore patients who developed cerebral hemorrhage did not deteriorate clinically: waiting for further confirmation and additional data from a future register, these observations may suggest that, notwithstanding a possible publication bias, i.v. thrombolytic therapy may be a safe treatment in these patients. PMID:24410387

Acampa, Maurizio; Guideri, Francesca; Tassi, Rossana; D'Andrea, Paolo; Marotta, Giovanna; Giudice, Giuseppe Lo; Martini, Giuseppe

2014-01-01

104

[Atrial fibrillation after open-heart surgery--incidence, prevention and treatment].  

PubMed

Atrial fibrillation is a common problem in the postoperative period following open-heart surgery. The pathogenesis of postoperative atrial fibrillation is likely to be multifactorial, however increased sympathetic activation may play a significant role. The aim of the study was to detect the incidence and possible reasons of atrial fibrillation in the first three postoperative days after open-heart surgery. Atrial fibrillation was detected in a total of 48 patients (mean age 64.8 +/- 8.8 years) of the 302 consecutive patients included in the study. The incidence of atrial fibrillation was 15.9%. In the history of patients with atrial fibrillation paroxysmal or persistent atrial fibrillation occurred in 18 cases. Acute ischaemia, hypopotassemia, high dose catecholamines contributed to the development of arrhythmias in 6, 4 and 4 cases, respectively. Lack of perioperative beta-blocker treatment was seen in 35 cases. Postoperative bleeding and reoperation occurred prior to the onset of atrial fibrillation in 9 instances. The applied antiarrhythmic therapy was metoprolol, amiodarone, propafenon and electrical cardioversion in 33, 21, 4 and 2 cases, respectively. Incidence of atrial fibrillation was found significantly lower in patients receiving beta-blocker premedication (13/181 [7.18%] versus 35/121 [28.9%]). There was no correlation between the incidence of atrial fibrillation and the length of the surgery, aortic-cross clamp time and the number of bypass grafts. Absence of preoperative beta-blocker treatment, previous atrial fibrillation and combined surgery were found to be strong predictors of atrial fibrillation. There was weaker association with increased age. On the basis of the outcome of our study beta-blocker premedication is suggested in most patients undergoing open-heart surgery. PMID:11184248

Vágó, H; Merkely, B; Szabolcs, Z; Moravcsik, E; Gellér, L; Szabó, T; Turbók, E; Matkó, I; Bodor, E

2000-10-01

105

SUPRASTERNAL NOTCH ECHOCARDIOGRAPHY AND ATRIAL ARRHYTHMIAS  

PubMed Central

Anterior-posterior single-crystal echocardiography has been used in atrial flutter and in sinus rhythm after cardioversion to demonstrate anterior movement of the posterior left atrial wall, representing the effects of atrial flutter and sinus contractions.1 This is thought to be the first report of characteristic superior movement of the inferior left atrial wall during atrial flutter, atrial tachycardia, and sinus rhythm by single-crystal suprasternal notch echocardiography. Images PMID:15216028

Sasse, Lewis; Frolich, Carla R.

1979-01-01

106

Atrial fibrillation: antiarrhythmic therapy.  

PubMed

Atrial fibrillation is the most common cardiac arrhythmia and is associated with significant morbidity, mortality, and economic cost. Although the benefit of anticoagulation has been well described, control of the underlying rhythm disturbance can be achieved in various ways. Numerous therapeutic options exist and continue to be developed; however, the single best strategy has not been elucidated, and rate or rhythm controlling strategies may both be undertaken. The selection of particular agents to successfully achieve these strategies takes into account patient preference and comorbidity, as well as the efficacy and side effect profiles of the possible medications. This review discusses the evidence behind the various agents typically used to treat atrial fibrillation as well as provides a framework on which to make clinical decisions while initiating and continuing therapy. PMID:25234389

Psotka, Mitchell A; Lee, Byron K

2014-10-01

107

Atrial fibrillation and inflammation  

PubMed Central

Atrial fibrillation (AF) is the most common clinical arrhythmia. Recent investigations have suggested that inflammation might have a role in the pathophysiology of AF. In this review, the association between inflammation and AF, and the effects of several agents that have anti-inflammatory actions, such as statins, polyunsaturated fatty acids, corticosteroids and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, have been investigated. PMID:21160591

Ozaydin, Mehmet

2010-01-01

108

The atrial natriuretic factor.  

PubMed Central

In less than three years since the rapid and potent natriuretic response to intravenous injection of atrial myocardial extract in rats was reported the factor responsible for the diuretic, natriuretic, and vasodilating activity of the atrial homogenates was isolated, its chemical structure elucidated, and its total synthesis achieved. Also the cDNA and the gene encoding for the atrial natriuretic factor in mice, rats, and man have been cloned and the chromosomal site identified. The major effects of this hormone are vasodilatation, prevention and inhibition of the contraction induced by noradrenaline and angiotensin II, diuresis, and natriuresis associated in most instances with a pronounced increase in glomerular filtration rate and filtration fraction, inhibition of aldosterone secretion, and considerable stimulation of particulate guanylate cyclase activity. High density specific binding sites have been demonstrated in the zona glomerulosa of the adrenal cortex, in the renal glomeruli, and in the collecting ducts, and in the brain areas involved in the regulation of blood pressure and of sodium and water (AV3V region, subfornical organ, nucleus tractus solitarius, area postrema). Images Fig 1 Fig 5 PMID:2945572

Genest, J

1986-01-01

109

Epicardial Atrial Defibrillation: Successful Treatment of Postoperative Atrial Fibrillation  

Microsoft Academic Search

Background. Atrial fibrillation is the most common complication after cardiac surgery. Current medical treat- ment using antiarrhythmics and anticoagulants has a significant morbidity. The goal of this study was to determine if epicardial atrial defibrillation can be safely performed and return patients to sinus rhythm. Methods. A prospective analysis of patients undergo- ing cardiac surgery was performed. Patients with a

Amit N. Patel; Baron L. Hamman; Amy N. Patel; Robert F. Hebeler; Richard E. Wood; Carol Ann Cockerham; Brittany A. Willey; Harold C. Urschel

110

Depression in Atrial Fibrillation in the General Population  

PubMed Central

Background Initial evidence suggests that depressive symptoms are more frequent in patients with atrial fibrillation. Data from the general population are limited. Methods and Results In 10,000 individuals (mean age 56±11 years, 49.4% women) of the population-based Gutenberg Health Study we assessed depression by the Patient Health Questionnaire (PHQ-9) and a history of depression in relation to manifest atrial fibrillation (n?=?309 cases). The median (25th/75th percentile) PHQ-9 score of depressive symptoms was 4 (2/6) in atrial fibrillation individuals versus 3 (2/6) individuals without atrial fibrillation, . Multivariable regression analyses of the severity of depressive symptoms in relation to atrial fibrillation in cardiovascular risk factor adjusted models revealed a relation of PHQ-9 values and atrial fibrillation (odds ratio (OR) 1.04, 95% confidence interval (CI) 1.01–1.08; P?=?0.023). The association was stronger for the somatic symptom dimension of depression (OR 1.08, 95% CI 1.02–1.15; P?=?0.0085) than for cognitive symptoms (OR 1.05, 95% CI 0.98–1.11; P?=?0.15). Results did not change markedly after additional adjustment for heart failure, partnership status or the inflammatory biomarker C-reactive protein. Both, self-reported physical health status, very good/good versus fair/bad, (OR 0.54, 95% CI 0.41–0.70; P<0.001) and mental health status (OR 0.61 (0.46–0.82); P?=?0.0012) were associated with atrial fibrillation in multivariable-adjusted models. Conclusions In a population-based sample we observed a higher burden of depressive symptoms driven by somatic symptom dimensions in individuals with atrial fibrillation. Depression was associated with a worse perception of physical or mental health status. Whether screening and treatment of depressive symptoms modulates disease progression and outcome needs to be shown. PMID:24324579

Wilde, Sandra; Wiltink, Jorg; Wild, Philipp S.; Sinning, Christoph R.; Lubos, Edith; Ojeda, Francisco M.; Zeller, Tanja; Munzel, Thomas; Blankenberg, Stefan; Beutel, Manfred E.

2013-01-01

111

[Delayed atrial excitation following bifocal pacemaker stimulation].  

PubMed

A patient with drug-resistant ventricular tachycardia due to ischemic heart disease with severe left ventricular failure was successfully treated by the implantation of a DDD pacemaker system pacing at a rate of 90 beats/min (overdrive suppression). Additional therapy with high doses of beta-blockers was necessary. The ECG demonstrated a delay of 100 ms between atrial spike and p-wave. The hemodynamic effects of this ineffective atrial contraction were assessed by jugular venous puls tracing, phonocardiography, echocardiography, and radionuclide-ventriculography. The desired positive effects of physiological pacing could only be achieved by further prolongation of the A-V interval by these 100 ms. This observation shows that, with DDD pacemakers, AV intervals of varying length may be necessary with VAT or VDD and DVI modes in individual cases. PMID:6868743

Alt, E; Wirtzfeld, A; Seidl, K; Haller, F; von Bibra, H; Sauer, E

1983-04-01

112

Clinical Results with Catheter Ablation: AV Junction, Atrial Fibrillation and Ventricular Tachycardia  

Microsoft Academic Search

With the limitations of pharmacologic and device therapies for atrial fibrillation and ventricular tachycardia, catheter ablation is assuming a larger role in the management of patients with these common arrhythmias. Multiple case series and clinical trials have helped to define the evolving role of these techniques for ablation of the atrioventricular node, atrial fibrillation, and ischemic ventricular tachycardia. Based on

Jonathan Weinstock; Paul J. Wang; Munther K. Homoud; Mark S. Link; N. A. Mark Estes

2003-01-01

113

Infective Left Atrial Dissecting Flap after Cardiac Surgery  

PubMed Central

Left atrial dissection (LatD), defined as the forced separation of the left atrial (LA) wall layers by blood, is a rare and severe complication of cardiac surgery. It is most frequently associated with atrioventricular junction injuries. We report a case of infected LatD after coronary artery bypass graft, mitral valve replacement, aortic valve replacement and ascending aortic root replacement. The patient was presented with septicemia and disseminated intravascular coagulation. To the best of our knowledge, this is the first case report of LA dissecting flap concomitant with attached infective vegetations identified by transesophageal echocardiography. PMID:25309695

Tabiban, Sasan; Ghaemian, Ali; Bagheri, Babak; Shokri, Mojtaba

2014-01-01

114

Syndrome of diminished vasodilator reserve of the coronary microcirculation (microvascular angina or syndrome X): Diagnosis by combined atrial pacing and thallium 201 imaging--a case report  

SciTech Connect

Patients with angina-like chest pain without evidence of epicardial coronary artery disease or coronary arterial vasospasm are becoming increasingly recognized. These are often related to noncardiac causes including esophageal, musculoskeletal, and hyperventilatory or panic states. However, recently a subgroup of such patients are being recognized as having true myocardial ischemia and chest pain on the basis of diminished coronary microvascular vasodilatory reserve (microvascular ischemia or Syndrome X). The authors describe such a patient who was found to have replication of anginal pain associated with a reversible ischemic defect on thallium 201 imaging during atrial pacing, suggesting ischemia in this myocardial segment. Resolution of angina and ST segment electrocardiographic changes of ischemia occurred with cessation of pacing. We believe this is the first report of a patient with this form of myocardial ischemia diagnosed by this method and should be considered in patients with anginal chest pain after significant coronary artery disease and coronary vasospasm have been excluded.

Magarian, G.J.; Palac, R.; Reinhart, S. (Veterans Administration Medical Center, Portland, OR (USA))

1990-08-01

115

Atrial isomerism: a pictorial review.  

PubMed

This review describes the broad spectrum of findings found in atrial isomerism, suggesting a sequential approach to image evaluation, and illustrates the most common situs disorders, for example, polysplenia and asplenia. PMID:22398009

Balan, Anu; Lazoura, Olga; Padley, Simon P; Rubens, Michael; Nicol, Edward D

2012-01-01

116

Fish Oil and Atrial Fibrillation  

MedlinePLUS

... the lower right-hand corner of the player. Fish Oil and Atrial Fibrillation HealthDay September 30, 2014 ... of Cardiology looks at whether high-doses of fish oil can help reduce the recurrence of AFib ...

117

Hypoplastic left heart syndrome with restrictive atrial septum and advanced heart block documented with a novel fetal electrocardiographic monitor  

PubMed Central

Hypoplastic left ventricle with congenital heart block has been reported previously in a fetus with concurrent left atrial isomerism and levo-transposition of the great arteries. We present the unusual case of an infant diagnosed in utero with hypoplastic left heart syndrome, a restrictive atrial septum and advanced heart block but with D-looping of the ventricles and no atrial isomerism. In addition, fetal heart rhythm was documented with the assistance of a new fetal electrocardiographic monitor. PMID:21374749

NARAYAN, H. K.; FIFER, W.; CARROLL, S.; KERN, J.; SILVER, E.; WILLIAMS, I. A.

2012-01-01

118

Heart failure resulting from giant left atrial synovial sarcoma metastasis.  

PubMed

Synovial sarcoma metastasis affecting the heart and infiltrating the mitral valve is a very rare pathology. We report the case of a 44-year-old male treated with chemotherapy for atypical synovial sarcoma of the oral mucosa who presented to our clinic after cardiac decompensation with a presumptive diagnosis of myxoma of the left atrium. A large necrotic tumour positive for CK 22, EMA, CD 99 and BCL-2 but negative for translocation in COBRA-FISH analysis by break-apart probe could be excised and revealed a very rare subtype of synovial sarcoma metastasis arising from the endocard of the left atrium. The tumour was resected and the mitral valve reconstructed through ring annuloplasty. PMID:21425056

Winkler, B; Grapow, M; Seeberger, M; Matt, P; Aulitzky, W; Eckstein, F

2012-02-01

119

A novel approach to atrial endocardial pacing.  

PubMed

We describe a patient who had tricuspid valve replacement and in whom dual-chamber pacing was accomplished by using a ventricular epicardial lead and by placing an atrial endocardial lead through the wall of the atrial appendage and positioning the tip against the endocardial surface of the atrial appendage. A ligature was placed around the atrial appendage where the lead passed through the wall of the right atrial appendage. This obviated the need for a second procedure to place the atrial lead in a transvenous fashion. After 5 years of follow-up the patient continues with normal DVI pacing. PMID:2464805

Hayes, D L; Vlietstra, R E; Puga, F J; Shub, C

1989-01-01

120

Outcomes of Medicare Beneficiaries Undergoing Catheter Ablation for Atrial Fibrillation  

PubMed Central

Background Atrial fibrillation is common among older persons. Catheter ablation is increasingly used in patients for whom medical therapy has failed. Methods and Results We conducted a retrospective cohort study of all fee-for-service Medicare beneficiaries 65 years or older who underwent catheter ablation for atrial fibrillation between July 1, 2007, and December 31, 2009. The main outcome measures were major complications within 30 days and mortality, heart failure, stroke, hospitalization, and repeat ablation within 1 year. A total of 15,423 patients underwent catheter ablation for atrial fibrillation. Mean age was 72 years, 41% were women, and more than 95% were white. For every 1000 procedures, there were 17 cases of hemopericardium requiring intervention, 8 cases of stroke, and 8 deaths within 30 days. Over 40% of patients required hospitalization within 1 year; however, atrial fibrillation or flutter was the primary discharge diagnosis in only 38.4% of cases. Eleven percent of patients underwent repeat ablation within 1 year. Renal impairment (hazard ratio, 2.07; 95% confidence interval, 1.66–2.58), age greater than 80 years (3.09; 2.32–4.11), and heart failure (2.54; 2.07–3.13) were major risk factors for 1-year mortality. Advanced age was a major risk factor for all adverse outcomes. Conclusions Major complications after catheter ablation for atrial fibrillation were associated with advanced age but were fairly infrequent. Few patients underwent repeat ablation. Randomized trials are needed to inform risk-benefit calculations for older persons with drug-refractory, symptomatic atrial fibrillation. PMID:23019293

Piccini, Jonathan P.; Sinner, Moritz F.; Greiner, Melissa A.; Hammill, Bradley G.; Fontes, João D.; Daubert, James P.; Ellinor, Patrick T.; Hernandez, Adrian F.; Walkey, Allan J.; Heckbert, Susan R.; Benjamin, Emelia J.; Curtis, Lesley H.

2012-01-01

121

Prenatal diagnosis of atrial isomerism in the Korean population  

PubMed Central

Objective To report our experiences in the prenatal diagnosis of atrial isomerism and postnatal outcomes. Methods A total of 80 fetuses prenatally diagnosed with atrial isomerism were retrospectively analyzed between 1999 and 2011 at a single institution. Results Of 43 fetuses with prenatally diagnosed right atrial isomerism (RAI), 40 cases were analyzed. The diagnostic accuracy was 93%. The main intracardiac anomalies in RAI were atrioventricular septal defect (AVSD), abnormal pulmonary venous connection, bilateral superior vena cava (BSVC), and pulmonary atresia. Among 28 live births, three infants were lost to follow up, and the overall survival rate was 60%. Of 37 fetuses with prenatally diagnosed left atrial isomerism (LAI), 35 were evaluated. The diagnostic accuracy was 97%. The main intracardiac anomalies in LAI were ventricular septal defect, BSVC, AVSD, double outlet right ventricle, and bradyarrhythmia. Among seven patients with bradyarrhythmia, only one showed a complete atrioventricular block. All fetuses had an interrupted inferior vena cava with azygous continuation. The overall survival rate was 90%. Conclusion Our study confirms the previous findings of fetal atrial isomerism. We also demonstrates a much lower prevalence of AVSD and complete heart block in LAI and a better survival rate in RAI. Although the postnatal outcomes for RAI were worse than those for LAI, successful postnatal surgery with active management improved the survival rate. PMID:24883290

Lee, Mi-Young; Shim, Jae-Yoon; Lee, Pil-Ryang; Lee, Byong Sop; Kim, Ellen Ai-Rhan; Kim, Young-Hwue; Park, Jeong-Jun; Yun, Tae-Jin; Kim, Ahm

2014-01-01

122

Bicameral repair of right pulmonary artery to left atrial communication.  

PubMed

A right pulmonary artery to left atrial communication is a very rare vascular congenital anomaly. Patients most commonly present in the neonatal period with congestive cardiac failure or at a later stage with central cyanosis and its complications. Various diagnostic modalities are available but angiography is the most important decision-making tool for the management of this lesion. We present an unusual case of right pulmonary artery to left atrial communication in a 14-year-old patient, who underwent successful surgical repair through a bicameral approach. PMID:21692017

Gajjar, T P; Desai, N B

2012-04-01

123

Incomplete endothelialization of left atrial appendage occlusion device 10 months after implantation.  

PubMed

We describe the case of a 74-year-old man with Rendu Osler Weber syndrome affected by permanent atrial fibrillation, who underwent percutaneous placement of a 24-mm Watchman left atrial appendage system. After anticoagulation therapy dismissal, he had a transient ischemic attack (TIA). Therefore he underwent surgical removal of the device, ablation of atrial fibrillation with Maze IV procedure and biatrial reduction. Very interestingly, no significant endothelialization of the device was observed 10 months after implantation. In conclusion, this case is important because, to our knowledge, it is the first finding of Watchman device with lack of endothelialization. PMID:22612654

Massarenti, Luca; Yilmaz, Alaaddin

2012-12-01

124

[Double tachycardia: association of an atrial flutter and a fascicular ventricular tachycardia].  

PubMed

Double tachycardia is an uncommon type of tachycardia. We report the case of a 42-year-old patient, admitted in our department for palpitations. Two types of tachycardia, narrow and wide QRS one, have been documented in the moment of palpitations. The electrophysiology study highlights an atrial flutter and a fascicular ventricular tachycardia. The patient had no recurrence of palpitations after atrial flutter ablation and medical treatment by verapamil for his ventricular tachycardia. This is the first published case combining an atrial flutter and a ventricular tachycardia. PMID:24054442

Monsel, F; El Hraiech, A; Amara, W

2013-11-01

125

Double-outlet left atrium: Ventriculo-atrial malalignment defect  

PubMed Central

A four-month-old female infant presented with heart failure and cyanosis. On echocardiography, there was no outlet to the right atrium except an atrial septal defect and the left atrium drained into the respective ventricles by two atrioventricular valves. The case is reported for its rarity, with a brief literature review. PMID:24688234

Shetkar, Sudhir S; Kothari, Shyam S

2013-01-01

126

Fatal evolution of a huge right atrial free-floating thrombus  

PubMed Central

Key Clinical Message Right atrial thrombus is a rare medical emergency that should be suspected in all cases of pulmonary embolism, and rapid action should be taken to ensure a timely, proper management. PMID:25356214

Bodian, Malick; Ba, Fatimata G; Jobe, Modou; Ndiaye, Mouhamadou B; Kane, Adama; Sarr, Simon A; Mbaye, Alassane; Gaye, Abdou M; Thiam, Ibou; Diao, Maboury; Sarr, Moustapha; Ba, Serigne A

2013-01-01

127

Myxoma Virus Expressing Interleukin15 Fails To Cause Lethal Myxomatosis in European Rabbits  

Microsoft Academic Search

Myxoma virus (MYXV) is a poxvirus pathogenic only for European rabbits, but its permissiveness in human cancer cells gives it potential as an oncolytic virus. A recombinant MYXV expressing both the tdTomato red fluorescent protein and interleukin-15 (IL-15) (vMyx-IL-15-tdTr) was constructed. Cells infected with vMyx- IL-15-tdTr secreted bioactive IL-15 and had in vitro replication kinetics similar to that of wild-type

Jia Liu; Sonia Wennier; Mary Reinhard; Edward Roy; Amy MacNeill; Grant McFadden

2009-01-01

128

Ventricular function after atrial cardioplegia.  

PubMed

Continuous retrograde coronary sinus cardioplegia (CSCP) has previously been carefully evaluated experimentally and shown to be efficacious during ischemia, even in the presence of coronary lesions and in the hypertrophied state. A new technique of retrograde cardioplegia delivery through the right atrium, using right ventricular distension and pressures of 60 mm Hg, has recently been described with excellent clinical results. This study was designed to specifically examine right ventricular function after atrial cardioplegia and acute passive right ventricular distension. CSCP (n = 10) was compared with cardioplegia delivered through the right atrium both continuously (n = 10) and intermittently (n = 8). When ventricular function was examined with the use of the load-independent relationship of stroke work vs end-diastolic length, there was a profound deterioration of right ventricular function in both atrial cardioplegia groups (44% and 37% of control values, respectively) after 1 hr of reperfusion. In contrast, biventricular function was fully preserved in the CSCP group 1 hr after reperfusion. Left ventricular function measured at the end of reperfusion was preserved in all three groups. Right ventricular ATP levels were slightly but significantly depressed in all groups and in the atrial cardioplegia groups, this metabolic change was also seen in the left ventricle. These metabolic and hemodynamic data may reflect the inability of atrial cardioplegia to cool the myocardium below 16 degrees C. Postoperative right ventricular dysfunction may be more common than has been previously thought when atrial cardioplegia is used, particularly in the absence of topical cooling. PMID:3665010

Salter, D R; Goldstein, J P; Abd-Elfattah, A; Murphy, C E; Brunsting, L A; Wechsler, A S

1987-11-01

129

The orosomucoid 1 protein (?1 acid glycoprotein) is overexpressed in odontogenic myxoma  

PubMed Central

Background Odontogenic myxoma (OM) is a benign, but locally invasive, neoplasm occurring in the jaws. However, the molecules implicated in its development are unknown. OM as well as Dental Follicle (DF), an odontogenic tissue surrounding the enamel organ, is derived from ectomesenchymal/mesencyhmal elements. To identify some protein that could participate in the development of this neoplasm, total proteins from OM were separated by two-dimensional electrophoresis and the profiles were compared with those obtained from DF, used as a control. Results We identified eight proteins with differential expression; two of them were downregulated and six upregulated in OM. A spot consistently overexpressed in odontogenic myxoma, with a molecular weight of 44-kDa and a pI of 3.5 was identified as the orosomucoid 1 protein. Western blot experiments confirmed the overexpression of this protein in odontogenic myxoma and immunohistochemical assays showed that this protein was mainly located in the cytoplasm of stellate and spindle-shaped cells of this neoplasm. Conclusion Orosomucoid 1, which belongs to a group of acute-phase proteins, may play a role in the modulation of the immune system and possibly it influences the development of OM. PMID:22888844

2012-01-01

130

Cryoballoon Ablation for Atrial Fibrillation  

PubMed Central

Focal point-by-point radiofrequency catheter ablation has shown considerable success in the treatment of paroxysmal atrial fibrillation. However, it is not without limitations. Recent clinical and preclinical studies have demonstrated that cryothermal ablation using a balloon catheter (Artic Front©, Medtronic CryoCath LP) provides an effective alternative strategy to treating atrial fibrillation. The objective of this article is to review efficacy and safety data surrounding cryoballoon ablation for paroxysmal and persistent atrial fibrillation. In addition, a practical step-by-step approach to cryoballoon ablation is presented, while highlighting relevant literature regarding: 1) the rationale for adjunctive imaging, 2) selection of an appropriate cryoballoon size, 3) predictors of efficacy, 4) advanced trouble-shooting techniques, and 5) strategies to reduce procedural complications, such as phrenic nerve palsy. PMID:22557842

Andrade, Jason G; Dubuc, Marc; Guerra, Peter G; Macle, Laurent; Rivard, Lena; Roy, Denis; Talajic, Mario; Thibault, Bernard; Khairy, Paul

2012-01-01

131

[Cross-stimulation in endocardiac AV sequential demand DVI pacemaker associated with great dilatation of the right atrial appendage].  

PubMed

We report on a case of ventricular stimulation by an atrial electrode in endocardiac DVI sequential pacemaker implanted in a patient with cardiomegaly and great atrial appendage. The appropriately placement of the electrode was confirmed by open-heart surgery in the valve replacement. This rare malfunction could be exceptionally studied anatomically. PMID:2146722

Candel Delgado, J M; Guerrero, J A; Marcote, F; Calleja Hernández, M

1990-01-01

132

[Atrial fibrillation. New views on an old disease].  

PubMed

Atrial fibrillation (Afib) is clinically the most common arrhythmia. Its main complications are recurrent embolic events and a variable deterioration of functional class. Atrial fibrillation induces changes in cellular ionic channels that self-perpetuate the arrhythmia. The pharmacologic treatment of Afib is directed toward correction of those changes and return to sinus rhythm. It is also intended to maintain adequate heart rates and prevent embolic events through anticoagulation or platelet antiagregation. There are presently several class IC or class III antiarrhythmics available for attempting a return to sinus rhythm. The success rates are irregular, the best achieved with flecainide or propafenone among patients without structural heart disease. Amiodarone is the best choice when there is such a problem. The combination possibilities are huge, so that each case must be individualized. The new class III antiarrhythmics are very effective, but have a relatively high rate of side effects including torsade de pointes. Anticoagulation should be the preferred treatment among the majority of patients, but each case should be individually evaluated. New therapies such as focal or linear catheter ablation techniques, atrial or biatrial programmed stimulation, and atrial cardioverter-defibrillator need longer follow-up and experience to be objectively evaluated, although there are reasons to be optimistic in the future, even if patients need antiarrhythmic support at present. Surgery has high morbi-mortality rates, so it is not the preferred approach. PMID:11692812

Asensio-Lafuente, E; Alvarez-Mosquera, J B; Lozano-Díaz, J E; Farías-Vega, A; Narváez-David, R; Dorantes-García, J; Orea-Tejeda, A; Rebollar-González, V; Portos-Silva, J M; Oseguera-Moguel, J

2001-01-01

133

[Natural history and outcomes of atrial fibrillation].  

PubMed

Atrial fibrillation occurs most of the time without any symptom. The first symptomatic episode may follow many silent episodes. The natural history of atrial fibrillation is relatively chaotic from paroxysmal to persistent and permanent atrial fibrillation. The consequence is that antithrombotic treatment depends on global thromboembolic risk and not on patient's perception of arrhythmia or sinus rhythm presentation. Unfortunately, the first appearance may be the most feared complication: stroke. Stroke due to atrial fibrillation are frequent, severe, with high mortality rate during hospitalization and during the following year. The severity of stroke during atrial fibrillation could explain a certain degree of cognitive decline. Heart failure is also a frequent atrial fibrillation complication due to sharing of common causes. Through those two complications, atrial fibrillation raises mortality rate. Less importantly, though leading to frequent hospitalizations, quality of life impairment is relatively frequent. PMID:23513777

Brigadeau, François; Lacroix, Dominique

2013-02-01

134

Atrial fibrillation in pigs induces left atrial endocardial transcriptional remodelling.  

PubMed

The leading cause of cardioembolic stroke is atrial fibrillation (AF), which predisposes to atrial thrombus formation. Although rheological alterations promote a hypercoagulable environment, as yet undefined factors contribute to thrombogenesis. The role of the endocardium has barely been explored. To approach this topic, rapid atrial pacing (RAP) was applied in four pigs to mimic AF. Left and right endocardial cells were isolated separately and their gene expression pattern was compared with that of four control pigs. The AF-characteristic rhythm disorders and endothelial nitric oxide synthase down-regulation were successfully reproduced, and validated RAP to mimic AF. A change was observed in the transcriptomic endocardial profile after RAP: the expression of 364 genes was significantly altered (p<0.01), 29 of them having passed the B>0 criteria. The left atrial endocardium [325 genes (7 genes, B>0)] was largely responsible for such alterations. Blood coagulation, blood vessel morphogenesis and inflammatory response are among the most significant altered functions, and help to explain the activation of coagulation observed after RAP: D-dimer, 0.49 (1.63) vs. 0.23 (0.24) mg/l [median (interquartile range)] in controls, p=0.02. Furthermore, three genes directly related to thrombotic processes were differentially expressed after RAP: FGL2 [fold change (FC)=0.85; p=0.007], APLP2 (FC=-0.47; p=0.005) and ADAMTS-18 (FC=-0.69; p=0.004). We demonstrate for the first time that AF induces a global expression change in the left atrial endocardium associated with an activation of blood coagulation. The nature of some of the altered functions and genes provides clues to identify new therapeutic targets. PMID:22836863

Cerveró, Jorge; Segura, Víctor; Macías, Alfonso; Gavira, Juan José; Montes, Ramón; Hermida, José

2012-10-01

135

Scarcity of atrial fibrillation in a traditional African population: a community-based study  

PubMed Central

Background In western societies, atrial fibrillation is an increasingly common finding among the elderly. Established risk factors of atrial fibrillation include obesity, diabetes, hypertension, and cardiovascular disease. Atrial fibrillation has almost exclusively been studied in western populations where these risk factors are widely present. Therefore, we studied the epidemiology of atrial fibrillation in a traditional African community. Methods In rural Ghana, among 924 individuals aged 50 years and older, we recorded electrocardiograms to detect atrial fibrillation. As established risk factors, we documented waist circumference, body mass index (BMI), capillary glucose level, blood pressure, and electrocardiographic myocardial infarction. In addition, we determined circulating levels of interleukin-6 (IL6), a proinflammatory cytokine, and C-reactive protein (CRP), a marker of systemic inflammation. We compared the risk factors with reference data from the USA. Results Atrial fibrillation was detected in only three cases, equalling 0.3% (95% CI 0.1–1.0%). Waist circumference, BMI, and capillary glucose levels were very low. Hypertension and myocardial infarction were uncommon. Circulating levels of IL6 were similar, but those of CRP were lower compared with the USA. Conclusion Atrial fibrillation is very scarce in this traditional African community. Its low prevalence compared with western societies can be explained by the rareness of its established risk factors, which are closely related to lifestyle, and by possible unmeasured differences in other risk factors or genetic factors. PMID:25037974

2014-01-01

136

Surgical Therapy of Atrial Fibrillation  

PubMed Central

Atrial fibrillation (AF) can be found in an increasing number of cardiac surgical patients due to a higher patient's age and comorbidities. Atrial fibrillation is known, however, to be a risk factor for a greater mortality, and one aim of intraoperative AF treatment is to approximate early and long-term survival of AF patients to survival of patients with preoperative sinus rhythm. Today, surgeons are more and more able to perform less complex, that is, minimally invasive cardiac surgical procedures. The evolution of alternative ablation technologies using different energy sources has revolutionized the surgical therapy of atrial fibrillation and allows adding the ablation therapy without adding significant risk. Thus, the surgical treatment of atrial fibrillation in combination with the cardiac surgery procedure allows to improve the postoperative long-term survival and to reduce permanent anticoagulation in these patients. This paper focuses on the variety of incisions, lesion sets, and surgical techniques, as well as energy modalities and results of AF ablation and also summarizes future trends and current devices in use. PMID:22536529

Haensig, Martin; Rastan, Ardawan Julian; Holzhey, David Michael; Mohr, Friedrich-Wilhelm; Garbade, Jens

2012-01-01

137

Malignant pleural mesothelioma forming a huge mediastinal mass and causing atrial fibrillation.  

PubMed

A patient with malignant pleural mesothelioma was admitted with atrial fibrillation. Chest computed tomography showed a huge mediastinal tumor adjacent to the heart. Autopsy revealed a 12×9.5-cm mediastinal mass involving the right lung, which distorted and stretched the myocardial sleeve surrounding the right inferior pulmonary vein. This case demonstrates that advanced malignant pleural mesothelioma can cause atrial fibrillation, possibly by stimulating myocardium around a pulmonary vein. PMID:23455791

Kuwabara, Hiroko; Tsuji, Hiroshi; Inada, Yuki; Shibayama, Yuro

2012-01-01

138

Total endoscopic robotic atrial septal defect repair in a patient with dextrocardia and situs inversus totalis.  

PubMed

Situs inversus with mirror-image of the heart is a rare condition. The present report describes a case of a patient with dextrocardia with situs inversus who had atrial septal defect with multiple holes in the fossa ovalis. The patient underwent total endoscopic atrial septal defect repair using the da Vinci surgical system. This procedure was achieved safely with good clinical and excellent cosmetic results. PMID:22200951

Iino, Kenji; Watanabe, Go; Ishikawa, Norihiko; Tomita, Shigeyuki

2012-04-01

139

Serum cholesterol levels and postoperative atrial fibrillation  

PubMed Central

Background Post-operative atrial fibrillation is an important complication after coronary bypass surgery. As inflammation and oxidative stress were makedly encountered in the etiology, high cholesterol was also defined to provoke atrial fibrillation. In this present study, the relationship between postoperative atrial fibrillation and preoperative serum lipid levels were evaluated. Methods A total of 100 patients, who were operated at the department of Cardiovascular Surgery of our hospital were included to the study analysis. Patients, who had preoperative atrial fibrillation, thyroid dysfunction, or left atrial dilatation (above 4.5 cm) were excluded from the study. Patients were divided into two groups with postoperative atrial fibrillation development (Group I n?=?36), and without atrial fibrillation development (Group II n?=?64). Preoperative routine blood analyses, ECG, echocardiography were evaluated. Patients were followed for atrial fibrillation development for one month starting from the intensive care unit at the postoperative period. Serum lipid profiles and thyroid function were measured. For homogenization of inflammatory factors and oxidative stress, treatments other than statins, betablockers, calcium channel blockers, aspirin, ACE inhibitors, and ARB were stopped for 10 days. Atrial fibrillation for at least ?5 minutes in the intensive care unit was accepted as postoperative atrial fibrillation. Results Demographic data were similiar between groups (p?>?0.05). There was no difference in TC levels between groups, whereas LDL-C levels were statistically lower in patients developing post-operative atrial fibrillation (106.67?±?28.36 vs 118.75?±?27.75; P?atrial fibrillation development. High levels of LDL-C in the preoperative period could be predictor of atrial fibrillation development in the post operative period. PMID:24712763

2014-01-01

140

Unexpected low prevalence of atrial fibrillation in cryptogenic ischemic stroke: a prospective study  

PubMed Central

Purpose Ischemic stroke is a frequent pathology with high rate of recurrence and significant morbidity and mortality. There are several causes of stroke, affecting prognosis, outcomes, and management, but in many cases, the etiology remains undetermined. We hypothesized that atrial fibrillation was involved in this pathology but underdiagnosed by standard methods. The aim of the study was to determine the incidence of atrial fibrillation in cryptogenic ischemic stroke by using continuous monitoring of the heart rate over several months. The secondary objective was to test the value of atrial vulnerability assessment in predicting spontaneous atrial fibrillation. Methods and results We prospectively enrolled 24 patients under 75 years of age, 15 men and 9 women of mean age 49 years, who within the last 4 months had experienced cryptogenic stroke diagnosed by clinical presentation and brain imaging and presumed to be of cardioembolic mechanism. All causes of stroke were excluded by normal 12-lead ECG, 24-h Holter monitoring, echocardiography, cervical Doppler, hematological, and inflammatory tests. All patients underwent electrophysiological study. Of the patients, 37.5% had latent atrial vulnerability, and 33.3% had inducible sustained arrhythmia. Patients were secondarily implanted with an implantable loop recorder to look for spontaneous atrial fibrillation over a mean follow-up interval of 14.5 months. No sustained arrhythmia was found. Only one patient had non-significant episodes of atrial fibrillation. Conclusion In this study, symptomatic atrial fibrillation or AF with fast ventricular rate has not been demonstrated by the implantable loop recorder in patients under 75 years with unexplained cerebral ischemia. The use of this device should not be generalized in the systematic evaluation of these patients. In addition, this study attests that the assessment of atrial vulnerability is poor at predicting spontaneous arrhythmia in such patients. PMID:20454840

Dion, Fanny; Saudeau, Denis; Bonnaud, Isabelle; Friocourt, Patrick; Bonneau, Armel; Poret, Philippe; Giraudeau, Bruno; Regina, Sandra; Fauchier, Laurent

2010-01-01

141

Treatment Guidelines of Atrial Fibrillation (AFib or AF)  

MedlinePLUS

... Tools & Resources Stroke More Treatment Guidelines of Atrial Fibrillation (AFib or AF) Updated:Apr 25,2014 What ... was last reviewed on 04/16/14. Atrial Fibrillation • Introduction • What is Atrial Fibrillation? • Why AFib Matters • ...

142

Left atrial appendage devices for stroke prevention in atrial fibrillation.  

PubMed

Atrial fibrillation (AF) is the most commonly encountered clinical arrhythmia, and stroke prevention remains an integral part of management of AF. Long-term therapy with oral anticoagulants, though effective, has many limitations, and these limitations have encouraged the search for device-based alternatives. In patients with non-valvular AF, approximately 90% of thrombi are thought to arise from the left atrial appendage (LAA). The LAA can be obliterated surgically or percutaneously, and this should reduce the incidence of systemic thromboembolic events in AF, ideally without the need for further anticoagulation. We explore the currently available LAA occlusion devices and the evidence behind these devices. Although additional evidence from randomized trials is required to fully characterize the safety and efficacy of all of these devices, LAA occlusion has the potential to offer an attractive alternative for those at high stroke risk but are under-protected because of contraindications to anticoagulant therapy. PMID:24789763

Hussain, Sarah K; Malhotra, Rohit; DiMarco, John P

2014-06-01

143

Effect of the atrial blanking time on the detection of atrial fibrillation in dual chamber pacing.  

PubMed

Patients with paroxysmal atrial fibrillation (PAF) and dual chamber pacemakers frequently have short postventricular atrial blanking times and sensitive atrial sensing thresholds used to provide reliable detection and mode switching during AF. However, short atrial blanking times increase the risk of atrial sensing of ventricular far-field signals. We evaluated if the length of the atrial blanking time influences the detection of AF. The study included ten patients with a VDDR (n = 7) or DDDR system (n = 3), who presented with AF at 18 follow-up visits. Bipolar atrial sensing was programmed to the most sensitive value. Atrial blanking times were programmed from 100 to 200 ms in 25-ms steps in each patient. Using marker annotation, the following parameters were measured at ten consecutive ventricular beats: VAF = the interval between ventricular stimulus and first sensing of AF; AFS = the number of atrial-sensed events between two ventricular events; and XAF = the interpolated number of atrial-sensed events during atrial blanking time. The intervals between ventricular events and between atrial-sensed event markers showed no significant differences for the five blanking times tested. There was no significant influence of the atrial blanking time onto the measured parameters (least square means +/- standard error) with VAF between 281 +/- 12 and 300 +/- 12 ms (P = NS), AFs between 3.4 +/- 0.2 and 3.6 +/- 0.2 beats (P = NS) and XAF between 1.84 +/- 0.12 and 2.03 +/- 0.12 beats (P = NS). At ventricular rates < 100/min, the atrial sensing of AF in dual chamber pacemakers demonstrated no evidence for deterioration by an increase of the atrial blanking time from 100 to 200 ms. Thus, the risk of ventricular far-field sensing may be reduced without compromising atrial sensing. PMID:11341088

Nowak, B; Kracker, S; Rippin, G; Horstick, G; Vincent, A; Geil, S; Himmrich, E; Meyer, J

2001-04-01

144

Atrial Na,K-ATPase Increase and Potassium Dysregulation Accentuate the Risk of Postoperative Atrial Fibrillation  

Microsoft Academic Search

Background: Postoperative atrial fibrillation is a common complication to cardiac surgery. Na,K-ATPase is of major importance for the resting membrane potential and action potential. The purpose of the present study was to evaluate the importance of Na,K-ATPase concentrations in human atrial biopsies and plasma potassium concentrations for the development of atrial fibrillation. Methods: Atrial myocardial biopsies were obtained from 67

Cao Thach Tran; Thomas Andersen Schmidt; John Brochorst Christensen; Keld Kjeldsen

2009-01-01

145

Aortic Perforation by Active-Fixation Atrial Pacing Lead: An Unusual but Serious Complication  

PubMed Central

Perforation of a cardiac chamber is an infrequent but serious sequela of pacemaker lead implantation. An even rarer event is the perforation of the aorta by a protruding right atrial wire. We present here the first case in the medical literature of aortic perforation as a sequela to the implantation of a cardiac resynchronization therapy defibrillator. The patient was a 54-year-old man with idiopathic dilated cardiomyopathy who underwent the implantation of a defibrillator, with no apparent sequelae. Six hours after the procedure, he experienced cardiac tamponade and required urgent open-chest surgery. The pericardial effusion was found to be caused by mechanical friction of a protruding right atrial wire on the aortic root. The aortic root and the atrial wall were both repaired with Prolene suture, which achieved complete control of the bleeding. There was no need to reposition the atrial wire. The patient had a good postoperative recovery. PMID:24955055

Nunez, Elaine; Osorio, Karina; Dallaglio, Paolo; Anguera, Ignasi; Toscano, Jacobo; Sabate, Xavier; Cequier, Angel

2014-01-01

146

Discharge of type B atrial receptors during changes in vascular volume and depression of atrial contractility*  

PubMed Central

1. Single unit recordings from type B atrial receptors were obtained from slips of the left cervical vagus nerve during acute increases and decreases in atrial pressure produced by infusion of isotonic saline and withdrawal of blood. 2. Atrial receptor discharge reached a peak frequency at the peak of the `v' wave of the atrial pulse, a time when the rate of change of atrial pressure was zero. 3. The receptor discharge exhibited hysteresis when increases in atrial pressure were compared to decreases in atrial pressure during circulatory volume expansion and haemorrhage, respectively. This hysteresis was not due to a change in atrial compliance. 4. The hysteresis was still observed when the pulse pressure of the `v' wave was plotted against receptor discharge. 5. Type B atrial receptors did not show adaptation after 15 min of a sustained increase in left atrial pressure. 6. Acute depression of atrial contractility with propranolol increased resting fibre discharge as a result of the associated increase in atrial pressure. ImagesFig. 1Fig. 3Fig. 12 PMID:4412838

Gilmore, Joseph P.; Zucker, Irving H.

1974-01-01

147

Atrial Fibrillation - Multiple Languages: MedlinePlus  

MedlinePLUS

... Bosanski) Chinese - Simplified (????) Chinese - Traditional (????) French (français) Hindi (??????) Japanese (???) Korean (???) Portuguese ( ... PDF Health Information Translations Return to top French (français) Atrial Fibrillation Fibrillation auriculaire - français (French) Bilingual PDF ...

148

Left Atrial Appendage Closure Devices  

PubMed Central

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

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

2014-01-01

149

Oxidative Stress and Atrial Fibrillation  

Microsoft Academic Search

\\u000a The pathological processes involved in initiation and perpetuation of atrial fibrillation (AF) are still unclear. AF is associated\\u000a with systemic and cardiac oxidative stress and inflammation. Many risk factors for AF, such as aging and diabetes, are associated\\u000a with an increased level of reactive oxygen species. In addition, oxidative stress has been shown at both cellular and tissue\\u000a levels to

Ali A. Sovari; Samuel C. Dudley

150

Monitoring anticoagulation in atrial fibrillation  

Microsoft Academic Search

Background: Randomized control trials and observational studies show high-quality warfarin therapy leads to safe and effective stroke\\u000a prophylaxis. In usual community practice, patient, physician and health care system factors are barriers to optimal anticoagulation.\\u000a We examined the predictive relationship between inpatient and outpatient INR values in chronic non-valvular atrial fibrillation\\u000a (AF) patients hospitalized for ischemic stroke (S), bleed (B) and

Chaitanya Sarawate; Mirko V. Sikirica; Vincent J. Willey; Michael F. Bullano; Ole Hauch

2006-01-01

151

Multiple atrial septal defects and patent ductus arteriosus: successful outcome using two Amplatzer septal occluders and Gianturco coils.  

PubMed

We report on a case of successful percutaneous closure of two atrial septal defects and a persistent ductus arteriosus using two Amplatzer septal occluders and a Gianturco coil in a 9-year-old child. PMID:9829882

Pedra, C A; Fontes-Pedra, S R; Esteves, C A; Assef, J; Fontes, V F; Hijazi, Z M

1998-11-01

152

Acute Regional Left Atrial Ischemia Causes Acceleration of Atrial Drivers during Atrial Fibrillation  

PubMed Central

Background The mechanisms by which acute left atrial ischemia (LAI) leads to AF initiation and perpetuation remain unclear. Methods and Results LAI (90-minute ischemia) was obtained in isolated sheep hearts by selectively perfusing microspheres into the left anterior atrial artery. Two CCD cameras and several bipolar electrodes enabled recording from multiple atrial locations: with a dual-camera set-up (Protocol 1, n=10; and 1?, n=4; for bi-atrial or atrio-ventricular camera set-ups respectively), in the presence of propranolol/atropine (1?M) added to the perfusate after LAI (protocol 2, n=3) and after a pre-treatment with glibenclamide 10 ?M (protocol 3, n=4). Spontaneous AF occurred in 41.2% (7/17) of the hearts that were in sinus rhythm before LAI. LAI caused APD shortening in both the ischemic (IZ) and non-ischemic (NIZ) zones by 21±8 and 34±13%, respectively (pacing, 5Hz, p<0.05 compared to baseline). Apparent impulse velocity was significantly reduced in the IZ but not in the NIZ (?65±19% and +9±18%, p=0.001 and n.s, respectively). During LAI-related AF, a significant NIZ maximal dominant frequency (DFmax) increase from 7.4±2.5 to 14.0±5.5 Hz; p<0.05, was observed. Glibenclamide, an IKATP channel blocker, averted LAI-related DFmax increase (NIZ: LAI vs Gli, 14.0±5.5 vs. 5.9±1.3 Hz, p<0.05). Interplay between spontaneous focal discharges and rotors, locating at the IZ-NIZ border zone, maintained LAI-related AF. Conclusions LAI leads to an IKATP conductance-dependent APD shortening and spontaneous AF maintained by both spontaneous focal discharges and reentrant circuits locating at the IZ border zone. PMID:23454487

Yamazaki, Masatoshi; Avula, Uma Mahesh R; Bandaru, Krishna; Atreya, Auras; Boppana, Venkata Subbarao C; Honjo, Haruo; Kodama, Itsuo; Kamiya, Kaichiro; Kalifa, Jerome

2014-01-01

153

Comparative Analysis of the Complete Genome Sequence of the California MSW Strain of Myxoma Virus Reveals Potential Host Adaptations  

PubMed Central

Myxomatosis is a rapidly lethal disease of European rabbits that is caused by myxoma virus (MYXV). The introduction of a South American strain of MYXV into the European rabbit population of Australia is the classic case of host-pathogen coevolution following cross-species transmission. The most virulent strains of MYXV for European rabbits are the Californian viruses, found in the Pacific states of the United States and the Baja Peninsula, Mexico. The natural host of Californian MYXV is the brush rabbit, Sylvilagus bachmani. We determined the complete sequence of the MSW strain of Californian MYXV and performed a comparative analysis with other MYXV genomes. The MSW genome is larger than that of the South American Lausanne (type) strain of MYXV due to an expansion of the terminal inverted repeats (TIRs) of the genome, with duplication of the M156R, M154L, M153R, M152R, and M151R genes and part of the M150R gene from the right-hand (RH) end of the genome at the left-hand (LH) TIR. Despite the extreme virulence of MSW, no novel genes were identified; five genes were disrupted by multiple indels or mutations to the ATG start codon, including two genes, M008.1L/R and M152R, with major virulence functions in European rabbits, and a sixth gene, M000.5L/R, was absent. The loss of these gene functions suggests that S. bachmani is a relatively recent host for MYXV and that duplication of virulence genes in the TIRs, gene loss, or sequence variation in other genes can compensate for the loss of M008.1L/R and M152R in infections of European rabbits. PMID:23986601

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

2013-01-01

154

VDD single pass lead pacing: sustained pacemaker mediated tachycardias unrelated to retrograde atrial activation.  

PubMed

Pacemaker mediated tachycardias (PMTs) are a well known complication of P synchronous pacing. Although the initiating mechanisms are several, all of them are associated with retrograde atrial activation, which is sensed by the atrial sensing channel, resulting in ventricular pacing. In 19 patients suffering from symptomatic AV conduction disturbances and normal sinus node function, a VDD pacing system connected to a single pass ventricular lead with dual chamber electrodes was implanted. The bipolar atrial electrode, floating in the right atrium, was used to detect endocardial atrial electrograms that were differentially processed within the pacemaker for optimal discrimination and filtering of undesirable signals. The widely programmable atrial sensitivity (amplitude and filtering) allowed stable P synchronized ventricular pacing in all patients, but in five of them, sustained PMTs not related to retrograde atrial activation was documented during the follow-up. The common mechanism for the onset and maintenance of these PMTs was traced to the abnormal sensing of the terminal forces of ventricular activation and/or of the T wave. The possibility of interferences between ventricular and atrial electrodes (crosstalk) was also considered. The reduction of atrial channel sensitivity represented in all cases the only effective procedure to prevent this type of PMT. In conclusion, the bet signal to noise ratio is an important endpoint to assure the proper function of a single lead VDD pacing system. Furthermore, using the differential amplifier built within the pacemaker, consideration should be given to the optimal mode of rejection of the terminal forces of the QRS and T wave. PMID:1279569

Sermasi, S; Marconi, M

1992-11-01

155

Atrial Arrhythmia Summit: Post Summit Report  

NASA Technical Reports Server (NTRS)

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.

Barr, Yael

2010-01-01

156

[Who should undergo atrial fibrillation ablation?].  

PubMed

Atrial fibrillation is the most common sustained arrhythmia and its prevalence increases significantly with age. This editorial discusses the review by Laish-Farkash et al. regarding ablation of atrial fibrillation, especially in the elderly, as well as new ablation modalities. PMID:25189029

Michowitz, Yoav; Belhassen, Bernard

2014-07-01

157

Refractory atrial fibrillation effectively treated with ranolazine  

PubMed Central

Atrial fibrillation is the most common sustained cardiac arrhythmia which is often troublesome to manage. Currently, rhythm and rate control medications are the mainstays of therapy. In 2 amiodarone-refractory highly symptomatic patients, an innovative approach using ranolazine, which selectively acts on Na+ channels and delays atrial depolarization, was tried successfully. PMID:24581108

Vaishnav, Aditi; Vaishnav, Avani; Lokhandwala, Yash

2014-01-01

158

[Catheter ablation of paroxysmal atrial fibrillation: state of the art].  

PubMed

Atrial fibrillation is the most common form of arrhythmia worldwide and is associated with potentially severe complications. Apart from antiarrhythmic drug therapy, interventional treatment by catheter ablation has emerged as an effective and safe alternative notably for the paroxysmal form. The pulmonary veins (PV) have been identified as a major source in the setting of paroxysmal atrial fibrillation. Circumferential wide area PV isolation, optimization of procedural techniques and the positioning of an ablation line deep in the left atrium have contributed to the increased success rates; however, the procedure is still associated with potentially severe complications and should therefore be carried out in centers with sufficient case numbers and operators with corresponding training and experience. PMID:25070932

Schäffer, Benjamin; Hoffmann, Boris A; Sultan, Arian; Schreiber, Doreen; Akbulak, Ozge; Moser, Julia; Steven, Daniel; Willems, Stephan

2014-12-01

159

Abrupt formation and spontaneous resolution of a right atrial thrombus detected by intraoperative transesophageal echocardiography during replacement of an abdominal aortic aneurysm.  

PubMed

Intraoperative formation of a thrombus in the right atrium and its management has occasionally been reported. However, spontaneous resolution of right atrial thrombi, without any event, is rare. We report a case of abrupt right atrial thrombus formation and spontaneous resolution, with no events, detected by transesophageal echocardiography during the replacement of an abdominal aortic aneurysm. PMID:20238231

Sung, Tae-Yun; Kim, Seong-Hyop; Kim, Duk-Kyung; Yoon, Tae-Gyoon; Kim, Tae-Yop; Lim, Jeong-Ae; Woo, Nam-Sik

2010-06-01

160

Current Issues in Atrial Fibrillation  

PubMed Central

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It places an enormous burden on the patients, caregivers, and the society at large. While the main themes in the care of an AF patient have not changed over the years and continue to focus on stroke prevention, control of the ventricular, rate and rhythm maintenance, there have been a number of new developments in each of these realms. This paper will discuss the “hot” topics in AF in 2012 including new and upcoming medical and invasive management strategies for this condition. PMID:22778994

Khaykin, Yaariv; Shamiss, Yana

2012-01-01

161

Architecture of atrial musculature in humans.  

PubMed Central

OBJECTIVE--To investigate the gross arrangement of the principal muscular bundles of the two atria, and to suggest how it may contribute to contraction and spread of atrial excitation. DESIGN--A prospective analysis based on anatomical examination of adult human hearts. SETTING--A national heart and lung institute and a tertiary referral centre for cardiac disease. MATERIAL--9 normal postmortem human hearts. METHODS--Dissection of atrial muscles with macrophotography. RESUltS--The atrial walls consist of circumferential and longitudinal muscular bundles, the former being arranged at the base of the atria with the latter predominating in the parietal walls. The muscular bundles in the right atrium are larger than those in the left. The main muscles forming the right atrial wall are the terminal crest and terminal pectinate muscles. The terminal crest, the most obvious muscle, is arranged longitudinally with its pectinate muscles connecting to the musculature of the atrioventricular vestibule. No structure resembling the terminal crest is seen in the left atrium. Instead the left atrial wall is composed of intermingled series of muscles, chief of these being the interatrial band and the septoatrial bundle. The former is arranged circumferentially at the atrial base, while the latter is mainly longitudinal. The wall of the right atrium is not of uniform thickness because of the presence of the terminal crest and its pectinate muscles on its internal surface. By contrast, the left atrial wall is much more uniform and its average thickness is greater than that of the right atrium. The rim of the oval fossa is the most important muscular structure on the septal surface and is formed by the infolded atrial walls. The other principal muscles of the atria attach to it, so that the rim provides mechanical support for overall movement of the atrial walls. Comparison of the gross arrangement of the atrial musculature with earlier echocardiographic measurements showed that this arrangement of the muscle explains movement of the atrioventricular ring and overall atrial contraction, and provides a suitable substrate for preferential conduction. CONCLUSION--The anatomical features of the atrial musculature explain the known facts concerning atrial contraction and preferential conduction. Images PMID:7626357

Wang, K.; Ho, S. Y.; Gibson, D. G.; Anderson, R. H.

1995-01-01

162

Bicuspid pulmonary valve with atrial septal defect leading to pulmonary aneurysm  

Microsoft Academic Search

Pulmonary artery aneurysms are rare. We describe two adult cases with pulmonary artery aneurysm with normal pulmonary pressure associated with bicuspid pulmonary valve and atrial septal defect (ASD). One case presented with moderate pulmonary valve stenosis and was treated with open surgery; the other patient had a small ASD and mild pulmonary valve insufficiency and is still periodically evaluated. Hemodynamic

Motohiko Goda; Werner Budts; Els Troost; Bart Meyns

163

Hemostasis of Left Atrial Appendage Bleed With Lariat Device  

PubMed Central

New devices designed for minimally invasive closure of the left atrial appendage (LAA) may be a viable alternative for patients in whom anticoagulation is considered high risk. The Lariat (Sentreheart, Redwood City, CA), which is currently FDA-approved for percutaneous closure of tissue, requires both trans-septal puncture and epicardial access. However it requires no anticoagulation after the procedure. Here we describe a case of effusion and tamponade during a Lariat procedure with successful completion of the case and resolution of the effusion.

Hussain, Amena; Saric, Muhamed; Bernstein, Scott; Holmes, Douglas; Chinitz, Larry

2014-01-01

164

Recurrent right atrial thrombosis due to behçet disease.  

PubMed

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

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

2014-10-01

165

Genome Comparison of a Nonpathogenic Myxoma Virus Field Strain with Its Ancestor, the Virulent Lausanne Strain ? †  

PubMed Central

One of the best-studied examples of host-virus coevolution is the release of myxoma virus (MV) for biological control of European rabbits in Australia and Europe. To investigate the genetic basis of MV adaptation to its new host, we sequenced the genome of 6918, an attenuated Spanish field strain, and compared it with that of Lausanne, the strain originally released in Europe in 1952. Although isolated 43 years apart, the genomes were highly conserved (99.95% identical). Only 32 of the 159 MV predicted proteins revealed amino acid changes. Four genes (M009L, M036L, M135R, and M148R) in 6918 were disrupted by frameshift mutations. PMID:19091868

Morales, Monica; Ramirez, Miguel A.; Cano, Maria J.; Parraga, Mario; Castilla, Joaquin; Perez-Ordoyo, Luis I.; Torres, Juan M.; Barcena, Juan

2009-01-01

166

Multidetector CT assessment of partial anomalous pulmonary venous return in association with sinus venosus type atrial septal defect.  

PubMed

Sinus venosus defects account for 15% of all atrial septal defects. They are frequently associated with partial anomalous pulmonary venous drainage of the right superior pulmonary vein into the superior vena cava (SVC). These defects require surgical correction and accurate pre-operative imaging assessment is critical. We present a case of sinus venosus atrial septal defect in which multidetector computed tomography (MDCT) angiography identified separate sites of pulmonary venous return. PMID:25392829

Hoey, Edward T D; Lewis, Gareth; Yusuf, Shamil

2014-10-01

167

Multidetector CT assessment of partial anomalous pulmonary venous return in association with sinus venosus type atrial septal defect  

PubMed Central

Sinus venosus defects account for 15% of all atrial septal defects. They are frequently associated with partial anomalous pulmonary venous drainage of the right superior pulmonary vein into the superior vena cava (SVC). These defects require surgical correction and accurate pre-operative imaging assessment is critical. We present a case of sinus venosus atrial septal defect in which multidetector computed tomography (MDCT) angiography identified separate sites of pulmonary venous return. PMID:25392829

Lewis, Gareth; Yusuf, Shamil

2014-01-01

168

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation  

PubMed Central

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting an estimated 6 million people in the United States 1. Since AF affects primarily elderly people, its prevalence increases parallel with age. As such, it is expected that 15.9 million Americans will be affected by the year 2050 2. Ischemic stroke occurs in 5% of non-anticoagulated AF patients each year. Current treatments for AF include rate control, rhythm control and prevention of stroke 3. The American College of Cardiology, American Heart Association, and European Society of Cardiology currently recommended rate control as the first course of therapy for AF 3. Rate control is achieved by administration of pharmacological agents, such as ?-blockers, that lower the heart rate until it reaches a less symptomatic state 3. Rhythm control aims to return the heart to its normal sinus rhythm and is typically achieved through administration of antiarrhythmic drugs such as amiodarone, electrical cardioversion or ablation therapy. Rhythm control methods, however, have not been demonstrated to be superior to rate-control methods 4-6. In fact, certain antiarrhythmic drugs have been shown to be associated with higher hospitalization rates, serious adverse effects 3, or even increases in mortality in patients with structural heart defects 7. Thus, treatment with antiarrhythmics is more often used when rate-control drugs are ineffective or contraindicated. Rate-control and antiarrhythmic agents relieve the symptoms of AF, including palpitations, shortness of breath, and fatigue 8, but don't reliably prevent thromboembolic events 6. Treatment with the anticoagulant drug warfarin significantly reduces the rate of stroke or embolism 9,10. However, because of problems associated with its use, fewer than 50% of patients are treated with it. The therapeutic dose is affected by drug, dietary, and metabolic interactions, and thus requires detailed monitoring. In addition, warfarin has the potential to cause severe, sometimes lethal, bleeding 2. As an alternative, aspirin is commonly prescribed. While aspirin is typically well tolerated, it is far less effective at preventing stroke 10. Other alternatives to warfarin, such as dabigatran 11 or rivaroxaban 12 demonstrate non-inferiority to warfarin with respect to thromboembolic events (in fact, dabigatran given as a high dose of 150 mg twice a day has shown superiority). While these drugs have the advantage of eliminating dietary concerns and eliminating the need for regular blood monitoring, major bleeding and associated complications, while somewhat less so than with warfarin, remain an issue 13-15. Since 90% of AF-associated strokes result from emboli that arise from the left atrial appendage (LAA) 2, one alternative approach to warfarin therapy has been to exclude the LAA using an implanted device to trap blood clots before they exit. Here, we demonstrate a procedure for implanting the WATCHMAN Left Atrial Appendage Closure Device. A transseptal cannula is inserted through the femoral vein, and under fluoroscopic guidance, inter-atrial septum is crossed. Once access to the left atrium has been achieved, a guidewire is placed in the upper pulmonary vein and the WATCHMAN Access Sheath and dilator are advanced over the wire into the left atrium. The guidewire is removed, and the access sheath is carefully advanced into the distal portion of the LAA over a pigtail catheter. The WATCHMAN Delivery System is prepped, inserted into the access sheath, and slowly advanced. The WATCHMAN device is then deployed into the LAA. The device release criteria are confirmed via fluoroscopy and transesophageal echocardiography (TEE) and the device is released. PMID:22395336

Mobius-Winkler, Sven; Sandri, Marcus; Mangner, Norman; Lurz, Phillip; Dahnert, Ingo; Schuler, Gerhard

2012-01-01

169

The diagnostic accuracy of the MyDiagnostick to detect atrial fibrillation in primary care  

PubMed Central

Background Atrial fibrillation is very common in people aged 65 or older. This condition increases the risk of death, congestive heart failure and thromboembolic conditions. Many patients with atrial fibrillation are asymptomatic and a cerebrovascular accident (CVA) is often the first clinical presentation. Guidelines concerning the prevention of CVA recommend monitoring the heart rate in patients aged 65 or older. Recently, the MyDiagnostick (Applied Biomedical Systems BV, Maastricht, The Netherlands) was introduced as a new screening tool which might serve as an alternative for the less accurate pulse palpation. This study was designed to explore the diagnostic accuracy of the MyDiagnostick for the detection of atrial fibrillation. Methods A phase II diagnostic accuracy study in a convenience sample of 191 subjects recruited in primary care. The majority of participants were patients with a known history of atrial fibrillation (n?=?161). Readings of the MyDiagnostick were compared with electrocardiographic recordings. Sensitivity and specificity and their 95% confidence interval were calculated using 2x2 tables. Results A prevalence of 54% for an atrial fibrillation rhythm was found in the study population at the moment of the study. A combination of three measurements with the MyDiagnostick for each patient showed a sensitivity of 94% (95% CI 87 – 98) and a specificity of 93% (95% CI 85 – 97). Conclusion The MyDiagnostick is an easy-to-use device that showed a good diagnostic accuracy with a high sensitivity and specificity for atrial fibrillation in a convenience sample in primary care. Future research is needed to determine the place of the MyDiagnostick in possible screening or case-finding strategies for atrial fibrillation. PMID:24913608

2014-01-01

170

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 : ...

171

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

NASA Astrophysics Data System (ADS)

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 (ff) for patients in sinus rhythm was always lower (around 1 Hz) than that in atrial fibrillation (5 to 8 Hz). Among patients with atrial fibrillation spectral power below ff 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 f1, f2, and other peak frequencies as linear combinations thereof (mf1±nf2), 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). Furthermore, the outcome of cardioversion was different for these two set of patients. In conclusion, Fourier analysis helped to a) differentiate between sinus rhythm and atrial fibrillation, b) understand the characteristics of the wide range of atrial fibrillation patients, and c) provide hints that atrial fibrillation could be a nonlinear process. Nonlinear dynamical tools helped to further characterize and sub-classify atrial fibrillation. These insights into atrial fibrillation could, eventually, lead to improved risk stratification of patients with regard to stroke risk and long term outcome.

Chandra, Shalabh; Grimm, Richard A.; Katz, Richard; Thomas, James D.

1996-06-01

172

[Biology of the substrate of atrial fibrillation].  

PubMed

Atrial fibrillation (AF), the most common sustained cardiac arrhythmia in clinical practice, is often associated with progressive dilatation and remodeling of the atria which constitute the substrate of the arrhythmia. This atrial remodeling is characterized by complex structural and functional alterations of the atrial myocardium: short action potentials, heterogeneous refractory periods, dystrophic myocytes and interstitial fibrosis which act together to favor local conduction bloc, activation of ectopies and the forma-tion of microreentries of the electrical excitation. However, the underlying mechanisms of the AF substrate are not yet fully understood. The possibility of studying human atrial myocytes has led to the identification of ionic currents that contribute to the shortening of the action potential and refractory periods during AF. The down-regulation of the L-type calcium current plays a central role in this electrical remodeling. It results mainly from the dephosphorylation of calcium channels as the consequence of an excessive stimulation of atrial myocytes by neurohormones such as the atrial natriuretic factor. Abnormal trafficking and targeting of ion channels at the plasma membrane has emerged as mechanisms that can contribute to the abnormal electrical properties of the atria during AF. Fibrosis is the other feature of the AF substrate and it is favored by the atrial hemodynamic overload. Local activation of the renin-angiotensin system is involved in the extracellular matrix remodeling of the atrial myocardium. Thrombin that accumulates in dilated and fibrillating atria could be another important mediator of the myocardial structural alterations during AF. This peptide, by binding on its receptor PAR1, can modulate several signaling pathways regulating growth and survival of myocardial cells. Better understanding of pathogenic factors involved in the formation of the AF substrate is crucial for the identification of novel biomarkers and therapeutic targets that could be used to improve the diagnostic and treatment of AF. PMID:22463991

Hatem, Stéphane

2012-01-01

173

Atrial Fibrillation and Delayed Gastric Emptying  

Microsoft Academic Search

BackgroundAtrial fibrillation and delayed gastric emptying (DGE) are common after pancreaticoduodenectomy. Our aim was to investigate a potential relationship between atrial fibrillation and DGE, which we defined as failure to tolerate a regular diet by the 7th postoperative day.MethodsWe performed a retrospective chart review of 249 patients who underwent pancreaticoduodenectomy at our institution between 2000 and 2009. Data was analyzed

Isadora C. Botwinick; R. Joseph Shonkwiler; John Steele; Gary Yu; John A. Chabot; Peter McCulloch

2011-01-01

174

[Radiofrequency transcatheter ablation in atrial tachycardia].  

PubMed

Incessant atrial tachycardia is an infrequent arrhythmia. Specially difficult to treat medically. Radiofrequency catheter ablation has been used successfully to cure a variety of supraventricular tachycardias. The purpose of this work is to report our initial experience in the treatment of atrial tachycardia. Ten patients, mean age 28.7 +/- 15 year with conventional drug-resistant symptomatic atrial tachycardia were treated with selective ablation of the focus using radiofrequency energy. It was found an abnormal automaticity in 10 tachycardias and in only one patient intra-atrial reentrant was supported. Radiofrequency energy was successful in 10 of 11 tachycardias with a mean of 9.3 +/- 6.8 applications using the technique of local atrial electrogram activation time with a mean value of -54 +/- -31 milliseconds at the successful ablation sites. No complications were observed and one patient had an early clinical recurrence. All patients with successful ablation are symptom-free, in sinus rhythm and without antiarrhythmic medications after 1 to 28 months of follow-up. Our initial experience support that radiofrequency catheter ablation is a safe and effective therapeutic option for incessant atrial tachycardia. PMID:10855411

Velázquez Rodríguez, E; Morales Hernández, J A

2000-01-01

175

Fetal heterotaxy with tricuspid atresia, pulmonary atresia, and isomerism of the right atrial appendages at 22 weeks.  

PubMed

We report the accurate prenatal diagnosis at 22 weeks gestation of right atrial isomerism in association with tricuspid atresia. Several distinctive sonographic features of isomerism of the right atrial appendages were present in this fetus: complex cardiac abnormality, ventriculoarterial discordance, juxtaposition of the aorta and the inferior vena cava to the right side, pulmonary atresia, and anomalous pulmonary venous return to the morphological right atrium. Tricuspid atresia, which is an extremely rare lesion within heterotaxy spectrum disorders, was present. Postnatal investigations confirmed all prenatally diagnosed abnormalities, with additional findings of pulmonary atresia with discontinuous pulmonary arteries and bilateral arterial ducts, asplenia, and bilateral eparterial bronchi. To our knowledge, tricuspid atresia in the setting of isomerism of the right atrial appendages has not previously been diagnosed or reported prenatally. Because of the complexity of cardiac lesions that may be present in cases of atrial isomerism, these disorders should be considered even if sonographic findings are uncommon or atypical. PMID:24147244

Solomon, Julia E; Stock, John H; Richardson, Randy R; Silverman, Norman H

2013-10-01

176

Blocked Atrial Bi/Trigeminy In Utero Evolving in Supraventricular Tachycardia after Birth  

PubMed Central

Transient episodes of fetal bradycardia (heart rate less than 110?bpm) are usually benign and typically result from increased vagal stimulation in the fetus. Causes of sustained fetal bradycardia include sinus bradycardia, blocked atrial bigeminy/trigeminy, high-degree atrioventricular block, and long QT syndrome. We present the case of a 34-year-old Caucasian patient referred to our department for “blocked atrial bigeminy with pseudobradycardia” detected elsewhere at 33 weeks of gestation. A fetal echocardiography showed during all the examination a blocked atrial trigeminy with a mean fetal heart rate of 100?bpm. After birth three subsequent ECGs until day 3 showed no evidence of atrial extrasystoles, confirming the well-known frequent regression of this kind of fetal benign arrhythmia, but on day 11 recurrence of supraventricular trigeminy and development of episodes of paroxystic supraventricular tachycardia were observed. On the basis of this observation, we recommend that fetuses with complex atrial ectopic beats should be closely monitored before and after birth for evidence of new arrhythmias. PMID:22844624

Martucci, V.; Cerekja, A.; Caiaro, A.; Bosco, G.; Lucchini, R.; Piacentini, G.; Marino, B.; Ventriglia, Flavia

2012-01-01

177

Robotic atrial septal defect repair and endoscopic treatment of atrial fibrillation  

Microsoft Academic Search

Computer (robotic) enhancement has emerged as a facilitator of minimally invasive cardiac surgery and has been used to perform portions of intracardiac procedures via thoracotomy incisions. This report describes the use of the da Vinci surgical system in two totally endoscopic (“closed chest”) cardiac operations: atrial septal defect closure and pulmonary vein isolation of atrial fibrillation. ASD closure: Fifteen patients

Michael Argenziano; Mathew R. Williams

2003-01-01

178

Radiofrequency ablation of atrial flutter due to administration of class IC antiarrhythmic drugs for atrial fibrillation  

Microsoft Academic Search

In selected patients, atrial fibrillation (AF) converts to atrial flutter (AFl) due to treatment with class IC antiarrhythmic drugs. In this study, we prospectively investigated the effects of AFl ablation and continuation of drug therapy in patients with AF who developed AFl due to long-term administration of class IC antiarrhythmic drugs. The study population consisted of 187 patients from an

Burghard Schumacher; Werner Jung; Thorsten Lewalter; Christian Vahlhaus; Christian Wolpert; Berndt Lüderitz

1999-01-01

179

Randomised trial of two approaches to screening for atrial fibrillation in UK general practice.  

PubMed Central

BACKGROUND: Atrial fibrillation is a common and treatable cause of stroke that often remains unrecognised. Screening has been suggested but there is very little evidence concerning the uptake of screening in the elderly population at risk, nor of the optimal method of screening in a general practice setting AIM: To compare the uptake and effectiveness of two methods of screening for atrial fibrillation in general practice--systematic nurse-led screening and prompted opportunistic case finding. DESIGN OF STUDY: Randomised controlled trial. SETTING: Patients aged 65 to 100 years (n = 3,001) from four general practices within the MRC general practice framework. METHOD: Each of the four study practices were selected from one quartile, after ranking all framework practices according to the small area standardised mortality ratio of the geographical area served. Patients were randomised either to nurse-led screening or to prompted opportunistic casefinding. The proportion of patients assessed and the proportion found to have atrial fibrillation were compared. The sensitivity and specificity of clinical assessment of pulse are also reported. RESULTS: Substantially more patients had their pulse assessed through systematic screening by invitation (1,099/1,499 [73%]) than through opportunistic case finding (439/1,502 [29%], difference = 44%, 95% confidence interval [CI] = 41% to 47%). Atrial fibrillation was detected in 67 (4.5%) and 19 (1.3%) patients respectively (difference = 3.2%, 95% CI= 2.0 to 4.4). Invitation to nurse-led screening achieved significantly higher assessment rates than case finding in all practices; however, the proportion of patients assessed in the case-finding arm varied markedly between practices (range = 8% to 52%). The number needed to screen to identify one additional patient with atrial fibrillation was 31 (95% CI = 23 to 50). The proportion of screened patients with atrial fibrillation receiving anticoagulation treatment was 25%, although in the majority (53/65 [82%]) atrial fibrillation had been previously recorded somewhere on their medical record. If the nurse used any irregularity of the pulse as the screening criterion, the sensitivity of screening was 91% and the specificity was 74%; sensitivity fell to 54% but specificity increased to 98% if the criterion used was continuous irregularity. CONCLUSIONS: Nurse-led screening for atrial fibrillation in UK general practice is both feasible and effective and will identify a substantial number of patients who could benefit from antithrombotic therapy. Although the majority of patients detected at first screening could be identified by careful scrutiny of medical records, review of record summaries was insufficient in the practices involved in this study and screening may be a more cost-effective option. PMID:12014534

Morgan, Stephen; Mant, David

2002-01-01

180

Massive left atrial sarcoma presenting with severe congestive heart failure.  

PubMed

Primary intimal sarcomas of the left atrium are extremely rare and highly aggressive tumours. To our knowledge, only 4 cases have been reported to date. We report on a 42-year-old man who presented with signs of congestive heart failure and was found to have an enormous left atrial bilobed tumour with obstruction of the mitral valve. The patient underwent a surgical excision of the sarcoma. The tumour recurred 8.5 months later and the patient required right pneumonectomy. PMID:25108492

Kuurstra, Emily J; Mullen, John C; MacArthur, Roderick G

2014-10-01

181

Amplatzer Closure of Atrial Septal Defect and da Vinci Robot-Assisted Repair of Vascular Ring  

Microsoft Academic Search

Technology for minimally invasive approaches to congenital heart disease is a rapidly evolving field. This case report reviews a novel approach to combining two of the newer technologies available to treat a pediatric patient with an atrial septal defect (ASD) and a vascular ring. This report is the first to describe the use of the da Vinci surgical system to

R. G. Ohye; E. J. Devaney; J. Graziano; A. Ludomirsky

2004-01-01

182

Right atrial bypass grafting for central venous obstruction associated with dialysis access: Another treatment option  

Microsoft Academic Search

Purpose: Central venous obstruction is a common problem in patients with chronic renal failure who undergo maintenance hemodialysis. We studied the use of right atrial bypass grafting in nine cases of central venous obstruction associated with upper extremity venous hypertension. To better understand the options for managing this condition, we discuss the roles of surgery and percutaneous transluminal angioplasty with

Rafik A. El-Sabrout; J. Michael Duncan

1999-01-01

183

Outcomes After Ablation for Typical Atrial Flutter (from the Loire Valley Atrial Fibrillation Project).  

PubMed

Similar predisposing factors are found in most types of atrial arrhythmias. The incidence of atrial fibrillation (AF) among patients with atrial flutter is high, suggesting similar outcomes in patients with those arrhythmias. We sought to investigate the long-term outcomes and prognostic factors of patients with AF and/or atrial flutter with contemporary management using radiofrequency ablation. In an academic institution, we retrospectively examined the clinical course of 8,962 consecutive patients admitted to our department with a diagnosis of AF and/or atrial flutter. After a median follow-up of 934 ± 1,134 days, 1,155 deaths and 715 stroke and/thromboembolic (TE) events were recorded. Patients with atrial flutter undergoing cavotricuspid isthmus ablation (n = 875, 37% with a history of AF) had a better survival rate than other patients (hazard ratio [HR] 0.35, 95% confidence interval [CI] 0.25 to 0.49, p <0.0001). Using Cox proportional hazards model and propensity score model, after adjustment for main other confounders, ablation for atrial flutter was significantly associated with a lower risk of all-cause mortality (HR 0.55, 95% CI 0.36 to 0.84, p = 0.006) and stroke and/or TE events (HR 0.53, 95% CI 0.30 to 0.92, p = 0.02). After ablation, there was no significant difference in the risk of TE between patients with a history of AF and those with atrial flutter alone (HR 0.83, 95% CI 0.41 to 1.67, p = 0.59). In conclusion, in patients with atrial tachyarrhythmias, those with atrial flutter with contemporary management who undergo cavotricuspid isthmus radiofrequency ablation independently have a lower risk of stroke and/or TE events and death of any cause, whether a history of AF is present or not. PMID:25200340

Clementy, Nicolas; Desprets, Laurent; Pierre, Bertrand; Lallemand, Bénédicte; Simeon, Edouard; Brunet-Bernard, Anne; Babuty, Dominique; Fauchier, Laurent

2014-11-01

184

Novel insights into the cellular basis of atrial fibrillation  

PubMed Central

Atrial fibrillation is the most common clinical cardiac arrhythmia. It is often initiated by ectopic beats arising from the pulmonary veins and atria. While pulmonary vein myocytes most likely contribute to atrial ectopic beats initiating atrial fibrillation, emerging evidence suggests the existence of other cell populations that may also contribute to atrial arrhythmias. In addition to sinus node-like and intestinal Cajal-like cells, we recently characterized a novel, melanocyte-like cell population in murine and human hearts that may contribute to atrial arrhythmogenic triggers in mice. Murine cardiac melanocyte-like cells are electrically excitable, and express adrenergic and muscarinic receptors. Adult mice lacking the gene encoding dopachrome tautomerase (Dct) are susceptible to atrial arrhythmias, and Dct is expressed by both murine and human cardiac melanocytes. While Dct-expressing cells are present in human hearts in regions from which atrial arrhythmias often arise, the contribution of these cells to clinical atrial arrhythmias remains to be determined. PMID:20602552

Patel, Vickas V

2010-01-01

185

Atrial trigeminy induced by a normally functioning DVI pacemaker.  

PubMed

Atrial trigeminy was seen in a patient with a normally functioning DVI pacemaker (Byrel-5992). Atrial competition resulted from coincidence of sinus and atrial escape rates together with late ventricular sensing. This resulted in atrial output stimuli occurring within the QRS complex. Alternate impulses occurred late enough to conduct to the ventricle after recovery of the AV node. Reprogramming the pacemaker to either a faster DVI rate or to VVI abolished the arrhythmia. PMID:6200856

Millar, R N; Obel, I W

1984-03-01

186

Electroanatomic Mapping-Guided Radiofrequency Ablation of Adenosine Sensitive Incessant Focal Atrial Tachycardia Originating from the Non-Coronary Aortic Cusp in a Child  

PubMed Central

Incessant focal atrial tachycardia may be encountered in the pediatric age group although it is rarely seen. Ablation using radiofrequency or cryothermal energy is the preferred method for drug-resistant cases. Recently, 3D electroanatomic mapping systems have been increasingly used for mapping and ablation. In this report, we presented, for the first time, a pediatric case with incessant focal atrial tachycardia originating from the non-coronary aortic sinus and ablated using 3D electroanatomic mapping system.

Koca, Serhat; Topaloglu, Serkan; Cay, Serkan; Pac, Aysenur

2014-01-01

187

Improved suppression of recurrent atrial fibrillation with dual-site right atrial pacing and antiarrhythmic drug therapy  

Microsoft Academic Search

ObjectivesWe compared the safety, tolerance and effectiveness of overdrive high right atrial (RA), dual-site RA and support (DDI or VDI) pacing (SP) in patients with symptomatic atrial fibrillation (AF) and bradycardias.

Sanjeev Saksena; Atul Prakash; Paul Ziegler; John D Hummel; Paul Friedman; Vance J Plumb; D. George Wyse; Eric Johnson; Stephanie Fitts; Rahul Mehra

2002-01-01

188

Left atrial appendage occlusion with the Watchman device in a patient with paroxysmal atrial fibrillation and intolerance of all forms of anticoagulation due to hereditary haemorrhagic telangiectasia.  

PubMed

An elderly woman presented to our attention because of paroxysmal atrial fibrillation and cerebrovascular events requiring systemic anticoagulation and a concomitant, serious bleeding diathesis (the Osler-Weber-Rendu syndrome, or hereditary haemorrhagic telangiectasia). Her risk of suffering a major stroke was significant given a CHA(2)DS(2)VASc score of 6. However, she was unable to tolerate any form of anticoagulation because of torrential epistaxis and previous gastrointestinal haemorrhage on antiplatelet therapy. We proceeded with percutaneous occlusion of the left atrial appendage with a Watchman device. Ten months post-procedure she is well, without recurrence of neurological symptoms, and off all forms of anticoagulation. The current internationally accepted practice post-deployment of the Watchman device mandates warfarin transition for 6 months to allow for endothelialisation of the device. However, there is no evidence in the literature to support left atrial appendage occlusion without any peri-procedural antiplatelet and anticoagulation therapy and therefore our case represents novel and important anecdotal evidence that secondary stroke prevention with left atrial appendage occlusion may be effective and safe even in patients who cannot tolerate any form of anticoagulation at all. PMID:24621286

Spina, R; Gunalingam, B

2014-03-01

189

Functional modeling in zebrafish demonstrates that the atrial-fibrillation-associated gene GREM2 regulates cardiac laterality, cardiomyocyte differentiation and atrial rhythm  

PubMed Central

SUMMARY Atrial fibrillation (AF) is the most common cardiac arrhythmia and carries a significant risk of stroke and heart failure. The molecular etiologies of AF are poorly understood, leaving patients with limited therapeutic options. AF has been recognized as an inherited disease in almost 30% of patient cases. However, few genetic loci have been identified and the mechanisms linking genetic variants to AF susceptibility remain unclear. By sequencing 193 probands with lone AF, we identified a Q76E variant within the coding sequence of the bone morphogenetic protein (BMP) antagonist gremlin-2 (GREM2) that increases its inhibitory activity. Functional modeling in zebrafish revealed that, through regulation of BMP signaling, GREM2 is required for cardiac laterality and atrial differentiation during embryonic development. GREM2 overactivity results in slower cardiac contraction rates in zebrafish, and induction of previously identified AF candidate genes encoding connexin-40, sarcolipin and atrial natriuretic peptide in differentiated mouse embryonic stem cells. By live heart imaging in zebrafish overexpressing wild-type or variant GREM2, we found abnormal contraction velocity specifically in atrial cardiomyocytes. These results implicate, for the first time, regulators of BMP signaling in human AF, providing mechanistic insights into the pathogenesis of the disease and identifying potential new therapeutic targets. PMID:23223679

Muller, Iris I.; Melville, David B.; Tanwar, Vineeta; Rybski, Witold M.; Mukherjee, Amrita; Shoemaker, M. Benjamin; Wang, Wan-Der; Schoenhard, John A.; Roden, Dan M.; Darbar, Dawood; Knapik, Ela W.; Hatzopoulos, Antonis K.

2013-01-01

190

ECG-based feature tracking in atrial tachyarrhythmias  

Microsoft Academic Search

A new method for extraction of general features in ECGs with atrial tachyarrhythmias is presented. The method is based on our recent method for atrial signal characterization which sequentially decomposes a time-frequency distribution into a set of parameters. In addition to rate and amplitude, the method tracks information on regularity, waveform, and structure of the atrial signal. The proposed method

M. Stridh; L. Sornmo; S. B. Olsson

2003-01-01

191

Catheter closure of secundum atrial septal defects.  

PubMed Central

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

O'Laughlin, M P

1997-01-01

192

New antithrombotics for atrial fibrillation.  

PubMed

Atrial fibrillation (AF) is the most commonly occurring arrhythmia, and is a condition of both significant clinical and economic importance. An antithrombotic agent is considered mandatory as part of the management in most patients with AF. It has been conclusively demonstrated that long-term anticoagulation therapy can significantly reduce the risk of stroke in patients with nonvalvular AF. While vitamin K antagonists (VKAs) such as warfarin are highly effective, they possess numerous limitations that curtail their use, or make their use challenging for clinicians and patients. A new generation of anticoagulants are being investigated in phase III clinical trials in patients with AF. One or more of these agents have the potential to either replace or act as alternatives to VKA therapy in AF. This group includes the direct thrombin inhibitor, dabigatran, the direct factor Xa inhibitors rivaroxaban, apixaban, and edoxaban, and finally, the vitamin K analogue, tecarfarin. Additional agents are being developed in phase I or II clinical trials. The direct thrombin and factor Xa inhibitors are generally small, synthetic molecules with predictable pharmacokinetics, a predictable pharmacodynamic effect, few drug interactions and do not require routine therapeutic drug monitoring. These new anticoagulants may well represent a new era in anticoagulation. However, they do possess their own limitations and will present new challenges for clinicians. PMID:20645985

Bereznicki, Luke R E; Peterson, Gregory M

2010-10-01

193

Determination of fibrillatory frequency for assessment of the atrial electrophysiologic state in human atrial fibrillation –  

Microsoft Academic Search

\\u000a Zusammenfassung   Vorhofflimmern (VHF) ist das elektrographische Bild mehrerer simultaner Kreiserregungen in den Vorhöfen. Weder der natürliche\\u000a Verlauf von VHF noch die Effektivität therapeutischer Maßnahmen sind mit klinischen oder echokardiographischen Variablen vorhersagbar.¶???Im\\u000a Gegensatz dazu konnten verschiedene Untersuchungen einen Zusammenhang zwischen invasiv ermittelter atrialer Flimmerfrequenz\\u000a (atriale Zykluslänge) und VHF-Komplexität, klinischem Verhalten sowie Kardioversionserfolg feststellen. Die atriale Flimmerfrequenz\\u000a kann ebenfalls aus dem Oberflächen-EKG

A. Bollmann; H. U. Klein; H.-D. Esperer

2000-01-01

194

Atrial natriuretic factor is a circulating hormone.  

PubMed

The radioimmunoassay of atrial natriuretic factor (ANF) has been applied for determination of immunoreactive ANF (IR-ANF) in rat plasma. Immunoreactive ANF has been extracted from rat plasma by immunoaffinity column on Sepharose-4B anti-ANF or by Vycor glass. The mean concentrations of IR-ANF in ether anesthetized rats were found to be 1.61 +/- 0.14 ng/ml in female and 1.25 +/- 0.21 ng/ml in male rats when extracted on Sepharose-4B anti-ANF, and 1.21 +/- 0.10 ng/ml in females and 1.02 +/- 0.11 ng/ml in males when extracted by Vycor glass. A close linear correlation has been observed between the plasma IR-ANF concentrations in aorta and jugular vein. The described results indicate that atrial cardiocytes secrete atrial natriuretic factor into plasma. The heart is, therefore, an endocrine organ. PMID:6542365

Gutkowska, J; Horký, K; Thibault, G; Januszewicz, P; Cantin, M; Genest, J

1984-11-30

195

Nitric Oxide Synthases and Atrial Fibrillation  

PubMed Central

Oxidative stress has been implicated in the pathogenesis of atrial fibrillation. There are multiple systems in the myocardium which contribute to redox homeostasis, and loss of homeostasis can result in oxidative stress. Potential sources of oxidants include nitric oxide synthases (NOS), which normally produce nitric oxide in the heart. Two NOS isoforms (1 and 3) are normally expressed in the heart. During pathologies such as heart failure, there is induction of NOS 2 in multiple cell types in the myocardium. In certain conditions, the NOS enzymes may become uncoupled, shifting from production of nitric oxide to superoxide anion, a potent free radical and oxidant. Multiple lines of evidence suggest a role for NOS in the pathogenesis of atrial fibrillation. Therapeutic approaches to reduce atrial fibrillation by modulation of NOS activity may be beneficial, although further investigation of this strategy is needed. PMID:22536189

Bonilla, Ingrid M.; Sridhar, Arun; Gyorke, Sandor; Cardounel, Arturo J.; Carnes, Cynthia A.

2012-01-01

196

Atrial Tachyarrhythmia in Rgs5-Null Mice  

PubMed Central

Aims The aim of this study was to elucidate the effects of regulator of G-protein signaling 5 (Rgs5), a negative regulator of G protein-mediated signaling, on atrial repolarization and tachyarrhythmia (ATA) in mice. Methods and Results In present study, the incidence of ATA were increased in Rgs5?/? Langendorff-perfused mouse hearts during program electrical stimulation (PES) (46.7%, 7 of 15) and burst pacing (26.7%, 4 of 15) compared with wild-type (WT) mice (PES: 7.1%,1 of 14; burst:7.1%,1 of 14) (P<0.05). And the duration of ATA also shown longer in Rgs5?/? heart than that in WT, 2 out of 15 hearts exhibited sustained ATA (>30 s) but none of them observed in WT mice. Atrial prolonged repolarization was observed in Rgs5?/? hearts including widened P wave in surface ECG recording, increased action potential duration (APD) and atrial effective refractory periods (AERP), all of them showed significant difference with WT mice (P<0.05). At the cellular level, whole-cell patch clamp recorded markedly decreased densities of repolarizing K+ currents including IKur (at +60 mV: 14.0±2.2 pF/pA) and Ito (at +60 mV: 16.7±1.3 pA/pF) in Rgs5?/? atrial cardiomyocytes, compared to those of WT mice (at +60 mV Ito: 20.4±2.0 pA/pF; Ikur: 17.9±2.0 pF/pA) (P<0.05). Conclusion These results suggest that Rgs5 is an important regulator of arrhythmogenesis in the mouse atrium and that the enhanced susceptibility to atrial tachyarrhythmias in Rgs5?/? mice may contribute to abnormalities of atrial repolarization. PMID:23144791

Qin, Mu; Huang, He; Wang, Teng; Hu, He; Liu, Yu; Gu, Yongwei; Cao, Hong; Li, Hongliang; Huang, Congxin

2012-01-01

197

Complex atrial arrhythmias as first manifestation of catecholaminergic polymorphic ventricular tachycardia: an unusual course in a patient with a new mutation in ryanodine receptor type 2 gene.  

PubMed

Catecholaminergic polymorphic ventricular tachycardia is a rare life-threatening arrhythmogenic disorder. An association with paroxysmal atrial fibrillation and other atrial arrhythmias has been described, but in all published cases the initial manifestation of the disease was ventricular arrhythmia. This is the first report about a patient who presented with complex atrial tachycardia and sinus node dysfunction about 1 year before the typical ventricular arrhythmias were observed, leading to the diagnosis of catecholaminergic polymorphic ventricular tachycardia. In this girl, a mutation of the ryanodine receptor type 2 gene, which has not been described so far, was discovered. PMID:23985380

Lawrenz, Wolfgang; Krogmann, Otto N; Wieczorek, Marcus

2014-08-01

198

[Catheter ablation of atrial fibrillation. Pulmonary vein isolation by using a new multipolar ablation catheter].  

PubMed

Catheter ablation of atrial fibrillation (AF) is an established therapeutical option, particularly in treatment of paroxysmal atrial fibrillation. This paper presents the results of using the PVAC multi-electrode ablation catheter (PVAC®, Medtronic Ablation Frontiers, Carlsbad, CA, USA). In 253 patients with paroxysmal or persistant AF, 1051 pulmonary veins were isolated, including ablation of 34 left common ostia and 1 right common ostium. Except one vein, all pulmonary veins in all patients were successfully isolated. In 23 patients with documented typical atrial flutter, the right atrial isthmus was additionally ablated within the same procedure. Follow-up (FU) visits were performed after 1, 3, 6 and 12 months with 12-lead-ECG, 24h-Holter-ECG and 4-days-Holter ECG. Mean FU was 11?±?7 months with 1.1 interventions per patient (24 redo cases). During FU, 122 of 181 patients with paroxysmal AF (69%) and 23 of 40 patients with persistant AF (58%) were in stable sinus rhythm (SR) after ablation. 159 (62.8%) patients wer under antiarrhythmic drugs after ablation, 214 (84.5%) patients with additional ?-blockers. Total procedure time was 71?±?19 min, and total fluoroscopy time was 16?±?6 min. In 3 cases (1.2%) procedure-related complications occured. Pulmonary vein isolation by using the PVAC-ablation catheter is a safe and effective method in treatment of paroxysmal and persistant AF. PMID:22528180

Spitzer, Stefan G; Karolyi, Laszlo

2011-05-01

199

Antithrombotic Therapy for Atrial Fibrillation  

PubMed Central

Background: The risk of stroke varies considerably across different groups of patients with atrial fibrillation (AF). Antithrombotic prophylaxis for stroke is associated with an increased risk of bleeding. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. Methods: We used the methods described in the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines article of this supplement. Results: For patients with nonrheumatic AF, including those with paroxysmal AF, who are (1) at low risk of stroke (eg, CHADS2 [congestive heart failure, hypertension, age ? 75 years, diabetes mellitus, prior stroke or transient ischemic attack] score of 0), we suggest no therapy rather than antithrombotic therapy, and for patients choosing antithrombotic therapy, we suggest aspirin rather than oral anticoagulation or combination therapy with aspirin and clopidogrel; (2) at intermediate risk of stroke (eg, CHADS2 score of 1), we recommend oral anticoagulation rather than no therapy, and we suggest oral anticoagulation rather than aspirin or combination therapy with aspirin and clopidogrel; and (3) at high risk of stroke (eg, CHADS2 score of ? 2), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest dabigatran 150 mg bid rather than adjusted-dose vitamin K antagonist therapy. Conclusions: Oral anticoagulation is the optimal choice of antithrombotic therapy for patients with AF at high risk of stroke (CHADS2 score of ? 2). At lower levels of stroke risk, antithrombotic treatment decisions will require a more individualized approach. PMID:22315271

You, John J.; Singer, Daniel E.; Howard, Patricia A.; Lane, Deirdre A.; Eckman, Mark H.; Fang, Margaret C.; Hylek, Elaine M.; Schulman, Sam; Go, Alan S.; Hughes, Michael; Spencer, Frederick A.; Manning, Warren J.; Halperin, Jonathan L.

2012-01-01

200

Myeloperoxidase acts as a profibrotic mediator of atrial fibrillation.  

PubMed

Observational clinical and ex vivo studies have established a strong association between atrial fibrillation and inflammation. However, whether inflammation is the cause or the consequence of atrial fibrillation and which specific inflammatory mediators may increase the atria's susceptibility to fibrillation remain elusive. Here we provide experimental and clinical evidence for the mechanistic involvement of myeloperoxidase (MPO), a heme enzyme abundantly expressed by neutrophils, in the pathophysiology of atrial fibrillation. MPO-deficient mice pretreated with angiotensin II (AngII) to provoke leukocyte activation showed lower atrial tissue abundance of the MPO product 3-chlorotyrosine, reduced activity of matrix metalloproteinases and blunted atrial fibrosis as compared to wild-type mice. Upon right atrial electrophysiological stimulation, MPO-deficient mice were protected from atrial fibrillation, which was reversed when MPO was restored. Humans with atrial fibrillation had higher plasma concentrations of MPO and a larger MPO burden in right atrial tissue as compared to individuals devoid of atrial fibrillation. In the atria, MPO colocalized with markedly increased formation of 3-chlorotyrosine. Our data demonstrate that MPO is a crucial prerequisite for structural remodeling of the myocardium, leading to an increased vulnerability to atrial fibrillation. PMID:20305660

Rudolph, Volker; Andrié, René P; Rudolph, Tanja K; Friedrichs, Kai; Klinke, Anna; Hirsch-Hoffmann, Birgit; Schwoerer, Alexander P; Lau, Denise; Fu, Xiaoming; Klingel, Karin; Sydow, Karsten; Didié, Michael; Seniuk, Anika; von Leitner, Eike-Christin; Szoecs, Katalin; Schrickel, Jan W; Treede, Hendrik; Wenzel, Ulrich; Lewalter, Thorsten; Nickenig, Georg; Zimmermann, Wolfram-Hubertus; Meinertz, Thomas; Böger, Rainer H; Reichenspurner, Hermann; Freeman, Bruce A; Eschenhagen, Thomas; Ehmke, Heimo; Hazen, Stanley L; Willems, Stephan; Baldus, Stephan

2010-04-01

201

Effect of years of endurance exercise on risk of atrial fibrillation and atrial flutter.  

PubMed

Emerging evidence suggests that endurance exercise increases the risk for atrial fibrillation (AF) in men, but few studies have investigated the dose-response relation between exercise and risk for atrial arrhythmias. Both exposure to exercise and reference points vary among studies, and previous studies have not differentiated between AF and atrial flutter. The aim of this study was to assess the risk for atrial arrhythmias by cumulative years of regular endurance exercise in men. To cover the range from physical inactivity to long-term endurance exercise, the study sample in this retrospective cohort study was based on 2 distinct cohorts: male participants in a long-distance cross-country ski race and men from the general population, in total 3,545 men aged ?53 years. Arrhythmia diagnoses were validated by electrocardiograms during review of medical records. Regular endurance exercise was self-reported by questionnaire. A broad range of confounding factors was available for adjustment. The adjusted odds ratios per 10 years of regular endurance exercise were 1.16 (95% confidence interval 1.06 to 1.29) for AF and 1.42 (95% confidence interval 1.20 to 1.69) for atrial flutter. In stratified analyses, the associations were significant in cross-country skiers and in men from the general population. In conclusion, cumulative years of regular endurance exercise were associated with a gradually increased risk for AF and atrial flutter. PMID:25169984

Myrstad, Marius; Nystad, Wenche; Graff-Iversen, Sidsel; Thelle, Dag S; Stigum, Hein; Aarønæs, Marit; Ranhoff, Anette H

2014-10-15

202

Methodology for patient-specific modeling of atrial fibrosis as a substrate for atrial fibrillation  

PubMed Central

Personalized computational cardiac models are emerging as an important tool for studying cardiac arrhythmia mechanisms, and have the potential to become powerful instruments for guiding clinical anti-arrhythmia therapy. In this article, we present the methodology for constructing a patient-specific model of atrial fibrosis as a substrate for atrial fibrillation. The model is constructed from high-resolution late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) images acquired in vivo from a patient suffering from persistent atrial fibrillation, accurately capturing both the patient’s atrial geometry and the distribution of the fibrotic regions in the atria. Atrial fiber orientation is estimated using a novel image-based method, and fibrosis is represented in the patient-specific fibrotic regions as incorporating collagenous septa, gap junction remodeling, and myofibroblast proliferation. A proof-of-concept simulation result of reentrant circuits underlying atrial fibrillation in the model of the patient’s fibrotic atrium is presented to demonstrate the completion of methodology development. PMID:22999492

McDowell, Kathleen S.; Vadakkumpadan, Fijoy; Blake, Robert; Blauer, Joshua; Plank, Gernot; MacLeod, Rob S.; Trayanova, Natalia A.

2012-01-01

203

Methodology for patient-specific modeling of atrial fibrosis as a substrate for atrial fibrillation.  

PubMed

Personalized computational cardiac models are emerging as an important tool for studying cardiac arrhythmia mechanisms, and have the potential to become powerful instruments for guiding clinical anti-arrhythmia therapy. In this article, we present the methodology for constructing a patient-specific model of atrial fibrosis as a substrate for atrial fibrillation. The model is constructed from high-resolution late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) images acquired in vivo from a patient suffering from persistent atrial fibrillation, accurately capturing both the patient's atrial geometry and the distribution of the fibrotic regions in the atria. Atrial fiber orientation is estimated using a novel image-based method, and fibrosis is represented in the patient-specific fibrotic regions as incorporating collagenous septa, gap junction remodeling, and myofibroblast proliferation. A proof-of-concept simulation result of reentrant circuits underlying atrial fibrillation in the model of the patient's fibrotic atrium is presented to demonstrate the completion of methodology development. PMID:22999492

McDowell, Kathleen S; Vadakkumpadan, Fijoy; Blake, Robert; Blauer, Joshua; Plank, Gernot; MacLeod, Rob S; Trayanova, Natalia A

2012-01-01

204

Right Atrial Isomerism in Four Siblings  

Microsoft Academic Search

Heterotaxy syndromes, right or left atrial isomerism, result from disruption of left–right axis determination and their manifestations include complicated heart defects. Recent studies in model organisms have revealed complex genetic pathways and several genes involved in this process. In affected humans, however, molecular studies have identified mutations in a small number of individuals, while in most the cause remains unknown.

M. Eronen; E. Kajantie; T. Boldt; O. Pitkänen; K. Aittomäki

2004-01-01

205

Obstructive sleep apnea and atrial arrhythmogenesis.  

PubMed

Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with relevant morbidity and mortality. Besides hypertension, valvular disease and cardiomyopathy, mainly ischemic and dilated, also other conditions like obesity, alcohol abusus, genetic factors and obstructive sleep apnea (OSA) are discussed to contribute to the progression from paroxysmal to persistent AF. The prevalence of OSA among patients with AF is 40-50%. OSA is characterized by periodic or complete cessation of effective breathing during sleep due to obstruction of the upper airways. Obstructive respiratory events result in acute intrathoracic pressure swings and profound changes in blood gases together leading to atrial stretch and acute sympatho-vagal dysbalance resulting in acute apnea related to electrophysiological and hemodynamic alterations. Additionally, repetitive obstructive events in patients with OSA may lead to sympathetic and neurohumoral activation and subsequent structural and functional changes in the atrium creating an arrhythmogenic substrate for AF in the long run. This review focuses on the acute and chronic effects of negative thoracic pressure swings, changes in blood pressure and sympatho-vagal dysbalance induced by obstructive respiratory events on atrial electrophysiology and atrial structure in patients with obstructive sleep apnea. PMID:25004989

Hohl, Mathias; Linz, Benedikt; Böhm, Michael; Linz, Dominik

2014-11-01

206

Lone atrial fibrillation: what do we know?  

Microsoft Academic Search

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Despite the common association of AF with cardiovascular disease, some patients can be classified as ‘lone AF’. The latter is essentially a diagnosis of exclusion, and should be preceded by careful evaluation, including thorough collection of medical history, physical examination, blood pressure measurement, laboratory tests, ECG, echocardiography and,

Dariusz Kozlowski; Szymon Budrejko; Gregory Y H Lip; Jacek Rysz; Dimitri P Mikhailidis; Grzegorz Raczak; Maciej Banach

2009-01-01

207

Carbamazepine induced atrial tachycardia with complete AV block  

PubMed Central

Background/Aim: Carbamazepine, a widely used antiepileptic drug that has been used for the treatment of both partial and generalized seizures, for trigeminal neuralgia, as a mood stabilizer and for treatment of neuropathic pain syndromes, may have negative chronotropic and dromotropic effects on the cardiac conduction system. Description of case: We report a case of cardiac syncope due to atrial tachycardia combined with complete atrioventricular block as a consequence of carbamazepine administration for trigeminal neuralgia. Conclusion: Although sinus tachycardia is the most frequently observed cardiac side effect of carbamazepine, sinus and nodal bradycardia, atrioventricular block, premature ventricular contractions, ventricular tachycardia and junctional escape rhythms have been reported in patients due to carbamazepine toxicity.

Koutsampasopoulos, K; Zotos, A; Papamichalis, M; Papaioannou, K

2014-01-01

208

Thrombi in all four cardiac chambers in a patient with an old anteroseptal myocardial infarction and atrial flutter.  

PubMed

Cases with thrombi in multiple cardiac chambers are rare. We report an extremely rare case in which thrombi were formed in all four cardiac chambers at the same time. A 55-year-old man presented with biventricular failure and liver dysfunction. A 12-lead ECG and an echocardiogram revealed an old anteroseptal myocardial infarction with aneurysm formation and atrial flutter. A transesophageal echocardiogram and a CT of the chest revealed thrombi in the right and left atrial appendage, right ventricular apex and left ventricular aneurysm. Pulmonary emboli were also identified. Stasis of the blood due to ventricular dysfunction and atrial flutter was considered to be responsible. The patient died of multiorgan failure due to circulatory failure. PMID:25422354

Ida, Hanae; Hirata, Kazuhito; Takahashi, Takanori; Hirosawa, Takanobu

2014-01-01

209

Prevalence of oral anticoagulation in atrial fibrillation  

PubMed Central

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

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

2014-01-01

210

The current status and future directions of myxoma virus, a master in immune evasion  

PubMed Central

Myxoma virus (MYXV) gained importance throughout the twentieth century because of the use of the highly virulent Standard Laboratory Strain (SLS) by the Australian government in the attempt to control the feral Australian population of Oryctolagus cuniculus (European rabbit) and the subsequent illegal release of MYXV in Europe. In the European rabbit, MYXV causes a disease with an exceedingly high mortality rate, named myxomatosis, which is passively transmitted by biting arthropod vectors. MYXV still has a great impact on European rabbit populations around the world. In contrast, only a single cutaneous lesion, restricted to the point of inoculation, is seen in its natural long-term host, the South-American Sylvilagus brasiliensis and the North-American S. Bachmani. Apart from being detrimental for European rabbits, however, MYXV has also become of interest in human medicine in the last two decades for two reasons. Firstly, due to the strong immune suppressing effects of certain MYXV proteins, several secreted virus-encoded immunomodulators (e.g. Serp-1) are being developed to treat systemic inflammatory syndromes such as cardiovascular disease in humans. Secondly, due to the inherent ability of MYXV to infect a broad spectrum of human cancer cells, the live virus is also being developed as an oncolytic virotherapeutic to treat human cancer. In this review, an update will be given on the current status of MYXV in rabbits as well as its potential in human medicine in the twenty-first century. Table of contents Abstract 1. The virus 2. History 3. Pathogenesis and disease symptoms 4. Immunomodulatory proteins of MYXV 4.1. MYXV proteins with anti-apoptotic functions 4.1.1. Inhibition of pro-apoptotic molecules 4.1.2. Inhibition by protein-protein interactions by ankyrin repeat viral proteins 4.1.3. Inhibition of apoptosis by enhancing the degradation of cellular proteins 4.1.4. Inhibition of apoptosis by blocking host Protein Kinase R (PKR) 4.2. MYXV proteins interfering with leukocyte chemotaxis 4.3. MYXV serpins that inhibit cellular pro-inflammatory or pro-apoptotic proteases 4.4. MYXV proteins that interfere with leukocyte activation 4.5. MYXV proteins with sequence similarity to HIV proteins 4.6. MYXV proteins with unknown immune function 5. Vaccination strategies against myxomatosis 5.1. Current MYXV vaccines 5.2. Vaccination campaigns to protect European rabbits in the wild 6. Applications of myxoma virus for human medicine 6.1. MYXV proteins as therapeutics for allograft vasculopathy and atherosclerosis 6.2. Applications for MYXV as a live oncolytic virus to treat cancer 7. Discussion and Conclusions 8. List of Abbreviations References Author Details Authors' contributions Competing interests Figure Legends Acknowledgements PMID:21658227

2011-01-01

211

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

PubMed

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

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

2014-09-30

212

Measurement and reproducibility of magnetocardiographic filtered atrial signal in patients with paroxysmal lone atrial fibrillation and in healthy subjects.  

PubMed

Magnetocardiography (MCG) is a method complementary to electrocardiography (ECG). We examined recording and reproducibility of atrial depolarization signal by MCG. Multichannel MCG over anterior chest and orthogonal 3-lead ECG were recorded in 9 patients who had paroxysmal lone atrial fibrillation and in 10 healthy subjects in duplicate at least 1 week apart. Data were averaged using atrial wave template and high-pass filtered at 25, 40, and 60 Hz. Atrial signal duration with automatic detection of onset and offset and root mean square amplitudes of the last portion of atrial signal were determined. Coefficient of variation of atrial signal duration by MCG at 40 Hz was 3.3% and difference between the measurements was 3.5 milliseconds on average. The corresponding figures obtained by signal-averaged ECG (SAECG) were 6.1% and 6.9 milliseconds. Coefficient of variation for root mean square of the last 40 milliseconds of atrial signal were 16% in MCG and 17% in SAECG. Reproducibility was best at 40-Hz filter and similar in patients and healthy subjects. In conclusion, the reproducibility of atrial signal variables in MCG is adequate and somewhat better than in SAECG and equal in patients with lone atrial fibrillation and healthy subjects. Magnetocardiography seems to be a potentially valuable method to evaluate features of atrial depolarization in patient studies. PMID:16216607

Koskinen, Raija; Lehto, Mika; Väänänen, Heikki; Rantonen, Juha; Voipio-Pulkki, Liisa-Maria; Mäkijärvi, Markku; Lehtonen, Lasse; Montonen, Juha; Toivonen, Lauri

2005-10-01

213

Energetic metabolism during acute stretch-related atrial fibrillation Shortened title: atrial fibrillation and metabolism  

PubMed Central

Background and methods Perturbations in energetic metabolism and impaired atrial contractility may play an important role in the pathogenesis of atrial fibrillation (AF). Besides, atrial stretch is commonly associated with AF. However, the atrial energetics of stretch-related AF are poorly understood. Here, we measured indicators of energy metabolism during acute-stretch related AF. PCr, adenine nucleotides and derivatives concentrations as well as the activity of the F0F1-ATPase and Na,K-ATPase were obtained after one hour of stretch and/or AF in isolated rabbit hearts and compared to control hearts without stretch and AF. Results After one hour of stretch-related AF, the total adenine nucleotides pool was significantly lower (42.2±2.6 versus 63.7±8.3 µmol/g protein in control group, p<0.05) and the PCr/ATP ratio significantly higher (2.3±0.3 vs 1.1± 0.1 in control group p<0.05), because of ATP, ADP and AMP decrease and PCr increase. The sum of high energy phosphate compounds did not change. There were no significant differences in F0F1-ATPase nor Na,K-ATPase activity between the groups. Conclusions Results show that in this experimental model, acute-stretch related AF induces specific modifications of atrial myocytes energetics that may play a pivotal role in the perpetuation of the arrhythmia. PMID:18553177

Kalifa, J; Maixent, JM; Chalvidan, T; Dalmasso, C; Colin, D; Cozma, D; Laurent, P; Deharo, JC; Djiane, P; Cozzone, P; Bernard, M

2010-01-01

214

Secretion of atrial natriuretic peptide (ANP) from fish atrial and ventricular myocytes in tissue culture.  

PubMed

Primary cultures of atrial and ventricular myocytes (approx. 1 x 10(5) cells/culture) were prepared from adult teleost fish Gila atraria and maintained for 10 days. Immunoreactive atrial natriuretic peptide (ir-ANP) from fish atrial and ventricular cells was 3.9 and 2.8 ng/culture respectively, values not significantly different. Atriocytes from rat and mouse secreted comparable amounts of ANP which were not significantly different from atrial fish cultures (5.2 and 4.3 ng/culture). In contrast, their ventricular myocytes secreted only small quantities of ANP (0.8 and 0.3 ng/culture). When analyzed by reversed-phase HPLC, the media of both fish atrial and ventricular myocytes contained a peptide which exhibited properties similar to authentic human ANP (Ser 99-Tyr 126), suggesting a significant degree of sequence homology between fish and mammalian ANP. Fish ventricular cells, unlike normal mammalian ventricular cells, secrete substantial quantities of immunoreactive-ANP. PMID:2521685

Baranowski, R L; Westenfelder, C

1989-01-01

215

The role of left atrial receptors in the diuretic response to left atrial distension  

PubMed Central

1. The diuretic response to distension of the whole left atrium caused by obstruction of the mitral orifice has been compared with the effects of distension (by means of small balloons) of the left pulmonary vein/left atrial junctions. 2. Distension of the pulmonary vein/atrial junctions caused an increase in heart rate and a diuresis similar to but smaller than that caused by mitral obstruction. 3. Section of both ansae subclaviae prevented the increase in heart rate produced by distension of the pulmonary vein/left atrial junctions but had little effect on the diuretic response either to pulmonary vein distension or to mitral obstruction. 4. A diuretic response to mitral obstruction could be demonstrated after all nerves from the lungs had been cut but not after the vagus nerves had been cut at levels likely to interrupt the majority of afferent fibres from left atrial receptors. 5. The results support the view that stimulation of left atrial receptors is a major factor in the production of a diuretic response to mitral obstruction. PMID:5698283

Ledsome, J. R.; Linden, R. J.

1968-01-01

216

Staged transthoracic approach to persistent atrial fibrillation (TOP-AF): study protocol for a randomized trial  

PubMed Central

Background Persistent atrial fibrillation frequently shows multiple different electrophysiological mechanisms of induction. This heterogeneity causes a low success rate of single procedures of ablation and a high incidence of recurrence. Surgical ablation through bilateral thoracotomy demonstrates better results after a single procedure. Prospective observational studies in inhomogeneous populations without control groups report a remarkable 90% of success with hybrid or staged procedures of surgical ablation coupled with catheter ablation. In this trial, we will examine the hypothesis that a staged approach involving initial minimally invasive surgical ablation of persistent atrial fibrillation, followed by a second percutaneous procedure in case of recurrence, has a higher success rate than repeated percutaneous procedures. Methods/Design This is a controlled (2:1) randomized trial comparing use of a percutaneous catheter with minimally invasive transthoracic surgical ablation of persistent atrial fibrillation. The inclusion and exclusion criteria, definitions, and treatment protocols are those reported by the 2012 Expert Consensus Statement on catheter and surgical ablation of atrial fibrillation. Patients will be randomized to either percutaneous catheter (n?=?100) or surgical (n?=?50) ablation as the first procedure. After 3 months, they are re-evaluated, according to the same guidelines, and receive a second procedure if necessary. Crossover will be allowed and data analyzed on an “intention-to-treat” basis. Primary outcomes are the incidence of sinus rhythm at 6 and 12 months and the proportions of patients requiring a second procedure. Discussion The use of a staged strategy combining surgical and percutaneous approaches might be more favorable in treatment of persistent atrial fibrillation than the controversial single percutaneous ablation. Trial registration ISRCTN08035058 Reg 06.20.2013 PMID:24885377

2014-01-01

217

Epidemiology of atrial fibrillation: European perspective  

PubMed Central

In the last 20 years, atrial fibrillation (AF) has become one of the most important public health problems and a significant cause of increasing health care costs in western countries. The prevalence of AF is increasing due to our greater ability to treat chronic cardiac and noncardiac diseases, and the improved ability to suspect and diagnose AF. At the present time, the prevalence of AF (2%) is double that reported in the last decade. The prevalence of AF varies with age and sex. AF is present in 0.12%–0.16% of those younger than 49 years, in 3.7%–4.2% of those aged 60–70 years, and in 10%–17% of those aged 80 years or older. In addition, it occurs more frequently in males, with a male to female ratio of 1.2:1. The incidence of AF ranges between 0.21 and 0.41 per 1,000 person/years. Permanent AF occurs in approximately 50% of patients, and paroxysmal and persistent AF in 25% each. AF is frequently associated with cardiac disease and comorbidities. The most common concomitant diseases are coronary artery disease, valvular heart disease, and cardiomyopathy. The most common comorbidities are hypertension, diabetes, heart failure, chronic obstructive pulmonary disease, renal failure, stroke, and cognitive disturbance. Paroxysmal AF occurs in younger patients and with a reduced burden of both cardiac disease and comorbidities. Generally, the history of AF is long, burdened by frequent recurrences, and associated with symptoms (in two thirds of patients). Patients with AF have a five-fold and two-fold higher risk of stroke and death, respectively. We estimate that the number of patients with AF in 2030 in Europe will be 14–17 million and the number of new cases of AF per year at 120,000–215,000. Given that AF is associated with significant morbidity and mortality, this increasing number of individuals with AF will have major public health implications. PMID:24966695

Zoni-Berisso, Massimo; Lercari, Fabrizio; Carazza, Tiziana; Domenicucci, Stefano

2014-01-01

218

Microcanonical processing methodology for ECG and intracardial potential: application to atrial fibrillation  

E-print Network

Cardiac diseases are the principal cause of human morbidity and mortality in the western world. The electric potential of the heart is a highly complex signal emerging as a result of nontrivial flow conduction, hierarchical structuring and multiple regulation mechanisms. Its proper accurate analysis becomes of crucial importance in order to detect and treat arrhythmias or other abnormal dynamics that could lead to life-threatening conditions. To achieve this, advanced nonlinear processing methods are needed: one example here is the case of recent advances in the Microcanonical Multiscale Formalism. The aim of the present paper is to recapitulate those advances and extend the analyses performed, specially looking at the case of atrial fibrillation. We show that both ECG and intracardial potential signals can be described in a model-free way as a fast dynamics combined with a slow dynamics. Sharp differences in the key parameters of the fast dynamics appear in different regimes of transition between atrial fibr...

Pont, Oriol; Yahia, Hussein; Derval, Nicolas; Hocini, Mélèze

2012-01-01

219

A Huge Mediastinal Organizing Hematoma Causing Reversal of Atrial Septal Defect Shunt Flow  

PubMed Central

We report a case of a 46-year-old woman who presented with subacute exertional dyspnea and severe hypoxia. A large cystic mass compressing the right side of the heart along with right-to-left atrial shunt flow through an alleged atrial septal defect (ASD) were detected on echocardiography. CT scan of the chest and MRI of the heart revealed a loculated cystic mediastinal mass with hemorrhage measuring 5.5×8 cm compressing the right atrium and ventricle. The patient underwent cyst resection and primary closure of the ASD. This report illustrates a case of an unusual symptomatic pericardial mass compressing the right atrium and ventricle in a patient with an secundum ASD. PMID:21430995

Kim, Eun Kyoung; Park, Sung Bum; Park, Silvia; Bahng, Sunha; Choe, Yeon Hyeon; Sung, Kiick

2011-01-01

220

Plasma atrial natriuretic peptide and spontaneous diuresis in sick neonates.  

PubMed Central

Plasma concentrations of immunoreactive human atrial natriuretic peptide (human ANP) were sequentially determined in 12 infants with respiratory distress syndrome (RDS) or meconium aspiration syndrome (MAS) during various phases of diuresis to elucidate the role of human ANP in the occurrence of spontaneous diuresis in the newborn. Plasma immunoreactive ANP concentrations during the diuretic as well as the maximum diuretic phase were significantly (p less than 0.001) higher than during the prediuretic phase. A gradual decrease occurred during the post diuretic phase, returning to prediuretic values after one week of life. Significant natriuresis, increased glomerular filtration rate, mild hyponatremia, and decreased blood pressure were observed in the diuretic phase in all the cases studied. These results suggest that hypersecretion of human ANP may play an important part in initiating spontaneous diuresis in sick neonates. PMID:2957964

Kojima, T; Hirata, Y; Fukuda, Y; Iwase, S; Kobayashi, Y

1987-01-01

221

Bicuspid aortic valve endocarditis complicated by mitral valve aneurysm.  

PubMed

We describe a case of mitral valve aneurysm associated with concomitant aortic valve endocarditis. Aneurysms appear as a localized saccular bulge of the anterior leaflet into the left atrium and thus are often misdiagnosed as mitral valve prolapse, myxomatous mitral valve, or atrial myxoma. The presentation and management of mitral valve aneurysms are the subject of this case report.? PMID:21447085

Ruparelia, Neil; Lawrence, David; Elkington, Andrew

2011-05-01

222

Fibrosis in Atrial Fibrillation - Role of Reactive Species and MPO  

PubMed Central

Atrial fibrosis with enhanced turnover and deposition of matrix proteins leads to inhomogeneous atrial electrical conduction and gives rise to electrical reentry circuits resulting in atrial fibrillation. The multifactorial pathogenesis of atrial fibrosis involves resident cardiac cells as well as infiltrating leukocytes, both generating and sequestering matrix metalloproteinases (MMPs), a key enzyme family involved in fibrosis. A growing body of evidence points toward an important role of reactive oxygen species (ROS) in the release and activation of pro-MMPs and the stimulation of pro-fibrotic cascades. Myeloperoxidase (MPO), a bactericidal enzyme released from activated polymorphonuclear neutrophils (PMN) is not only associated with a variety of cardiovascular diseases, but has also been shown to be mechanistically linked to atrial fibrosis and fibrillation. MPO catalyzes the generation of reactive species like hypochlorous acid, which affect intracellular signaling cascades in various cells and advance activation of pro-MMPs and deposition of atrial collagen resulting in atrial arrhythmias. Thus, inflammatory mechanisms effectively promote atrial structural remodeling and importantly contribute to the initiation and perpetuation of atrial fibrillation. PMID:22723783

Friedrichs, Kai; Baldus, Stephan; Klinke, Anna

2012-01-01

223

Right atrial metastasis from hepatocellular carcinoma.  

PubMed

A 65-year-old patient with a past medical history of hypertension, alcoholism, micronodular cirrhosis, and coronary artery bypass grafting 10 years ago developed a hepatocellular carcinoma, treated by chemoembolization. One month after treatment, thoracoabdominal CT scan showed no residual hepatic tumor, but tumoral aspect in the right atrium with extension into the inferior vena cava. The patient being asymptomatic, cardiac ultrasound confirmed the presence of a free, mobile, pediculated tumor in the right atrium. Surgical exploration found a well-circumscribed mass, attached to the atrial wall by a 1.5-cm diameter pedicle implanted near the inferior vena cava ostium, moving freely in the right atrial cavity. The tumor was easily resected by section of the pedicle and its surrounding parietal implantation zone. No complications occurred postoperatively, and the patient was discharged on the 10th postoperative day. Three years after, the patient is in good health and is asymptomatic; cardiac ultrasound showed no tumor recurrence. PMID:17488426

Mansour, Ziad; Gerelli, Sébastien; Kindo, Michel J; Billaud, Philippe J; Eisenmann, Bernard; Mazzucotelli, Jean-Philippe

2007-01-01

224

Ultrastructural cytochemistry of atrial muscle cells  

Microsoft Academic Search

Sections of atrial cardiocytes from young rats were subjected to radioautography after a single intravenous injection of L-leucine-4,5 3H to identify the sites of synthesis and to follow the migration of newly-formed proteins. As early as 2 min after injection of L-leucine 3H, the label was highest in the rough endoplasmic reticulum (RER), suggesting that cisternal ribosomes are sites of

L. Yunge; S. Benchimol; M. Cantin

1980-01-01

225

'Acquired' left ventricular to right atrial shunt after mitral valve replacement: Detection by transthoracic colour Doppler echocardiography  

PubMed Central

Left ventricular to right atrial communications are rare types of ventricular septal defects usually of congenital origin. A case of an iatrogenic shunt between the left ventricle and the right atrium as a rare complication of mitral valve replacement is reported. PMID:17622397

Uslu, Nevzat; Kayacioglu, Ilyas; Ates, Mehmet; Eren, Mehmet

2007-01-01

226

Characteristics, Treatment and Outcome of Ischemic Stroke with Atrial Fibrillation in a Chinese Hospital-Based Stroke Study  

Microsoft Academic Search

Background: There is scant information on characteristics, treatment, functional outcome and case fatality of ischemic stroke with atrial fibrillation (AF) in China. Methods: For this study, first-ever ischemic stroke patients who were admitted within 1 month of stroke onset during the period of March 2002 through December 2008 were included. Data on ischemic stroke patients were collected which included: demographics,

Sen Lin; Bo Wu; Zi-Long Hao; Fan-Yi Kong; Wen-Dan Tao; De-Ren Wang; Sha He; Ming Liu

2011-01-01

227

[Anomalous right upper pulmonary venous drainage into the superior vena cava with coexistence sinus venosus atrial septal defect (ASD)].  

PubMed

Article presents a case of a 71-year old woman with pulmonary right upper venous drainage into the superior vena cava and with coexistence sinus venous type Atrial Septal Defect (ASD) which was revealed as interesting finding in multislices computed tomography angiography during estimation of coronary arteries. PMID:23944110

Laskowicz, Bartosz; Urba?czyk-Zawadzka, Ma?gorzata; Krupi?ski, Maciej; Konieczy?ska, Ma?gorzata; Irzyk, Ma?gorzata; Bany?, Robert Pawe?; Machnik, Roman; Urbanik, Andrzej

2013-01-01

228

Atrial fibrillation pearls and perils of management.  

PubMed Central

Atrial fibrillation, a common arrhythmia, is responsible for considerable cardiovascular morbidity. Its management demands more than antiarrhythmic therapy alone, but must address the causes and consequences of the arrhythmia. Although remediable causes are infrequently found, a thorough search for associated heart disease or its risk factors results in better-informed patient management. Controlling the ventricular response and protecting from thromboembolic complications are important initial goals of therapy and may include the administration of aspirin in younger, low-risk patients. Older patients and those with risk factors for systemic embolism are not adequately protected from stroke complications by aspirin therapy alone. It remains controversial whether all high-risk patients should receive warfarin and at what intensity. Whether and how sinus rhythm should be restored and maintained poses the greatest therapeutic controversy for atrial fibrillation. The mortal risk of antiarrhythmic therapy is substantially greater in patients with evidence of heart failure. In such persons, the risks and benefits of maintaining normal sinus rhythm with antiarrhythmic medications should be weighted carefully. A definitive cure for atrial fibrillation remains elusive, but promising surgical and catheter ablation therapies are being developed. PMID:8686300

Kudenchuk, P J

1996-01-01

229

[Dilated cardiomyopathy induced by ectopic atrial tachycardia].  

PubMed

The deleterious effect of chronic or incessant supraventricular tachycardia on ventricular function is well-known and it has been demonstrated than can ultimately lead to dilated cardiomyopathy if unrecognized. Any variety of supraventricular tachycardia with chronic evolution may lead to left ventricular dysfunction, ectopic atrial tachycardia because of its persistent nature, often incessant and poorly responsive to antiarrhythmic drugs is a frequent cause of reversible congestive heart failure in patients without other demonstrable organic heart disease. Five patients (aged 14 to 52 years) were referred with symptoms of heart failure, NYHA functional class II (one patient), class III (one patient) and class IV (3 patients) associated with an incessant ectopic atrial tachycardia. Four patients underwent radiofrequency catheter ablation of the ectopic focus and one patient was treated with amiodarone. All patients were successfully treated and the echocardiographic assessment of left ventricular function indicated regression of the cardiomyopathy picture with recovery of systolic function, (mean left ventricular ejection fraction 39.2 +/- 6.1% before vs mean 62.4 +/- 4.8% after (p < 0.01). The clinical and echocardiographic picture of cardiomyopathy induced by incessant ectopic atrial tachycardia is reversible after successful treatment. This stresses the necessity of recognizing such arrhythmia as cause of primary heart failure. PMID:10959459

Velázquez Rodríguez, E; Martínez Enríquez, A

2000-01-01

230

Symptomatic atrial arrhythmias and transcatheter closure of atrial septal defects in adult patients  

PubMed Central

Objective: To determine whether transcatheter device closure of a secundum atrial septal defect (ASD) will reduce the risk of developing subsequent atrial arrhythmias. Design: The incidence and predictors of symptomatic atrial tachyarrhythmias (AT) were examined in adults undergoing transcatheter closure of ASDs. Setting: Toronto Congenital Cardiac Centre for Adults. Patients: 132 consecutive patients, mean (SD) age 44 (16) years; 74% female. Main outcome measure: Sustained or symptomatic atrial arrhythmias at early follow up (six weeks; n ?=? 115) and intermediate follow up (last clinic visit 17 (11) months post surgery; n ?=? 121). Results: 15% of the patients (20 of 132) had AT before the procedure (14 paroxysmal, six persistent). Patients without a history of arrhythmia had a low incidence of AT during early follow up (6%) and intermediate follow up (1%/year), while all patients with persistent AT before closure remained in atrial fibrillation or flutter. Of patients in sinus rhythm but with a previous history of AT, two thirds remained arrhythmia-free at follow up, with overall incidences of paroxysmal and persistent AT of 17%/year and 11%/year. A history of AT before closure (risk ratio (RR) 35.0, 95% confidence interval (CI) 7.2 to 169.0) and age ? 55 years at the time of device insertion (RR 5.6, 95% CI 1.2 to 25.0) predicted AT after closure. Conclusions: Device closure of an ASD before the onset of atrial arrhythmias may protect against the subsequent development of arrhythmia, in particular in patients less than 55 years of age. PMID:15367523

Silversides, C K; Siu, S C; McLaughlin, P R; Haberer, K L; Webb, G D; Benson, L; Harris, L

2004-01-01

231

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

NASA Technical Reports Server (NTRS)

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.

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

2000-01-01

232

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

PubMed Central

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

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

2014-01-01

233

Variation in left atrial transmural wall thickness at sites commonly targeted for ablation of atrial fibrillation  

Microsoft Academic Search

Background  The number of catheter ablations performed for atrial fibrillation (AF) has increased dramatically over the past several years.\\u000a Regional variation in left atrial (LA) wall thickness is known to exist but have not been described in detail. AF ablation\\u000a success and complication rates may be related to regional differences in LA wall thickness.\\u000a \\u000a \\u000a \\u000a Objective  To evaluate differences in transmural wall thickness

Burr Hall; Vinodh Jeevanantham; Rochelle Simon; John Filippone; Gabriel Vorobiof; James Daubert

2006-01-01

234

Implantation strategy of the atrial dipole impacts atrial sensing performance of single lead VDD pacemakers.  

PubMed

Intermittent atrial undersensing is observed in a considerable percentage of patients with single lead VDD pacemakers. Analyzing the 2-year data of the Saphir Multicenter Follow-Up Study, the authors investigated predictors for the occurrence of undersensing. The study included 194 patients with high degree AV block who received a VDD pacemaker system with an identical sensing amplifier. Placement strategy of the atrial dipole was left to the discretion of the implanting physician. At the final position, atrial potential amplitudes were measured during deep and shallow respiration. Atrial dipole position was determined by intraoperativefluoroscopy subdividing the right atrium in a high, mid, and low portion. Undersensing was defined by evidence of at least one not sensed P wave during Holter monitoring or exercise testing and by the presence of 0.1-0.2 mV amplitudes in the P wave amplitude histogram of the pacemaker. Incidence of undersensing was 25.8%; 9.3% of patients showed frequent (> 5%) or symptomatic undersensing. Patients with undersensing were older (76.6 +/- 10.6 vs 64.2 +/- 14.8 years), showed a lower minimum of intraoperative atrial potential amplitude (P(min) 0.86 +/- 0.64 vs 1.43 +/- 0.77 mV), a wider range of potential amplitude (deltaP 1.71 +/- 1.44 vs 0.94 +/- 0.84 mV), and a higher incidence of dipole placement in the low right atrium (50.0% vs 11.1 %, P < 0.001 for all comparisons). In a multivariate regression analysis, patient age > 66 years, Pmin < 0.6 mV, > 1.3 mV and atrial dipol placement in the lowright atrium were independently predictive for undersensing. Minimal atrialpotential amplitude, range of potential amplitude, and atrial dipole position influence atrial sensing performance in single lead VDD pacing. Thus, implantation guidelines should reflect these rules to improve the outcome of VDD pacemaker recipients. PMID:11990661

Wiegand, Uwe K H; Nowak, Bernd; Reisp, Udo; Peiffer, Torsten; Bode, Frank; Potratz, Jürgen

2002-03-01

235

Pulmonary Vein Stenosis After Catheter Ablation of Atrial Fibrillation  

Microsoft Academic Search

Background—This report describes the complication of pulmonary vein stenosis with resultant severe pulmonary hypertension that developed in 2 patients after successful catheter ablation of chronic atrial fibrillation. Methods and Results—Three months after successful catheter ablation of atrial fibrillation, both patients developed progressive dyspnea and pulmonary hypertension. Both were found to have severe stenosis of all 4 pulmonary veins near the

Ivan M. Robbins; Edward V. Colvin; Thomas P. Doyle; W. Evans Kemp; James E. Loyd; William S. McMahon; G. Neal Kay

236

Human Atrial Fibrillation: insights from computational electrophysiological models  

PubMed Central

Computational electrophysiology has proven useful to investigate the mechanisms of cardiac arrhythmias at various spatial scales, from isolated myocytes to the whole heart. Here we review how mathematical modeling has aided our understanding of human atrial myocyte electrophysiology to study the contribution of structural and electrical remodeling to human atrial fibrillation. We suggest potential new avenues of investigation and model development. PMID:22732550

Bers, Donald M.; Grandi, Eleonora

2012-01-01

237

The evolution of atrial fibrillation ablation from triggers to substrate  

Microsoft Academic Search

The surgical approach to treat atrial fibrillation involves compartmentalizing the atrium. By dividing the atrium into discrete segments, the surgeon prevents the arrhythmia's ability to sustain by decreasing the required atrial substrate for propagation of the fibrillatory wavelets. Endocardial catheter ablation techniques used to replicate the surgical procedure were fraught with long procedure times and unacceptably high thromboembolic complications. The

Ralph J. Verdino

2006-01-01

238

[Relevance of magnetic resonance imagingfor catheter ablation of atrial fibrillation].  

PubMed

Currently, atrial fibrillation is the most common form of arrhythmia encountered in clinical practice. Until recently the treatment approach to atrial fibrillation was limited by imprecise risk stratification models and suboptimal therapy options. At present cardiac magnetic resonance imaging (MRI) is an important noninvasive diagnostic modality which aids in the completion of complex electrophysiological and ablation interventions. Cardiac MRI and 3D imaging reconstruction are used clinically to assess the cardiac chambers as well as complex anatomical structures. Through the development of cardiac MRI it has become possible to detect areas of fibrosis in the left atrium which can be the cause of atrial fibrillation. The most recent clinical data suggest that there is a strong correlation between the amount of left atrial fibrosis and recurrent atrial fibrillation following ablation procedures and will in the future allow more individualized treatment strategies for patients with atrial fibrillation. In addition, cardiac MRI allows the direct visualization of catheter-induced lesions after ablation procedures which helps in assessing therapy success and can also assist in the early detection of procedure-related complications. Furthermore, with the implementation of cardiac MRI it appears possible to assess the stroke risk in patients with atrial fibrillation. Promising future developments will allow individualized therapy for patients with atrial fibrillation in addition to improving safety and procedure results after ablation. PMID:25160815

Mahnkopf, Christan; Mitlacher, Marcel; Brachmann, Johannes

2014-12-01

239

Dabigatran versus Warfarin in Patients with Atrial Fibrillation  

Microsoft Academic Search

Background Warfarin reduces the risk of stroke in patients with atrial fibrillation but increases the risk of hemorrhage and is difficult to use. Dabigatran is a new oral direct throm- bin inhibitor. Methods In this noninferiority trial, we randomly assigned 18,113 patients who had atrial fi- brillation and a risk of stroke to receive, in a blinded fashion, fixed doses

Stuart J. Connolly; Michael D. Ezekowitz; D. Phil; John Eikelboom; Jonas Oldgren; Amit Parekh; Janice Pogue; Paul A. Reilly; Ellison Themeles; Jeanne Varrone; Susan Wang; Marco Alings; Denis Xavier; Jun Zhu; Rafael Diaz; Basil S. Lewis; Harald Darius; Hans-Christoph Diener; Campbell D. Joyner; Lars Wallentin

2010-01-01

240

Congenital intrapericardial aneurysm of the left atrial appendage  

Microsoft Academic Search

Congenital aneurysmal dilatation of the left atrial appendage is a rare but correctable lesion. It represents a diagnostic dilemma in patients with cardiomegaly and is commonly associated with supraventricular arrhythmias and life-threatening systemic embolization. We describe the diagnostic evaluation and surgical treatment during 1997 of a patient with congenital aneurysmal dilatation of the left atrial appendage. The patient was discharged

Giuseppe Pome’; Stefano Pelenghi; Modestina Grassi; Gabriele Vignati; Alessandro Pellegrini

2000-01-01

241

Ruptured aneurysm of the sinus of Valsalva associated with an atrial septal aneurysm.  

PubMed

Aneurysm of the sinus of Valsalva (ASV) is a rare cardiac disease that may be acquired or congenital. It is usually an asymptomatic condition; however, when it ruptures, symptoms appear and the condition deteriorates rapidly. Atrial septal aneurysm (ASA) is a localized "saccular" deformity of the interatrial septum that is associated with cerebrovascular events of embolic origin. We will report on a case of a 69-year-old woman who was referred to our department because of congestive heart failure. Echocardiographic evaluation, both transthoracic and transesophageal, disclosed a ruptured aneurysm of the right sinus of Valsalva into the right atrium (RA), which was associated with an aneurysm of the atrial septum. PMID:11153021

Karavidas, A; Matsakas, E; Foukarakis, M; Panou, F; Dounis, G; Zacharoulis, A

2000-11-01

242

Curative treatment of atrial fibrillation with intraoperative radiofrequency ablation: Short-term and midterm results  

Microsoft Academic Search

Objective: This report describes the early and midterm results after intraoperative radiofrequency ablation of atrial fibrillation for patients with isolated chronic atrial fibrillation or atrial fibrillation in combination with additional valvular and nonvalvular cardiac diseases. Methods: From August 1998 to March 2001, a total of 234 patients with chronic atrial fibrillation underwent isolated intraoperative radiofrequency ablation alone (n = 74,

Friedrich W. Mohr; Alexander M. Fabricius; Volkmar Falk; Rüdiger Autschbach; Nicolas Doll; Ulrich von Oppell; Anno Diegeler; Hans Kottkamp; Gerd Hindricks

2002-01-01

243

Regional left atrial stasis during fibrillation and flutter determinants and relation to stroke  

Microsoft Academic Search

Objectives. This study sought to 1) determine the location of left atrial stasis during atrial arrhythmia; 2) define the degree of stasis associated with significant risk of stroke; and 3) identify clinical or transthoracic echocardiographic data useful for predicting left atrial stasis.Background. Prior studies suggest that stroke during atrial arrhythmia is related to stasis in either the body of the

Bruce K. Shively; Erika A. Gelgand; Michael H. Crawford

1996-01-01

244

Role of atrial electrophysiology and autonomic nervous system in patients with supraventricular tachycardia and paroxysmal atrial fibrillation  

Microsoft Academic Search

Objectives. The purposes of this study were to evaluate the atrial electrophysiology and autonomic nervous system in patients who had paroxysmal supraventricular tachycardia (PSVT) associated with paroxysmal atrial fibrillation (PAF).Background. PAF frequently appeared in patients with PSVT. However, the critical determinants for the occurrence of PAF were not clear.Methods. This study population consisted of 50 patients who had PSVT with

Yi-Jen Chen; Shih-Ann Chen; Ching-Tai Tai; Zu-Chin Wen; An-Ning Feng; Yu-An Ding; Mau-Song Chang

1998-01-01

245

Minimally invasive surgery for atrial fibrillation  

PubMed Central

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

Suwalski, Piotr

2013-01-01

246

Current Hot Potatoes in Atrial Fibrillation Ablation  

PubMed Central

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

Roten, Laurent; Derval, Nicolas; Pascale, Patrizio; Scherr, Daniel; Komatsu, Yuki; Shah, Ashok; Ramoul, Khaled; Denis, Arnaud; Sacher, Frederic; Hocini, Meleze; Haissaguerre, Michel; Jais, Pierre

2012-01-01

247

Transmembrane chloride currents in human atrial myocytes.  

PubMed

The present study was designed to evaluate the presence of basal, swelling-induced, and cAMP-dependent Cl- currents in human atrial myocytes studied with the whole cell patch-clamp technique. Under basal conditions, a small outwardly rectifying background conductance was noted that reversed close to 0 mV and was not altered by Cl- replacement. Isoproterenol (1 microM), forskolin (3 microM), and 8-bromoadenosine 3',5'-cyclic monophosphate (50 microM) did not increase membrane conductance, even when responsiveness to isoproterenol was confirmed by an increase in Ca2+ current and when perforated-patch techniques (nystatin) were used. Exposure to hyposmotic solutions increased cell volume and induced a whole cell conductance that showed outward rectification, was inhibited by 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid (100 microM), and responded to changes in Cl- gradient in a fashion consistent with a Cl(-)-selective conductance, with estimated relative permeabilities of 1, 0.25, and 0.07 for Cl-, methanesulfonate, and aspartate, respectively. The results suggest that human atrial cells lack basal and adenosine 3',5'-cyclic monophosphate-dependent Cl- current but manifest a substantial Cl- conductance in the presence of cell swelling. PMID:8779912

Li, G R; Feng, J; Wang, Z; Nattel, S

1996-02-01

248

Regulation of atrial natriuretic peptide secretion.  

PubMed

To evaluate the role of the autonomic nervous system in the regulation of atrial natriuretic peptide (ANP) secretion, the secretory responses of isolated perfused rat hearts to adrenaline and acetylcholine were studied. Infusion of adrenaline produced a dose-dependent rise in heart rate and contractile force associated with a marked increase in perfusate ANP immunoreactivity. The ANP response was almost completely abolished by the alpha-adrenoceptor antagonist phentolamine (10(-6)) and attenuated by the beta-adrenoceptor antagonist metoprolol (10(-5)). Thus, both alpha- and beta-adrenoceptors may mediate the adrenaline effect on ANP release. Perfusion of the isolated heart with 10(-6) or 10(-5) acetylcholine resulted in a short rise in hormone release followed by a gradual decline. The negative ionotropic and chronotropic effects of acetylcholine and the rise in ANP induced by acetylcholine were blocked by atropine, suggesting that a muscarinic receptor is involved. The finding that both adrenaline and acetylcholine alter ANP secretion rate points to the participation of autonomic nerves in the regulation of ANP release from atrial cardiocytes. PMID:2956388

Toth, M; Ruskoaho, H; Lang, R E

1986-12-01

249

Long-term outcome of electrical cardioversion in patients with chronic atrial flutter.  

PubMed Central

OBJECTIVE: To determine the long-term outcome of serial electrical cardioversion therapy in patients with chronic atrial flutter. DESIGN: Prospective study, case series. SETTING: University hospital. PATIENTS: 50 consecutive patients with chronic (> 24 hours) atrial flutter without a previous relapse on antiarrhythmic drugs. INTERVENTIONS: Elective electrical cardioversion therapy, if necessary repeated, to obtain and keep patients in sinus rhythm. If the first cardioversion resulted in sinus rhythm, patients were not given antiarrhythmic drugs. Relapses were managed by repeated cardioversions then anti-arrhythmic drugs were used serially in a set sequence. MAIN OUTCOME MEASURE: Maintenance of sinus rhythm. RESULTS: Mean (SD) follow up was 3.5 (1.7) years. The first cardioversion was successful in 48 patients (96%). After a single shock and without antiarrhythmic drugs being used, 42% of the patients maintained sinus rhythm in the long-term. Only left atrial size was inversely related to the efficacy of one shock (P = 0.025). With serial cardioversion 90% of the patients were kept in sinus rhythm for 5 years. Univariate analysis showed that a long duration of arrhythmia and impaired cardiac function were both related to poor outcome. During follow up 3 patients died of progression of heart failure and another 5 died suddenly. None of these 5 patients was on antiarrhythmic drugs. CONCLUSIONS: Electrical cardioversion was an effective and safe method of converting chronic atrial flutter to sinus rhythm. To maintain sinus rhythm, more than half of the patients required multiple shocks and prophylactic antiarrhythmic drugs. Sudden death was relatively frequent in the study population; the limited data available from this study suggest that such deaths were caused by the underlying disease and not drug related proarrhythmia. PMID:9038696

Crijns, H. J.; Van Gelder, I. C.; Tieleman, R. G.; Brugemann, J.; De Kam, P. J.; Gosselink, A. T.; Bink-Boelkens, M. T.; Lie, K. I.

1997-01-01

250

Atrial fibrillation in patients with gastroesophageal reflux disease: A comprehensive review  

PubMed Central

AIM: To analyze the potential relationship between gastroesophageal reflux disease (GERD) and the development of atrial fibrillation (AF). METHODS: Using the key words “atrial fibrillation and gastroesophageal reflux”, “atrial fibrillation and esophagitis, peptic”, “atrial fibrillation and hernia, hiatal” the PubMed, EMBASE, Cochrane Library, OVIDSP, WILEY databases were screened for relevant publications on GERD and AF in adults between January 1972-December 2013. Studies written in languages other than English or French, studies not performed in humans, reviews, case reports, abstracts, conference presentations, letters to the editor, editorials, comments and opinions were not taken into consideration. Articles treating the subject of radiofrequency ablation of AF and the consecutive development of GERD were also excluded. RESULTS: Two thousand one hundred sixty-one titles were found of which 8 articles met the inclusion criteria. The presence of AF in patients with GERD was reported to be between 0.62%-14%, higher compared to those without GERD. Epidemiological data provided by these observational studies showed that patients with GERD, especially those with more severe GERD-related symptoms, had an increased risk of developing AF compared with those without GERD, but a causal relationship between GERD and AF could not be established based on these studies. The mechanisms of AF as a consequence of GERD remain largely unknown, with inflammation and vagal stimulation playing a possible role in the development of these disorders. Treatment with proton pomp inhibitors may improve symptoms related to AF and facilitate conversion to sinus rhythm. CONCLUSION: Although links between AF and GERD exist, large randomized clinical studies are required for a better understanding of the relationship between these two entities. PMID:25071357

Roman, Crina; Bruley des Varannes, Stanislas; Muresan, Lucian; Picos, Alina; Dumitrascu, Dan L

2014-01-01

251

Recent advances in the molecular pathophysiology of atrial fibrillation  

PubMed Central

Atrial fibrillation (AF) is an extremely common cardiac rhythm disorder that causes substantial morbidity and contributes to mortality. The mechanisms underlying AF are complex, involving both increased spontaneous ectopic firing of atrial cells and impulse reentry through atrial tissue. Over the past ten years, there has been enormous progress in understanding the underlying molecular pathobiology. This article reviews the basic mechanisms and molecular processes causing AF. We discuss the ways in which cardiac disease states, extracardiac factors, and abnormal genetic control lead to the arrhythmia. We conclude with a discussion of the potential therapeutic implications that might arise from an improved mechanistic understanding. PMID:21804195

Wakili, Reza; Voigt, Niels; Kaab, Stefan; Dobrev, Dobromir; Nattel, Stanley

2011-01-01

252

Transseptal fine needle aspiration of a large left atrial tumour.  

PubMed

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

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

2010-07-01

253

[Percutaneous left atrial appendage closure: an alternative in patients with atrial fibrillation and high bleeding risk?].  

PubMed

Atrial fibrillation (AF) is the most common cardiac arrhythmia and its prevalence increases with age. AF increases the risk of stroke by a factor of 5 and strokes related to AF are associated with higher mortality and morbidity when compared with strokes in patients with sinus rhythm. Oral anticoagulation is efficient to reduce the risk of stroke in AF patients, but with a substantial risk of bleeding. In clinical practice, 50% of the AF patients with an indication for oral anticoagulation do not receive the treatment. Indeed, many patients do not tolerate oral anticoagulation and this is still true despite the new drugs. Recently, percutaneous left atrial appendage closure for AF patients with high risk of stroke became a valid alternative to oral anticoagulation for stroke prevention. PMID:22737951

Noble, Stéphane; Müller, Hajo; Stampfli, Tomoe; Meier, Bernhard; Roffi, Marco

2012-05-30

254

[Prophylaxis and therapy for atrial fibrillation after general thoracic surgery].  

PubMed

Following thoracic surgery atrial fibrillation (AF) frequently occurs in 12 to 44?% of cases postoperatively and is related to an increased morbidity and mortality. In 2011, the Society of Thoracic Surgeons of the United States published guidelines for the prophylaxis and treatment of postoperative AF. High evidence levels are provided for continuing ?-blocker treatment despite its known negative inotropic effects. Alternatively, the calcium channel blocker diltiazem, or amiodarone for patients without pneumonectomy are recommended for prophylactic therapy. For rate control of AF occurring post surgery, not only selective ?1-blockers, calcium channel blockers, but also magnesium or digoxin are suitable in haemodynamically stable patients. Amiodarone, ?1-blockers and flecainide are preferred for rhythm control in case of haemodynamic stability in regard to possible side effects and contraindications. In contrast, electrical cardioversion is indicated in those patients with haemodynamic instability. Persistent AF of >?48 hours is a target for anticoagulation treatment depending on the individual aspects of the patient and in accordance to the CHADS2 score. The present review article further discusses the evidence for the recommended medical therapy and treatment strategies. PMID:25264722

Karagiannidis, C; Meissner, A; Koryllos, A; Windisch, W; Strassmann, S

2014-09-01

255

Association of left atrial endothelin-1 with atrial rhythm, size and fibrosis in patients with structural heart disease  

PubMed Central

Background Atrial fibrillation (AF) promotes atrial remodeling and can develop secondary to heart failure (HF) or mitral valve disease. Cardiac endothelin-1 (ET-1) expression responds to wall stress, and can promote myocyte hypertrophy and interstitial fibrosis. We tested the hypothesis that atrial ET-1 is elevated in AF and is associated with AF persistence. Methods and Results Left atrial appendage (LAA) tissue was studied from coronary artery bypass graft, valve repair, and/or Maze procedure patients in sinus rhythm with no history of AF (SR, n=21), with history of AF but in SR at surgery (AF/SR, n=23), and in AF at surgery (AF/AF, n=32). The correlation of LA size with atrial protein and mRNA expression of ET-1 and ET-1 receptors (ETAR and ETBR) was evaluated. LAA ET-1 content was higher in AF/AF than in SR, but receptor levels were similar. Immunostaining revealed that ET-1 and its receptors were present both in atrial myocytes and in fibroblasts. ET-1 content was positively correlated with LA size, HF, AF persistence, and severity of mitral regurgitation (MR). Multivariate analysis confirmed associations of ET-1 with AF, hypertension (HTN) and LA size. LA size was associated with ET-1 and MR severity. ET-1 mRNA levels were correlated with genes involved in cardiac dilatation, hypertrophy and fibrosis. Conclusion Elevated atrial ET-1 content is associated with increased LA size, AF rhythm, HTN and HF. ET-1 is associated with atrial dilatation, fibrosis and hypertrophy, and likely contributes to AF persistence. Interventions that reduce atrial ET-1 expression and/or block its receptors may slow AF progression. PMID:20495015

Mayyas, Fadia; Niebauer, Mark; Zurick, Andrew; Barnard, John; Gillinov, A. Marc; Chung, Mina K.; Van Wagoner, David R.

2011-01-01

256

Effect of atorvastatin on left atrial function of patients with paroxysmal atrial fibrillation.  

PubMed

The aim of this study was to evaluate the effects of atorvastatin on left atrial (LA) function in paroxysmal atrial fibrillation patients. Fifty-eight paroxysmal atrial fibrillation patients were divided into two groups (treatment and control groups). The echocardiography parameters, including LA active emptying volume (LAAEV), LA active emptying fraction, LA maximum volume, LA total emptying volume, LA total emptying fraction, and LA ejection force (LAEF), were measured before treatment, and then 12 and 18 months after treatment. Compared to pre-treatment levels, the parameters reflecting LA pump function, such as LAAEV and LAEF, decreased significantly in treatment groups 12 months after treatment (P < 0.05). LAAEV and LAEF significantly increased 18 months after treatment (P < 0.05), and the indicators reflecting LA reservoir function, such as maximum volume, total emptying volume, and total emptying fraction increased significantly 18 months after treatment (P < 0.05). Compared with pre-treatment levels, LAAEV and LAEF decreased significantly 18 months after treatment in the control group (P < 0.05). These results demonstrated that long-term atorvastatin treatment could ameliorate the function of the atrium sinistrum. PMID:24065687

Li, Y D; Tang, B P; Guo, F; Li, J X; Han, W; Tang, Q; Zhang, Y Y

2013-01-01

257

Intraoperative mapping of the right atrial free wall during sinus rhythm: variety of activation patterns and incidence of postoperative atrial fibrillation  

Microsoft Academic Search

Objective: The atrial conduction properties associated with cardiac disease are speculated as the background of postoperative atrial fibrillation (POAF). We examined the atrial conduction patterns and conduction properties during sinus rhythm (SR) in patients that had undergone cardiac operations and evaluated the incidence of POAF in all patients. Methods: Fifty-two patients with stable SR who underwent cardiac surgery, with a

Shun-ichiro Sakamoto; Shigeo Yamauchi; Hiromasa Yamashita; Hajime Imura; Yuji Maruyama; Hidetsugu Ogasawara; Nobuo Hatori; Kazuo Shimizu

2006-01-01

258

Case report: Radiofrequency catheter ablation of typical atrial flutter and the atrioventricular junction via the superior vena caval approach in a patient with a congenital absence of an inferior vena cava.  

PubMed

The absence of an inferior vena cava is a rare congenital condition often without clinical significance. Alternative venous approaches are often needed to treat these patients. We report a case of successful ablation of both isthmus dependent flutter and the AV junction using the superior vena cava in a patient with an inferior vena cava anomaly. PMID:16421696

Pai, Rakesh K; MacGregor, John F; Abedin, Moeen; Hamdan, Mohamed H

2005-12-01

259

Prevalence of Chronic Atrial Fibrillation in Dialysis Patients  

E-print Network

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...

Wetmore, James B.

2011-05-31

260

Atrial fibrillation: unanswered questions and future directions.  

PubMed

Just more than a decade ago, Haissaguerre and colleagues provided the seminal demonstration of the role of pulmonary vein triggers in the pathogenesis of atrial fibrillation (AF) and the potential therapeutic role of catheter ablation to treat patients who have paroxysmal AF. This initial observation ushered in the modern era of catheter ablation to treat patients who have AF, and tremendous progress has been made in understanding its pathogenesis and the catheter approaches to treating this rhythm. Although the current state of AF catheter ablation is well described earlier in this issue, this article reflects on some of the major unanswered questions about AF management, and the future technological and investigational directions being explored in the nonpharmacologic management of AF. PMID:18061007

Reddy, Vivek Y

2008-01-01

261

Right atrial isomerism in four siblings.  

PubMed

Heterotaxy syndromes, right or left atrial isomerism, result from disruption of left-right axis determination and their manifestations include complicated heart defects. Recent studies in model organisms have revealed complex genetic pathways and several genes involved in this process. In affected humans, however, molecular studies have identified mutations in a small number of individuals, while in most the cause remains unknown. Furthermore, although family data suggest, autosomal recessive inheritance, such genes have not yet been identified. We have studied six members of a family, four children affected with right atrial isomerism (RAI) and their healthy parents, for disturbances of left-right axis development. The children, one female and three males who all had complicated heart defects, succumbed and had an autopsy. Their nonconsanguineous parents were examined by cardiac and abdominal ultrasound or MRI. In all four children the heart defects included single ventricle with dysplastic atrioventricular (AV) valve, total anomalous pulmonary venous drainage (TAPVD), and malposition of great arteries (MGA) with pulmonary stenosis (PS). All had asplenia; two also had dextrocardia and abdominal situs inversus. The diagnosis of RAI was made postnatally in the first child and prenatally in others. Two siblings had no surgery and died as a newborn, one with obstructed supracardiac TAPVD and the other with regurgitating AV valve. Two children underwent heart surgery. One had repair of obstructive infracardiac TAPVD but died in infancy. The other underwent both hemi-Fontan operation and heart transplantation but died at the age of 2 years. This is the first report describing four children with RAI in the same family. The occurrence of RAI in male and female siblings without any indication of left-right axis abnormalities in their parents suggests autosomal recessive inheritance of human isomerism. PMID:14648004

Eronen, M; Kajantie, E; Boldt, T; Pitkänen, O; Aittomäki, K

2004-01-01

262

Early repolarization as a risk factor of atrial fibrillation.  

PubMed

Early repolarization pattern is a common ECG pattern characterized by J-point and ST segment elevation in 2 or more contiguous leads. There are some opinions that early repolarization may be associated with some kind of arrhythmias (including life-threatening arrhythmias) Aim of this study was to declare correlation between early repolarization and atrial fibrillation. In this study participated patients (19-68 years old) with early repolarization and without exclusion criteria. Monitoring was made by helping 24h ambulatory ECG monitoring. Variables are expressed as mean ± SD, The analysis was performed using Student's t test, statistical tests were two-tailed, and a p value < 0.05 was considered statistically significant. We compared rate of atrial fibrillation in patients with early repolarization to rate of atrial fibrillation in general population; The comparison of this two data shows that rate of atrial fibrillation in patients with early repolarization is significant higher than rate of atrial fibrillation in general population (7,3 fold higher; 14,6% Vs 2%). So, early repolarization may be considered as independent risk factor of atrial fibrilallation. This is principally new and very important information. PMID:24850607

Matoshvili, Z; Petriashvili, S; Archvadze, A; Azaladze, I

2014-04-01

263

Reflex effects on the heart of stimulating left atrial receptors  

PubMed Central

1. Stimulation of left atrial receptors, by distension of the pulmonary vein/left atrial junctions, is known to cause a reflex increase in heart rate; the efferent pathway is known to be solely in the sympathetic nerves. 2. In expectation of a concomitant positive inotropic response the effect of stimulating the left atrial receptors on the inotropic state of the left ventricle was studied, using as a known sensitive index of inotropic changes the maximal rate of rise of pressure in the left ventricle (dP/dt max). 3. Stimulation of left atrial receptors resulted in an increase in heart rate but there were no significant concomitant changes in dP/dt max. 4. It is concluded that activity in this discrete efferent pathway does not include an inotropic effect on the left ventricle and therefore the reflex involves only those sympathetic nerves which innervate the sinu-atrial node. 5. The possible function of atrial receptors in the regulation of heart volumes is discussed. PMID:5124571

Furnival, C. M.; Linden, R. J.; Snow, H. M.

1971-01-01

264

Multiple Biomarkers and Atrial Fibrillation in the General Population  

PubMed Central

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

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

265

A Functional Polymorphism C-509T in TGF?-1 Promoter Contributes to Susceptibility and Prognosis of Lone Atrial Fibrillation in Chinese Population  

PubMed Central

Transforming growth factor-?1 (TGF-?1) is an important mediator of atrial fibrosis and atrial fibrillation (AF). But the involved genetic mechanism is unknown. Herein, the TGF-?1 C-509T polymorphism (rs1800469) was genotyped in a case-control study of 840 patients and 845 controls in Chinese population to explore the association between the polymorphism and susceptibility and prognosis of lone AF. As a result, the CT and/or TT genotypes had an increased lone AF risk [adjusted odds ratio (OR)?=?1.50 for CT, OR?=?3.72 for TT, and OR?=?2.15 for CT/TT], compared with the TGF-?1CC genotype. Moreover, patients carrying CT/TT genotypes showed a higher possibility of AF recurrence after catheter ablation, compared with patients carrying CC genotype. In a genotype-phenotype correlation analysis using 24 normal left atrial appendage samples, increasing gradients of atrial TGF-?1 expression levels positively correlated with atrial collagen volume fraction were identified in samples with CC, CT and TT genotypes. The in vitro luciferase assays also showed a higher luciferase activity of the -509T allele than that of the -509C allele. In conclusion, the TGF-?1 C-509T polymorphism is involved in the etiology of lone AF and thus may be a marker for genetic susceptibility to lone AF and predicting prognosis after catheter ablation in Chinese populations. Therefore, we provide new information about treatment strategies and our understanding of TGF-?1 in AF. PMID:25402477

Røe, Oluf Dimitri; Chen, Xin; Chen, Yijiang; Wang, Dongjin

2014-01-01

266

Right mesothelial pericardial cyst determining intractable atrial arrhythmias.  

PubMed

Pericardial cysts are intrathoracic lesions usually considered to be congenital and less frequently to be acquired. They are normally found incidentally upon chest radiography, computed tomography (CT)-scan or echocardiography. They are usually asymptomatic and have a benign behavior although sometimes they can cause clinical symptoms and diagnosis can be uncertain. We present, herein, the case of a 51-year-old male with a history of atrial arrhythmia resistant to transcatheter ablation therapies with an accidental finding of a pericardial cyst adherent to the lateral wall of the right atrium at the emerging superior vena cava. The patient was studied with transesophageal echocardiography, CT-scan and cardiovascular magnetic resonance with the evidence of dimensional increasing of the cyst at seriate controls. Considering this, in the absence of a definitive diagnosis and suspecting a link between the mass and the arrhythmia, the cyst was surgically removed through median sternotomy, off-pump on a beating heart. Postoperative course was unremarkable. Histopathologic examination confirmed it was a mesothelial pericardial cyst. At 12 months of follow-up the patient is doing well and he is in sinus rhythm. In conclusion, we believe that, although the majority of pericardial cysts need only radiological and clinical follow-up, surgical resection should be performed when the patient is symptomatic and when diagnosis is uncertain. PMID:21303864

Generali, Tommaso; Garatti, Andrea; Gagliardotto, Piervincenzo; Frigiola, Alessandro

2011-05-01

267

Novel mitral clipping technique overcoming extreme atrial dilatation.  

PubMed

The mitral clipping technique is emerging as a promising new treatment option for severe mitral regurgitation. The device was designed and assessed in intermediate risk populations, which is in contrast to the real world, where most patients are deemed to be at very high risk for open heart surgery. The cardiac anatomy of these patients often challenges the freedom grades of the current mitral clip device. In this case presentation, we describe a novel technique overcoming extreme atrial dilation in a patient with severe mitral regurgitation despite previous implantation of two mitral clips. Based on a low/anterior trans-septal puncture, this procedure relied on a counter clock-wise 90° turn of the steerable sheath and alignment of the clip delivery system to the mitral valve, thereby gaining additional longitudinal freedom. This resulted in the successful implantation of two additional clips with achievement of a mild to moderate mitral regurgitation without relevant gradient and dramatic and sustained clinical improvement of the patient. © 2013 Wiley Periodicals, Inc. PMID:24167092

Tiroch, Klaus; Vorpahl, Marc; Seyfarth, Melchior

2014-10-01

268

Three-dimensional echocardiographic delineation of an acquired aorto-left atrial fistula complicating native aortic valve endocarditis - "advantage of three dimensions".  

PubMed

Aorto-atrial fistulas are rare, but important complications resulting from aortic valve infective endocarditis, aortic valve surgery, or aortic dissection. We hereby report a case of a 20-year male, referred to us with infective endocarditis of the native aortic valve with severe aortic regurgitation and symptoms of heart failure. Detailed evaluation with two-dimensional and three-dimensional transthoracic echocardiography revealed aorto-left atrial fistula secondary to the involvement of the mitral-aortic intervalvular fibrosa (MAIVF) region. The patient underwent successful removal of the vegetations, closure of the defect along with aortic valve replacement, and mitral valve repair. PMID:23931072

Chandra, Sharad; Ameta, Deepak; Kharwar, Rajiv Bharat; Goyal, Mukesh; Kumar, Devesh; Dwivedi, Sudhanshu Kumar; Saran, Ram Kirti

2013-11-01

269

Incessant nonreentrant tachycardia due to simultaneous conduction over dual atrioventricular nodal pathways mimicking atrial fibrillation in patients referred for pulmonary vein isolation.  

PubMed

It has been reported that conduction over the fast and slow pathways of the AV node can occur simultaneously, leading to a double ventricular response from each atrial beat. We report the cases of two patients referred to us for evaluation of symptomatic, incessant, and irregular narrow-complex tachycardia, misdiagnosed as atrial fibrillation, for consideration of pulmonary vein isolation. At presentation, careful evaluation of the electrograms revealed the presence of two ventricular activations for each atrial beat. At electrophysiologic study, both patients were found to have nonreentrant tachycardias arising from simultaneous conduction over the fast and slow pathways of the AV node. In one patient, the tachycardia had resulted in cardiomyopathy. Slow AV nodal pathway ablation performed in both patients resulted in cure of their tachycardias and recovery of ventricular function in the patient with cardiomyopathy. PMID:12930257

Mansour, Moussa; Marrouche, Nassir; Ruskin, Jeremy; Natale, Andrea; Keane, David

2003-07-01

270

Occult left atrial ball-like thrombus in a patient referred for surgical removal of suspected cerebellum tumor  

PubMed Central

Summary Background Atrial fibrillation and related cardio-embolic cerebrovascular accidents are two well-defined major healthcare problems worldwide. It has been approximated that 2.2 million people in America and 4.5 million in European Union have paroxysmal or persistent atrial fibrillation. And atrial fibrillation itself is an independent long-term risk factor of stroke. We present a case of patient referred to our center for surgical removal of suspected cerebellum tumor, a case that had a rather unexpected ending. Case Report A 58-year-old male patient with a history of atrial fibrillation, congestive heart failure (NYHA II/III), stable coronary artery disease, diabetes type 2 and hyperlipidemia presented with vertigo, headaches, mainly during physical activity and increased tiredness. Performed computer tomography revealed two lesions in the cerebellum and in the left lateral chamber. The diagnosis of a proliferative disease of the cerebellum was established and patient was referred to the Neurosurgical Department. Fortunately, before the operation the echocardiography was performed, which revealed two lesions in left atrium. The decision of the Heart Team was to refer the patient for an open-heart surgery, in which two thrombi were removed. Neurosurgeons decided to withdraw from further surgery and proceed with head MRI and conservative treatment, deciding that the lesion in the cerebellum was most likely an ischemic area. Conclusions Looking at the brain lesion should always be done from the whole patient’s perspective. And using mutlimodality imaging may lead to appropriate diagnosis, correct course of therapeutic action and unexpected ending of a rather non-extraordinary case. PMID:24653787

Mozenska, Olga; Kalinska, Irena; Brodowski, Karol; Walecki, Jerzy; Kosior, Dariusz A.

2014-01-01

271

Concealed left superior accessory pathway. Distinctive features of retrograde atrial activation and successful ablation using transseptal approach.  

PubMed

Concealed left superior accessory pathways are very infrequent and can be difficult to diagnose and ablate. We describe here the case of a patient presenting with reciprocating tachycardia involving superior and inferior left accessory pathways. Left superior accessory pathway was suspected because of the simultaneous retrograde atrial activation at the distal coronary sinus (CS) and His bundle lead and could be successfully ablated using transseptal catheterization. PMID:19966325

Maury, Philippe; Duparc, Alexandre; Graffeille, Alain; Hebrard, Aurelien; Mondoly, Pierre; Rollin, Anne; Delay, Marc

2010-04-01

272

Anaesthetic management of a patient with Laurence Moon Biedl syndrome undergoing ostium primum atrial septal defect closure  

PubMed Central

Laurence-Moon-Biedl Syndrome is primarily a rare, recessively inherited genetic disorder. The cardinal features are polydactyly, obesity and retinitis pigmentosa, mental retardation, genital hypoplasia and cardiac anomalies. This spectrum may extend and may also involve renal anomalies. Here, we report a rare case of 15-year-old boy who was overweight and suffering from Laurence Moon Biedl syndrome scheduled for closure of atrial septal defect.

Dhulkhed, Vithal K.; Shetti, Akshaya N.; Dhulkhed, Pavan V.

2013-01-01

273

Dissociation between the secretion and renal action of endogenous atrial natriuretic peptide in the syndrome of inappropriate antidiuresis.  

PubMed

A patient is described with the syndrome of inappropriate antidiuresis (SIAD) and renal sodium retention secondary to a lymphoma. The basal atrial natriuretic peptide (ANP) level and the ANP response to volume expansion were normal (age adjusted) but the natriuretic effect of ANP was attenuated by an unidentified factor. The case emphasizes the dominance of circulating volume over plasma tonicity in the regulation of ANP secretion. PMID:2140892

Eadington, D W; Cowan, F M

1990-01-01

274

Catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with complete situs inversus, atrial septal defect and "inverse" persistent left superior vena cava.  

PubMed

We report a case of successful radiofrequency ablation for atypical atrioventricular nodal reentrant tachycardia in a patient with complete situs inversus, secundum atrial septal defect and an "inverse" persistent left superior vena cava. The procedure was performed under the monoplane fluoroscopic guidance using the inferior approach. PMID:17045667

Hirai, Yukoh; Chou, Chung-Chuan; Wen, Ming-Shien

2007-01-31

275

Late Presentation of Persistent Left Superior Caval Vein in a Univentricular Heart with Successful Transcutaneous Occlusion Using Cera Lifetech Atrial Septal Occluder  

PubMed Central

We present a case of persistent left superior caval vein in a univentricular heart presenting with progressive and disabling cyanosis in a 35-year-old man eighteen years after his Kawashima operation. The vein was successfully occluded using an atrial septal occluder with significant improvement of symptoms and oxygen saturation.

AL-Ammouri, Iyad; Alhourani, Ahmad

2014-01-01

276

Comparison of unipolar and bipolar active fixation atrial pacing leads.  

PubMed

The purpose of this investigation was to compare the acute pacing and sensing characteristics of a new bipolar active fixation atrial pacing lead with those of a unipolar atrial lead of similar design. Pacing threshold voltage and current, lead impedance, and atrial electrogram amplitude and slew rate were measured at the time of surgery in 28 consecutive patients undergoing DDD pacing system implantation. Eleven patients received a Medtronic 6957J-58 unipolar active fixation atrial lead and 17 patients were given a Medtronic 4016-58 bipolar lead. Both leads are polyurethane-insulated with the distal electrode being a platinum alloy screw-helix with a surface area of 8.0 mm2. There were no significant differences in the threshold voltage (1.01 V unipolar versus 1.05 V bipolar) or current (1.93 mA unipolar versus 1.78 mA bipolar) of the two leads. The mean impedance of the bipolar active fixation lead was 618 ohms compared to 479 ohms for the unipolar lead (p = 0.02). The mean amplitude of the atrial electrogram was 4.64 mV for the bipolar lead and 3.11 mV for the unipolar lead (p = 0.02). The atrial electrogram exceeded 5 mV in 10 of 17 patients with the bipolar lead but zero of 11 with the unipolar lead. There was no significant difference in the mean slew rate of the leads (1.09 V/s bipolar versus 0.73 V/s unipolar; p = 0.18). Over a follow-up period of up to 10 months, all patients remained in either the DDD or DDI modes with no episodes of atrial sensing or pacing failure.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2456532

Kay, G N; Epstein, A E; Plumb, V J

1988-05-01

277

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

PubMed Central

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.

Mendes, Fernanda de Souza Nogueira Sardinha; Atie, Jacob; Garcia, Marcelo Iorio; Gripp, Eliza de Almeida; de Sousa, Andrea Silvestre; Feijo, Luiz Augusto; Xavier, Sergio Salles

2014-01-01

278

Lack of Replication in Polymorphisms Reported to be Associated with Atrial Fibrillation  

PubMed Central

Background Atrial fibrillation (AF) is the most common sustained arrhythmia and has a substantial heritable component. Numerous associations between single nucleotide polymorphisms (SNPs) and AF have been described, but few have been replicated. Objective We sought to systematically replicate SNPs reported to be associated with AF in two large study samples of European descent. Methods We searched PubMed for studies reporting associations between SNPs and AF published before July 1st, 2007. SNPs were genotyped in two independent case control samples from Germany and the United States. Associations between SNPs and AF were assessed using logistic regression models adjusting for age, sex and hypertension. A meta-analysis of the results from the two studies was performed. Results We identified 21 SNPs and the ACE I/D polymorphism that were reported to be associated with AF in the literature. Nine of these genetic variants were not represented on common genome-wide SNP arrays. We successfully genotyped 21 of these 22 variants in 2,145 cases with AF from the German Competence Network for Atrial Fibrillation and 4,073 controls from the KORA S4 study, and 16 variants in 790 cases and 1,330 controls from the Massachusetts General Hospital. None of the SNPs replicated in independent populations with AF. Conclusion Our results suggest that previously reported associations to AF were likely false-positives, and highlight the need for systematic replication of genetic associations in large, independent cohorts to accurately detect variants associated with disease. PMID:21056700

Sinner, Moritz F.; Lubitz, Steven A.; Pfeufer, Arne; Makino, Seiko; Beckmann, Britt-Maria; Lunetta, Kathryn L.; Steinbeck, Gerhard; Perz, Siegfried; Rahman, Rosanna; Sonni, Akshata; Greenberg, Steven M.; Furie, Karen L.; Wichmann, H.-Erich; Meitinger, Thomas; Peters, Annette; Benjamin, Emelia J; Rosand, Jonathan; Ellinor, Patrick T; Kaab, Stefan

2011-01-01

279

Atrial lead malposition in a dual chamber (DDD,M) pacemaker.  

PubMed

A model 7000 pacemaker in the DVI mode emitted two stimuli, the first stimulating the right ventricle and the second 110 ms later. The atrial lead was found in the right ventricular outflow tract. The QRS complex produced by the atrial lead fell after the blanking period, and "committed" the ventricular stimulus 110 ms after the "atrial." Intracardiac electrography during the original implant would have enabled proper atrial lead position. PMID:6641312

Barber, K; Amikam, S; Furman, S

1983-12-01

280

DICTIONARY LEARNING FOR THE SPARSE MODELLING OF ATRIAL FIBRILLATION IN ECG SIGNALS  

E-print Network

DICTIONARY LEARNING FOR THE SPARSE MODELLING OF ATRIAL FIBRILLATION IN ECG SIGNALS B. Mailhé, R propose a new method for ventricular cancellation and atrial modelling in the ECG of patients suffering activity. Index Terms-- ECG, atrial fibrillation, monochannel source separation, dictionary learning

Paris-Sud XI, Université de

281

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

PubMed Central

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

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

1994-01-01

282

Attenuation of electrical remodelling in chronic atrial fibrillation following oral treatment with verapamil  

Microsoft Academic Search

Aims Electrical remodelling with shortening of the atrial refractory period and increased fibrillatory rate occurs after onset of atrial fibrillation and can be attenuated by pre-treatment with intravenous verapamil. The aim of the present study was to investigate whether already established fibrillatory-induced shortening of atrial fibrillatory cycle length could be reversed with oral verapamil. Methods and Results Thirteen patients (nine

C. J. Meurling; M. P. Ingemansson; A. Roijer; J. Carlson; C. J. Lindholm; B. Smideberg; L. Sornmo; M. Stridh; S. B. Olsson

1999-01-01

283

Esophageal perforation during left atrial radiofrequency ablation: Is the risk too high?  

Microsoft Academic Search

Objective: Intraoperative radiofrequency ablation of atrial fibrillation (IRAAF) is a recently developed procedure being performed in an increasing number of patients. We have performed left atrial IRAAF in 387 patients since August 1998. The purpose of this article is to describe a serious complication of this procedure, namely IRAAF-induced esophageal perforation, in detail to identify possible risk factors.Methods: Left atrial

Nicolas Doll; Michael A. Borger; Alexander Fabricius; Susann Stephan; Jan Gummert; Friedrich W. Mohr; Johann Hauss; Hans Kottkamp; Gerd Hindricks

2003-01-01

284

Preoperative Arrhythmias Such as Atrial Fibrillation: Cardiovascular Surgery Risk Factor  

PubMed Central

Atrial fibrillation is still the most common arrhythmia that occurs in heart surgery. However, there is few literature data on the manner in which preoperative atrial fibrillation may influence the postoperative outcome of various heart surgery procedures. The purpose of our research is to assess the effects of preoperative atrial fibrillation on patients having undergone different heart surgery procedures. The results of our research are a review of clinical data which were collected prospectively, over a 10-year period, from all the patients who had undergone heart surgery in our Institute. The study group included 1119 heart surgery patients, who were divided as follows: the preoperative AFib group (n = 226, 20.19%) and the sinus rhythm group (n = 893, 79.80%). Major postoperative complications and hospital mortality rates were analyzed. According to our statistical analysis, preoperative atrial fibrillation significantly increased the mortality risk (P = 0.001), the patients' mechanical ventilation needs (P = 0.022), the rate of occurrence of infectious complications (P < 0.5), the rate of occurrence of complications such as acute kidney failure (P = 0.012), and the time spent by the patients in the intensive care ward (P < 0.01). In conclusion, preoperative atrial fibrillation in heart surgery patients increases the mortality and major complication risk further to heart surgery. PMID:25105131

Anghel, Diana; Anghel, Radu; Corciova, Flavia; Enache, Mihail; Tinica, Grigore

2014-01-01

285

Electrical Remodeling of the Human Atrium: Similar Effects in Patients With Chronic Atrial Fibrillation and Atrial Flutter 1 1 To discuss this article on-line, visit the ACC Home Page at www.acc.org\\/members and click on the JACC Forum  

Microsoft Academic Search

Objectives. This study sought to determine whether chronic atrial fibrillation (AF) and atrial flutter in patients lead to electrical remodeling of the human atrial myocardium, manifested by an abnormal relation between atrial cycle length and action potential duration (APD).Background. Experimental studies in goats and isolated human atrial tissue have shown that prolonged AF leads to persistent shortening of atrial refractoriness,

Michael R Franz; Pamela L Karasik; Cuilan Li; Jean Moubarak; Mary Chavez

1997-01-01

286

[Atrial fibrillation and thromboprophylaxis in elderly patients].  

PubMed

Chronic, nonvalvular atrial fibrillation occurs more frequently with increasing age, together with an increasing risk for ischemic stroke. Guidelines recommend oral anticoagulation with a vitamin K antagonist for patients >65 years without risk factors and patients <65 years with risk factors for cardiac diseases. Advancing age also increases the risk for bleeding complications under oral anticoagulants; thus, only a part of these patients receives anticoagulant therapy. The risk of falls in elderly patients is of advancing relevance for this therapeutic decision. Oral direct thrombin inhibitors like ximelagatran may be an alternative choice for therapy. Ischemic strokes and systemic embolism in the same frequency with 2x36 mg ximelagatran over 18 months (91/3664 patients: 1.6%/year, for study Sportif III and Sportif V) compared with warfarin (93/3665 patients: 1.6%/year for study Sportif III and Sportif V). All bleeding complications occurred less frequently under therapy with ximelagatran. This could be of importance for elderly patients with risk factors for bleeding or risk of falling. PMID:15674738

Jörg, I; Harenberg, J; Fenyvesi, T; Gladisch, R

2005-02-01

287

New Oral Anticoagulants for Atrial Fibrillation  

PubMed Central

Atrial fibrillation (AF) is the most common cardiac arrhythmia in the U.S. Anticoagulation is recommended for stroke prevention in AF patients with intermediate-to-high stroke risk (i.e., patients with a CHADS2 score of 1 or greater). Warfarin was previously the only option for oral anticoagulation in these patients, but three new oral anticoagulants have become available as alternatives for warfarin in patients with nonvalvular AF. The advantages of the newer agents include a rapid onset, predictable pharmacokinetics, and no need for routine anticoagulation monitoring. Dabigatran (Pradaxa) and apixaban (Eliquis) have demonstrated improved efficacy compared with warfarin. Rivaroxaban (Xarelto) was non-inferior to warfarin for stroke prevention in AF. Apixaban demonstrated a reduced incidence of major bleeding compared with warfarin and a reduction in all-cause mortality. Limitations to the use of the new oral anticoagulants include the lack of a reversal agent; an inability to use the therapies in specific patient populations (such as those with severe renal or hepatic impairment); limited experience with drug–drug and drug–disease interactions; and a lack of available coagulation tests to quantify their effects. Although the newer agents have higher acquisition costs, the benefits of cost savings may be derived from the potential for decreasing the incidence of hemorrhagic stroke and intracranial bleeding and reducing the need for anticoagulation monitoring. Benefits and risks should be carefully weighed before these agents are prescribed for patients presenting with new-onset AF. PMID:24672216

Shafeeq, Hira; Tran, Tran H.

2014-01-01

288

Percutaneous left atrial appendage occlusion for stroke prevention in atrial fibrillation: an update  

PubMed Central

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice. One of its most devastating complications is the development of thromboembolism leading to fatal or disabling stroke. Oral anticoagulation (OAC, warfarin) is the standard treatment for stroke prevention in patients with AF with an increased stroke risk. However, there are several obstacles to long-term OAC therapy, including the risk of serious bleeding, several drug–drug interactions and the need for frequent blood testing. Although newer oral anticoagulants have been developed, these drugs also face issues of major bleeding and non-compliance. Therefore, alternative treatment options for stroke prevention in patients with AF with a high stroke risk are needed. Percutaneous left atrial appendage (LAA) occlusion is an evolving therapy, which should be taken into consideration in those patients with non-valvular AF with a high stroke risk and contraindications for OAC. This article aims to discuss the rationale for LAA closure, the available LAA occlusion devices and their clinical evidence until now. Moreover, we discuss the importance of proper patient selection, the role of various imaging techniques and the need for a more tailored postprocedural antithrombotic therapy. PMID:25332785

De Backer, O; Arnous, S; Ihlemann, N; Vejlstrup, N; J?rgensen, E; Pehrson, S; Krieger, T D W; Meier, P; S?ndergaard, L; Franzen, O W

2014-01-01

289

Treatment of Atrial Fibrillation By The Ablation Of Localized Sources  

PubMed Central

Objectives We hypothesized that human atrial fibrillation (AF) may be sustained by localized sources (electrical rotors and focal impulses), whose elimination (Focal Impulse and Rotor Modulation, FIRM) may improve outcome from AF ablation. Background Catheter ablation for AF is a promising therapy, whose success is limited in part by uncertainty in the mechanisms that sustain AF. We developed a computational approach to map whether AF is sustained by several meandering waves (the prevailing hypothesis) or localized sources, then prospectively tested whether targeting patient-specific mechanisms revealed by mapping would improve AF ablation outcome. Methods We recruited 92 individuals during 107 consecutive ablation procedures for paroxysmal or persistent (72%) AF. Cases were prospectively treated, in a 2-arm 1:2 design, by ablation at sources (FIRM-Guided) followed by conventional ablation (n=36), or conventional ablation alone (n=71; FIRM-Blinded). Results Localized rotors or focal impulses were detected in 98 (97%) of 101 cases with sustained AF, each exhibiting 2.1±1.0 sources. The acute endpoint (AF termination or consistent slowing) was achieved in 86% of FIRM-guided versus 20% of FIRM-Blinded cases (p<0.001). FIRM ablation alone at the primary source terminated AF in 2.5 minutes (median; IQR 1.0–3.1). Total ablation time did not differ between groups (57.8±22.8 versus 52.1±17.8 minutes, p=0.16). During 273 days (median; IQR 132–681 days) after a single procedure, FIRM-Guided cases had higher freedom from AF (82.4% versus 44.9%; p<0.001) after a single procedure than FIRM-blinded cases with rigorous, often implanted, ECG monitoring. Adverse events did not differ between groups. CONCLUSIONS Localized electrical rotors and focal impulse sources are prevalent sustaining-mechanisms for human AF. FIRM ablation at patient-specific sources acutely terminated or slowed AF, and improved outcome. These results offer a novel mechanistic framework and treatment paradigm for AF. (ClinicalTrials.gov number, NCT01008722) PMID:22818076

Narayan, Sanjiv M.; Krummen, David E.; Shivkumar, Kalyanam; Clopton, Paul; Rappel, Wouter-Jan; Miller, John M.

2012-01-01

290

Atrial and ventricular isomyosin composition in patients with different forms of cardiac hypertrophy.  

PubMed

In man, various forms of compensatory and idiopathic hypertrophic states can be differentiated by haemodynamic and angiographic parameters. They are morphologically indistinguishable with regard to muscle fibre diameter and non-muscle tissue content. They are, however, accompanied by contractile dysfunction of various degrees or even by hypercontractility. In hearts subjected to chronic increase in workload the peptide pattern of the slow ventricular myosin heavy chain (HC) type VM-3 does not change, while that of the fast atrial type HC does. In atria also the ventricular type of myosin light chain-2 (VLC-2) is occurring. In certain forms of hypertrophy we found the atrial type ALC-1 occurring in the ventricular tissue, in individual cases amounting to 30% of total LC-1, on average, 12% in dilated cardiomyopathy, 6% in pressure and 3% in volume overload and 2% in cases with reduced myocardial mass due to infarction. No such increase of ALC-1 was found in hypertrophic cardiomyopathy or in coronary heart disease without infarction. The isoform expression of myosin HC and LC is thus governed independently of one another in response to altered physiological or pathological conditions. A significant correlation of the ALC-1 content in ventricles could be established with the peak circumferential wall stress. This may imply the involvement of the LC-1 in the contractile properties of the myofibrils. PMID:2959263

Schaub, M C; Hirzel, H O

1987-01-01

291

Left atrial pressure in normotensive and spontaneously hypertensive rats.  

PubMed

The left atrial pressure in adult spontaneously hypertensive rats (SHR) of the Okamoto strain and normotensive control rat (NCR) was measured via chronically implanted catheters. In SHR left atrial pressure in end-expiration was more than twice as high (10.3 +/- 0.4 mmHg) as in NCR (4.6 +/- 0.3 mmHg). There was no difference in the intrapleural pressure between the two groups of rats, therefore the enhanced left atrial pressure in SHR represents a real rise in the diastolic filling pressure of its left ventricle. This is considered to be the most important compensation for the earlier reported rightward shift of the Frank-Starling curve in SHR (Hallbäck, Isaksson & Noresson 1975, Noresson et al. 1979a). Without this compensation the stroke volume would have been drastically reduced for the hypertrophied heart. PMID:160746

Noresson, E; Ricksten, S E; Thorén, P

1979-09-01

292

Evaluation of the WATCHMAN left atrial appendage closure device.  

PubMed

Left atrial appendage device occlusion for the preventions of systemic thromboembolism and stroke represents a major breakthrough in the field of cardiovascular disease. The wide prevalence of atrial fibrillation with devastating consequences of thromboembolic stroke as a result of thrombus arising from the left atrial appendage has led to the development of transcatheter and surgical based occlusion devices. Though this device is yet to be formally approved for a clinical indication in the USA, the WATCHMAN appendage occlusion device remains the most rigorously examined and studied of all transcatheter-based devices in this space. This review will focus on the needs assessment in this space, the technology of the current WATCHMAN device, trials and studies looking at safety and efficacy, specific patient populations who might benefit as well as future perspectives. PMID:25060590

Alli, Oluseun; Holmes, David

2014-11-01

293

[Stroke prevention in atrial fibrillation : old and new anticoagulants].  

PubMed

Atrial fibrillation is the most common form of cardiac arrhythmia with an age-dependent increase in prevalence. It is common clinical practice to treat patients with atrial fibrillation and who have a high risk for thromboembolic stroke with vitamin K antagonists. However, due to the many problems with vitamin K antagonist therapy many high risk patients are either not treated at all or receive insufficient anticoagulation treatment. The new oral anticoagulants, e.g. dabigatran as a direct thrombin antagonist or rivaroxaban and apixaban as factor Xa antagonists were tested in large scale clinical trials with respect to the efficacy in stroke prevention in atrial fibrillation patients. The therapeutic superiority over warfarin could be impressively proven either with respect to the efficacy in stroke prevention and/or to the safety of therapy with a significant decrease in cerebral bleeding complications. PMID:23632424

Darius, H; Sommer, S

2013-05-01

294

Diagnosis of the cavo-hepato-atrial pathway in Budd-Chiari syndrome by ultrasonography  

PubMed Central

The aim of this study was to investigate the ultrasonic features of the cavo-hepato-atrial pathway in Budd-Chiari syndrome (BCS), by which blood is drained from the occluded inferior vena cava (IVC) to the right atrium via hepatic veins. Ultrasonograms from 11 patients with BCS with cavo-hepato-atrial pathways were retrospectively studied. Doppler ultrasound was used to observe the direction of the flow and measure the velocity of the blood-draining vessels. Blood flow in the draining vessels and the collaterals was shown as blue, red or bicolored depending on whether the flow direction was away from the transducer, towards the transducer or both. For measurement, the Doppler angle between the axis of the Doppler beam and that of the vein examined was always <60°. Ultrasonography was performed 1–2 weeks prior to digital subtraction angiography (DSA). All patients were confirmed by DSA. Membranous and segmental occlusions of IVCs were observed in seven and four cases, respectively. Blood flow from the IVC reversed to the hepatic/accessory hepatic vein, continued through the dilated intrahepatic collaterals, onward to the other hepatic vein and finally to the right atrium. The majority of the inlets (8/11) of hepatic veins above the occlusion were narrow compared with the dilated distant parts of the lumens. Accelerated blood flow in the inlets was detected in all patients regardless of the luminal diameter. In conclusion, the results from the present study suggest that the unusual cavo-hepato-atrial pathway can be diagnosed reliably by ultrasonography, which may be useful for clinical management. PMID:25120601

GAI, YONG-HAO; CAI, SHI-FENG; FAN, HUI-LI; LIU, QING-WEI

2014-01-01

295

Thoracic CT  

MedlinePLUS

... under which the test may be performed: Alcoholic cardiomyopathy Asbestosis Atrial myxoma Cardiac tamponade Coarctation of the aorta Dilated cardiomyopathy Echinococcus Heart failure Histoplasmosis Hypertensive heart disease Idiopathic ...

296

Inflammation and C-Reactive Protein in Atrial Fibrillation: Cause or Effect?  

PubMed Central

Atrial fibrillation is associated with substantial morbidity and mortality rates. The incompletely understood pathogenesis of this cardiac dysrhythmia makes it difficult to improve approaches to primary and secondary prevention. Evidence has accumulated in regard to a relationship between inflammation and atrial fibrillation. Investigators have correlated the dysrhythmia with myocarditis, pericardiotomy, and C-reactive protein levels, suggesting that inflammation causes atrial fibrillation or participates in its onset and continuation. Conversely, other investigators suggest that atrial fibrillation induces an inflammatory response. In this review, we summarize and critically discuss the nature and clinical role of inflammation and C-reactive protein in atrial fibrillation. PMID:25425976

Galea, Roberto; Cardillo, Maria Teresa; Caroli, Annalisa; Marini, Maria Giulia; Sonnino, Chiara; Narducci, Maria L.

2014-01-01

297

Esophageal perforation after radiofrequency ablation for atrial fibrillation.  

PubMed

A 69-year-old man underwent left atrial radiofrequency ablation for atrial fibrillation. After 10 minutes, the procedure was terminated due to pericardial tamponade secondary to perforation during mapping. Pericardiocentesis resolved the tamponade. Ablation was completed one week later, and the patient was discharged. Two days later, he presented with odynophagia. Computed tomography demonstrated small bilateral pleural effusions. He was judged to be stable and was discharged again, but returned 2 days later with chest pain. He was found to have esophageal perforation with empyema, which was repaired using a muscle patch and esophageal stenting, successfully treating the lesion with minimal morbidity. PMID:24887888

Manouchehri, Namdar; Turner, Simon R; Lockwood, Evan; Sterns, Laurence D; Bédard, Eric Lr

2014-11-01

298

The burden of atrial fibrillation in the Netherlands  

Microsoft Academic Search

Background  Atrial fibrillation (AF) is the most common sustained atrial arrhythmia and it is independently associated with an increased\\u000a morbidity and mortality. As a result of the high prevalence of AF, the economic and clinical impact of the disease is substantial.\\u000a This study describes the economic and clinical impact of AF in the Netherlands.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Epidemiological data on AF in the Netherlands

H. E. Heemstra; R. Nieuwlaat; M. Meijboom; H. J. Crijns

299

Persistent lone atrial fibrillation -- its progress after clinical diagnosis  

PubMed Central

Eighty-three patients whose atrial fibrillation appeared to be permanent and the sole cardiac abnormality at the time of diagnosis were followed for one to 19 years (mean 7.5 years). None suffered systemic embolism. Three died, none of cardiac disease. Sinus rhythm returned in seven. Another six developed features suggestive of other heart disease. In the remaining 67, the initial diagnosis of persistent lone atrial fibrillation remained tenable and they remained well. The medium-term prognosis for patients with this disorder seems good. PMID:529243

Close, J. B.; Evans, D. W.; Bailey, S. M.

1979-01-01

300

Stroke and bleeding risk in atrial fibrillation.  

PubMed

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

Senoo, Keitaro; Lane, Deirdre; Lip, Gregory Yh

2014-09-01

301

Left atrium segmentation for atrial fibrillation ablation  

NASA Astrophysics Data System (ADS)

Segmentation of the left atrium is vital for pre-operative assessment of its anatomy in radio-frequency catheter ablation (RFCA) surgery. RFCA is commonly used for treating atrial fibrillation. In this paper we present an semi-automatic approach for segmenting the left atrium and the pulmonary veins from MR angiography (MRA) data sets. We also present an automatic approach for further subdividing the segmented atrium into the atrium body and the pulmonary veins. The segmentation algorithm is based on the notion that in MRA the atrium becomes connected to surrounding structures via partial volume affected voxels and narrow vessels, the atrium can be separated if these regions are characterized and identified. The blood pool, obtained by subtracting the pre- and post-contrast scans, is first segmented using a region-growing approach. The segmented blood pool is then subdivided into disjoint subdivisions based on its Euclidean distance transform. These subdivisions are then merged automatically starting from a seed point and stopping at points where the atrium leaks into a neighbouring structure. The resulting merged subdivisions produce the segmented atrium. Measuring the size of the pulmonary vein ostium is vital for selecting the optimal Lasso catheter diameter. We present a second technique for automatically identifying the atrium body from segmented left atrium images. The separating surface between the atrium body and the pulmonary veins gives the ostia locations and can play an important role in measuring their diameters. The technique relies on evolving interfaces modelled using level sets. Results have been presented on 20 patient MRA datasets.

Karim, R.; Mohiaddin, R.; Rueckert, D.

2008-03-01

302

Stroke and Bleeding Risk in Atrial Fibrillation  

PubMed Central

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.

Senoo, Keitaro; Lane, Deirdre

2014-01-01

303

Fish Intake and Risk of Incident Atrial Fibrillation  

PubMed Central

Background— Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is particularly common in the elderly. Although effects of fish intake, including potential antiarrhythmic effects, may favorably influence risk of AF, relationships between fish intake and AF incidence have not been evaluated. Methods and Results— In a prospective, population-based cohort of 4815 adults ?age 65 years, usual dietary intake was assessed at baseline in 1989 and 1990. Consumption of tuna and other broiled or baked fish correlated with plasma phospholipid long-chain n-3 fatty acids, whereas consumption of fried fish or fish sandwiches (fish burgers) did not. AF incidence was prospectively ascertained on the basis of hospital discharge records and annual electrocardiograms. During 12 years’ follow-up, 980 cases of incident AF were diagnosed. In multivariate analyses, consumption of tuna or other broiled or baked fish was inversely associated with incidence of AF, with 28% lower risk with intake 1 to 4 times per week (HR=0.72, 95% CI=0.58 to 0.91, P=0.005), and 31% lower risk with intake ?5 times per week (HR=0.69, 95% CI=0.52 to 0.91, P=0.008), compared with <1 time per month (P trend=0.004). Results were not materially different after adjustment for preceding myocardial infarction or congestive heart failure. In similar analyses, fried fish/fish sandwich consumption was not associated with lower risk of AF. Conclusions— Among elderly adults, consumption of tuna or other broiled or baked fish, but not fried fish or fish sandwiches, is associated with lower incidence of AF. Fish intake may influence risk of this common cardiac arrhythmia. PMID:15262826

Mozaffarian, Dariush; Psaty, Bruce M.; Rimm, Eric B.; Lemaitre, Rozenn N.; Burke, Gregory L.; Lyles, Mary F.; Lefkowitz, David; Siscovick, David S.

2005-01-01

304

Acute Exposure to Air Pollution Triggers Atrial Fibrillation  

PubMed Central

Objective The aim of the present study is to evaluate the association of air pollution with the onset of atrial fibrillation (AF). Background Air pollution in general and more specifically particulate matter has been associated with cardiovascular events. Although ventricular arrhythmias are traditionally thought to convey the increased cardiovascular risk, AF may also contribute. Methods Patients with dual chamber implantable cardioverter defibrillators (ICDs) were enrolled and followed prospectively. The association of AF onset with air quality including ambient PM2.5, black carbon, sulfate, particle number, NO2, SO2, and O3 in the 24 hours prior to the arrhythmia was examined utilizing a case-crossover analysis. In sensitivity analyses, associations with air pollution between 2 and 48 hours prior to the AF were examined. Results Of 176 patients followed for an average of 1.9 years, 49 patients had 328 episodes of AF lasting ? 30 seconds. Positive but nonsignificant associations were found for PM2.5 in the prior 24 hours, but stronger associations were found with shorter exposure windows. The odds of AF increased by 26% (95% CI 8% to 47%) for each 6.0 µg/m3 increase in PM2.5 in the 2 hours prior to the event (p=0.004). The odds of AF was highest at the upper quartile of mean PM2.5. Conclusion Particulate matter was associated with increased odds of AF onset within hours following exposure in patients with known cardiac disease. Air pollution is an acute trigger of AF, likely contributing to the pollution-associated adverse cardiac outcomes observed in epidemiological studies. PMID:23770178

Link, Mark S.; Luttmann-Gibson, Heike; Schwartz, Joel; Mittleman, Murray A.; Wessler, Benjamin; Gold, Diane R.; Dockery, Douglas W.; Laden, Francine

2013-01-01

305

Impact of microRNA Expression in Human Atrial Tissue in Patients with Atrial Fibrillation Undergoing Cardiac Surgery  

PubMed Central

Background Although microRNA (miRNA) regulates initiation and/or progression of atrial fibrillation (AF) in canine AF models, the underlying mechanism in humans remains unclear. We speculated that certain miRNAs in atrial tissue are related to AF, and evaluated the relationship of miRNA expression in human atrial tissue in cardiac surgery patients. Methods Right atrial tissues from 29 patients undergoing cardiovascular surgery were divided into 3 groups [A: chronic AF or unsuccessful maze, n=6; B: successful maze, n=10; C: sinus rhythm (SR) n=13]. miRNA expression was determined using high density microarrays and with Reverse transcriptase-polymerase chain reaction (RT-PCR). Fibrosis was examined using Masson trichrome staining. Results miRNA microarray analysis showed elevated miRNA-21, miRNA-23b, miRNA-199b, and miRNA-208b in AF as compared to SR groups. RT-PCR showed elevated miRNA-21 (1.9-fold) and miRNA-208b (4.2-fold) in AF as compared to the SR groups. miRNA-21 expression increased from Group C to A (A: 2.1-fold, B: 1.8-fold, C: 1.0-fold). Fibrosis increased from C to A (A: 43.0±12.9%, B: 21.3±6.1%, C: 11.9±3.1%). Percent fibrosis and miRNA-21 expression were correlated (r=0.508, p<0.05). The plasma levels of miRNA-21 in AF patients was significantly decreased as compared to the healthy volunteers (p<0.05). Conclusion The expression of miRNA-21 in human atrial tissue was found to be related to atrial fibrosis and might affect AF occurrence, indicating its usefulness as a biomarker for cardiac surgery management. PMID:24069193

Nishi, Hiroyuki; Sakaguchi, Taichi; Miyagawa, Shigeru; Yoshikawa, Yasushi; Fukushima, Satsuki; Saito, Shunsuke; Ueno, Takayoshi; Kuratani, Toru; Sawa, Yoshiki

2013-01-01

306

Alterations in the expression of atrial calpains in electrical and structural remodeling during aging and atrial fibrillation.  

PubMed

The aim of this study was to investigate the correlation between the change in the expression of atrial calpains and electrical, molecular and structural remodeling during aging and atrial fibrillation (AF). Adult and aged canines in sinus rhythm (SR) and with persistent AF (induced by rapid atrial pacing) were investigated. A whole-cell patch clamp was used to measure the L-type Ca2+ current (ICa-L) in cells in the left atrium. The mRNA and protein expression of the L-type calcium channel alc subunit (LVDCCa1c) and calpains were measured by quantitative (q)PCR and western blot analysis. Histopathological and ultrastructural changes were analyzed via light and electron microscopy. The quantity of apoptotic myocytes was determined by a terminal deoxynucleotidyl-transferase-mediated dUTP nick end labeling (TUNEL) assay. In SR groups, atrial cells of the aged canines exhibited a longer action potential (AP) duration to 90% repolarization (APD90), lower AP plateau potential and peak ICa-L current densities (P<0.05). In the adult and aged groups, AF led to a higher maximum diastolic potential, an increase in AP amplitude and decreases in APD90, AP plateau potential and peak ICa-L densities (P<0.05). Compared with the control group, the mRNA and protein expression levels of LVDCCa1c were decreased in the aged groups; however, the mRNA and protein expression of calpain 1 was increased in the adult and the aged groups with AF (P<0.05). Samples of atrial tissue exhibited abnormal histopathological and ultrastructural changes, such as accelerated fibrosis and apoptosis with aging and in AF. Age-related alterations in atrial tissues were attributed to the increased expression of calpain 1. The general pathophysiological alterations in normal aged atria may therefore produce a substrate that is conducive to AF. PMID:24043247

Xu, Guo-Jun; Gan, Tian-Yi; Tang, Bao-Peng; Chen, Zu-Heng; Mahemuti, Ailiman; Jiang, Tao; Song, Jian-Guo; Guo, Xia; Li, Yao-Dong; Zhou, Xian-Hui; Zhang, Yu; Li, Jin-Xin

2013-11-01

307

A hazardous finding of a rare anomalous left main coronary artery in a patient with a secundum atrial septal defect  

PubMed Central

A 23-year-old male referred for evaluation of a “choking” sensation with exertion and a murmur. A transthoracic echocardiogram demonstrated right atrial and ventricular dilatation, right ventricular volume overload, and a large secundum atrial septal defect (ASD) with left to right shunt and a calculated pulmonary-to-systemic blood flow ratio (Qp/Qs) estimated at 2.3 to 1. Cardiac catheterization also demonstrated evidence of the ASD with Qp/Qs of 4.6 to 1 with a significant step-up in oxygen saturation at the right atrial level. Additionally, an anomalous left main coronary artery (ALMCA) origin from the anterior right coronary cusp was suspected. Using 64-slice multidetector computed tomography coronary angiography (CCTA) the left main coronary artery was seen to arise from the right coronary cusp then traverse between the pulmonary trunk and the proximal ascending aorta before bifurcating into the left anterior descending and circumflex arteries that followed their normal courses distally. Based on the high risk nature of associated sudden death from an anomalous left main coronary artery (ALMCA) coursing between the aorta and the pulmonary trunk, the patient underwent surgical re-implantation of the ALMCA to the left coronary cusp and repair of the ASD. This case highlights a rare finding of a hazardous ALMCA in a patient with a secundum ASD and the utility of CCTA in evaluating the course of coronary anomalies along with other cardiac pathology. PMID:18629372

Emery, Michael; Ghumman, Waqas; Teague, Shawn; Mahenthiran, Jo

2008-01-01

308

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

PubMed Central

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.

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

2014-01-01

309

Estrogen receptor 1 gene (TA)n polymorphism is associated with lone atrial fibrillation in men  

PubMed Central

Aim To determine the association between the number of thymine-adenine (TA)n dinucleotide repeats in the promoter region of the gene coding for the estrogen receptor alpha (ESR1) and the prevalence of lone atrial fibrillation (AF) in men. Methods We conducted a case-control study involving 89 men with lone AF and 166 healthy male controls. The ESR1 genotype was established by polymerase chain reaction and capillary electrophoresis. To assess the association of ESR1 genotype with AF, logistic regression models were built with AF as outcome. Results Men with lone AF had significantly greater number of (TA)n repeats of single alleles than controls (mean?±?standard deviation, 19.2?±?4.2 vs 18?±?4.3, P?=?0.010). After adjustment for other factors, a unit-increase in (TA)n repeat number was associated with a significantly greater likelihood of AF (odds ratio 1.069; 95% confidence interval 1.024-1.116, P?=?0.002). Conclusions Our results indicate that a greater number of (TA)n repeats in the promoter region of ESR1 is associated with a significantly increased likelihood of lone atrial fibrillation in men. PMID:24577825

Golubic, Karlo; Smalcelj, Anton; Sertic, Jadranka; Juricic, Ljiljana

2014-01-01

310

Epidemiology and natural history of atrial fibrillation: clinical implications  

Microsoft Academic Search

With a substantial impact on morbidity and mortality, the growing “epidemic” of atrial fibrillation (AF) intersects with a number of conditions, including aging, thromboembolism, hemorrhage, hypertension and left ventricular dysfunction. Currently, the epidemiology and natural history of AF govern all aspects of its clinical management. The ongoing global investigative efforts toward understanding AF are also driven by epidemiologic findings. New

Sumeet S Chugh; Joseph L Blackshear; Win-Kuang Shen; Stephen C Hammill; Bernard J Gersh

2001-01-01

311

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

PubMed Central

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

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

2013-01-01

312

Development of Epicardial Mapping System for Studying Atrial Fibrillation  

Microsoft Academic Search

Epicardial mapping system is an important tool for studying electrophysiological characteristics of atrial fibrillation (AF). AF is the most common arrhythmia and is becoming more prevalent each year. Most in vivo experimental research on AF is performed by simultaneous epicardial mapping technique. An epicardial mapping system is developed to record electrical activities from 128 sites at the same time, with

Cuiwei Yang; Weijia Lu; Tuo Zhou; Xiaomei Wu; Zuxiang Fang

2008-01-01

313

A New System for Whole-atrial Epicardial Mapping  

Microsoft Academic Search

Epicardial mapping system is an important tool in the study and treatment of cardiac arrhythmias. Surgical therapy has been applied to eliminate atrial fibrillation (AF) for almost two decades, but there is still little effect on the treatment of AF in respect that the mechanism of AF is still unknown. Further investigation into the electrophysiological properties in AF is required

Cuiwei Yang; Zuxiang Fang; Xiaomei Wu; Jun Lu; Anqi Lou

2005-01-01

314

Atrial natriuretic peptide in peripheral organs other than the heart  

Microsoft Academic Search

Summary The heart atria represent the major site of synthesis of atrial natriuretic peptide (ANP) in mammals including man, and its function as a regulator of water and salt homeostasis has been repeatedly suggested. However, more recently ANP has been located in organs not intimately related to cardiovascular physiology, e.g. the adrenals, lungs, and gut, as well as tissues belonging

A. M. Vollmar

1990-01-01

315

Older Age Is the Strongest Predictor of Postoperative Atrial Fibrillation  

Microsoft Academic Search

Background: Identification of patients vulnerable for atrial fibrillation (AF) after major thoracic surgery will allow targeting those most likely to benefit from prophylactic therapy. The goal of the current study was to evaluate the accuracy of easily available clinical characteristics for the prediction of this complication. Methods: Patients undergoing major elective thoracic surgery were chosen from an ongoing prospective database.

David Amar; Hao Zhang; Denis H. Y. Leung; Nancy Roistacher; Alan H. Kadish

2002-01-01

316

Predicting Atrial Fibrillation termination using ECG features, a comparison  

Microsoft Academic Search

In this study, surface ECG recordings have been used to accomplish a non-invasive method which can predict spontaneous termination of Atrial Fibrillation (AF) and discriminate terminating (T) and non-terminating (N) AF episodes. The data set was provided by Physionet including holter recordings of 50 patients (20 training and 30 test sets). Concerning that most relevant information about the AF exists

S. Saberi; V. Esmaeili; F. Towhidkhah; M. H. Moradi

2008-01-01

317

Graded balloon dilation atrial septostomy in severe primary pulmonary hypertension  

Microsoft Academic Search

Objectives. We sought to investigate the acute hemodynamic effects of graded balloon dilation atrial septostomy (BDAS) and to define the long-term impact of this procedure on New York Heart Association functional class and survival in adult patients with primary pulmonary hypertension (PPH).Background. Current treatment strategies for patients with severe and refractory PPH are limited by either technical difficulties and high

Julio Sandoval; Jorge Gaspar; Tomás Pulido; Edgar Bautista; Maria Luisa Martínez-Guerra; Marco Zeballos; Andrés Palomar; Arturo Gómez

1998-01-01

318

Vagally Mediated Atrial Fibrillation in a Young Man  

Microsoft Academic Search

trial fibrillation may be provoked by either vagal or sympathetic stimulation. Sympa- thetic effects are common in middle-aged and elderly patients with underlying heart dis- ease. However, in the young, nondiseased heart, vagal influences are more likely to pre- dominate. Recognition of vagally mediated atrial fibrillation in young adults as a unique clinical entity has diagnostic and therapeutic implications. Arch

Erika N. Ringdahl

319

Asymptomatic right atrial aneurysm: fortuitous finding and resection  

Microsoft Academic Search

A rare right atrial aneurysm is described in a 36-year-old man. After median sternotomy for coronary bypass, a thin-walled aneurysmal dilatation of the right atrium was seen by chance. The patient was in sinus rhythm. The aneurysm was surgically resected. The postoperative course was uneventful.

C. J. A. M. Zeebregts; A. G. Hensens; L. K. Lacquet

1997-01-01

320

Pathophysiological Determinants of Worse Stroke Outcome in Atrial Fibrillation  

Microsoft Academic Search

Background: The reasons for worse outcome following ischemic stroke in patients with atrial fibrillation (AF) remain unclear. We aimed to elucidate the pathophysiological determinants of poorer stroke outcome in patients with AF using systematic MRI data from the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). Methods: Comparisons of infarct size, hypoperfusion volume, infarct growth, arterial occlusion, recanalization, reperfusion, hemorrhagic transformation and

Hans T. H. Tu; Bruce C. V. Campbell; Soren Christensen; Marnie Collins; Deidre A. De Silva; Kenneth S. Butcher; Mark W. Parsons; Patricia M. Desmond; P. Alan Barber; Christopher R. Levi; Christopher F. Bladin; Geoffrey A. Donnan; Stephen M. Davis

2010-01-01

321

Transthoracic echocardiographic guidance of transcatheter atrial septal defect closure  

Microsoft Academic Search

This study examines the safety and efficacy of transthoracic echocardiographic (TTE) guidance of atrial septal defect (ASD) device closure. We evaluated 74 patients for TTE-guided ASD closure. Fifty-six patients had successful device implantation using TTE guidance. Twelve patients were referred for surgical ASD closure on the basis of TTE evaluation. Five patients with multiple ASDs or poor transthoracic acoustic windows

Richard E Kardon; Mary C Sokoloski; Daniel S Levi; James S Perry; Douglas J Schneider; Vivekanand Allada; John W Moore

2004-01-01

322

Atrial natriuretic peptide blocks renin response to renal hypotension  

SciTech Connect

The authors have reported that the renin response to systemic hypotension is inhibited in the presence of elevated atrial pressure and that elevations in atrial pressure of similar or larger magnitude cause graded increases in plasma atrial natriuretic peptide (ANP). Therefore they tested the hypothesis that comparable increments in plasma ANP can inhibit renal hypotension-induced increases in plasma renin activity (PRA) in conscious dogs. Renal perfusion pressure was controlled using cuffs implanted around the abdominal aorta just above the renal arteries. Reducing renal perfusion pressure by 10 or 30% of control caused graded increases in PRA. Infusion of 1-28 rat ANP, which increased plasma ANP by 34.8 +/- 7.5 (SE) pg/ml, eliminated increases in PRA in response to a 10% reduction in renal perfusion pressure and markedly inhibited the response to a 30% pressure reduction. ANP and PRA were measured by radioimmunoassay. These results indicate that increments in plasma ANP which reproduce endogenous release inhibit renal hypotension-induced stimulation of PRA. Furthermore, the results provide an explanation for the inhibition of the renin response to renal hypotension during elevate atrial pressure.

Scheuer, D.A.; Thrasher, T.N.; Quillen, E.W. Jr.; Metzler, C.H.; Ramsay, D.J.

1987-02-01

323

Ablation strategies reflect evolving concepts of atrial fibrillation mechanisms  

Microsoft Academic Search

Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice and results in the largest number of arrhythmia related hospital admissions. Despite the enormity of its impact on patients and the health care system, current medical therapy for AF is inadequate. Therapeutic approaches have been guided by understanding of fibrillation mechanisms. AF results from multiple simultaneous reentrant wavefronts.

Daniel L. Lustgarten; Peter S. Spector

2001-01-01

324

Takotsubo Cardiomyopathy as a Sequela of Elective Direct-Current Cardioversion for Atrial Fibrillation  

PubMed Central

In takotsubo cardiomyopathy, the clinical appearance is that of an acute myocardial infarction in the absence of obstructive coronary artery disease, with apical ballooning of the left ventricle. The condition is usually precipitated by a stressful physical or psychological experience. The mechanism is unknown but is thought to be related to catecholamine excess. We present the case of a 67-year-old woman who experienced cardiogenic shock caused by takotsubo cardiomyopathy, immediately after undergoing elective direct-current cardio-version for atrial fibrillation. After a course complicated by left ventricular failure, cardiogenic shock, and ventricular tachycardia, she made a complete clinical and echocardiographic recovery. In addition to this case, we discuss the possible direct effect of cardioversion in takotsubo cardiomyopathy. PMID:24808781

Siegfried, Jonathan S.; Bhusri, Satjit; Guttenplan, Nils; Coplan, Neil L.

2014-01-01

325

Aorto-right atrial fistula: Late complication of tricuspid valve infective endocarditis  

PubMed Central

Abnormal connections between the ascending aorta and the cardiac chambers are rare, especially in the context of right-sided infective endocarditis (IE). Transthoracic echocardiography (TTE) with color-flow Doppler, transesophageal echocardiography (TEE), or both may be required for diagnosis. We present the case of a woman admitted with right-sided heart failure (HF) symptoms. She had a previous history of tricuspid valve IE 30 years ago. TTE and TEE revealed an aorto-right atrium fistula located just under the non-coronary cusp into the right atrium at the level of the previously affected tricuspid valve. The Patient refused surgery and was discharged home on HF medications. She has been stable for the last 3 years. The peculiarity of this case is the late symptomatic presentation of the aorto-atrial fistula and the unusual association to tricuspid valve IE. PMID:25349657

Villablanca, Pedro A; Sukhal, Shashvat; Maitas, Oscar; Onuegbu, Afiachuukwu; Munoz-Pena, Juan M; Joseph, Ajay; Requena, Carlos; Mohananey, Divyanshu

2014-01-01

326

Connexin40 Imparts Conduction Heterogeneity to Atrial Tissue  

PubMed Central

Impulse propagation in cardiac tissue is a complex process in which intercellular coupling through gap junction channels is a critical component. Connexin40 (Cx40) is an abundant gap junction protein that is expressed in atrial myocytes. Alterations in the expression of Cx40 have been implicated in atrial arrhythmogenesis. The purpose of the current study was to assess the role of Cx40 in atrial impulse propagation. High-resolution optical mapping was used to study conduction in the right and left atrial appendages of isolated Langendorff-perfused murine hearts. Wild-type (Cx40+/+), heterozygous (Cx40+/?), and knockout (Cx40?/?) mice, both adult and embryonic, were studied to assess the effects of reduced Cx40 expression on sinus node function and conduction velocity at different pacing cycle lengths (100 and 60 ms). In both adult and late-stage embryonic Cx40+/+ mice, heterogeneity in CV was found between the right and left atrial appendages. Either partial (Cx40+/?) or complete (Cx40?/?) deletion of Cx40 was associated with the loss of conduction heterogeneity in both adult and embryonic mice. Additionally, sinus node impulse initiation was found to be ectopic in Cx40?/? mice at 15.5 days postcoitus, whereas Cx40+/+ mice showed normal activation occurring near the crista terminalis. Our findings suggest that Cx40 plays an essential role in establishing interatrial conduction velocity heterogeneity in the murine model. Additionally, we describe for the first time a developmental requirement for Cx40 in normal sinus node impulse initiation at 15.5 days postcoitus. PMID:18599871

Leaf, David E.; Feig, Jonathan E.; Vasquez, Carolina; Riva, Pamela L.; Yu, Cindy; Lader, Joshua M.; Kontogeorgis, Andrianos; Baron, Elvera L.; Peters, Nicholas S.; Fisher, Edward A.; Gutstein, David E.; Morley, Gregory E.

2009-01-01

327

Connexin40 imparts conduction heterogeneity to atrial tissue.  

PubMed

Impulse propagation in cardiac tissue is a complex process in which intercellular coupling through gap junction channels is a critical component. Connexin40 (Cx40) is an abundant gap junction protein that is expressed in atrial myocytes. Alterations in the expression of Cx40 have been implicated in atrial arrhythmogenesis. The purpose of the current study was to assess the role of Cx40 in atrial impulse propagation. High-resolution optical mapping was used to study conduction in the right and left atrial appendages of isolated Langendorff-perfused murine hearts. Wild-type (Cx40(+/+)), heterozygous (Cx40(+/-)), and knockout (Cx40(-/-)) mice, both adult and embryonic, were studied to assess the effects of reduced Cx40 expression on sinus node function and conduction velocity at different pacing cycle lengths (100 and 60 ms). In both adult and late-stage embryonic Cx40(+/+) mice, heterogeneity in CV was found between the right and left atrial appendages. Either partial (Cx40(+/-)) or complete (Cx40(-/-)) deletion of Cx40 was associated with the loss of conduction heterogeneity in both adult and embryonic mice. Additionally, sinus node impulse initiation was found to be ectopic in Cx40(-/-) mice at 15.5 days postcoitus, whereas Cx40(+/+) mice showed normal activation occurring near the crista terminalis. Our findings suggest that Cx40 plays an essential role in establishing interatrial conduction velocity heterogeneity in the murine model. Additionally, we describe for the first time a developmental requirement for Cx40 in normal sinus node impulse initiation at 15.5 days postcoitus. PMID:18599871

Leaf, David E; Feig, Jonathan E; Vasquez, Carolina; Riva, Pamela L; Yu, Cindy; Lader, Joshua M; Kontogeorgis, Andrianos; Baron, Elvera L; Peters, Nicholas S; Fisher, Edward A; Gutstein, David E; Morley, Gregory E

2008-10-24

328

Assessment of atrial electromechanical delay in patients with migraine.  

PubMed

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

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

2014-12-01

329

Study protocol: the DESPATCH study: Delivering stroke prevention for patients with atrial fibrillation - a cluster randomised controlled trial in primary healthcare  

PubMed Central

Background Compelling evidence shows that appropriate use of anticoagulation in patients with nonvalvular atrial fibrillation reduces the risk of ischaemic stroke by 67% and all-cause mortality by 26%. Despite this evidence, anticoagulation is substantially underused, resulting in avoidable fatal and disabling strokes. Methods DESPATCH is a cluster randomised controlled trial with concealed allocation and blinded outcome assessment designed to evaluate a multifaceted and tailored implementation strategy for improving the uptake of anticoagulation in primary care. We have recruited general practices in South Western Sydney, Australia, and randomly allocated practices to receive the DESPATCH intervention or evidence-based guidelines (control). The intervention comprises specialist decisional support via written feedback about patient-specific cases, three academic detailing sessions (delivered via telephone), practice resources, and evidence-based information. Data for outcome assessment will be obtained from a blinded, independent medical record audit. Our primary endpoint is the proportion of nonvalvular atrial fibrillation patients, over 65 years of age, receiving oral anticoagulation at any time during the 12-month posttest period. Discussion Successful translation of evidence into clinical practice can reduce avoidable stroke, death, and disability due to nonvalvular atrial fibrillation. If successful, DESPATCH will inform public policy, providing quality evidence for an effective implementation strategy to improve management of nonvalvular atrial fibrillation, to close an important evidence-practice gap. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12608000074392 PMID:21599901

2011-01-01

330

Totally thoracoscopic surgery for the treatment of atrial septal defect without of the robotic Da Vinci surgical system  

PubMed Central

Background More and more surgeons and patients focus on the minimally invasive surgical techniques in the 21st century. Totally thoracoscopic operation provides another minimal invasive surgical option for patients with ASD (atrial septal defect). In this study, we reported our experience of 61 patients with atrial septal defect who underwent totally thoracoscopic operation and discussed the feasibility and safety of the new technique. Methods From January 2010 to October 2012, 61 patients with atrial septal defect underwent totally thoracoscopic closure but not traditional median sternotomy surgery. We divided the 61 patients into two groups based on the operation sequence. The data of group A (the first 30 cases) and group B (the last 31 cases). The mean age of the patients was 35.1?±?12.8 years (range, 6.3 to 63.5 years), and mean weight was 52.7?±?11.9 kg (range, 30.5 to 80 kg). Mean size of the atrial septal defect was 16.8?±?11.3 mm (range, 13 to 39 mm) based on the description of the echocardiography. Results All patients underwent totally thoracoscopy successfully, 36 patients with pericardium patch and 25 patients were sutured directly. 7 patients underwent concomitant tricuspid valvuloplasty with Key technique. No death, reoperation or complete atrioventricular block occurred. The mean time of cardiopulmonary bypass was 68.5?±?19.1 min (range, 31.0 to 153.0 min), the mean time of aortic cross-clamp was 27.2?±?11.3 min (range, 0.0 to 80.0 min) and the mean time of operation was 149.8?±?35.7 min (range, 63.0 to 300.0 min). Postoperative mechanical ventilation averaged 4.9?±?2.5 hours (range, 3.5 to 12.6 hours), and the duration of intensive care unit stay 20.0?±?4.8 hours (range, 15.5 to 25 hours). The mean volume of blood drainage was 158?±?38 ml (range, 51 to 800 ml). No death, residual shunt, lung atelectasis or moderate tricuspid regurgitation was found at 3-month follow-up. Conclusion The totally thoracoscopic operation is feasible and safe for patients with ASD, even with or without tricuspid regurgitation. This technique provides another minimal invasive surgical option for patients with atrial septal defect. PMID:23634811

2013-01-01

331

Identification and Purification of Human Induced Pluripotent Stem Cell-Derived Atrial-Like Cardiomyocytes Based on Sarcolipin Expression  

PubMed Central

The use of human stem cell-derived cardiomyocytes to study atrial biology and disease has been restricted by the lack of a reliable method for stem cell-derived atrial cell labeling and purification. The goal of this study was to generate an atrial-specific reporter construct to identify and purify human stem cell-derived atrial-like cardiomyocytes. We have created a bacterial artificial chromosome (BAC) reporter construct in which fluorescence is driven by expression of the atrial-specific gene sarcolipin (SLN). When purified using flow cytometry, cells with high fluorescence specifically express atrial genes and display functional calcium handling and electrophysiological properties consistent with atrial cardiomyocytes. Our data indicate that SLN can be used as a marker to successfully monitor and isolate hiPSC-derived atrial-like cardiomyocytes. These purified cells may find many applications, including in the study of atrial-specific pathologies and chamber-specific lineage development. PMID:25010565

Josowitz, Rebecca; Lu, Jia; Falce, Christine; D'Souza, Sunita L.; Wu, Meng; Cohen, Ninette; Dubois, Nicole C.; Zhao, Yong; Sobie, Eric A.; Fishman, Glenn I.; Gelb, Bruce D.

2014-01-01

332

Comparison of ability to identify left atrial thrombus by three-dimensional tomography versus transesophageal echocardiography in patients with atrial fibrillation  

Microsoft Academic Search

We sought to determine the potential use of recently introduced cardiac 3-dimensional computed tomography as an alternative to transesophageal echocardiography for examination of the left atrial appendage. Our data suggest that computed tomography is a potential alternative for assessing the anatomy of the left atrial appendage and for detecting thrombi.

Wael A. Jaber; Richard D. White; Stacie A. Kuzmiak; Janet M. Boyle; Andrea Natale; Carolyn Apperson-Hansen; James D. Thomas; Craig R. Asher

2004-01-01

333

Left atrial appendage: morphology and function in patients with paroxysmal and persistent atrial fibrillation.  

PubMed

The anatomical and functional characteristics of the left atrial appendage (LAA) and its relationships with anatomical remodeling and ischemic stroke in patients with atrial fibrillation (AF) have not been clearly established. The purpose of this study was to determine whether functional and morphological features of the LAA independently predict clinical outcome and stroke in patients with AF who underwent catheter ablation (CA). Two hundred sixty-four patients with AF, including 176 with paroxysmal AF (PAF, 54.0 ± 11.4 years old, M:F = 138:38) and 88 with persistent AF (PeAF, 56.4 ± 9.6 years old, M:F = 74:14) were studied. Of these patients, 31 (11.7 %) had a history of stroke/TIA (transient ischemic attack). The LA and LAA volumes were 124.0 ± 42.4 and 24.9 ± 4.3 ml in PeAF, these values were greater than those in PAF (81.2 ± 24.8 ml and 21.2 ± 5.1 ml, P < 0.001). The AF type (P = 0.016) and AF duration (P = 0.005), and anti-arrhythmic drugs use (P < 0.001) were significant predictors of AF recurrence after CA in all patients. Compared with patients without history of stroke, stroke patients had larger LA volume (106.9 ± 23.0 vs. 94.0 ± 38.9 ml, P = 0.004) and had lower LAA EF (50.0 ± 11.0 vs. 65.7 ± 13.4 %, P < 0.001). The independent predictors of stroke were age (P = 0.002) and LAA EF (P < 0.001) in PAF patients and that was only age (P = 0.001) in PeAF patients. In anatomical and morphological parameters of the LA and LAA, only depressed systolic function of the LAA was significantly related to stroke/TIA and recurrence of AF after CA in paroxysmal AF patients. Further large scaled prospective study is required for validation. PMID:23197275

Park, Hwan-Cheol; Shin, Jinho; Ban, Ji-Eun; Choi, Jong-Il; Park, Sang-Weon; Kim, Young-Hoon

2013-04-01

334

Early Heparin Administration Reduces Risk for Left Atrial Thrombus Formation during Atrial Fibrillation Ablation Procedures  

PubMed Central

Objective. Despite the use of anticoagulation during left atrial (LA) ablation procedures, ischemic cerebrovascular accidents (CVAs) are recognized as a serious complication. Heparin is usually given after safe transseptal access has been obtained, resulting in a short unprotected dwell time of catheters within the LA, which may account for CVAs. We investigated the frequency of CVAs and LA thrombus formation as detected by intracardiac ultrasound (ICE) depending on the timing of heparin administration. Methods and Results. Sixty LA ablation procedures with the use of ICE were performed in 55 patients. Patients were grouped by heparin administration after (Group I, n = 13) and before (Group II, n = 47) transseptal access. Group I patients were younger (56.6 ± 13.7 versus 65.9 ± 9.9 years, P = .01); other clinical and echocardiographic characteristics did not differ between groups. Early thrombus formation was observed in 2 (15.4%) of group I patients as compared to 0% of group II patients (P = .04). One CVA (2.1%) occurred in one group II patient without prior thrombus detection, and none occurred in group I patients (P = ns). Conclusion. Early administration of heparin reduces the risk of early intracardiac thrombus formation during LA ablation procedures. This did not result in reduced rate of CVAs. PMID:21747989

Asbach, Stefan; Biermann, Jürgen; Bode, Christoph; Faber, Thomas S.

2011-01-01

335

Hands-free approach for the left atrial appendage in Cox maze IV.  

PubMed

Surgical excision of the left atrial appendage is an essential key in the Cox maze IV procedure. Management of very thin, friable, and delicate tissue in the base of the left atrial appendage can be difficult. We have designed a simple method to expose adequately without handling the base of the left atrial appendage. With this technique, the risk of bleeding due to excessive traction or manipulation of the heart is dramatically reduced. PMID:24585281

Garcia-Villarreal, Ovidio A

2014-11-01

336

Surgical Removal of an Atrial Septal Occluder Device Embolized to the Main Pulmonary Artery  

PubMed Central

Percutaneous closure of atrial septal defects in adults has emerged as an alternative to surgery. We report a sequela of such closure in a 16-year-old boy: embolization of the atrial septal defect occluder into the main pulmonary artery when the patient experienced an episode of intense coughing immediately after device deployment. We removed the device surgically and closed the atrial septal defect in a standard manner, with an autologous pericardial patch. PMID:24512412

Boysan, Emre; Cicek, Mustafa Cuneyt; Hamurcu, Ziyaddin; Gurkahraman, Sami

2014-01-01

337

Cardiovascular and renal effects of eel and rat atrial natriuretic peptide in rainbow trout, Salmo gairdneri.  

PubMed

The renal and in vitro vascular effects of atrial natriuretic peptides have been examined in several species of fish. However, comparatively few investigations have described the effects of these peptides on the cardiovascular system in vivo. In the present experiments the dorsal aorta and urinary bladder were cannulated and the effects of atrial natriuretic peptides from rat and eel were monitored in conscious trout during bolus injection or continuous atrial natriuretic peptide infusion. The results show that the initial pressor effect of atrial natriuretic peptides is independent of environmental salinity adaptation (fresh or seawater) and the chemical form of atrial natriuretic peptide injected, but it is affected by the rate of atrial natriuretic peptide administration. This pressor response, and the accompanying diuresis, are mediated through alpha-adrenergic activation. Continuous infusion of either rat or eel atrial natriuretic peptide produces a steady fall in mean arterial blood pressure, which is temporally preceded by an increase in heart rate and a decrease in pulse pressure. Diuresis induced by atrial natriuretic peptides is only partially sustained during continuous infusion. Propranolol partially blocks the increase induced in heart rate by atrial natriuretic peptides, but does not affect either pulse pressure or mean arterial pressure. Propranolol significantly increases urine flow in saline-infused animals but has no apparent effect on animals subjected to infusions of atrial natriuretic peptides. These results indicate that there are multiple foci for the action of atrial natriuretic peptides in trout and that in many instances the effects of atrial natriuretic peptides are mediated through secondary effector systems. PMID:1357012

Olson, K R; Duff, D W

1992-01-01

338

Venous Thromboembolism Increases the Risk of Atrial Fibrillation: The Troms? Study  

PubMed Central

Background Pulmonary embolism (PE) may trigger atrial fibrillation through increased right atrial pressure and subsequent atrial strain, but the degree of evidence is low. In this study, we wanted to investigate the impact of incident venous thromboembolism (VTE) on future risk of atrial fibrillation in a prospective population?based study. Methods and Results The study included 29 974 subjects recruited from the Tromsø study (1994–1995, 2001–2002, 2007–2008). Incident VTE and atrial fibrillation events were registered from date of enrolment to end of follow?up, December 31, 2010. Cox proportional hazard regression models using age as time?scale and VTE as a time?dependent variable were used to estimate crude and multivariable hazard ratios (HRs) for atrial fibrillation with 95% confidence intervals (CIs). During 16 years of follow up, 540 (1.8%) subjects had an incident VTE event, and 1662 (5.54%) were diagnosed with atrial fibrillation. Among those with VTE, 50 (9.3%) developed subsequent atrial fibrillation. Patients with VTE had 63% higher risk of atrial fibrillation compared to subjects without VTE (multivariable?adjusted HR: 1.63, 95% CI: 1.22 to 2.17). The risk of atrial fibrillation was particularly high during the first 6 months after the VTE event (HR 4.00, 95% CI: 2.21 to 7.25) and among those with PE (HR 1.78, 95% CI: 1.13 to 2.80). Conclusions We found that incident VTE was associated with future risk of atrial fibrillation. Our findings support the hypothesis that PE may lead to cardiac dysfunctions that, in turn, could trigger atrial fibrillation. PMID:24385452

Hald, Erin M.; Enga, Kristin F.; L?chen, Maja-Lisa; Mathiesen, Ellisiv B.; Nj?lstad, Inger; Wilsgaard, Tom; Braekkan, Sigrid K.; Hansen, John-Bjarne

2014-01-01

339

Binding of angiotensin and atrial natriuretic peptide in brain of hypertensive rats  

Microsoft Academic Search

Atrial natriuretic peptides, produced in the mammalian cardiac atrium, are released into the general circulation and may be actively involved in the control of blood pressure and in fluid homeostasis as antagonists of the peripheral angiotensin system1-4. Certain cardiovascular effects of atrial natriuretic peptides may be centrally mediated, as binding sites for atrial natriuretic factor (8-33) (ANF) have been localized

Juan M. Saavedra; Fernando M. A. Correa; Laura M. Plunkett; Anita Israel; Masaki Kurihara; Kazuto Shigematsu

1986-01-01

340

Fluid dynamic comparison of intra-atrial and extracardiac total cavopulmonary connections  

Microsoft Academic Search

Objective: Extracardiac total cavopulmonary connection has recently been introduced as an alternative to intra-atrial procedures. The purpose of this study was to compare the hydrodynamic efficiency of extracardiac and intra-atrial lateral tunnel procedures in total cavopulmonary connections. Methods: Intra-atrial lateral tunnel, extracardiac tunnel, and extracardiac conduit with and without caval vein offset were performed on explanted sheep heart preparations and

Albert C. Lardo; Steven A. Webber; Ingeborg Friehs; Pedro J. del Nido; Edward G. Cape

1999-01-01

341

Computer-assisted animation of atrial tachyarrhythmias recorded with a 64-electrode basket catheter  

Microsoft Academic Search

OBJECTIVESThe aim of this study was to assess the value of a new mapping technique based on computer-assisted animation of multielectrode basket catheter (BC) recordings in patients with atrial arrhythmias.BACKGROUNDThe three-dimensional activation patterns of cardiac arrhythmias are not completely understood owing to limitations of conventional mapping techniques.METHODSThe study included 32 patients with atrial tachycardia (AT) and 38 patients with atrial

Bernhard Zrenner; Gjin Ndrepepa; Michael Schneider; Martin Karch; Florian Hofmann; Albert Schömig; Claus Schmitt

1999-01-01

342

Aortic dissection type A after right atrial cryoablation during port access mitral valve surgery.  

PubMed

The case of a 63-year-old woman who underwent minimal invasive mitral and tricuspid valve repair and a concomitant CryoMaze is described. During creation of the last lesion of the right-sided maze procedure, dissection of the ascending aorta occurred that necessitated emergency sternotomy, replacement of the ascending aorta, and aortocoronary bypass grafting to the right coronary artery (RCA) because of detachment of the RCA from the aortic annulus. Repair of this complication was successful; nevertheless, the patient died 5 days after the operation because of multiorgan failure. The cause of this complication can only be speculated, but a relation to the CyroMaze is obvious. Because of the restricted incision with impaired vision especially in the area of the right atrial appendage, the cryoprobe could have come into contact with the orifice of the RCA during the last lesion, with subsequent detachment of the RCA from the aorta, which could subsequently have caused dissection. PMID:23274873

Fleck, Tatjana; Dworschak, Martin; Wisser, Wilfried

2012-01-01

343

Use of vitamins C and E as a prophylactic therapy to prevent postoperative atrial fibrillation .  

E-print Network

??Oxidative stress has been strongly involved in the underlying mechanism of atrial fibrillation, particularly in the arrhythmia occurring in patients undergoing cardiac surgery with extracorporeal… (more)

Rodrigo, Ramón

2010-01-01

344

Transthoracic echocardiographic predictors of left atrial hypertension in patients on venoarterial extracorporeal membrane oxygenation.  

PubMed

Decompression of the left heart in patients supported with extracorporeal membrane oxygenation (ECMO) is often warranted to protect the myocardium and facilitate recovery. We studied the ability of standard echocardiographic parameters to predict left atrial hypertension by reviewing 3 cardiac patients supported with ECMO who subsequently underwent left atrial decompression. We found that standard echocardiographic parameters poorly predict the need for left atrial decompression on ECMO. Following a more specific diagnostic algorithm to estimate left-sided filling pressure in patients with depressed ejection fraction may significantly improve the ability of echocardiography to accurately predict left atrial hypertension and the need for decompression. PMID:24403357

Eckhauser, Aaron W; Jones, Chris; Witte, Madolin K; Puchalski, Michael D

2014-01-01

345

Immunoreactive atrial natriuretic factor (IR-ANF) in human plasma.  

PubMed

A direct radioimmunoassay for ANF in human plasma was developed. A synthetic alpha-human atrial peptide (Ser 99-Tyr 126) was used for preparation of the iodinated tracer and the standards. The sensitivity of the method is 1.9 pg/ml. Concentration of immunoreactive ANF (IR-ANF) in plasma of 59 clinically normal subjects was 65.3 +/- 2.5 pg/ml (mean +/- SE). In two patients who underwent atrial pacing an increase of about 100 percent in circulating IR-ANF was observed. IR-ANF was extracted from human plasma by Vycor glass and purified by HPLC. The main immunoreactive isolated peak contained a low molecular weight peptide. PMID:3159387

Gutkowska, J; Bourassa, M; Roy, D; Thibault, G; Garcia, R; Cantin, M; Genest, J

1985-05-16

346

[Pulmonary vein ablation in atrial fibrillation. Initial experience].  

PubMed

Despite the progress in the knowledge of the pathophysiology of the atrial fibrillation (AF), the pharmacologic and non pharmacologic approach to prevent and control this arrhythmia has been shown to be discouraging. In the past few years a new type of AF has been described, of which the focal mechanism -especially bound to the pulmonary veins- allows ablation treatment through the radiofrequency (RF) with a catheter. We present our initial experience with this type of method, in two young patients who suffered from multiples episodes of AF and resistance to the conventional treatment. In both patients the RF ablation was done in the left superior pulmonary vein. One of them received an ablation in only one focus, and the other needed a veno-atrial disconnection through the elimination of the pulmonary venous potential from this vein. After three month of follow-up, patients remain asymptomatic with no relapse. PMID:12015937

Velarde, José Luis; Martellotto, Ricardo; Scanavacca, Mauricio; Arévalo, Aldo; Colque, Roberto; Jiménez, Marcelo

2002-05-01

347

Bland–White–Garland syndrome and atrial septal defect—  

Microsoft Academic Search

Summary  We report on a 40–year–old woman referred for evaluation of a cardiac murmur and dyspnea on exertion. The electrocardiogram\\u000a (ECG) showed incomplete right bundle branch block, and echocardiography revealed a large atrial septal defect (ASD, ostium\\u000a secundum type) with dilated right–sided heart chambers. At cardiac catheterization, a large left–to–right shunt (78% of the\\u000a pulmonary blood flow) was found, and surprisingly,

Tino Schneider; Hans Rickli; Volker Gliech; Micha Maeder

2006-01-01

348

Migraine with aura following atrial septostomy for pulmonary arterial hypertension  

Microsoft Academic Search

Background A 34-year-old woman with known familial pulmonary arterial hypertension presented with syncope. Despite medical therapy with an endothelin-receptor antagonist and a phosphodiesterase inhibitor, the patient had NYHA class III symptoms, with exertional dyspnea. Right heart catheterization revealed severe pulmonary hypertension (right atrial pressure 15 mmHg, right ventricular pressure 80\\/15 mmHg, pulmonary artery pressure 80\\/35 mmHg, mean pulmonary artery pressure

Mark P Rogan; Kevin P Walsh; Sean P Gaine

2007-01-01

349

Epicardial Adipose Tissue Thickness and Ablation Outcome of Atrial Fibrillation  

PubMed Central

Objectives Epicardial fat was closely related to atrial fibrillation (AF). Transthoracic echocardiography (TTE) has been proposed to be a convenient imaging tool in assessing epicardial adipose tissue (EAT). The goal of the present study was to investigate whether the EAT thickness measured on TTE was a useful parameter in predicting procedural outcomes of AF ablations. Methods and Results A total of 227 paroxysmal AF (PAF) and 56 non-paroxysmal AF (non-PAF) patients receiving catheter ablations from 2008-2010 were enrolled. Echocardiography-derived regional EAT thickness from parasternal long-axis view was quantified for each patient. Free of recurrence was defined as the absence of atrial arrhythmias without using antiarrhythmic agents after ablations. The mean EAT thickness of the study population was 6.1 ± 0.8 mm. Non-PAF patients had a thicker EAT than that of PAF patients (7.0 ± 0.7 mm versus 5.9 ± 0.7 mm, p value <0.001). During the follow-up of 16 ± 9 months, there were 95 patients (33.6%) suffering from recurrences of atrial arrhythmias. Non-PAF, chads2 score, left atrial diameter and EAT thickness were independent predictors of recurrence after catheter ablations. At a cutoff value of 6 mm for PAF and 6.9 mm for non-PAF, the measurement of EAT thickness could help us to identify patients at risk of recurrences. Conclusions EAT thickness may serve as a useful parameter in predicting recurrences after AF ablations. Compared to other imaging modalities, TTE can be an alternative choice with less cost and time in assessing the effects of EAT on ablation outcomes. PMID:24066158

Tsao, Hsuan-Ming; Lin, Yenn-Jiang; Yun, Chun-Ho; Lai, Yau-Huei; Chang, Shih-Lin; Lo, Li-Wei; Hu, Yu-Feng; Tuan, Ta-Chuan; Chang, Hung-Yu; Kuo, Jen-Yuan; Yeh, Hung-I; Wu, Tsu-Juey; Hsieh, Ming-Hsiung; Yu, Wen-Chung; Chen, Shih-Ann

2013-01-01

350

Antithrombotic therapy in atrial fibrillation: guidelines translated for the clinician  

Microsoft Academic Search

Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice, accounting for approximately one-third\\u000a of hospitalizations for cardiac rhythm disturbances. The highest incidence of AF is in patients 70–80 years old and other\\u000a high-risk populations. Although the diagnosis of AF is usually straightforward, effective treatment strategies are less well\\u000a implemented. This is particularly true for antithrombotic therapy, which is

Renato D. Lopes; Jonathan P. Piccini; Elaine M. Hylek; Christopher B. Granger; John H. Alexander

2008-01-01

351

Automatic atrial tachycardia in an infant following general anesthesia.  

PubMed

Automatic atrial tachycardia (AAT) is a rare supraventricular tachyarrhythmia (<10% of all supraventricular tachycardias), which can present in infants or young children. There are no published reports of AAT occurring in an infant or child following noncardiac surgery and general anesthesia. This report describes the management of a previously healthy 5-month-old infant, who developed AAT in the postanesthesia care unit following an uneventful circumcision under general anesthesia. PMID:15675935

Tripi, Paul A; Dorostkar, Parvin

2005-02-01

352

Role of Cholinergic Innervation and RGS2 in Atrial Arrhythmia  

PubMed Central

The heart receives sympathetic and parasympathetic efferent innervation as well as the ability to process information internally via an intrinsic cardiac autonomic nervous system (ICANS). For over a century, the role of the parasympathetics via vagal acetylcholine release was related to controlling primarily heart rate. Although in the late 1800s shown to play a role in atrial arrhythmia, the myocardium took precedence from the mid-1950s until in the last decade a resurgence of interest in the autonomics along with signaling cascades, regulators, and ion channels. Originally ignored as being benign and thus untreated, recent emphasis has focused on atrial arrhythmia as atrial fibrillation (AF) is the most common arrhythmia seen by the general practitioner. It is now recognized to have significant mortality and morbidity due to resultant stroke and heart failure. With the aging population, there will be an unprecedented increased burden on health care resources. Although it has been known for more than half a century that cholinergic stimulation can initiate AF, the classical concept focused on the M2 receptor and its signaling cascade including RGS4, as these had been shown to have predominant effects on nodal function (heart rate and conduction block) as well as contractility. However, recent evidence suggests that the M3 receptor may also playa role in initiation and perpetuation of AF and thus RGS2, a putative regulator of the M3 receptor, may be a target for therapeutic intervention. Mice lacking RGS2 (RGS2?/?), were found to have significantly altered electrophysiological atrial responses and were more susceptible to electrically induced AF. Vagally induced or programmed stimulation-induced AF could be blocked by the selective M3R antagonist, darifenacin. These results suggest a potential surgical target (ICANS) and pharmacological targets (M3R, RGS2) for the management of AF. PMID:22754542

Jones, Douglas L.; Tuomi, Jari M.; Chidiac, Peter

2012-01-01

353

An Unusual Cause of Low-Flow, Low-Gradient Severe Aortic Stenosis: Left-to-Right Shunt due to Atrial Septal Defect  

Microsoft Academic Search

Paradoxical low-flow, low-gradient severe aortic valve stenosis (AVS) may occur despite preserved left-ventricular (LV) ejection fraction in older females with marked LV concentric remodeling and small LV cavity size or in patients with coexisting severe mitral regurgitation. This report illustrates the case of a paradoxical low-flow, low-gradient severe AVS despite preserved LV function related to an ostium secundum atrial septal

Pierre Vladimir Ennezat; Francis Juthier; André Vincentelli; Philippe Pibarot; Sylvestre Maréchaux

2009-01-01

354

Renal denervation: effects on atrial electrophysiology and arrhythmias.  

PubMed

Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with significant morbidity and mortality. Currently, atrial endocardial catheter ablation, mainly targeting focal discharges in the pulmonary veins, is the most widely used interventional treatment of drug-refractory AF. Despite technical improvements, results are not yet optimal. There is ongoing search for alternative and/or complementary interventional targets. Conditions associated with increased sympathetic activation such as hypertension, heart failure and sleep apnea lead to structural, neural and electrophysiological changes in the atrium thereby contributing to the progression from paroxysmal to persistent AF and increasing recurrence rate of AF after PVI. Until now, interventional modulation of autonomic nervous system was limited by highly invasive techniques. Catheter-based renal denervation (RDN) was introduced as a minimally invasive approach to reduce renal and whole body sympathetic activation with accompanying blood pressure control and left-ventricular morphological and functional changes in resistant hypertension. This review focuses on the potential atrial antiarrhythmic and antiremodeling effects of RDN in AF patients with hypertension, heart failure, and sleep apnea and discusses the possible role of RDN in the treatment of AF. PMID:24682223

Linz, Dominik; van Hunnik, Arne; Ukena, Christian; Ewen, Sebastian; Mahfoud, Felix; Schirmer, Stephan H; Lenski, Matthias; Neuberger, Hans-Ruprecht; Schotten, Ulrich; Böhm, Michael

2014-10-01

355

Left atrial appendage exclusion—Where do we stand?  

PubMed Central

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

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

356

Association of inflammation with atrial fibrillation in hyperthyroidism  

PubMed Central

Objectives The aim of this study was to evaluate the relationship between inflammation and development of atrial fibrillation (AF) in patients with hyperthyroidism. Methods A total of 65 patients with newly diagnosed hyperthyroidism, 35 of whom were in sinus rhythm and 30 of whom in AF. Thirty five age- and gender-matched patients in a control group were included in the study. Factors associated with the development of AF were evaluated by multivariate regression analysis. Results Factors associated with AF in multivariate analysis included high sensitivity C reactive protein (HsCRP) [odds ratio (OR): 11.19; 95% confidence interval (95% CI): 1.80-69.53; P = 0.003], free T4 (OR: 8.76; 95% CI: 2.09–36.7; P = 0.003), and left atrial diameter (OR: 1.25; 95% CI: 1.06–1.47; P = 0.008). Conclusions The results of the present study suggest that HsCRP, an indicator of inflammation, free T4 and left atrial diameter are associated with the development AF in patients with hyperthyroidism. PMID:23341838

Ozaydin, Mehmet; Kutlucan, Ali; Turker, Yasin; Koroglu, Banu; Arslan, Akif; Uysal, Bayram A.; Erdogan, Dogan; Varol, Ercan; Dogan, Abdullah

2012-01-01

357

Atrial high rate episodes in patients with dual-chamber cardiac implantable electronic devices: unmasking silent atrial fibrillation.  

PubMed

Assessment of the prevalence of silent paroxysmal atrial fibrillation (AF) represents a challenge, since the arrhythmia may be brief, completely asymptomatic, and difficult to detect. Lack of symptoms from AF should not be equated to lack of risk of thromboembolic complications. Today's cardiac implantable electronic devices (CIED) diagnostics include system diagnostics accurately revealing asymptomatic cardiac arrhythmias as atrial high rate episodes (AHRE). The presence of AHRE has been related to increased risk of stroke and systemic embolism. The application of anticoagulation therapy in patients with device-detected AHRE is yet unclear and challenging in the absence of randomized studies. Until further studies are available, anticoagulation therapy should be individualized and promoted attending to the CHADS2 score. Future guidelines should deal with this peculiar AF scenario to make professionals who routinely perform CIED follow-ups aware of these relevant episodes and their clinical implications. PMID:24888216

Benezet-Mazuecos, Juan; Rubio, José Manuel; Farré, Jerónimo

2014-08-01

358

Score for atrial fibrillation detection in acute stroke and transient ischemic attack patients in a Brazilian population: The acute stroke atrial fibrillation scoring system  

PubMed Central

OBJECTIVE: Atrial fibrillation is a common arrhythmia that increases the risk of stroke by four- to five-fold. We aimed to establish a profile of patients with atrial fibrillation from a population of patients admitted with acute ischemic stroke or transient ischemic attack using clinical and echocardiographic findings. METHODS: We evaluated patients consecutively admitted to a tertiary hospital with acute ischemic stroke or transient ischemic attack. Subjects were divided into an original set (admissions from May 2009 to October 2010) and a validation set (admissions from November 2010 to April 2013). The study was designed as a cohort, with clinical and echocardiographic findings compared between patients with and without atrial fibrillation. A multivariable model was built, and independent predictive factors were used to produce a predictive grading score for atrial fibrillation (Acute Stroke AF Score-ASAS). RESULTS: A total of 257 patients were evaluated from May 2009 to October 2010 and included in the original set. Atrial fibrillation was diagnosed in 17.5% of these patients. Significant predictors of atrial fibrillation in the multivariate analysis included age, National Institutes of Health Stroke Scores, and the presence of left atrial enlargement. These predictors were used in the final logistic model. For this model, the area under the receiver operating characteristic curve was 0.79. The score derived from the logistic regression analysis was The model developed from the original data set was then applied to the validation data set, showing the preserved discriminatory ability of the model (c statistic?=?0.76). CONCLUSIONS: Our risk score suggests that the individual risk for atrial fibrillation in patients with acute ischemic stroke can be assessed using simple data, including age, National Institutes of Health Stroke Scores at admission, and the presence of left atrial enlargement. PMID:24714831

de Figueiredo, Marcelo Marinho; Rodrigues, Ana Clara Tude; Alves, Monique Bueno; Neto, Miguel Cendoroglo; Silva, Gisele Sampaio

2014-01-01

359

Evaluation of left atrial function in hypertensive patients with and without left ventricular hypertrophy using velocity vector imaging.  

PubMed

To study left atrial deformation characteristics using Velocity vector imaging (VVI) in hypertensive patients with and without left ventricular hypertrophy (LVH), and to explore its value for detection of left atrial dysfunction in these patients. Sixty-four patients with essential hypertension were divided into normal left ventricular geometry (LVN, 37 cases) and LVH (27 cases) groups, according to their left ventricular mass index. Twenty-five age-matched healthy participants were included as control group. Two-dimensional dynamic images of the apical four- and two-chamber echocardiographic views were obtained, and strain/strain rate (SR) curves of eight atrial segments were derived by VVI software. Peak systolic strain (?sys), systolic SR (SRs), early and late diastolic SR (SRe, SRa) were measured and calculated. Peak early diastolic mitral inflow and annulus velocities were also measured and their ratio (E/E') calculated. Compared with the control group, SRe decreased and SRa increased significantly in LVH group (P < 0.05), while no significant difference was found between LVN and control groups with respect to SRe, SRa, SRs and ?sys (P > 0.05). Also, no significant difference was observed in SRe, SRa, SRs and ?sys between LVH and LVN groups (P > 0.05). SRe and SRa correlated significantly with E/E' (r = -0.634, r = 0.609; both P < 0.001). Strain/SR parameters derived from VVI may reflect decreased conduit, increased booster pump function of the left atrium in hypertensive patients with LVH and correlate with left ventricular diastolic function. PMID:25005684

Yang, Li; Qiu, Qiong; Fang, Si-Hua

2014-12-01

360

Effect of phenylephrine on focal atrial fibrillation originating in the pulmonary veins and superior vena cava  

Microsoft Academic Search

OBJECTIVESThis study was aimed at evaluating the effects of phenylephrine infusion on the occurrence of focal atrial fibrillation (AF).BACKGROUNDParoxysmal AF can be initiated by ectopic atrial beats originating in the pulmonary vein (PV) or superior vena cava (SVC). The effect of change in autonomic tone on this focal AF is unknown.METHODSThis study included 12 patients with frequent bursts of AF

Ching-Tai Tai; Chuen-Wang Chiou; Zu-Chi Wen; Ming-Hsiung Hsieh; Chin-Feng Tsai; Wei-Shiang Lin; Chien-Cheng Chen; Yung-Kuo Lin; Wen-Chung Yu; Yu-An Ding; Mau-Song Chang; Shin-Ann Chen

2000-01-01

361

Correlation between Preoperative Pulmonary Artery Pressure and Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery  

Microsoft Academic Search

Background : Atrial fibrillation (AF) is the most common arrhythmia to occur after cardiac surgery. The incidence of post-operative atrial fibrillation (POAF) has been reported to range from 10 to 65%. It is associated with increased morbidity, mortality, longer hospital stay and increased costs. A number of studies have examined the predictors of POAF. There have never been any studies

Songkhram Chockchai; Nakarin Sansanayudh; Pachum Tasukon; Prasart Laothavorn; Chumpol Piamsomboon; Sopon Sanguanwong; Chanarong Naksawadi; Preecha Uerojanaungkul; Waraporn Tiyanon; Verapon Pinphanichakarn; Ram Rungsindha; Worasin Ketanond; Teerachat Silarat; Chatchai Temyord; Chakrit Kongthai; Kriengchai Prasongsukarn

362

Surgical management of complications after transcatheter closure of an atrial septal defect or patent foramen ovale  

Microsoft Academic Search

Objective: During recent years, transcatheter closure has become an alternative to operations for the treatment of atrial septal defects and patent foramen ovale. However, this procedure may be unsuccessful or complicated and requires surgical treatment. Methods: We retrospectively analyzed the outcomes of patients who needed surgical treatment after failed or complicated transcatheter closure of an atrial septal defect or a

Pascal A. Berdat; Tushar Chatterjee; Jean-Pierre Pfammatter; Stefan Windecker; Bernhard Meier; Thierry Carrel

2000-01-01

363

A methodology for predicting paroxysmal atrial fibrillation based on ECG arrhythmia feature analysis  

Microsoft Academic Search

This article addresses the Computers in Cardiology Challenge 2001 for predicting the onset of paroxysmal atrial fibrillation (PAF) from the surface electrocardiogram (ECG). To predict PAF, we developed an algorithm based upon the number and timing of atrial premature complexes (APCs) in the ECG. The algorithm detects classical isolated APCs, then predicts PAF based on a measurement of APC rate

W. Zong; R. Mukkamala; R. G. Mark

2001-01-01

364

Special character of atrial paroxysmal fibrillation in coincidence with WPW syndrome  

Microsoft Academic Search

The paper summarizes the knowledge on paroxysmal atrial fibrillation in WPW syndrome. The pecu- liarities, ECG features, risk markers of sudden cardiac death, pharmacologic and non farmacologic therapy and prevention of this arrhythmia are presented. Potentially dangerous effects of drugs such as digoxin, verapamil, adenosine and betablockers are emphasized. (Short communication) In patients with WPW syndrome, paroxysmal atrial fibrilla- tion

Jurkovicova O; Bratisl Lek Listy

2001-01-01

365

Concomitant mitral valve or atrial septal defect surgery and the modified Cox-maze procedure  

Microsoft Academic Search

Atrial fibrillation (AF) is generally associated with rheumatic valve disease and atrial septal defects (ASD) in young adults. Surgical correction of both disorders fails to convert to sinus rhythm or prevent further episodes of paroxysmal or chronic AF in most patients. The role and efficacy of combining mitral valve surgery or ASD correction with AF surgery in this setting has

Néstor Sandoval; Victor M. Velasco; Hernando Orjuela; Victor Caicedo; Hernando Santos; Fernando Rosas; Juan R. Correa; Iván Melgarejo; Carlos A. Morillo

1996-01-01

366

The shape of human atrial action potential accounts for different frequency-related changes in vitro  

Microsoft Academic Search

We aimed at investigating frequency-related changes of human atrial action potential (AP) in vitro to see whether baseline AP shape might account for different responses to increasing stimulation rates. Human right atrial trabeculae (n = 48) obtained from adult (n = 38, mean age 59 ± 8, range 45–72 years) consecutive patients (?30% of those operated upon by a single

Amos Adeyemo Dawodu; Francesco Monti; Katsunori Iwashiro; Michele Schiariti; Roberta Chiavarelli; Paolo Emilio Puddu

1996-01-01

367

Repair of atrial septal defect through a right posterolateral thoracotomy: a cosmetic approach for female patients  

Microsoft Academic Search

Background. Because the operation for atrial septal defect is considered a low-risk procedure, the cosmetic result has become an important issue. Principally for cosmetic reasons, anterolateral thoracotomy is frequently used for closure of atrial septal defect in young female patients. However, in anterolateral thoracotomy, the skin incision frequently crosses the future breast line, which may cause breast and pectoral muscle

Naoki Yoshimura; Masahiro Yamaguchi; Yoshihiro Oshima; Shigeteru Oka; Yoshio Ootaki; Masahiro Yoshida

2001-01-01

368

Efficacy of substituting innovator propafenone for its generic formulation in patients with atrial fibrillation  

Microsoft Academic Search

The clinical outcomes of 114 patients with atrial fibrillation who had been treated with the innovator propafenone, and in whom the drug was then replaced with generic propafenone because of cost containment, were compared. The generic formulation was found to be at least as safe and effective as the innovator drug, with regard to atrial fibrillation recurrence, emergency room and

Guy Amit; Amit Rosen; Avraham B. Wagshal; Dan Y. Bonneh; Tzvika Liss; Aviva Grosbard; Reuven Ilia; Amos Katz

2004-01-01

369

Direct Activation of Mammalian Atrial Muscarinic Potassium Channels by GTP Regulatory Protein Gk  

Microsoft Academic Search

The mammalian heart rate is regulated by the vagus nerve, which acts via muscarinic acetylcholine receptors to cause hyperpolarization of atrial pacemaker cells. The hyperpolarization is produced by the opening of potassium channels and involves an intermediary guanosine triphosphate-binding regulatory (G) protein. Potassium channels in isolated, inside-out patches of membranes from atrial cells now are shown to be activated by

Atsuko Yatani; Juan Codina; Arthur M. Brown; Lutz Birnbaumer

1987-01-01

370

Aorto–Left Atrial Fistula With Bicuspid Aortic Valve and Coronary Artery Origin Anomaly  

Microsoft Academic Search

Published reports of aorto–left atrial fistula are very rare. We report a 20-year-old man who had an aorto–left atrial fistula with bicuspid aortic valve and coronary artery origin anomaly. Because acquired etiologic factors were not detected, we believe that the lesions were structural defects of congenital origin.

Mehmet ?ah Topcuo?lu; Mustafa ?an; Cem Kayhan; Tümer Ulus

1997-01-01

371

Atrial fibrillation and obesity among older Chinese: The Guangzhou Biobank Cohort Study  

Microsoft Academic Search

BackgroundAtrial fibrillation (AF) is the most common form of arrhythmia, and its prevalence is increasing. Few studies have examined its association with obesity as defined by different criteria, particularly in developing countries. We investigated the association between atrial fibrillation (AF) and obesity indices among older Chinese.

Mei Jing Long; Chao Qiang Jiang; Tai Hing Lam; Lin Xu; Wei Sen Zhang; Jie Ming Lin; Jian Ping Ou; Kar Keung Cheng

2011-01-01

372

TNNI3K mutation in familial syndrome of conduction system disease, atrial tachyarrhythmia and dilated cardiomyopathy.  

PubMed

Locus mapping has uncovered diverse etiologies for familial atrial fibrillation (AF), dilated cardiomyopathy (DCM), and mixed cardiac phenotype syndromes, yet the molecular basis for these disorders remains idiopathic in most cases. Whole-exome sequencing (WES) provides a powerful new tool for familial disease gene discovery. Here, synergistic application of these genomic strategies identified the pathogenic mutation in a familial syndrome of atrial tachyarrhythmia, conduction system disease (CSD), and DCM vulnerability. Seven members of a three-generation family exhibited the variably expressed phenotype, three of whom manifested CSD and clinically significant arrhythmia in childhood. Genome-wide linkage analysis mapped two equally plausible loci to chromosomes 1p3 and 13q12. Variants from WES of two affected cousins were filtered for rare, predicted-deleterious, positional variants, revealing an unreported heterozygous missense mutation disrupting the highly conserved kinase domain in TNNI3K. The G526D substitution in troponin I interacting kinase, with the most deleterious SIFT and Polyphen2 scores possible, resulted in abnormal peptide aggregation in vitro and in silico docking models predicted altered yet energetically favorable wild-type mutant dimerization. Ventricular tissue from a mutation carrier displayed histopathological hallmarks of DCM and reduced TNNI3K protein staining with unique amorphous nuclear and sarcoplasmic inclusions. In conclusion, mutation of TNNI3K, encoding a heart-specific kinase previously shown to modulate cardiac conduction and myocardial function in mice, underlies a familial syndrome of electrical and myopathic heart disease. The identified substitution causes a TNNI3K aggregation defect and protein deficiency, implicating a dominant-negative loss of function disease mechanism. PMID:24925317

Theis, Jeanne L; Zimmermann, Michael T; Larsen, Brandon T; Rybakova, Inna N; Long, Pamela A; Evans, Jared M; Middha, Sumit; de Andrade, Mariza; Moss, Richard L; Wieben, Eric D; Michels, Virginia V; Olson, Timothy M

2014-11-01

373

Left atrial functional reservoir: predictive value for outcome of catheter ablation in paroxysmal atrial fibrillation.  

PubMed

Left arial (LA) function, defined according to conduit, reservoir and booster functions, is closely linked to left ventricular (LV) mechanics, particularly during diastole. Right ventricular pacing (RVP) is thought to impair LA diastolic restoring forces through alteration of ventricular activation. The aim of this study was to determine whether the LA functional reservoir estimated as the change in mean LA ejection fraction (EF) immediately after RVP, and for the second and for the third beats after RVP, predicts clinical outcome in patients with paroxysmal atrial fibrillation (AF) who have undergone catheter ablation (CA). Data from 155 patients with paroxysmal AF (56.0 ± 10.6 years, M:F = 114:41) were analyzed. All patients underwent LA angiography during RVP. LA EFs were measured at the immediate first (LA EF1), second (LA EF2) and third beats (LA EF3) after RVP, using a right anterior oblique 30° view. During follow-up, AF recurred in 35 patients (22.6 %). Mean LA EF1 was 37.9 ± .8 % in the AF recurrence group and 48.0 ± 8.6 % in the non-recurrence group (P < 0.001). Mean LA EF2 and LA EF3 were also lower in the AF recurrence group than in the non-recurrence group (P < 0.001, respectively). Mean percent changes from LA EF2 to LA EF3 were -0.4 ± 3.4 in the AF recurrence group and 5.2 ± 4.9 in the non-recurrence group (P = 0.041). The change in mean EF from LA EF1 to LA EF3 in the non-recurrence group was significantly greater than in the recurrence group (P = 0.001). Cox regression analysis showed that predictors of AF recurrence were LA EF2, LA EF3 and accompanied obstructive sleep apnea (OSA) (P < 0.001, respectively). Decreased functional LA reservoir (LA EF after RVP) and OSA are significantly related to recurrence of AF following CA in patients with paroxysmal AF. PMID:25034621

Park, Hwan-Cheol; Lee, Yonggu; Lee, DaeIn; Park, Yae Min; Shim, Jaemin; Ban, Ji-Eun; Choi, Jong-Il; Park, Sang-Weon; Kim, Young-Hoon

2014-12-01

374

Detection of paroxysmal atrial fibrillation or flutter in patients with acute ischemic stroke or transient ischemic attack by Holter monitoring  

PubMed Central

Background and purpose Paroxysmal atrial fibrillation and flutter are strong risk factors for stroke. Due to high recurrence rate of ischemic events and given the benefit of oral anticoagulation over antiplatelet drugs, it is important to identify this arrhythmia. Unfortunately, paroxysmal AF or flutter is asymptomatic in majority and therefore, difficult to detect. Methods Consecutive patients presenting with symptoms of acute ischemic stroke or transient ischemic attack were included. All patients free of AF or flutter on presentation underwent 24 h Holter monitoring within 7 days of admission. Results Overall, fifty two (52) patients (mean age 59.51 ± 13.45 years) with acute stroke (80.8%) and TIA (19.8%) underwent 24 h Holter monitoring. Paroxysmal AF was detected in 3 cases (5.8%), all 3 patients had acute stroke and were older than age 60 years. Type of stroke was the only factor which was associated with greater risk of having paroxysmal AF or flutter, AF accounted for 50% cases (2 out of 4) of clinically suspected cardio embolic stroke. Conclusion Screening consecutive patients with ischemic stroke with routine Holter monitoring will identify new atrial fibrillation/flutter in approximately one in 17 patients. Older age and type of stroke are strongly associated with increased risk. By carefully selecting the patients, the detection rates could be further increased. PMID:24814113

Thakkar, Sandeep; Bagarhatta, Rajeev

2014-01-01

375

Cardioembolic vs. Noncardioembolic Strokes in Atrial Fibrillation: Frequency and Effect of Antithrombotic Agents in the Stroke Prevention in Atrial Fibrillation Studies  

Microsoft Academic Search

Background: While atrial fibrillation (AF) increases the risk of cardioembolic stroke, some ischemic strokes in AF patients are noncardioembolic. Objectives: To assess ischemic stroke mechanisms in AF and to compare their responses to antithrombotic therapies. Methods: On-therapy analyses of ischemic strokes occurring in 3,950 participants in the Stroke Prevention in Atrial Fibrillation I–III clinical trials. Strokes were classified by presumed

R. G. Hart; L. A. Pearce; V. T. Miller; D. C. Anderson; J. F. Rothrock; G. W. Albers; E. Nasco

2000-01-01

376

Opportunistic detection of atrial fibrillation in subjects aged 65 years or older in primare care: a randomised clinical trial of efficacy. DOFA-AP study protocol  

PubMed Central

Background Clinical Practice Guidelines recommend using peripheral blood pulse measuring as a screening test for Atrial Fibrillation. However, there is no adequate evidence supporting the efficacy of such procedure in primary care clinical practice. This paper describes a study protocol designed to verify whether early opportunistic screening for Atrial Fibrillation by measuring blood pulse is more effective than regular practice in subjects aged 65 years attending primary care centers. Methods/design An cluster-randomized controlled trial conducted in Primary Care Centers of the Spanish National Health Service. A total of 269 physicians and nurses will be allocated to one of the two arms of the trial by stratified randomization with a 3:2 ratio (three practitioners will be assigned to the Control Group for every two practitioners assigned to the Experimental Group). As many as 12 870 patients aged 65 years or older and meeting eligibility criteria will be recruited (8 580 will be allocated to the Experimental Group and 4 290 to the Control Group). Randomization and allocation to trial groups will be carried out by a central computer system. The Experimental Group practitioners will conduct an opportunistic case finding for patients with Atrial Fibrillation, while the Control Group practitioners will follow the regular guidelines. The first step will be finding new Atrial Fibrillation cases. A descriptive inferential analysis will be performed (bivariate and multivariate by multilevel logistic regression analysis). Discussion If our hypothesis is confirmed, we expect Primary Care professionals to take a more proactive approach and adopt a new protocol when a patient meeting the established screening criteria is identified. Finally, we expect this measure to be incorporated into Clinical Practice Guidelines. Trial registration The study is registered as NCT01291953 (ClinicalTrials.gob) PMID:23130754

2012-01-01

377

Totally thoracoscopic repair of atrial septal defect reduces systemic inflammatory reaction and myocardial damage in initial patients  

PubMed Central

Background To compare the effect of totally thoracoscopic with conventional, open repair of atrial septal defect. Methods Forty atrial septal defect cases were divided into two groups by surgical approach: totally thoracoscopic approach (group A, n?=?20) and conventional open approach (group B, n?=?20). In group A, surgical procedures were performed through three portal incisions in the right lateral chest wall under thoracoscopic vision without the aid of a computerized robotic surgical system. Notably, all operations were completed by one surgeon who had just begun using this technique. In group B, the atrial septal defects were repaired in conventional open fashion. Clinical outcomes and serum levels of tumor necrosis factor ? (TNF-?), interleukin-6 (IL-6), interleukin-10 (IL-10), intercellular adhesion molecule 1 (ICAM-1), and creatine kinase isoenzyme-myocardial band (CK-MB) for the two groups were evaluated and compared. Results All operations were performed successfully without serious complications. Durations of cardiopulmonary bypass (CPB), CPB setup, aortic cross-clamping, and operative procedure were significantly longer in group A than in group B (P?

2014-01-01

378

Modified technique of stent fenestration of the atrial septum  

PubMed Central

Objectives: To develop a modified technique for stenting the atrial septum in the treatment of patients with a failing Fontan operation or pulmonary hypertension. Setting: Two tertiary referral centres. Study design: Prospective collaborative clinical study. Patients and methods: A stent was mounted on a standard valvoplasty balloon catheter which was constricted to a predefined diameter by a loop created from a temporary pacing wire. Full balloon inflation created a diabolo shaped stent configuration. The technique was employed in 12 consecutive patients to relieve symptoms of a failing Fontan circulation (n = 6) or severe pulmonary hypertension (n = 6). Results: Ex vivo studies confirmed that a diabolo shaped stent configuration could be achieved using the above technique. Transcatheter stent implantation was successful in all 12 patients. All six Fontan patients showed significant clinical improvement. Right atrial pressure decreased from (mean (SD)) 16.8 (2.5) to 13.7 (1.9) mm Hg (p < 0.05), and arterial oxygen saturation from 92.8 (1.8)% to 82.7 (3.8)% (p < 0.01). Six patients underwent successful stent fenestration for treatment of pulmonary hypertension. All stents were patent and stable at the most recent follow up (mean 1.75 (1.05) years). No early or late stent related complications were encountered. Conclusions: This new technique allows placement of a diabolo shaped stent with a predefined diameter across the atrial septum. The diabolo shape increases stent stability, facilitates recrossing of the stent during future catheter interventions, and ensures medium term stent patency. PMID:12975427

Stumper, O; Gewillig, M; Vettukattil, J; Budts, W; Chessa, M; Chaudhari, M; Wright, J G C

2003-01-01

379

Role of abnormal sarcoplasmic reticulum function in atrial fibrillation  

PubMed Central

Summary Atrial fibrillation (AF) is the most common cardiac arrhythmia, and is a cause of significant morbidity and mortality if left untreated. AF has been associated with profound changes in sarcoplasmic reticulum Ca2+ homeostasis, which might contribute to both reduced contractile function and increased arrhythmogenesis in atria. Studies in human tissue samples and various animal models of AF have revealed changes in both expression levels and posttranslational modifications of key Ca2+ handling proteins, which may contribute to arrhythmogenesis. In this review, we will focus on the molecular basis of alterations in sarcoplasmic reticulum Ca2+ handling in AF and their potential therapeutic implications. PMID:21625324

2011-01-01

380

RELATIONSHIP OF LEFT VENTRICULAR SIZE TO LEFT ATRIAL AND LEFT ATRIAL APPENDAGE SIZE IN SINUS RHYTHM PATIENTS WITH DILATED CARDIOMYOPATHY  

PubMed Central

Introduction: Thromboembolic events are a frequent cause of mortality in patients with congestive heart failure. The aim of or study was to evaluate the relationship of left ventricular end diastolic diameter (LVEDD) to left atrial (LA) size and left atrial appendage (LAA) size in patients with dilated cardiomyopathy in sinus rhythm, as well as to determine the prevalence of thrombi in LV and LA /LAA. Methods: This was a prospective cross-sectional study, conducted from December 2009 until December 2011. The study included 95 patients with dilated cardiomyopathy in sinus rhythm. Patients with swallowing problems, acute myocardial infarction, atrial fibrillation/flatter, severe systolic dysfunction, and/or patients who were taking oral anticoagulation therapy were excluded. Results: Mean patient age was 58.6 ± 12.2 years and 68.4% were men. Mean LVEDD of our population was 66.5 ± 6.5 mm, while mean LA atrium, LA volume and LAA maximal area were 46 ± 5.1 mm, 87.2 ± 38.7 cm3 and 4.7 ± 1.2 cm2, respectively. LA diameter (p<0.001) and LAA maximal area (p=0.01) showed to be independent predictors of LV size. LV thrombus was detected in 13 (13.7%) patients, while LAA thrombus in 46 (48.4%) patients of our study population. Conclusions: In conclusion, dilated LV size is associated with enlarged LA and LAA size. On the other hand, dilation of LV, LA and LAA is related to high prevalence of left chamber cardiac thrombi. PMID:23322961

Bakalli, Aurora; Georgievska-Ismail, Ljubica; Musliu, Nebi; Kocinaj, Dardan; Gashi, Zaim; Zeqiri, Nexhmi

2012-01-01

381

Importance of Atrial Surface Area and Refractory Period in Sustaining Atrial Fibrillation: Testing the Critical Mass Hypothesis  

PubMed Central

Objective The critical mass hypothesis for atrial fibrillation (AF) was proposed in 1914; however, there have been few studies defining the relationship between atrial surface area and AF. This study evaluated the effect of tissue area and effective refractory period (ERP) on the probability of sustaining AF in an in vivo model. Methods Domestic pigs (n=9) underwent median sternotomy. Epicardial activation maps were constructed from bipolar electrograms recorded from form fitting electrode templates placed on the atria. Baseline ERPs were determined. ERP was lowered with a continuous infusion of acetylcholine (0.005-0.04 mg/kg/min) until AF could be sustained after burst pacing. The atria were sequentially partitioned using bipolar radiofrequency ablation. ERPs were lowered using acetylcholine until AF could be sustained in each subdivision of atrial tissue. Each subdivision was further divided until AF was no longer inducible. At study completion, the heart was excised and the surface area of each section was measured. Results Over a range of ERPs from 75 to 250ms, the probability of AF was correlated with increasing tissue area (range 19.5 to 105 cm2) and decreasing ERP. Logistic regression analysis identified shorter ERP (p < 0.001) and larger area (p = 0.006) as factors predictive of an increased probability of sustained AF (AUC of ROC = 0.878). Conclusions The probability of sustained AF was significantly associated with increasing tissue area and decreasing ERP. These data may lead to a greater understanding of the mechanism of AF and help to design better interventional procedures. PMID:22995722

Lee, Anson M.; Aziz, Abdulhameed; Didesch, Jacob; Clark, Kal L.; Schuessler, Richard B.; Damiano, Ralph J.

2014-01-01

382

Transcatheter closure of secundum atrial septal defects with the atrial septal defect occlusion system (ASDOS): initial experience in children.  

PubMed Central

OBJECTIVE--To report initial experiences with transcatheter occlusion of atrial septal defects using a new occlusion device. SUBJECTS--10 children aged 1.1 to 14.9 years. INCLUSION CRITERIA--Patients with a body weight above 10 kg, normal pulmonary resistance and an indication for surgical closure of a secundum atrial septal defect, a residual tissue rim of interatrial septum surrounding the defect of more than 5 mm, and a maximum defect diameter of 20 mm. METHODS--The defects were closed by a transcatheter device (ASDOS) consisting of two umbrellas which are introduced over a guidewire loop. Both umbrellas consist of a central body and five arms formed from preshaped nitinol wire covered with a thin polyurethane patch. The central body of the distal umbrella contains a thread, the proximal umbrella contains a bolt. The two umbrellas are connected by screwing the bolt on the thread using a screwdriver catheter. RESULTS--The implantation was performed under echocardiographic guidance; in six of 10 patients, transoesophageal echocardiography was necessary. The "stretched" diameter of the defect evaluated during balloon sizing ranged from 10 to 20 mm, and the pulmonary to systemic blood flow ratio from 1.5:1 to 2.8:1. Transcatheter closure was successfully performed in 9/10 patients using devices with a diameter of 25 mm to 40 mm. No severe complications occurred. However, in one patient with a pre-existing prolonged PR interval brief periods of second and third degree atrioventricular block occurred after the implantation but normalised within 3 d. During a follow up period of 21 to 29 weeks no device embolisation, thromboembolic complications, fractures of the implanted device, atrial perforations, pericardial effusions, obstructions of systemic or pulmonary veins, atrioventricular valve dysfunction, or other complications occurred. CONCLUSIONS--The new device is a promising transcatheter approach for the occlusion of secundum atrial septal defects in children. However, further evaluation and long term data are needed before this transcatheter technique can be recommended. Images PMID:8624881

Hausdorf, G.; Schneider, M.; Franzbach, B.; Kampmann, C.; Kargus, K.; Goeldner, B.

1996-01-01

383

Obesity, Diabetes and Atrial Fibrillation; Epidemiology, Mechanisms and Interventions  

PubMed Central

The last few decades have witnessed a global rise in adult obesity of epidemic proportions. The potential impact of this is emphasized when one considers that body mass index (BMI) is a powerful predictor of death, type 2 diabetes (T2DM) and cardiovascular (CV) morbidity and mortality [1, 2]. Similarly we have witnessed a parallel rise in the incidence of atrial fibrillation (AF), the commonest sustained cardiac arrhythmia, which is also a significant cause of cardiovascular morbidity and mortality. Part of this increase is attributable to advances in the treatment of coronary heart disease (CHD) and heart failure (HF) improving life expectancy and consequently the prevalence of AF. However, epidemiological studies have demonstrated an independent association between obesity and AF, possibly reflecting common pathophysiology and risk factors for both conditions. Indeed, weight gain and obesity are associated with structural and functional changes of the cardiovascular system including left atrial and ventricular remodeling, haemodynamic alterations, autonomic dysfunction, and diastolic dysfunction. Moreover, diabetic cardiomyopathy is characterized by an adverse structural and functional cardiac phenotype which may predispose to the development of AF [3]. In this review, we discuss the pathophysiological and mechanistic relationships between obesity, diabetes and AF, and the challenges posed in the management of this high-risk group of individuals. PMID:22920475

Asghar, O; Alam, U; Hayat, SA; Aghamohammadzadeh, R; Heagerty, AM; Malik, RA

2012-01-01

384

Atrial fibrillation in heart failure: The sword of Damocles revisited  

PubMed Central

Heart failure (HF) and atrial fibrillation (AF) frequently coexist and have emerged as major cardiovascular epidemics. There is growing evidence that AF is an independent prognostic marker in HF and affects patients with both reduced as well as preserved LV systolic function. There has been a general move in clinical practice from a rhythm control to a rate control strategy in HF patients with AF, although recent data suggests that rhythm control strategies may provide better outcomes in selected subgroups of HF patients. Furthermore, various therapeutic modalities including pace and ablate strategies with cardiac resynchronisation or radiofrequency ablation have become increasingly adopted, although their role in the management of AF in patients with HF remains uncertain. This article presents an overview of the multidimensional impact of AF in patients with HF. Relevant literature is highlighted and the effect of various therapeutic modalities on prognosis is discussed. Finally, while novel anticoagulants usher in a new era in thromboprophylaxis, research continues in a variety of new pathways including selective atrial anti-arrhythmic agents and genomic polymorphisms in AF with HF. PMID:23888191

Khan, Muhammad A; Ahmed, Fozia; Neyses, Ludwig; Mamas, Mamas A

2013-01-01

385

Fiber photo-catheters for laser treatment of atrial fibrillation  

PubMed Central

A fiber photo-catheter has been developed for surgical treatment of atrial fibrillation with laser radiation. Atrial fibrillation (AF) is a heart rhythm abnormality that involves irregular and rapid heartbeats. Recent studies demonstrate the superiority of treating AF disease with optical radiation of the near infrared region. To produce long continuous transmural lesions, solid-state lasers and laser diodes, along with end-emitting fiber catheters, have been used experimentally. The absence of side-emitting flexible catheters with the ability to produce long continuous lesions limits the further development of this technology. In this research, a prototype of an optical catheter, consisting of a flexible 10-cm fiber diffuser has been used to make continuous photocoagulation lesions for effective maze procedure treatments. The system also includes: a flexible optical reflector; a series of openings for rapid self-attachment to the tissue; and an optional closed-loop irrigating chamber with circulating saline to cool the optical diffuser and irrigate the tissue. PMID:19587838

Peshko, Igor; Rubtsov, Vladimir; Vesselov, Leonid; Sigal, Gennady; Laks, Hillel

2009-01-01

386

Stroke Prevention in Atrial Fibrillation: Concepts and Controversies  

PubMed Central

Atrial fibrillation (AF) is the commonest cardiac rhythm disorder worldwide, affecting 1% of the general population. It is estimated that up to 16 million people in the US will suffer from the arrhythmia by 2050. AF is an independent stroke risk factor and associated with more severe strokes. For six decades, warfarin has been the only truly effective therapy to protect against stroke for patients with atrial fibrillation. Despite the proven worth of warfarin, its limitations have seen reluctance amongst physicians and patients to utilise this efficacious agent. This has meant that substantial numbers of patients are either unprotected against stroke or suboptimally protected with antiplatelet therapy. Contemporary well-validated stroke risk factor schemes (CHA2DS2-VASc) now permit rapid but comprehensive evaluation of a patient’s risk for thromboembolism, allowing better identification of low-risk patients who do not require antithrombotic therapy, and whilst for those with ?1 stroke risk factors require formal oral anticoagulation. Aspirin has been proven to be inferior to anticoagulation, and is not free of bleeding risk. We also have simple scores to easily evaluate a patient’s risk of haemorrhage (e.g. HAS-BLED). The emergence of new oral anticoagulants should further improve stroke prevention in AF, and they successfully negotiate many of the hurdles to oral anticoagulation generated by warfarin’s limitations. Monitoring, reversal, and perioperative management are areas which require further investigation to enhance our ability to safely and effectively utilise the new agents. PMID:22920480

Ahmad, Yousif; Lip, Gregory YH

2012-01-01

387

ET-1 levels in cardioischemic patients undergoing atrial pacing.  

PubMed

Atrial pacing (AP) procedure was carried out in 11 cardioischemic patients to reproduce tachycardia-induced myocardial ischemia. Six control subjects underwent the same procedure until the maximum pacing rate was reached. During the procedure, endothelin-1 (ET-1) and plasma lactate levels were measured in the coronary sinus and in the aortic root. In all the patients, atrial pacing provoked electrocardiographic signs and metabolic evidence of myocardial ischemia and a significant decrease (p<0.001) in left ventricular ejection fraction. At AP-induced ischemia, coronary sinus (17.31 +/- 4.20 pg/mL) and arterial (9.60 +/- 3.31 pg/mL) ET-1 plasma levels were significantly different (p<0.001) in the patients. On the contrary, at maximum pacing rate, no significant difference (p=0.186) emerged between coronary sinus (9.72 +/- 1.09 pg/mL) and arterial (8.95 +/- 0.75 pg/mL) plasma ET-1 levels in the control group. These results suggest that, in cardioischemic patients, tachycardia can induce the coronary endothelium to release significant amounts of ET-1. PMID:11563817

Parlapiano, C; Borgia, M C; Tonnarini, G; Alessandri, N; Campana, E; Quaglione, R; Ciccaglioni, A; Giancaspro, G; Pantone, P; Giovanniello, T; Califano, F

2001-01-01

388

Management of Atrial Fibrillation in Critically Ill Patients  

PubMed Central

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

Arrigo, Mattia

2014-01-01

389

[Surgical ablation of atrial fibrillation. Indications, techniques and results].  

PubMed

Catheter ablation has been the preferred choice of treatment for many patients with atrial fibrillation (AF) and advanced to a first line treatment option. However, incomplete ablation lines and varying long-term success rates remain a problem in certain subgroups, especially patients with persistent AF or large left atria. Alternative energy sources and advances in the device design have shifted the surgeons' focus on less invasive procedures. Minimally invasive performed endocardial ablation or even endoscopical ablation on the beating heart reveals success rates of 90?% freedom from atrial fibrillation at 2 years independent from the duration or type of AF. The randomized FAST-trial demonstrated superiority of endoscopic ablation compared to catheter ablation after 1 year. Given the multiple theories of the mechanism causing AF and the results that can be achieved by minimally invasive surgery, a thoroughly assessment of the individual patients is mandatory and surgery should be considered in all symptomatic patients who have failed catheter ablation or who are not good candidates for catheter ablation. PMID:23595229

Weimar, Timo; Hanke, Thorsten; Doll, Nicolas

2013-03-01

390

Blunt atrial transseptal puncture using excimer laser in swine  

PubMed Central

Objectives We describe a new approach that may enhance safety of atrial transseptal puncture, using a commercially available laser catheter that is capable of perforation only when energized. We test this approach in swine. Background Despite wide application, conventional needle transseptal puncture continues to risk inadvertent non-target perforation and its consequences. Methods We used a commercial excimer laser catheter (0.9mm Clirpath, Spectranetics). Perforation force was compared in vitro with a conventional Brockenbrough needle. Eight swine underwent laser transseptal puncture under X-ray fluoroscopy steered using a variety of delivery catheters. Results The 0.9mm laser catheter traversed in vitro targets with reduced force compared with a Brockenbrough needle. In vitro, the laser catheter created holes that were 25–30% larger than the Brockenbrough needle. Laser puncture of the atrial septum was successful and accurate in all animals, evidenced by oximetry, pressure, angiography, and necropsy. The laser catheter was steered effectively using a modified Mullins introducer sheath and using two different deflectable guiding catheters. The mean procedure time was 15 ± 6 minutes, with an average 3.0 ± 0.8 seconds of laser activation. There were no adverse sequelae after prolonged observation. Necropsy revealed discrete 0.9mm holes in all septae. Conclusion Laser puncture of the interatrial septum is feasible and safe in swine, using a blunt laser catheter that perforates tissues in a controlled fashion. PMID:17896413

Elagha, Abdalla A.; Kim, Ann H.; Kocaturk, Ozgur; Lederman, Robert J.

2009-01-01

391

Kinetics of atrial repolarization alternans in a free-behaving ovine model  

PubMed Central

INTRODUCTION Repolarization alternans (Re-ALT), a beat-to-beat alternation in action potential repolarization, promotes dispersion of repolarization, wavebreaks and reentry. Recently, Re-ALT has been shown to play an important role in the transition from rapid pacing to atrial fibrillation (AF) in humans. The detailed kinetics of atrial Re-ALT, however, has not been reported so far. We developed a chronic free-behaving ovine pacing model to study the kinetics of atrial Re-ALT as a function of pacing rate. METHODS Thirteen sheep were chronically implanted with two pacemakers for the recording of broadband right atrial unipolar electrograms and delivery of rapid pacing protocols. Beat-to-beat differences in atrial T-wave apex amplitude as a measure of Re-ALT and activation time were analyzed at incremental pacing rates until the effective refractory period (ERP) defined as stable 2:1 capture. RESULTS Atrial Re-ALT appeared intermittently but without periodicity, and increased in amplitude as a function of pacing rate until ERP. Intermittent 2:1 atrial capture was observed at pacing cycle lengths 40ms above ERP, and increased in duration as a function of pacing rate. Episodes of rapid pacing-induced AF were rare, and were preceded by Re-ALT or complex oscillations of atrial repolarization, but without intermittent capture. CONCLUSION We show in vivo that atrial Re-ALT developed and increased in magnitude with rate until stable 2:1 capture. In rare instances where capture failure did not occur, Re-ALT and complex oscillations of repolarization surged and preceded AF initiation. PMID:22554055

Jousset, Florian; Tenkorang, Joanna; Vesin, Jean-Marc; Pascale, Patrizio; Ruchat, Patrick; Rollin, Anne Garderes; Fromer, Martin; Narayan, Sanjiv M.; Pruvot, Etienne

2012-01-01

392

Incidence of secondary pulmonary hypertension in adults with atrial septal or sinus venosus defects  

PubMed Central

OBJECTIVE—To examine the incidence of raised pulmonary artery pressure and resistance in adults with isolated atrial septal defect within the oval fossa (so called secundum defect) or sinus venosus defect.?DESIGN—A historical, retrospective, unrandomised study.?SETTING—A tertiary referral centre.?METHODS—Cardiac catheterisation was performed in all patients, with measurement of pulmonary artery pressure and resistance. Pulmonary to systemic flow ratio was calculated using the Fick principle. Pulmonary hypertension was defined as mean pulmonary artery pressure > 30 mm Hg, and increased resistance as an Rp/Rs ratio > 0.3.?PATIENTS—All patients with a secundum atrial septal or sinus venosus defect who presented between July 1988 and December 1997 were enrolled in the study.?RESULTS—Pulmonary artery pressure and resistance in the patients with sinus venosus defect (n = 31) was higher than in patients with atrial septal defect (n = 138). Pulmonary hypertension was present in 26% of patients with sinus venosus and in 9% of patients with atrial septal defect. The incidence of raised pulmonary vascular resistance was 16% in patients with sinus venosus and 4% in patients with atrial septal defect. The increase in resistance occurred at a younger age in sinus venosus defect than in atrial septal defect.?CONCLUSIONS—Patients with sinus venosus defect have higher pulmonary pressures and resistances and develop these complications at younger age than patients with atrial septal defects. Thus they should be managed differently than patients with "simple" atrial septal defects.???Keywords: sinus venosus defect; atrial septal defect; pulmonary hypertension; congenital heart defects PMID:10377305

Vogel, M; Berger, F; Kramer, A; Alexi-Meshkishvil..., V; Lange, P

1999-01-01

393

Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data  

PubMed Central

BACKGROUND—Atrial fibrillation is the most common supraventricular arrhythmia in patients with acute myocardial infarction. Recent advances in pharmacological treatment of myocardial infarction may have changed the impact of this arrhythmia.?OBJECTIVE—To assess the incidence and prognosis of atrial fibrillation complicating myocardial infarction in a large population of patients receiving optimal treatment, including angiotensin converting enzyme (ACE) inhibitors.?METHODS—Data were derived from the GISSI-3 trial, which included 17 944 patients within the first 24 hours after acute myocardial infarction. Atrial fibrillation was recorded during the hospital stay, and follow up visits were planned at six weeks and six months. Survival of the patients at four years was assessed through census offices.?RESULTS—The incidence of in-hospital atrial fibrillation or flutter was 7.8%. Atrial fibrillation was associated with indicators of a worse prognosis (age > 70 years, female sex, higher Killip class, previous myocardial infarction, treated hypertension, high systolic blood pressure at entry, insulin dependent diabetes, signs or symptoms of heart failure) and with some adverse clinical events (reinfarction, sustained ventricular tachycardia, ventricular fibrillation). After adjustment for other prognostic factors, atrial fibrillation remained an independent predictor of increased in-hospital mortality: 12.6% v 5%, adjusted relative risk (RR) 1.98, 95% confidence interval (CI) 1.67 to 2.34. Data on long term mortality (four years after acute myocardial infarction) confirmed the persistent negative influence of atrial fibrillation (RR 1.78, 95% CI 1.60 to 1.99).?CONCLUSIONS—Atrial fibrillation is an indicator of worse prognosis after acute myocardial infarction, both in the short term and in the long term, even in an unselected population.???Keywords: atrial fibrillation; acute myocardial infarction; prognosis PMID:11602545

Pizzetti, F; Turazza, F; Franzosi, M; Barlera, S; Ledda, A; Maggioni, A; Santoro, L; Tognoni, G

2001-01-01

394

Pathophysiologic basis of autonomic ganglionated plexus ablation in patients with atrial fibrillation.  

PubMed

The intrinsic cardiac autonomic nervous system (ganglionated plexuses [GP]) plays a significant role in the initiation and maintenance of atrial fibrillation (AF) in both experimental models and AF patients. Left atrial GP, located in epicardial fat pads and the ligament of Marshall, contain afferent neurons from the atrial myocardium and the central autonomic nervous system, efferent neurons (cholinergic and adrenergic neurons), and interconnecting neurons, which allow communication between GP. Stimulation of the GP produces both parasympathetic stimulation (markedly shortens action potential duration) and sympathetic stimulation (increases calcium transient) in the pulmonary vein (PV) myocardium and atrial myocardium. In a canine model, GP stimulation resulted in early afterdepolarizations, and calcium transient triggered firing in the adjacent PV and initiated AF. Fractionated atrial potentials (FAP) were consistently located in the left atrium close to the stimulated GP. Ablation of the stimulated GP eliminated the FAP surrounding the GP. In patients with paroxysmal AF, epicardial and endocardial high-frequency stimulation produced a positive vagal response (transient AV block during AF and hypotension), allowing the identification and localization of five major left atrial GP (superior left GP, inferior left GP, Marshall tract GP, anterior right GP, inferior right GP). High-density electroanatomic maps of the left atrium and PVs obtained during AF showed the FAP are located in four main left atrial areas (left atrial appendage ridge FAP area, superior-left FAP area, inferoposterior FAP area, anterior-right FAP area). All five GP are located within one of the four FAP areas. In 63 patients with paroxysmal AF, GP ablation alone (before PV antrum isolation) significantly decreased the occurrence of PV firing (47/63 patients before ablation vs 9/63 patients after ablation, P <.01). GP ablation also decreased the inducibility of sustained AF (43/63 patients vs 23/63 patients, P <.01) and markedly reduced or eliminated the left atrial FAP areas. PMID:19959140

Nakagawa, Hiroshi; Scherlag, Benjamin J; Patterson, Eugene; Ikeda, Atsuhsi; Lockwood, Deborah; Jackman, Warren M

2009-12-01

395

Cost-Effectiveness of Procedures for Treatment of Ostium Secundum Atrial Septal Defects Occlusion Comparing Conventional Surgery and Septal Percutaneous Implant  

PubMed Central

Objectives The study performs a cost-effectiveness analysis of procedures for atrial septal defects occlusion, comparing conventional surgery to septal percutaneous implant. Methods A model of analytical decision was structured with symmetric branches to estimate cost-effectiveness ratio between the procedures. The decision tree model was based on evidences gathered through meta-analysis of literature, and validated by a panel of specialists. The lower number of surgical procedures performed for atrial septal defects occlusion at each branch was considered as the effectiveness outcome. Direct medical costs and probabilities for each event were inserted in the model using data available from Brazilian public sector database system and information extracted from the literature review, using micro-costing technique. Sensitivity analysis included price variations of percutaneous implant. Results The results obtained from the decision model demonstrated that the percutaneous implant was more cost effective in cost-effectiveness analysis at a cost of US$8,936.34 with a reduction in the probability of surgery occurrence in 93% of the cases. Probability of atrial septal communication occlusion and cost of the implant are the determinant factors of cost-effectiveness ratio. Conclusions The proposal of a decision model seeks to fill a void in the academic literature. The decision model proposed includes the outcomes that present major impact in relation to the overall costs of the procedure. The atrial septal defects occlusion using percutaneous implant reduces the physical and psychological distress to the patients in relation to the conventional surgery, which represent intangible costs in the context of economic evaluation. PMID:25302806

da Costa, Marcia Gisele Santos; Santos, Marisa da Silva; Sarti, Flavia Mori; Senna, Katia Marie Simoes e.; Tura, Bernardo Rangel; Goulart, Marcelo Correia

2014-01-01

396

Angina pectoris in young patients: clinical appraisal and evaluation by exercise, atrial pacing, and myocardial lactate metabolism.  

PubMed

Young patients with a symptom complex of angina pectoris constitute a problematic group in medicine. Many of them require a detailed investigation. By combining electrophysiologic and metabolic measurements with dynamic clinical experiments, one can distinguish with great probability between normal and pathological findings. Exercise ECG, atrial pacing and simultaneous sampling of blood from artery and coronary sinus were undertaken in 57 patients aged 40 or less. Although the patients were selected according to a history of effort angina, results were normal in four and in seven other only one test was pathological. The sensitivity was highest in atrial pacing (78%) and somewhat lower in exercise ECG (75%) and lactate extraction (67%). The specificity of the tests in series was about 53%. Concordant results made a diagnosis of ischemic heart disease highly probable. Discrepancies and probably false negative results in individual cases are evident. The need for angiographic evaluation of coronary arteries and left ventricular function is clear. The stepwise advance from the usual physical examination to more demanding investigations provides a possibility of classifying the patients according to the needs of an accurate medical appraisal. PMID:920258

Rajasalmi, M; Takkunen, J

1977-01-01

397

The clinical efficacy of dabigatran etexilate for preventing stroke in atrial fibrillation patients  

PubMed Central

The use of novel oral anticoagulants (NOACs) for stroke and systemic embolism prevention in the setting of specifically non valvular atrial fibrillation has provided clinicians with a realistic treatment alternative to the traditional dose-adjusted, warfarin-based anticoagulation that is targeted to a therapeutic international normalized ratio range of 2.0–3.0. We discuss the use of dabigatran in the setting of mechanical heart valves, atrial fibrillation or left atrial catheter ablation procedures, reversal of the drug in the setting of adverse bleeding events, and background on the molecular biology and development of this novel treatment for stroke reduction. PMID:23874100

Ellis, Christopher R; Kaiser, Daniel W

2013-01-01

398

Assessment of atrial capture in committed atrioventricular sequential (DVI) pacing systems.  

PubMed

Two patients with committed dual unipolar AV sequential pacing systems are presented in whom atrial capture was unable to be demonstrated on the surface electrocardiogram. The bedside examination is proposed as a means of identifying the presence or absence of atrial capture with subsequent confirmation by M-mode echocardiographs and jugular venous pulse tracings. Mode, rate, and output programmability may aid in the evaluation of these pacing systems. Intentional reduction of the ventricular output to subthreshold levels in pacemakers capable of this degree of programmability will permit the rapid bedside confirmation of atrial capture without the need for expensive and time-consuming noninvasive tests. PMID:6191300

Levine, P A; Brodsky, S J; Seltzer, J P

1983-05-01

399

Never Out of the Woods: Onset of Events in Long QT Syndrome Late in Life Provoked by Atrial Arrhythmias  

PubMed Central

The assessment of risk in the asymptomatic patient with long QT syndrome can often be a challenging task, particularly when the available evidence is limited to relatively small retrospective registries, not to mention the need to consider the effect of individual patient factors which are often difficult to quantitate. We describe the relatively uncommon case of a man with a long-standing diagnosis of Long QT 2 syndrome who suffered his first cardiac event in his late 60's, likely precipitated by the development of paroxysmal atrial tachycardia. A brief review of the available literature on risk assessment in adults with genetically confirmed long QT syndrome who have remained asymptomatic late into adulthood will follow the case. PMID:25408567

Ng, Justin; Barbhaiya, Chirag; Reichlin, Tobias; Nagashima, Koichi; John, Roy

2014-01-01

400

Radiographic and echocardiographic assessment of left atrial size in 100 cats with acute left-sided congestive heart failure.  

PubMed

The aims of this study were to evaluate left atrial size in cats with acute left-sided congestive heart failure. We hypothesized that left atrial size as determined by thoracic radiography can be normal in cats with acute left-sided congestive heart failure. One hundred cats with acute left-sided congestive heart failure in which thoracic radiography and echocardiography were performed within 12 h were identified. Left atrial size was evaluated using right lateral and ventrodorsal radiographs. Measurements were compared to two-dimensional echocardiographic variables of left atrial size and left ventricular size. On echocardiography, left atrial enlargement was observed in 96% cats (subjective assessment) whereas maximum left atrial dimension was increased (>15.7 mm) in 93% cats. On radiographs left atrial enlargement (subjective assessment) was found in 48% (lateral view), 53% (ventrodorsal view), and 64% (any view) of cats whereas left atrial enlargement was absent in 36% of cats in both views. Agreement between both methods of left atrial size estimation was poor (Cohen's kappa 0.17). Receiver operating characteristic curve analysis identified a maximum echocardiographic left atrial dimension of approximately 20 mm as the best compromise (Youden index) between sensitivity and specificity in the prediction of radiographic left atrial enlargement. Left atrial enlargement as assessed by thoracic radiography may be absent in a clinically relevant number of cats with congestive heart failure. Therefore, normal left atrial size on thoracic radiographs does not rule out presence of left-sided congestive heart failure in cats with clinical signs of respiratory distress. PMID:24330164

Schober, Karsten E; Wetli, Ellen; Drost, Wm Tod

2014-01-01

401

The benefit of atrial septal defect closure in elderly patients*  

PubMed Central

Objective Closure of an atrial septal defect in elderly patients is controversial. The aim of the study was to evaluate the outcomes of transcatheter closure of secundum atrial septal defects (ASDs) in elderly patients. Patients and methods From a total of 488 patients with ASDs who underwent transcatheter closure, 75 patients aged over 60 years (45 female, 30 male) with a mean age of 65.3±15.7 (60–75) years were analyzed. All patients had an isolated secundum ASD with a mean pulmonary blood flow:systemic blood flow of 2.84±1.9 (1.5–3.9). Symptom-limited treadmill exercise tests with respiratory gas-exchange analysis and transthoracic color Doppler echocardiographic study, as well as quality of life measured using the Short Form (36) Health Survey (SF-36) were repeated in all patients before the procedure and after 12 months of follow-up. Results The atrial septal device was successfully implanted in all patients (procedure time 37.7±4.5 [13–59] minutes, fluoroscopy time 11.2±9.9 [6–40] minutes). There were no major complications. The defect echo diameter was 17.7±15.8 (12–30) mm. The mean balloon-stretched diameter of ASDs was 22.4±7.9 (14–34) mm. The diameter of the implanted devices ranged from 16 to 34 mm. Significant improvement of exercise capacity was noted at 6 and 12 months after the procedure. Exercise time within 6 months of ASD closure was longer (P<0.001) compared to baseline values, and also oxygen consumption increased (P<0.001). Seven quality-of-life parameters (except mental health) improved at 12-month follow-up compared to baseline data. The mean SF-36 scale increased significantly in 66 (88%) patients, with a mean of 46.2±19.1 (5–69). As early as 1 month after the procedure, a significant decrease of the right ventricular dimension and the right atrium dimension was observed (P<0.001). The right ventricular dimension decreased in 67 patients (89.3%). Conclusion Closure of ASDs in elderly patients caused significant clinical and hemodynamic improvement after percutaneous treatment, which was maintained during long-term follow-up, justifying this procedure in old age. PMID:25075179

Komar, Monika; Przewlocki, Tadeusz; Olszowska, Maria; Sobien, Bartosz; Podolec, Piotr

2014-01-01

402

Identification of Native Atrial G-protein-regulated Inwardly Rectifying K (GIRK4) Channel Homomultimers*  

E-print Network

Identification of Native Atrial G-protein-regulated Inwardly Rectifying K (GIRK4) Channel-protein-regulated inwardly rectifying K (GIRK) channels play critical inhibitory roles throughout the nervous system, heart

Clapham, David E.

403

The Three Integrated Phases of Left Atrial Macrophysiology and Their Interactions  

PubMed Central

Our understanding of the left atrium is growing, although there are many aspects that are still poorly understood. The left atrium size as an imaging biomarker has been consistently shown to be a powerful predictor of outcomes and of different cardiovascular disorders, such as, but not limited to, atrial fibrillation, congestive heart failure, mitral regurgitation and stroke. Left atrial function has been conventionally divided into three integrated phases: reservoir, conduit and booster-pump. The highly dynamic left atrium and its response to the stretch and secretion of atrial neuropeptides leaves the left atrium far from being a simple transport chamber. The aim of this review is to provide an understanding of the left atrial physiology and its relation to disorders within the heart. PMID:25167138

Mehrzad, Raman; Rajab, Mohammad; Spodick, David H.

2014-01-01

404

Etiologic significance of enlargement of the left atrial appendage in adults  

SciTech Connect

Fifty-one patients were divided into two groups: 20 patients with proven rheumatic mitral valve disease (RMVD) and 31 patients with left atrial enlargement (LAE) of a nonrheumatic etiology. The latter group included patients with ischemic papillary muscle dysfunction, mitral valve prolapse, and congestive cardiomyopathy. Radiographic studies showed that enlargement of the left atrial appendage (LAAE) was present in 18 of 20 rheumatics but in only one of 31 nonrheumatics. There was no direct relationship between enlargement of the LAA and radiographic or echocardiographic left atrial size, degree of pulmonary venous hypertension (PVH), or presence of atrial fibrillation. It is postulated that rheumatic influammation of the LAA allows it to dilate out of proportion to the body of the left atrium. In the adult patient with radiographic findings of PVH, LAAE is a valuable and specific radiographic sign of rheumatic mitral valve disease.

Green, C.E.; Kelley, M.J.; Higgins, C.B.

1982-01-01

405

Wavelet-Based Filtering for the Clinical Evaluation of Atrial Fibrillation.  

National Technical Information Service (NTIS)

This paper describes the work in progress to develop a new ECG signal filtering technique to aid the clinical analysis of atrial fibrillation. The method separates the wavelet transform modulus maxima corresponding to the signal scalogram into a number of...

J. N. Watson, P. S. Addison, N. Grubb, G. R. Clegg, C. E. Robertson

2001-01-01

406

Exploring alternans characteristics of electrocardiogram for prediction of Paroxysmal Atrial Fibrillation  

E-print Network

The goal of our thesis was to investigate if P-wave and PQ segment alternans can be used to detect and predict Paroxysmal Atrial Fibrillation (PAF) from an Electrocardiogram (ECG). The work involved implementing an algorithm ...

Dosani, Adnan, 1982-

2004-01-01

407

Atrial and ventricular myosins from human hearts II. Isoenzyme distribution after myocardial infarction  

Microsoft Academic Search

Summary Human atrial and ventricular myosins were prepared from autopsy specimens from subjects with coronary heart disease. Cardiac myosin light chain isotypes were resolved using twodimensional gel electrophoresis, whereas myosin isozymes were detected by pyrophosphate gel electrophoresis.

U. Hoffmann; C. Axmann; N. Palm

1987-01-01

408

Reactive oxygen species-targeted therapeutic interventions for atrial fibrillation  

PubMed Central

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

Sovari, Ali A.; Dudley, Samuel C.

2012-01-01

409

Systematic overview and clinical applications of pacing atrial stress echocardiography.  

PubMed

Pacing atrial stress echocardiography (PASE) has been studied over the past 3 decades for the evaluation of myocardial ischemia. Published studies suggest that PASE may be used as an alternative to exercise or pharmacologic stress imaging. The recent introduction of improved pacing electrodes, together with use of accelerated and shortened pacing protocols and improvements in transthoracic echocardiographic imaging techniques, makes PASE an appealing stress imaging method. A critical analysis of the diagnostic accuracy of PASE shows equivalence with other imaging stress modalities. PASE has been found to be highly feasible and accurate technique that may expedite the diagnosis and risk stratification of patients with coronary artery disease. This review addresses the history, hemodynamics, protocols, accuracy, clinical utility, and cost-effectiveness of PASE as well as elucidating its place among other stress modalities. PMID:16893716

Modi, Shreyas A; Siegel, Robert J; Birnbaum, Yochai; Atar, Shaul

2006-08-15

410

A Simple Model for Identifying Critical Structures in Atrial Fibrillation  

E-print Network

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 wavefront propagation on a structure mimicking the branching network architecture of heart muscle and show how AF emerges spontaneously as age-related parameters change. We identify 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. This analytical result allows us to locate the transition in parameter space and highlights that the transition from regular to fibrillatory behaviour is a finite-size effect present in systems of any size. These clinically testable predictions might inform ablation therapies and arrhythmic risk assessment.

Christensen, Kim; Peters, Nicholas S

2014-01-01

411

Repolarization currents in embryonic chick atrial heart cell aggregates.  

PubMed Central

Outward membrane currents in aggregates of atrial cells prepared from 7-12-d-old chick embryonic hearts were measured with the two microelectrode voltage-clamp technique. Two outward current components, Ix1 and Ix2, were found in the plateau potential range of the action potential. The Ix1 component is activated between -50 and -20 mV; the Ix2 component is activated between -15 and +20 mV. The Ix1 component inwardly rectifies, whereas Ix2 has an approximately linear current-voltage relation. These preparations lack a time-dependent pacemaker current component, even though they beat spontaneously with an interbeat interval of approximately 1 s. A mathematical model of electrical activity is described based on our measurements of time-dependent outward current, and measurements in the literature of inward current components. PMID:3790689

Shrier, A; Clay, J R

1986-01-01

412

Standardized review of atrial anatomy for cardiac electrophysiologists.  

PubMed

Catheter ablation of cardiac arrhythmias has rapidly evolved from a highly experimental procedure to a standard form of therapy for various tachyarrhythmias. The advances in this field have included, first, the development of techniques of catheter ablation that often requires the precise destruction of minute amounts of arrhythmogenic tissues and, second, techniques of resynchronization therapy that require pacing different parts of the ventricles. A detailed prepocedural knowledge of cardiac anatomy can improve the safety of the procedure and its rate success. It helps the electrophysiologist to choose the appropiate region for ablation, shortening the procedural time. The atrial anatomy structures are usually localized before ablation by different imaging techniques such as fluoroscopy, electroanatomic mapping, intracardiac echocardiography or multidetector computed tomography. In this review, we describe the normal anatomy of the atria, highlighting the landmarks of interest to intervencional cardiologist, stressing their relationship to other structures. This article is part of a JCTR special issue on Cardiac Anatomy. PMID:23389853

Sánchez-Quintana, Damián; Pizarro, Gonzalo; López-Mínguez, José Ramón; Ho, Siew Yen; Cabrera, José Angel

2013-04-01

413

Recognising and managing atrial fibrillation in the community.  

PubMed

Atrial fibrillation (AF) is the most common cardiac arrhythmia and has greater prevalence in the increasing ageing population, with an estimated 10% of those over 80 years having AF. Symptoms associated with AF include palpitations, dizziness, shortness of breath and fatigue. Those presenting with these symptoms need to be investigated and the appropriate treatment should be initiated if AF is detected. For those with AF, there is a significant risk of stroke if patients are not adequately anti-coagulated. This article outlines methods for detecting AF in the community and provides an overview of current treatment options, including the newer anti-coagulant agents. The importance of assessing stroke risk and conveying this risk to those with AF is essential. Community health professionals play an important role in monitoring, treating and managing AF within the community setting and supporting and educating the patient in minimising the risk of serious thromboembolic complications such as stroke. PMID:25184894

Lee, Geraldine; Campbell-Cole, Carolyn

2014-09-01

414

Interventional treatment of atrial fibrillation - contemporary methods and perspectives.  

PubMed

Atrial fibrillation (AF) is estimated to affect nearly 3 million people around the world. It is the most common arrhythmia and its incidence increases with age. Catheter ablation is an interventional procedure performed to reduce the patient's AF burden when pharmacotherapy did not succeed in relieving the patient's symptoms. The ablation is most effective in paroxysmal AF; however, many techniques are being developed to make this procedure more eligible for patients with persistent arrhythmia. The most common AF ablation technique involves separating electric activity of the pulmonary veins from the left atrium. Over recent years, many novel and promising techniques were developed (e.g., balloon cryoablation, circular catheter ablation, laser ablation, robotic navigation, etc.), which may further improve AF ablation efficacy. PMID:25060723

Zuchowski, Bartosz; Kaczmarek, Krzysztof; Szumowski, Lukasz; Li, Yi-Gang; Ptaszynski, Pawel

2014-11-01

415

Oral anticoagulants for stroke prevention in atrial fibrillation.  

PubMed

The availability of 4 non-vitamin K oral anticoagulants (NOACs), that is, dabigatran, rivaroxaban, apixaban, and edoxaban, has changed the landscape of stroke prevention in patients with atrial fibrillation. This review article provides an overview of the 4 phase III studies that have compared these NOACs, examining major outcomes of efficacy and safety. A range of practical questions relating to the NOACs have emerged, including topics such as patient selection, treating patients with renal impairment, treating elderly patients, and combining anticoagulant therapy with antiplatelet drugs. We also address the interaction of various patient characteristics with the treatments and suggest the features can assist the physician in the choice of a particular NOAC for a particular patient(s). PMID:25194766

Senoo, Keitaro; Lane, Deirdre A; Lip, Gregory Y H

2014-09-01

416

Diagnosis and management of atrial fibrillation: an overview.  

PubMed

Atrial fibrillation (AF) has been defined as the new cardiovascular "epidemic". Its prevalence is rising in developed countries, and the associated social and economic costs are high. In the last few years, there has been an increasing interest in understanding the mechanisms of AF and its management. New pharmacotherapies together with novel techniques for surgical and catheter treatment of AF have been developed, allowing the maintenance of sinus rhythm and the alleviation of symptoms in a large number of patients with AF. However, there are still some challenges that need to be addressed. This article gives an overview of the current state of the art on novel techniques for diagnosis and management of AF. PMID:25130510

Romero, Iñaki; Nedios, Sotirios; Kriatselis, Charalampos

2014-10-01

417

[New frontiers for an ancient disease: genetics of atrial fibrillation].  

PubMed

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

Disertori, Marcello; Mazzola, Silvia; Quintarelli, Silvia; Arbustini, Eloisa

2013-01-01

418

Effect of human atrial natriuretic peptide on blood pressure after sodium depletion in essential hypertension  

Microsoft Academic Search

Human atrial natriuretic peptide was infused over four hours in three patients with essential hypertension. When the patients had a sodium intake of 200 mmol (mEq) daily an infusion of 0.5 micrograms atrial natriuretic peptide\\/min caused no significant change in blood pressure, whereas an infusion of 1.0 micrograms\\/min caused a gradual decrease in blood pressure and an increase in heart

W M Janssen; P E de Jong; G K van der Hem; D de Zeeuw

1986-01-01

419

Atrial natriuretic factor-a circulating hormone stimulated by volume loading  

Microsoft Academic Search

The cardiocytes of mammalian cardiac atria contain granules very similar to those in endocrine cells1,2. The number of these atrial granules is related directly to salt loading and blood volume3. Furthermore, crude extracts of rat atria and granule preparations have powerful natriuretic and diuretic effects4,5. These effects are mediated by peptides identified previously as atrial natriuretic factor (ANF). The peptides

R. E. Lang; H. Thölken; D. Ganten; F. C. Luft; H. Ruskoaho; Th. Unger

1985-01-01

420

Atrial fibrillation in the Wolff-Parkinson-White syndrome: ECG recognition and treatment in the ED  

Microsoft Academic Search

Estimated to occur in 0.1% to 0.3% of the population, Wolff-Parkinson-White syndrome (WPW) is a condition where atrial impulses bypass the atrioventricular node and activate the ventricular myocardium directly via an accessory pathway. Clinical clues to the diagnosis include a young patient with previous episodes of palpitations, rapid heart rate, or syncope. Although several different rhythm presentations are possible, atrial

Brian T. Fengler; William J. Brady; Claire U. Plautz

2007-01-01