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1

A case of left atrial myxoma with unusual tumor vascularity.  

PubMed

A 69-year-old woman presented with a 2-week history of chest pain and mitral and aortic valve replacement 15 and 5 years earlier. Transthoracic echocardiography revealed a well-seated monoleaflet mitral valve and a bileaflet aortic valve with normal function. Cardiac catheterization showed 3-vessel coronary artery disease and an abnormal cluster of new vessels derived from the left atrial circumflex and posterior ventricle branches. Two- and 3-dimensional transesophageal echocardiography identified a semi-mobile oval left atrial mass with multiple internal cystic spaces, attached to the fossa ovalis region in the interatrial septum. The mass was resected. The pathological diagnosis was atrial myxoma. PMID:24887916

Shabestari, Mahmoud Mohammadzadeh; Fazlinezhad, Afsoon; Moravvej, Zahra; Tashnizi, Mohammad Abbasi; Azari, Ali; Bigdelu, Leila

2013-11-26

2

[Atrial myxomas--echophonocardiographic characteristics].  

PubMed

Myxomas (MY) of the atria are benign tumors of the heart usually originated from the interatrial septum. Moving of these tumors into the blood stream cause obstruction of the atrio-ventricular valves and appearance of pathological sounds and murmurs. The main goal of this study is analysis of echophonocardiographic examinations in 4 patients with left atrial myxomas and in one patient with right atrial myxoma. In all the cases, the oval tumor masses with diastolic movements from the atrium towards the ventricle and obstruction of the atrial ventricular ostium were clearly visualized on two-dimensional echocardiography (2D). Simultaneous M-mod echocardilographic and phonocardiographic examinations showed individual phases of myxoma movement and occurrence of sounds. In the patients with left atrial myxoma, echophonocardiography documented the splitting of the first sound (0.05-0.06 sek), protomesosystolic murmur, occurrence of tumor "hit" in the early diastole (0.08-0.11 sec after second heart sound) and a presystolic murmur above the tricuspid valve were found. In all the patients, surgical removal of myxoma was successfully performed followed by disappearance of the symptoms and pathological sounds, which was confirmed on both echocardiogram and phonocardiograms. PMID:10593117

Buksa, M; Haraci?, A

1999-01-01

3

[Surgical excision of left atrial myxoma shortly after cerebral embolism;report of a case].  

PubMed

A 48-year-old male visited the emergency room suffering from acute dysarthria and right hemiplegia. Brain magnetic resonance imaging (MRI) revealed multiple cerebral infarctions. Echocardiography showed a mass in the left atrium. He was diagnosed with cerebral embolism due to left atrial myxoma. Open heart surgery immediately after the attack is generally considered contraindicated because of such problems as hemorrhagic infarction or brain edema. However, relapse of embolism may make the condition worse and miss the timing of surgery. Eventually, we electively performed excision of the myxoma 20 days after the onset of cerebral infarction. The postoperative course was uneventful. This is a report about a rare case of open heart surgery shortly after the attack. The indication and the appropriate timing of open heart surgery following cerebral embolism were discussed. PMID:25743557

Yamada, Hideaki; Fujimatsu, Toshihiro; Suzuki, Hiroyuki; Wada, Hideichi; Tashiro, Tadashi

2015-03-01

4

Late diastolic tumor "plop" in an asymptomatic case of right atrial myxoma.  

PubMed

Myxomas of the right atrium are rare tumors of the heart. They have been almost always described as symptomatic tumors. Auscultation and phonocardiography have been revealed tumor "plop" (P) as an early diastolic phenomenon, but the late "plop" has not be described. The aim of the case report is to present late diastolic tumor "plop" in an asymptomatic case of right atrial myxoma. A thirty year old man without any subjective symptoms was admitted to the clinic because of a murmur found during a routine examination when applying for a new job. Two dimensional echocardiography showed slightly enlarged right atrium with a myxoma in it. M-mode echocardiogram taken from parasternal short axis plane revealed a wide cluster of echoes in the right atrium moving into the right ventricle inflow tract in diastole. Simultaneous phonocardiogram showed splitting of the first sound (0.06 sec.). The tumor "plop" occurred in late diastole, 0.22 seconds after the second sound (S2) and coincided with maximum tumor protrusion into the right ventricle. After successful operation of the tumor without catheterisation, echophonocardiographic finding has become quite normal. PMID:10386041

Buksa, M; Haraci?, A

1999-01-01

5

Endometrial Adenocarcinoma with Concomitant Left Atrial Myxoma.  

PubMed

BACKGROUND: Atrial myxomas are the most common primary heart tumors and predominantly considered to be benign lesions. Case Study: We report a case involving a 77-year-old woman who presented with a pelvic mass. She was found to have a primary endometrial cancer and primary lung cancer with concomitant metastatic adrenal gland and mesenteric lesions. Her prior medical history also included an untreated 4.0 x 2.0-cm left atrial myxoma which was identified on CT scan during the workup of her pelvic mass. RESULTS: A clinical decision was made to proceed with surgery for the pelvic mass with a subsequent recommendation for left atrial mass resection. Currently, the patient is scheduled to begin chemotherapy for primary lung cancer. CONCLUSION: The reported incidence of uterine cancer and a concurrent atrial myxoma is very rare. Consequently, the manner and timing in which treatment should be provided is imprecise. In the present case, the risk for cardiac complications was high, but given the presence of a partial bowel obstruction and the need to diagnose the primary site of her metastatic malignancy, the decision was made to proceed with exploratory abdominal surgery. PMID:20740179

Abaid, Lisa N; Epstein, Howard D; Chang, Miles; Kankus, Rita; Goldstein, Bram H

2009-01-01

6

Recurrent myxoma implanted in the left atrial appendage.  

PubMed

We present the case of a young woman who developed myxomas in multiple cardiac chambers for the third time. One of the tumors was found in the left atrial appendage with the use of transesophageal echocardiography, indicating that this technique is the method of choice for the follow-up of multiple myxomas. PMID:10978976

Roldán, F J; Vargas-Barrón, J; Espinola-Zavaleta, N; Keirns, C; Romero-Cárdenas, A

2000-02-01

7

A Rare Case of Large Left Atrial Myxoma Associated with Carney Syndrome  

PubMed Central

Abstract Carney Syndrome (CS) is an autosomal dominant multiple neoplasia syndrome that includes cardiac, endocrine, cutaneous, and neural tumors. Cardiac myxomas can be seen in the course of CS. A 46-year-old female patient was admitted to our clinic with palpitation, cough, and exertional dyspnea. Physical examination revealed pigmented lesions, especially scattered in the neck, chest, and extremities. Echocardiography revealed a left atrial mass, 6 × 4 cm in size, originating from the interatrial septum that was protruding into the left ventricle through the mitral valve during diastole. The tumor was excised from the interatrial septum with its pedicle. The patient was discharged at the fifth postoperative day without any complication. Cardiac myxomas are a cornerstone of this disease since cardiac manifestations and related complications account for the majority of mortality seen in the course of CS.

Kocabeyo?lu, Sinan Sabit; Özyüksel, Arda; Çetin, Erdem

2014-01-01

8

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. PMID:25408917

Fung, Kenneth; Edmondson, Stephen

2014-01-01

9

Atrial myxoma: a rare cause of ischemic stroke.  

PubMed

Arial myxoma can present as stroke and should be considered as a differential diagnosis of stroke in young individuals. We present here a 42 years female who presented with sudden loss of conciousness. After extensive work up for young stroke, left atrial myxoma was detected and tumor was removed surgically and histopathological report was consistent with the atrial myxoma. PMID:24482970

Negi, R C; Chauhan, Vivek; Sharma, Brij; Bhardwaj, Rajeev; Thakur, Surinder

2013-04-01

10

Multiple Metastatic Intracranial Lesions Associated with Left Atrial Myxoma  

PubMed Central

Summary Background One of the most common cardiac tumors is myxoma. Despite its predominantly benign course, diverse cardiological, systemic as well as neurological complications have been reported. Case Report We are the first from Poland to present the case of a patient with multiple central nervous system metastases associated with the left atrial myxoma. Various diagnostic, neuroradiological and histopathological procedures were described. The patient underwent cardiac surgery. Conclusions Follow-up studies excluded the recurrence of the heart tumor and confirmed partial resolution of brain metastases. Nevertheless, subsequent neurological assessment was advised according to the literature data and possible late relapses mainly due to cerebral emboli. PMID:25152797

Kierdaszuk, Biruta; Gogol, Pawe?; Kolasa, Anna; Maj, Edyta; Zakrzewska-Pniewska, Beata; Go??biowski, Marek; Kami?ska, Anna M.

2014-01-01

11

Cerebral aneurysm associated with cardiac myxoma: Case Report  

PubMed Central

Left atrial myxomas are a rare but well known cause of cerebrovascular accidents in young people. Cerebral embolism is the most common cause of cerebral ischemic stroke. The intracranial aneurysm is rarely associated with myxoma. We report the case of a patient who had an operation of PICA aneurysm due to subarachnoid hemorrhage ten months before the discovery of the large left atrial myxoma. Fortunately, the untimely diagnosis of the myxoma did not have other consequences. In order to prevent possible complications of we should keep in mind that these two apparently different entities could be associated. PMID:21342146

Ivanovi?, Branislava A.; Tadi?, Marijana; Vraneš, Mile; Orbovi?, Bojana

2011-01-01

12

[Left atrial giant myxoma incidentally discovered during endoscopic ultrasonography; report of a case].  

PubMed

A 49-year-old female patient with a symptom of dysphagia underwent endoscopic ultrasonography (EUS) of the upper gastrointestinal tract, which incidentally revealed a tumor compressing the esophagus from outside. Transthoracic echocardiography performed after EUS showed a giant tumor in the left atrium. The tumor, measuring 75×68×43 mm, weighing 105 g was successfully removed, and pathologically diagnosed as myxoma. Her symptom disappeared completely. When performing clinical studies, it is important to pay every attention not to miss any abnormal findings beyond the scope of targeted areas. We also mentioned an ambiguity of the term," giant" regarding the size and weight of myxoma. PMID:25434549

Saitoh, Hirofumi; Morita, Terumasa; Sugiura, Hirotaka; Otsuka, Hideaki; Tomii, Koichi; Takayama, Tsugumi; Okura, Yuji; Kurita, Satoshi; Kawasaki, Takashi

2014-12-01

13

Bi-atrial myxomas presenting as recurrent pulmonary emboli in a girl.  

PubMed Central

A 14-year-old girl whose sole presenting features were symptoms of pulmonary embolism, was found to have bi-atrial myxomas. The diagnosis was made preoperatively, and the patient had a successful outcome following elective surgery. The absence of other features such as systemic embolism, atrioventricular valvular obstruction, fever and constitutional symptoms makes this a most unusual case. Right atrial myxoma should be considered in any patient presenting with pulmonary embolism for which there is no obvious source. Images Fig. 1 Fig. 2 PMID:6709549

Hanly, J.; de Buitleir, M.; Shaw, K.; Maurer, B.; FitzGerald, M. X.

1984-01-01

14

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

PubMed

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

Xiao, Zheng-hua; Hu, Jia; Zhu, Da; Shi, Ying-kang; Zhang, Er-yong

2013-01-01

15

Giant right atrial myxoma leading to cardiac arrest in an infant.  

PubMed

We present the case of a three-month-old infant with a giant right atrial myxoma obstructing the tricuspid valve, who following haemodynamic deterioration and cardiac arrest, was operated upon as an emergency. On echocardiogram, there was a mass attached to the tricuspid annulus, in close proximity to the septal leaflet, with dimensions of 16.6 × 12.5 mm. The mass was prolapsing through the tricuspid valve into the right ventricle and obstructing the inflow. While preparing for surgery, cardiac arrest occurred, so the patient underwent an emergency operation under cardiopulmonary resuscitation. The mass was excised without damaging the tricuspid valve and the conduction system. Histologically, the mass consisted of a myxoid matrix with scatted globoid and star-shaped myxoma cells. The patient stayed 15 days in the intensive care unit and was discharged home on the 20th day postoperatively. Although accepted as a benign tumour, a myxoma can display an aggressive clinical course in infants. In centres where cardiac operations cannot be performed, these patients need to be transferred to cardiac centres as soon as possible. Whatever the clinical presentation, we advocate immediate surgical extirpation of the tumour in order to avoid any unpredictable consequences in its clinical course. PMID:22331270

Vuran, C; Babaoglu, K; Ozker, E; Ayabakan, C; Saritas, B; Kocyigit, O I; Turkoz, R

2012-02-01

16

Orbital myxoma: a case report.  

PubMed

Orbital myxomas are extremely rare tumors. We describe a 75-year old male patient with lower eyelid ectropion and 8-mm of left non-axial proptosis. Orbital CT and MRI revealed a well-demarcated lesion in the lateral quadrant of the orbit. After complete surgical excision, histopathological examination led to the diagnosis of orbital myxoma. The patient was followed-up for 1 year without recurrence. PMID:23560550

Tawfik, Hatem A; Elraey, Haidy Z

2013-06-01

17

Recurring cardiac myxoma.  

PubMed Central

Of a series of 14 patients surviving operation for atrial myxoma, two developed signs of recurrence of the tumour. In both cases the patients underwent two further separate operations for recurrent lesions. The time before the second recurrence was nearly 11 years and four and a half years. In neither case did histological examination show malignant change. These two cases of recurrent atrial myxoma, together with four other reported cases, indicate that a second recurrence may occur in about 25% of patients with a first recurrence. Multiple foci of tumour growth is probably the explanation for recurrence in most cases. PMID:4005088

Gray, I R; Williams, W G

1985-01-01

18

Left atrial myxoma—influence of tumour size on electrocardiographic findings  

PubMed Central

Objective The data of 51 patients (33 females) who underwent excision of left atrial (LA) myxoma were retrospectively reviewed for correlation of tumour size and electrocardiographic (ECG) findings. Methods and results Mean age was 39.1 ± 15 years (range 9–53 years). The LA enlargement (LAE) on ECG was defined by standard criteria. The LAE in ECG in these patients did not correlate with echocardiographic LA dimensions or with the degree of left ventricular (LV) inflow obstruction. But it was found that the presence of LAE in ECG predicted maximum tumour dimension of >5 cm and correlated with the degree of mitral regurgitation (MR). The LAE in ECG disappeared following surgery in 87.5% of patients. Conclusion The LA enlargement on ECG in a patient with LA myxoma signifies larger tumour size or the presence of significant MR but is not necessarily associated with an increased LA size or LV inflow obstruction. PMID:22572494

Harikrishnan, S.; Bohora, Shomu; Pillai, Vivek V.; Sanjay, G.; Rajeev, E.; Tharakan, J.M.; Titus, T.; Kumar, V.K. Ajith; Sivasankaran, S.; Namboodiri, K.K.N.

2012-01-01

19

New diagnosis of left atrial myxoma in a 93-year-old woman.  

PubMed

A 93-year-old woman with a history of hypertension was noted to have a mass in the left atrium prolapsing partially through the mitral valve on a routine surface echocardiogram in 2002. A transesophageal echocardiogram was then performed revealing an irregular mass with an appearance of protruding fronds of tissue. The echogenicity of the mass was inhomogeneous with some areas of punctate calcification, and the mass was attached to the interatrial septum. The echocardiographic appearance of the mass was almost pathognomic of atrial myxoma, and this is the oldest patient yet to have been diagnosed with a probable myxoma. The patient did not want surgical removal of the mass. She is still asymptomatic at the age of 95 years. PMID:15891245

Kang, Gurjaipal; Bhullar, Parampal; Kang, Manjot

2005-01-01

20

Odontogenic myxoma of the maxilla: A report of a rare case and review of the literature  

PubMed Central

Odontogenic myxoma represents an uncommon benign neoplasm comprising of 3–6% of all odontogenic tumors. This article presents a rare case of odontogenic myxoma occurring in the maxilla of a 7-year-old male patient with a brief review of the pathogenesis, clinical, radiological, histopathological, ultrastructural and immunohistochemical characteristics of odontogenic myxoma. PMID:21180454

Singaraju, Sasidhar; Wanjari, Sangeetha P; Parwani, Rajkumar N

2010-01-01

21

Intracerebral Hemorrhage after Intravenous Thrombolysis in Patients with Cerebral Microbleeds and Cardiac Myxoma  

PubMed Central

Background and purpose: Cardiac myxoma is a rare etiology of stroke. Both cerebral microbleeds and cardiac myxoma may increase the risk of intracerebral hemorrhage after intravenous (IV) thrombolysis. However, data are still limited. We report a case of multiple cerebral microbleeds treated with IV thrombolysis with later findings of cardiac myxoma. Summary of case: A 58-year-old-man presented with right-sided hemiplegia and global aphasia. The presumptive diagnosis of acute left middle cerebral artery (MCA) infarction was made. Previous magnetic resonance imaging showed multiple cerebral microbleeds. The patient received IV thrombolysis. Bilateral cerebellar hemorrhage occurred after thrombolysis, and a median suboccipital craniectomy and hematoma removal was performed. Transthoracic echocardiogram found a left atrial myxoma. The tumor was then surgically removed. Six months later, neurological deficit improved. Conclusion: Cerebral microbleeds may be associated with atrial myxoma. IV thrombolysis could benefit acute ischemic stroke patients with both baseline cerebral microbleeds and atrial myxoma. PMID:25520700

Chutinet, Aurauma; Roongpiboonsopit, Duangnapa; Suwanwela, Nijasri C.

2014-01-01

22

A rare case of odontogenic myxoma in a dog.  

PubMed

A case of odontogenic myxoma in an old Doberman bitch involving the periodontal region of the mandible was recorded. Grossly, the tumour mass was soft and slimy, having brownish-black foci on cut surface. Histopathologically, the tumour predominantly consisted of mesenchyme-like cells with prominent nuclei and nucleoli. The tumour had abundant ground substance, rich in acid mucopolysaccharides. PMID:16176569

Gupta, K; Singh, A; Sood, N; Mohindroo, J; Sood, N K

2005-10-01

23

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

24

Odontogenic myxoma.  

PubMed

Odontogenic myxoma is a rare, benign, locally aggressive and non metastasizing neoplasm which is believed to arise from the odontogenic ectomesenchyme and bears a close microscopic resemblance to mesenchymal portion of a tooth germ. This is a case report of odontogenic myxoma in a 32 year old female patient and the treatment rendered to her. PMID:24822019

Kumar, Naresh; Kohli, Munish; Pandey, Saumya; Agarwal, Poonam

2014-06-01

25

Intramuscular myxoma associated with an increased carbohydrate antigen 19.9 level in a woman: a case report  

Microsoft Academic Search

Introduction  Intramuscular myxoma is a rare benign soft tissue tumor. The lack of specific symptoms and widely used laboratory tests makes\\u000a the diagnosis quite difficult. We present a case of an Intramuscular myxoma associated with an increased carbohydrate antigen\\u000a 19.9 level. To the best of our knowledge, there have not been any reported cases of an association of Intramuscular myxoma\\u000a with

Dimitrios Theodorou; Eleftheria S Kleidi; Georgia I Doulami; Panagiotis G Drimousis; Andreas Larentzakis; Kostas Toutouzas; Stylianos Katsaragakis

2011-01-01

26

Oncologic profile of maxillary odontogenic myxoma: A rare case  

PubMed Central

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

Sarkar, Reena Radhikaprasad

2013-01-01

27

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

28

[Clinical characteristics of myxoma of the heart].  

PubMed

The authors describe 3 cases of left atrial myxoma confirmed by two-dimensional echocardiography and at operation. One patient had the symptoms of embolisms to the cerebral and renal vessels in the absence of heart disease, 2 patients presented with the symptoms of congestive heart failure. In one patient, loud first sound as well as systolic and diastolic murmur at the heart apex were documented. The nonspecific manifestations (weight loss, fever, high ESR, dysproteinemia, and rheumatoid factor) were observed in all the cases. The difficulties encountered in the clinical diagnosis of heart myxoma are discussed. The differential diagnosis is made between valvular heart disease and infective endocarditis, systemic vasculitis, cardiomyopathy, etc. Echocardiography to exclude myxoma should be performed in patients with thromboembolism, rheumatic valvular disease, subacute endocarditis (particularly in the absence of the classical symptoms) and in those with fever of unknown origin. PMID:4012632

Mukhin, N A; Kornev, B M; Moiseev, S V; Bogomolova, E L; Maksimov, N A

1985-01-01

29

Myxoma of the small intestine complicated by ileo-ileal intussusception: Report of an extremely rare case  

PubMed Central

INTRODUCTION Myxomas of the small intestine are extremely rare types of primary bowel neoplasms. Their presence can trigger intestinal intussusception in the adults. We present the eighth case of intestinal myxoma reported in the English literature. PRESENTATION OF CASE Our patient is a 44-year-old Caucasian female who presented with clinical and imaging findings of intestinal intussusception. Laparotomy revealed ileo-ileal intussusception caused by an intramural mass of the middle-ileum which was resected. Histological and immunohistochemical studies pointed to the diagnosis of benign intestinal myxoma, while imaging studies of the heart excluded a synchronous cardiac myxoma. Twenty months after surgery she remains disease-free. DISCUSSION The myxoma is a benign, true neoplasm which resembles primitive mesenchyme. It occurs predominantly in the heart and is also found in several soft tissues and bones. Myxomas seem to grow at different rates of speed, they infiltrate adjacent structures and they do not metastasize, apart from cardiac variants. Intestinal myxomas share some clinical characteristics which are emphasized. CONCLUSION Myxomas of the small intestine should be included in the differential diagnosis of ileal tumors in middle-aged women manifesting as intestinal intussusception. Treatment should include wide resection of the affected intestinal segment with primary anastomosis. A close follow-up control of the patients along with cardiac imaging evaluation is recommended postoperatively, in order to detect and treat any possible recurrence of the tumor or a synchronous cardiac myxoma. PMID:23702367

Varsamis, Nikolaos; Tavlaridis, Theodoros; Lostoridis, Eftychios; Tziastoudi, Eirini; Salveridis, Nikolaos; Chatzipourgani, Chrysanthi; Pouggouras, Constantinos; Pakataridis, Athanasios; Christodoulidis, Constantinos

2013-01-01

30

Odontogenic myxoma.  

PubMed

Odontogenic myxoma is a rare intraosseous neoplasm, which is benign but locally aggressive. It rarely appears in any bone other than the jaws. It is considered to be derived from the mesenchymal portion of the tooth germ. Clinically, it is a slow-growing, expansile, painless, non-metastasizing, central tumor of jaws, chiefly the mandible. Here we report the case of a typical odontogenic myxoma in a 26-year-old female patient, which had acquired large dimensions and involved the entire left half of the mandible including the ramus, resulting in a gross facial deformity, within a span of one and a half years. PMID:24163558

Gupta, Suchitra; Grover, Neeraj; Kadam, Ajit; Gupta, Shally; Sah, Kunal; Sunitha, J D

2013-01-01

31

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

PubMed

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

2013-07-01

32

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

33

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

PubMed

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

2014-09-01

34

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

35

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

PubMed Central

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

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

2014-01-01

36

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

PubMed

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

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

2014-01-01

37

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

PubMed

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

Jain, Vijay Kumar; Reddy, Soundarya Narayana

2013-09-01

38

Peripheral odontogenic myxoma of maxillary gingiva: A rare clinical entity  

PubMed Central

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

Jain, Vijay Kumar; Reddy, Soundarya Narayana

2013-01-01

39

Odontogenic myxoma of the mandible.  

PubMed

Odontogenic myxomas are benign but locally aggressive neoplasms found almost exclusively in the jaws and arise only occasionally in other bones. We present a rare case of odontogenic myxoma occurring in the mandible of a 19-year-old male patient with a brief review of clinical and radiological features, and diagnostic and operative dilemmas in managing the same. PMID:22830060

Manne, Rakesh Kumar; Kumar, Venkata Suneel; Venkata Sarath, P; Anumula, Lavanya; Mundlapudi, Sridhar; Tanikonda, Rambabu

2012-01-01

40

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

41

Significance of 18?F-FDG PET and immunohistochemical GLUT-1 expression for cardiac myxoma  

PubMed Central

Cardiac tumours are relatively rare and are difficult to diagnose merely with imaging techniques. We demonstrated an unusual case of left atrial myxoma, displaying the successful detection by positron emission tomography using 2-deoxy-2-[18?F] fluoro-D-glucose (18?F-FDG PET), correlated closely to more intense and enhanced immunoreactivity with glucose transporter-1 (GLUT-1) in a substantial number of cardiac myxoma cells. Further prospective studies are needed to validate the significance of 18?F-FDG PET findings for cardiac myxoma and the association with immunohistochemical GLUT-1 expression in its tumour cells, after collecting and investigating a larger number of surgical cases examined with both of them. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2991481941253449 PMID:24934577

2014-01-01

42

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

PubMed Central

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

Limdiwala, Piyush; Shah, Jigna

2015-01-01

43

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

PubMed

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

Limdiwala, Piyush; Shah, Jigna

2015-01-01

44

An unusual biatrial cardiac myxoma in a young patient.  

PubMed

This is a report of a biatrial cardiac myxoma in a young man with a 10-month history of exertional dyspnea and palpitation. The echocardiogram revealed biatrial myxoma prolapsing through the mitral and tricuspid valves during diastole. All cardiac chambers were enlarged and dysfunctional. The electrocardiogram revealed a rapid ventricular response with atrial flutter rhythm. The masses were resected and diagnosed as myxoma by a histological examination. The follow-up echocardiogram revealed significant improvement in ventricular function and reduction in the cardiac chambers' volume. There was no evidence of myxoma recurrence. The most probable cause of the patient's heart failure was considered to be tachycardia-induced cardiomyopathy. PMID:25705602

Azari, Ali; Moravvej, Zahra; Chamanian, Soheila; Bigdelu, Leila

2015-02-01

45

An Unusual Biatrial Cardiac Myxoma in a Young Patient  

PubMed Central

This is a report of a biatrial cardiac myxoma in a young man with a 10-month history of exertional dyspnea and palpitation. The echocardiogram revealed biatrial myxoma prolapsing through the mitral and tricuspid valves during diastole. All cardiac chambers were enlarged and dysfunctional. The electrocardiogram revealed a rapid ventricular response with atrial flutter rhythm. The masses were resected and diagnosed as myxoma by a histological examination. The follow-up echocardiogram revealed significant improvement in ventricular function and reduction in the cardiac chambers’ volume. There was no evidence of myxoma recurrence. The most probable cause of the patient’s heart failure was considered to be tachycardia-induced cardiomyopathy. PMID:25705602

Azari, Ali; Moravvej, Zahra; Chamanian, Soheila; Bigdelu, Leila

2015-01-01

46

Odontogenic myxoma of the maxilla: A report of a rare case and review on histogenetic and diagnostic concepts  

PubMed Central

Odontogenic myxoma (OM) is a rare and locally invasive benign neoplasm (comprising of 3-6% of all odontogenic tumors) found exclusively in the jaws. OM commonly occurs in the second and third decades, and the mandible is involved more commonly than the maxilla. The lesion often grows without symptoms and presents as a painless swelling. The radiographic features are variable, and the diagnosis is therefore not easy. This article presents a rare case of OM occurring in the maxilla of a 37-year-old female patient with a brief review of the pathogenesis, clinical, radiological, histopathological, ultrastructural and immunohistochemical characteristics of OM. PMID:22639512

Shah, Ajaz; Lone, Parveen; Latoo, Suhail; Ahmed, Irshad; Malik, Altaf; Hassan, Shahid; Naik, Aijaz; Rashid, Rizwan Ur

2011-01-01

47

Clinical Presentation and Treatment Options for Mitral Valve Myxoma  

Microsoft Academic Search

Myxomas rarely are located on the mitral valve. We report the case of a 44-year-old man operated on successfully with mitral valve conservation, which is the 21st case of mitral valve myxoma reported in the western literature. Among the cases reported in the literature, the diagnosis was made at the time of autopsy in 6 cases, with premortem heart failure

Nabil Chakfé; Jean-Georges Kretz; Philippe Valentin; Bernard Geny; Hélène Petit; Sorin Popescu; Saleem Edah-Tally; Gilbert Massard

1997-01-01

48

Orbital Nerve Seath Myxoma with Extraocular Muscle Involvement: A Rare Case.  

PubMed

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

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

2014-01-29

49

Case studies of two related Chinese patients with Carney complex presenting with extensive cardiac myxomas and PRKAR1A gene mutation of c.491_492delTG.  

PubMed

Carney complex is an autosomal dominant disease that is clinically characterized by cardiac myxomas, spotty skin pigmentation, and endocrine overactivity. Carney complex is most commonly caused by mutations in the PRKAR1A gene on chromosome 17q22-24. Currently, there are at least 117 pathogenic mutations in PRKAR1A that have been identified. Herein, we report on two cases of Carney complex in related Chinese patients with a c.491_492delTG mutation that presented with multiple and extensive cardiac myxomas and skin pigmentation. PMID:25778043

Guo, Hongwei; Xu, Jianping; Xiong, Hui; Hu, Shengshou

2015-12-01

50

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

51

A Canine Case of Primary Intra-Right Atrial Paraganglioma  

PubMed Central

ABSTRACT An 11-year-old mixed breed dog was presented with signs of anorexia. Radiographic and ultrasound examinations revealed a large mass in the heart, between the right atrium and the right ventricle. Upon gross inspection, a multilobulated tumor arising from the right atrial wall and occupying the right atrium was identified. Microscopical analysis demonstrated that this tumor consisted of neoplastic cells with granular cytoplasm, which were separated into nests by fine fibrovascular stroma and were negative for Grimelius’s method. Immunohistochemical examinations revealed that the neoplastic cells expressed chromogranin A, synaptophysin and neuron specific enolase. Electron microscopy revealed that the cytoplasm of the neoplastic cells held secretory granules. Based on these pathological findings, the tumor was diagnosed as a paraganglioma. This report is a rare case of primary paraganglioma deriving from the right atrium and provides a detailed characterization of its morphological features. PMID:24670962

YANAGAWA, Hirotaka; HATAI, Hitoshi; TAODA, Takahiro; BOONSRIROJ, Hassadin; KIMITSUKI, Kazunori; PARK, Chun-Ho; OYAMADA, Toshifumi

2014-01-01

52

A canine case of primary intra-right atrial paraganglioma.  

PubMed

An 11-year-old mixed breed dog was presented with signs of anorexia. Radiographic and ultrasound examinations revealed a large mass in the heart, between the right atrium and the right ventricle. Upon gross inspection, a multilobulated tumor arising from the right atrial wall and occupying the right atrium was identified. Microscopical analysis demonstrated that this tumor consisted of neoplastic cells with granular cytoplasm, which were separated into nests by fine fibrovascular stroma and were negative for Grimelius's method. Immunohistochemical examinations revealed that the neoplastic cells expressed chromogranin A, synaptophysin and neuron specific enolase. Electron microscopy revealed that the cytoplasm of the neoplastic cells held secretory granules. Based on these pathological findings, the tumor was diagnosed as a paraganglioma. This report is a rare case of primary paraganglioma deriving from the right atrium and provides a detailed characterization of its morphological features. PMID:24670962

Yanagawa, Hirotaka; Hatai, Hitoshi; Taoda, Takahiro; Boonsriroj, Hassadin; Kimitsuki, Kazunori; Park, Chun-Ho; Oyamada, Toshifumi

2014-07-01

53

Cardiac myxoma the great imitators: comprehensive histopathological and molecular approach.  

PubMed

Cardiac myxomas are rare benign and slowly proliferating neoplasms of uncertain histogenesis with heterogeneous histomorphology and variable and sometimes clinically quite malignant pathological manifestations. Majority of cardiac myxoma occur sporadically while a relatively small proportion of diagnosed cases develop as a part of Carney complex syndrome with established familial pattern of inheritance. Although histologically indistinguishable these two forms of cardiac myxoma exhibit distinct cytogenetic make-up and apparent pathological differences important for their clinical presentation and prognosis. Additional problem is presented with secondary lesions with more aggressive histology and significantly faster cell proliferation suggesting their successive malignant alteration. Surgical resection of cardiac myxoma is currently the only treatment of choice. However, to avoid potentially hazardous operating procedures and possible postoperative complications and to prevent recurrence of the neoplastic lesions it is necessary to develop alternative approaches and identify a possible drug targets for their successful pharmacological treatment. Due to the rarity of the disease, a small number of cases in one institution and lack of comprehensive experimental data particularly concerning the cases of metastatic dissemination and secondary lesions with malignant nature, a comprehensive multi-institutional approach is required for better understanding of their molecular pathology and illumination of key molecular, genetic as well as epigenetic markers and regulatory pathways responsible for their development. In this article we provide comprehensive pathohistological, molecular and cytogenetic overview of sporadic cardiac myxoma cases restating the major hypothesis concerning their histogenesis and emphasizing potential approaches for their further reexamination. PMID:22243936

Gošev, Igor; Pai?, Frane; Duri?, Zeljko; Gošev, Milorad; Iv?evi?, Sanja; Jakuš, Floriana Buli?; Bio?ina, Bojan

2013-03-20

54

Delayed diagnosed posterior interosseous nerve palsy due to intramuscular myxoma  

PubMed Central

We present a case of posterior interosseous nerve palsy after bowel surgery associated with intramuscular myxoma of the supinator muscle. The initial symptoms of swelling of the forearm made it difficult to distinguish the condition from extravasations after intravenous cannulation. The diagnosis was finally established with nerve conduction studies and MRI 3?months after symptom onset. The patient underwent surgery for removal of the tumour and decompression of the posterior interosseous nerve. The histological examination identified the tumour as intramuscular myxoma and the patient made a full recovery with no recurrence of the lesion until present. Every swelling on the forearm causing neurological disorders is tumour suspected and should be examined clinically as well as electrophysically and radiographically. Early surgery and nerve decompression should follow immediately after the diagnosis. In case of intramuscular myxoma, good recovery of function after surgery with low recurrence risk may be expected. PMID:23576649

Kursumovic, A; Mattiassich, G; Rath, S

2013-01-01

55

Myxoma is not a single entity: A review of the concept of myxoma  

Microsoft Academic Search

Myxoid lesions can be subdivided into (1) mainstream myxomas of soft tissues, (2) mainstream myxomas located outside the soft tissue, (3) inadequately substantiated myxomas, (4) myxoid soft tissue tumors or lesions not regarded as myxomas, (5) myxoid fatty conditions, (6) other soft tissue lesions and tumors that are sometimes markedly myxoid, (7) other soft tissue tumors in which myxoid foci

P. W. Allen

2000-01-01

56

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...

57

Ruptured Abdominal Aortic Aneurysm after Resection of an Infected Cardiac Myxoma  

PubMed Central

A 12-year-old girl with a high fever underwent echocardiography and was found to have a myxoma that arose from the atrial side of the anterior mitral valve leaflet. The tumor was successfully excised. Histologic examination of the tumor showed myxoma cells and an organized thrombus with bacterial colonization. The patient was discharged from the hospital on antibiotic treatment. After remaining asymptomatic for 3 weeks, she was readmitted with acute abdomen. Ultrasonography and magnetic resonance angiography detected intra-abdominal hemorrhaging and a saccular aneurysm of the abdominal aorta. The patient underwent successful emergency surgery. To our knowledge, no other report has been published concerning an abdominal aortic aneurysm secondary to bacterial infection of a cardiac myxoma. Although complications this severe are rarely observed in patients who have endocarditis, early recognition and treatment can be life-saving. PMID:17622377

Guler, Niyazi; Ozkara, Cenap; Kaya, Yuksel; Saglam, Enis

2007-01-01

58

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

PubMed Central

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

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

2014-01-01

59

Soft tissue myxoma- a rare differential diagnosis of localized oral cavity lesions.  

PubMed

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

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

2014-12-01

60

Initial description of radiofrequency catheter ablation as treatment for atrial flutter in Marfan's syndrome: a case report and literature review.  

PubMed

Marfan's syndrome is a common connective tissue disease with different musculoskeletal, ophthalmic and cardiac manifestations. Marfan's patients carry increased risk for cardiac arrhythmias. Only three cases of atrial flutter in Marfan's patients are described in the literature. We report a fourth case of a young Marfan's patient who presents with typical atrial flutter after motor vehicle accident. After electrical cardioversion, sinus rhythm was restored but he had recurrent atrial flutter on follow up. The patient then underwent electrophysiological study and successful radiofrequency catheter ablation of the flutter circuit. Since discharge, the patient has had no documented arrhythmias on follow up. PMID:17597390

Halawa, Ahmad; Brahmbhatt, Vipul; Fahrig, Stephen A

2007-06-01

61

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

62

[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

63

Odontogenic myxoma of the face: mimicry of cherubism.  

PubMed

The present study is a case report of a 3-year-old girl who was referred to our clinic with the clinical features of cherubism. A locally aggressive tumor was diffusely infiltrating the maxilla and mandible. At 4 years after resection, our patient has not demonstrated any signs of recurrence, which might point to a role for adjunctive chemotherapy, in this case imatinib (Gleevec), for odontogenic myxoma. PMID:25200927

Kleiber, Grant M; Skapek, Stephen X; Lingen, Mark; Reid, Russell R

2014-11-01

64

Molecular Basis of Cardiac Myxomas  

PubMed Central

Cardiac tumors are rare, and of these, primary cardiac tumors are even rarer. Metastatic cardiac tumors are about 100 times more common than the primary tumors. About 90% of primary cardiac tumors are benign, and of these the most common are cardiac myxomas. Approximately 12% of primary cardiac tumors are completely asymptomatic while others present with one or more signs and symptoms of the classical triad of hemodynamic changes due to intracardiac obstruction, embolism and nonspecific constitutional symptoms. Echocardiography is highly sensitive and specific in detecting cardiac tumors. Other helpful investigations are chest X-rays, magnetic resonance imaging and computerized tomography scan. Surgical excision is the treatment of choice for primary cardiac tumors and is usually associated with a good prognosis. This review article will focus on the general features of benign cardiac tumors with an emphasis on cardiac myxomas and their molecular basis. PMID:24447924

Singhal, Pooja; Luk, Adriana; Rao, Vivek; Butany, Jagdish

2014-01-01

65

Presentation of intramuscular myxoma as an unusual neck lump.  

PubMed

Intramuscular myxoma (IM) has a distinct diagnostic identity among soft tissue myxomas. IMs have an approximate incidence of 1 per million of the population per year, with a female-to-male ratio of 14:3. The age range for presentation is 40 to 70 years, and the thigh is affected most frequently. IMs most commonly affect larger muscle groups, making the head and neck a rare site. To the authors' knowledge, there is 1 previous report of an IM presenting in the sternocleidomastoid muscle. In addition, IMs usually present as slow-growing asymptomatic swellings. Although abnormal gag reflexes have been reported in cases of glossopharyngeal schwannoma and neurofibroma in patients with neurofibromatosis-1, a gag reflex has not been reported previously as a complication of IM in the head and neck. A case of IM in the left sternocleidomastoid muscle, presenting with an intense gag reflex on palpation, in a 70-year-old woman is presented. PMID:23351479

Kalsi, Jagdip Singh; Pring, Miranda; Hughes, Ceri; Fasanmade, Adekunmi

2013-05-01

66

The natural history of primary temporal bone myxoma.  

PubMed

Primary myxomas of the temporal bone are rare tumors. If misdiagnosed, they can grow into locally aggressive expansile masses resulting in hearing loss, facial paralysis, dural invasion, and mass effect on the adjacent brain parenchyma. This case demonstrates the natural history of an extraordinarily rare tumor over a longer period not previously described. The importance of correlating histopathologic findings with diagnostic imaging features to enable an accurate diagnosis is also emphasized. PMID:22483549

Guha-Thakurta, Nandita; Deavers, Michael; DeMonte, Franco; Gidley, Paul W

2012-08-01

67

An aggressive odontogenic myxoma of the maxilla  

PubMed Central

Odontogenic myxoma (OM) is a relatively rare benign odontogenic tumor of mesenchymal origin. OM is more common in the mandible than in the maxilla. It is an asymptomatic lesion that shows an infiltrative growth pattern. When the maxillary sinus is involved, it often fills the entire antrum. Odontogenic tumors are uncommon in the maxillary molar area, which often leads to diagnostic dilemma as this region of the maxilla is in the vicinity of vital structures, and radiographic overlapping of structures is always present. We present a similar case of a 17-year-old male patient who reported with a swelling in the left maxilla that infiltrated the maxillary sinus in a short duration of time. PMID:25565756

Kiresur, Mohammad Asif; Hemavathy, Sathyavanthan

2014-01-01

68

An aggressive odontogenic myxoma of the maxilla.  

PubMed

Odontogenic myxoma (OM) is a relatively rare benign odontogenic tumor of mesenchymal origin. OM is more common in the mandible than in the maxilla. It is an asymptomatic lesion that shows an infiltrative growth pattern. When the maxillary sinus is involved, it often fills the entire antrum. Odontogenic tumors are uncommon in the maxillary molar area, which often leads to diagnostic dilemma as this region of the maxilla is in the vicinity of vital structures, and radiographic overlapping of structures is always present. We present a similar case of a 17-year-old male patient who reported with a swelling in the left maxilla that infiltrated the maxillary sinus in a short duration of time. PMID:25565756

Kiresur, Mohammad Asif; Hemavathy, Sathyavanthan

2014-10-01

69

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

70

Rapidly progressing left atrial hemangiopericytoma.  

PubMed

Cardiac hemangiopericytoma is a rare soft tissue tumor. We describe a case of hemangiopericytoma in the left atrium, which was diagnosed as myxoma preoperatively. A 70-year-old woman was admitted with heart failure. An echocardiogram showed a large myxoma-like mass in the left atrium, herniating into the left ventricle; therefore, an emergency operation was performed. Histological examination revealed a malignant hemangiopericytoma. The patient's postoperative course was uneventful, but she died due to a local recurrence 4 months after the operation. PMID:24696103

Nakamura, Tamami; Ito, Hiroshi; Sakata, Kensuke; Kobayashi, Yurio

2014-04-15

71

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

PubMed Central

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 atrial fibrillation in the adolescent population. Case presentations We report the cases of two Caucasian adolescent boys of 14 and 16 years of age at the time of presentation, each without a significant cardiac history, who presented with palpitations or vague chest discomfort or both after a recent history of excessive caffeine consumption. Both were found to have atrial fibrillation on electrocardiogram; one patient required digoxin to restore a normal sinus rhythm, and the other self-converted after intravenous fluid administration. Conclusion With the increasing popularity of energy drinks in the pediatric and adolescent population, physicians should be aware of the arrhythmogenic potential associated with highly caffeinated beverage consumption. It is important for pediatricians to understand the lack of regulation in the caffeine content and other ingredients of these high-energy beverages and their complications so that parents and children can be educated about the risk of cardiac arrhythmias with excessive energy drink consumption. PMID:21247417

2011-01-01

72

Transcatheter closure of atrial septal defect associated with arrhythmogenic right ventricular cardiomyopathy: a case report and literature review.  

PubMed

Arrhythmogenic right ventricular cardiomyopathy is characterised by progressive, fibrofatty replacement of myocardium, and ventricular arrhythmias, and its prognosis is usually poor. Arrhythmogenic right ventricular cardiomyopathy associated with atrial septal defect is very rare, and this combination may make the diagnosis, treatment, and prognosis difficult. We present a case of a patient with this association who underwent interventional treatment with a septal defect occluder. Transcatheter closure of atrial septal defect in a patient with arrhythmogenic right ventricular cardiomyopathy is hitherto unreported. During a 3-year follow-up he remained relatively stable. We also review the cases reported in the medical literature describing this uncommon association between arrhythmogenic right ventricular cardiomyopathy and atrial septal defect or patent foramen ovale. PMID:25266992

Wang, Haiyan; Ding, Hongyu; Lei, Lei; Zhang, Xiaohong; Gong, Yuling; Hou, Yinglong

2015-03-01

73

Primary intracranial myxoma of the lateral skull base: a rare entity in clinical practice.  

PubMed

Myxomas are rare benign tumors arising from mesenchymal tissues throughout the body. These tumors are usually seen in the atrium of the heart and the jawbone. Involvement of the skull base with intracranial extension is extremely rare, and only a few cases of primary intracranial myxomas have been described in the literature. A rare case of primary myxoma of the temporal bone is presented in this article. The patient underwent a skull base surgery with a pre-diagnosis of possible chondrosarcoma. The tumor pathology revealed a diagnosis of myxoma with bone and meningeal involvement. Despite the radical surgery, the tumor showed a local recurrence in three years. A second surgery with subtotal petrosectomy was required. In the article, the etiology, histological and radiological findings as well as treatment options of this rare entity were briefly discussed under the highlights of the relevant literature. Such a localization and intracranial extension of myxomas is extremely unusual in clinical practice; the diagnosis therefore requires a high degree of suspicion and detailed histopathological examination. The differential diagnosis frequently includes chondrosarcomas, chordoma, metastatic tumors of the skull, hemangiopericytoma, meningioma and other neoplasms of the dura and skull base in this location. PMID:20066630

Oruckaptan, H Hakan; Sarac, Sarp; Gedikoglu, Gokhan

2010-01-01

74

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

75

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

76

Odontogenic myxoma in a 52-year-old woman.  

PubMed

Odontogenic myxoma (OM) is a rare benign but locally aggressive tumour of the jaws. It is usually seen in the second to third decade of life. Women are more frequently affected than men and it has more predilections for the mandible rather than the maxilla. OM presents as an asymptomatic swelling in most of the cases. Owing to the non-capsulated and aggressive nature of OM, a high rate of recurrence has been reported. Here we present a case of OM in a 52-year-old woman managed by segmental mandibulectomy. Sign of recurrence was seen after 18?months of follow-up. PMID:24859552

Ram, Hari; Mehta, Gagan; Kumar, Manoj; Lone, Parveen

2014-01-01

77

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

78

Antithrombotic therapy in a patient with mild haemophilia A and atrial fibrillation: case report and brief review of the literature.  

PubMed

The remarkable advances made in recent decades in the treatment of haemophilia have resulted in a longer life expectancy for haemophilia patients. The care of diseases related to ageing in these patients is becoming of great interest. We briefly discuss the current possibilities for antithrombotic therapy in patients with haemophilia describing the case of a 67-year-old patient with mild haemophilia A and atrial fibrillation requiring antithrombotic therapy. PMID:25803515

Aguilar, Carlos

2015-04-01

79

Thrombus in the left atrial appendage: a case report of neonate.  

PubMed

A Japanese girl first pointed out the mass in the left atrial appendage by the echocardiography on the 3rd day of life. At 30th day of life, the mass in the left atrial appendage was excised en bloc successfully under cardiopulmonary bypass because it appeared mobile. Its pathologic finding revealed an old organised thrombus. She is doing well with no episode of thrombus formation or thromboembolism, 2 years postoperatively. PMID:24666924

Fujiwara, Keiichi; Yoshizawa, Kosuke; Sakazaki, Hisanori

2015-03-01

80

A Case of Aorta-Right Atrial Tunnel Presented with an Asymptomatic Murmur  

PubMed Central

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

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

2013-01-01

81

Iatrogenic left ventricular-right atrial communication after tricuspid annuloplasty; a case report  

PubMed Central

A 75-year-old man (Asian, Japanese) was readmitted for examination of a heart murmur and haemolytic anemia 3 months after mitral valve and tricuspid annuloplasties and coronary artery bypass. A new systolic murmur was heard, and echocardiography showed a high-velocity jet originating from the left ventricular outflow tract and extending to the right atrium, a small defect between the left ventricle and the right atrium. No periprosthetic leaks were found in the mitral position. We judged that surgical repair of the defect was essential to treat mechanical haemolysis. At operation, we found a communication (3 mm in diameter) just beneath the detached prosthetic ring at the anteroseptal commissure of the tricuspid valve. After partially removing the tricuspid ring from the anteroseptal commissure area, the defect was closed using a single mattress suture with pledget. In this case, the tricuspid annuloplasty stitch in the atrioventricular region was probably placed on the membranous septum rather than on the tricuspid annulus. A tear then occurred in the atrioventricular membranous septum, leading to left ventricular–right atrial communication. PMID:24942072

2014-01-01

82

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

83

Immunomodulation by viruses: the myxoma virus story  

Microsoft Academic Search

Myxoma virus is a poxvirus pathogen of rabbits that has evolved to replicate successfully in the presence of an active immune response by an infected host. To accomplish this, the virus has developed a variety of strategies to avoid detection by or obstruct specific aspects of the antiviral response whose consolidated action is antagonistic to virus survival. We describe two

Piers Nash; John Barrett; Jing-Xin Cao; Sheela Hota-Mitchell; Alshad S. Lalani; Helen Everett; Xiao-Ming Xu; Janine Robichaud; Shawna Hnatiuk; Cheryl Ainslie; Bruce T. Seet; Grant McFadden

1999-01-01

84

Congenital absence of left atrial appendage: A case report and literature review  

PubMed Central

Congenital absence of left atrial appendage (LAA) is an extremely rare entity. A 50-year-old man with no past cardiac history was admitted with symptomatic atrial fibrillation (AF). Before subjecting him to direct current (DC) cardioversion, the patient underwent a transesophageal echocardiography (TEE) examination, but neither LAA nor a cardiac thrombus could be detected. Absence of both was confirmed by cardiac computer tomography (CT) and a cardiac magnetic resonance imaging (MRI) scan. The patient reverted to sinus rhythm with an uneventful synchronized biphasic DC shock of 100 joules.

Ghori, M.A.; Alessandro, Salustri

2014-01-01

85

[Infected myxoma as a cause of acute infective endocarditis].  

PubMed

Myxoma is the most frequent primary cardiac tumor. In the typical clinical picture mostly dominate signs of intracardial obstruction, embolisation or general signs of neoplastic process. The myxoma can mimic the course of acute endocarditis. Genuine proof of infection is rare. We report on a patient with familiar form of infected myxoma, who was treated succesfully with antiobiotic therapy and surgical extirpation of the tumor. PMID:20329587

Surovcík, R; Jebavý, P; Feuereisl, R; Frídl, P; Pavlovic, J; St?rba, D

2010-02-01

86

The importance of the sinus node artery in the blood supply of the atrial myocardium. An anatomical study of 360 cases.  

PubMed

The sinus node artery (SNA) and its contribution to the blood supply of the atrial myocardium (AM) were studied using X-rays and corrosion casting in a series of 360 human hearts. In 68 cases (19%) the SNA supplied the right atrium and part of the atrial septum (group A), in 211 cases (59%) it supplied the myocardium of one atrium (right or left), the atrial septum and part of the other atrium (group B), and in 81 cases (22%) the SNA supplied almost the entire AM (group C). In 133 cases (37%) the vessel supplying the sinus node (SN) was not the main continuation of the SNA, contrary to what is generally accepted. The SNA has many intercoronary and intracoronary anastomoses which comprise an important anastomosing net between the right coronary (RC) and left circumflex (LCir) arteries. These findings suggest that the SNA plays a major role in the blood supply of the AM apart from the SN. PMID:6601894

Nerantzis, C E; Toutouzas, P; Avgoustakis, D

1983-01-01

87

[A rare cardiac tumor: the malignant fibrous histiocytoma. Description of a case].  

PubMed

The present report describes the case of a 61-year-old woman with malignant fibrous histiocytoma of the left atrium originating from the left atrial free wall, operated on in emergency for a suspected large left atrial myxoma that, at the echo scan, was consistently protruding through the left atrioventricular orifice at each diastole and was almost completely occluding the left ventricular inflow, causing signs of congestive heart failure and severe dyspnea. Surgery was performed as radically as possible, but the histological examination of the specimen revealed the exact diagnosis of the neoplasm. About 75% of primary tumors are benign and 75% of these are atrial myxomas. The malignant tumors consist of various sarcomas: myxosarcoma, liposarcoma, angiosarcoma, fibrosarcoma, leiomyosarcoma, osteosarcoma, synovial sarcoma, rhabdomyosarcoma, undifferentiated sarcoma, reticulum cell sarcoma, neurofibrosarcoma, and malignant fibrous histiocytoma. The long-term results for sarcomas are very poor and there are few survivors after several months from surgery due to the extent of local spread and invasion or because of the frequent distant metastases. Malignant fibrous histiocytoma constitutes about 2% of all cardiac malignancies, which might grow within several localized areas, occasionally in the heart. Echocardiography represents the best examination procedure for both diagnosis and follow-up of patients with cardiac tumors. PMID:15554023

Talamonti, Ennio; Patrizi, Giampiero; Gabrieli, Luca; Gamboni, Alessandro; Cimato, Paolo; Ricci, Silvio

2004-08-01

88

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

PubMed Central

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

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

2014-01-01

89

Nerve sheath myxoma of the dorsal paravertebral space  

PubMed Central

INTRODUCTION Nerve sheath myxomas (NSM) are rare benign soft tissue tumors. The dorsal paravertebral placed NMS diagnosis can be difficult. PRESENTATION OF CASE This article presents clinical, radiological findings and treatment of the NSM of the dorsal paravertebral space in a 32-year-old man presented with a right shoulder and back pain for 4 years. DISCUSSION NSM is a rare and benign tumor and that most often occurs in the skin of the head, neck or upper limbs of younger patients. Rare locations such as intracranial, spinal canal, trunk, lower limb and oral cavity were also reported. The appropriate treatment of NSM is surgical excision. Diagnosis is difficult in an uncommon presentation. CONCLUSION Although the most presented case of NMS are dermal tumors, it may also be found extremely rare locations. We conclude that, the definitive treatment of NSM is surgical excision with safe margins even when it is possible. PMID:25462051

Malkoc, Melih; Ormeci, Tugrul; Keskinbora, Mert; Y?lmaz, Adem; Korkmaz, Ozgur; Tanik, Canan Besleyici

2014-01-01

90

A rare case of sinus of valsalva-right atrial fistula secondary to an abscess perforation from underlying aortic valve endocarditis  

PubMed Central

Sinus of Valsalva-right atrial fistulas are abnormal connections between the aorta and the right atrium, and present challenging surgical conditions. An extremely rare etiology of aorto-right atrial fistula is infective endocarditis. This case report presents a 21 year old Caucasian female patient who had native aortic valve Staphylococcus aureus endocarditis complicated by sinus of Valsalva abscess perforation associated with an acute heart block, an aorto-right atrial fistula, severe heart failure, and cardiogenic shock. She underwent emergent aortic valve replacement and complex sinus of Valsalva fistula pericardial patch reconstruction and repair. This case report further explores the advantages and disadvantages of different valves for different patient populations, and evaluates the patient’s prosthesis mismatch and effective orifice area. PMID:25022608

2014-01-01

91

Establishment and characterization of a bovine rectal myxoma cell line.  

PubMed

A new bovine cell line was developed from tumor biopsy material of rectum obtained from clinical case of 7 years old cattle with tumor mass obliterating the rectal opening. Histopathology of tumor revealed scattered stellate cells arranged singly or in clusters in loose mucinous ground substance, simulating myxoma. The cells obtained from tumor mass have been cultured for more than 36 months in DMEM supplemented with 10% fetal bovine serum (FBS). The population doubling time of this cell line was about 20.64h. The cytogenetic analysis revealed several chromosomal abnormalities with bizarre karyotype. The origin of the cell line was confirmed by PCR amplification of 1086bp fragment of 16s rRNA using bovine species specific primers. The new cell line would act as in vitro model to study many aspect of cancer biology such as tumor development, differentiation and therapeutics regimen to combat cancer. PMID:25441618

Sahoo, Aditya P; Tiwari, Ashok K; Ravi Kumar, G; Chaturvedi, U; Veer Singh, Lakshya; Saxena, Shikha; Palia, S K; Jadon, N S; Singh, R; Singh, K P; Brahmaprakash, B S; Maiti, S K; Das, A K

2015-02-01

92

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

PubMed

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

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

2012-09-01

93

Persistent Isolated Right Atrial Standstill Associated With Left Atrial Tachycardia  

PubMed Central

Introduction: Atrial standstill is a rare condition, characterized by absence of atrial electrical and mechanical activity evident in surface electrocardiography echocardiography, or fluoroscopy, which is associated with unresponsiveness of atria to maximal output electrical stimulation. This condition can be present with thromboembolic complication, low cardiac output, and sometimes palpitation. Case Presentation: Here we presented a woman with right atrial stand still and left atrial tachycardia. It was confirmed by electrocardiogram, echocardiography, and intracardiac electrogram in basal state and during maximal output electrical stimulation. We treated her by implanting pacemaker to control bradycardia, oral calcium channel blocker to control palpitation episodes, and anticoagulation. Conclusions: Atrial standstill can be present partially that can be localized in one atrium and is associated with tachycardia in the other atrium.

Jorat, Mohammad Vahid; Nikoo, Mohammad Hosein; Yousefi, Aida

2014-01-01

94

Atrial Fibrillation  

MedlinePLUS

... information about the heart's electrical system and detailed animations, go to the Diseases and Conditions Index How ... can't restore a normal heart rhythm. The animation below shows atrial fibrillation. Click the "start" button ...

95

A not so benign atrial flutter: spontaneous 1:1 conduction of atrial flutter  

PubMed Central

A 1:1 conduction of atrial tachyarrhythmias, although not uncommon, usually is associated with the use of antiarrhythmic drugs; hyperthyroidism etc. Spontaneous 1:1 conduction of atrial flutter is indeed rare. We present a case of a spontaneous 1:1 conduction of a cavotricuspid isthmus-dependent atrial flutter. PMID:23608866

Murthy, Avinash M A; Jain, Ankit; Tan, Henry

2013-01-01

96

Atrial tachycardia  

Microsoft Academic Search

Opinion statement  The available therapies for atrial tachycardia include the use of antiarrhythmic drug [1,2,3–7], radiofrequency catheter ablation\\u000a [8,9,10], and antiarrhythmic surgery [11,12]. The growing realization that catheter ablation cures atrial tachycardia with\\u000a high efficacy and safety has contributed to the increasing popularity of the procedure and makes it the therapy of choice\\u000a in symptomatic patients. Antiarrhythmic drugs are thought to

Anil K. Bhandari

1999-01-01

97

Calcified right atrial mass  

PubMed Central

This is the report of a case of a grossly calcified right atrial mass in a woman of 40 who also suffered from systemic hypertension, pyelonephritis, and hepatic cirrhosis. The differential diagnosis, surgical treatment, and necropsy findings are described along with a review of the literature. Images PMID:5039455

Fleming, H. A.; Stovin, P. G. I.

1972-01-01

98

A case report of "lipomatous hypertrophy of the cardiac interatrial septum", with a proposal for a new term "lipomatous hamartoma of the cardiac atrial septum".  

PubMed

An autopsy case of "lipomatous hypertrophy of the cardiac interatrial septum" (LHIS) combined with marked stenosis and calcification of the aortic and mitral valves due to fibrous valvular endocarditis, malignant lymphoma, and mucin-producing cancer of the pancreas is reported. LHIS and mucin-producing cancer of the pancreas were incidental findings at autopsy. Microscopically, the LHIS in this case consisted of proliferation of mature fat cells, brown fat cells and cardiac muscle cells. Since these three cell types are normal structural components of the interatrial septum, it was considered that the LHIS was a hamartomatous rather than hypertrophic lesion, of the cardiac atrial septum. Accordingly it was concluded that the term "lipomatous hamartoma of the cardiac atrial septum" was more appropriate for this lesion in the case presented here. As far as we know, this is the first reported case of LHIS in Japan. PMID:2467515

Inoue, T; Mohri, N; Nagahara, T; Takanashi, R

1988-12-01

99

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, Jürgen; Böse, Dirk; Garvey, J Lee; Breuckmann, Frank

2014-01-01

100

Cardiac Myxoma: 40 Years’ Experience in 63 Patients  

Microsoft Academic Search

Background. Cardiac myxomas were resected in 63 patients, including the first successful procedure in the world.Methods. Patient data and data obtained during follow-up of the survivors were reviewed.Results. Preoperatively, valve obstruction occurred in 56% and emboli in 32% of the patients. The myxomas were located in the left atrium in 88%, right atrium in 10%, and both atria in 1

Staffan Bjessmo; Torbjörn Ivert

1997-01-01

101

Surgical treatment of odontogenic myxoma and facial deformity in the same procedure.  

PubMed

Odontogenic myxoma (OM) is an uncommon benign tumor with aggressive and invasive behavior. Predominant symptoms are usually slow and painless swelling, sometimes resulting in perforation of the cortical borders of the affected bone. In this paper, a case report of a patient with an OM on the right maxillary sinus and a vertical excess of maxilla will be presented. The treatment chosen was tumor resection in association with orthognathic surgery with biomodels assessment for surgical planning. A 3-year follow-up showed disease free and stability of the new position of maxilla. The international literature is evaluated to discuss this case report. PMID:24124313

Mayrink, Gabriela; Luna, Anibal Henrique Barbosa; Olate, Sergio; Asprino, Luciana; De Moraes, Marcio

2013-07-01

102

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

Microsoft Academic Search

We have shown previously the oncolytic potential of myxoma virus in a murine xenograft model of human glioma. Here, we show that myxoma virus used alone or in combination with rapamycin is effective and safe when used in experimental models of medulloblastoma in vitro and in vivo. Nine of 10 medulloblastoma cell lines tested were susceptible to lethal myxoma virus

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

103

Extraskeletal multiple myeloma presenting with an atrial mass: a case report and a review of the literature  

PubMed Central

Introduction Extraskeletal presentation at diagnosis or during the course of multiple myeloma is a rare event. The prognosis is usually very poor. At the moment there is no agreed gold standard for the treatment of this presentation. Case presentation A 79-year-old Caucasian woman was treated at our hospital for right atrial myeloma localization. Our patient showed the following signs and symptoms of congestive heart failure: dyspnea, hypotension, cyanosis and facial edema. Surgery was not considered feasible due to the extent of the disease. Our patient underwent external-beam radiation therapy using an intensity modulated technique, thus obtaining a persistent complete remission. Our patient has been in continuous complete local remission for 25 months since the end of radiotherapy. Conclusion The role of radiotherapy is not defined in multiple myeloma with extraskeletal presentation. Our regimen seems to be effective in controlling the disease in this patient. This case report adds to the existing literature as it describes an unusual presentation of the disease and a new therapeutic approach to this rare presentation of multiple myeloma. PMID:22883512

2012-01-01

104

Large thrombus formation from right atrial incision site after closure of atrial septal defect.  

PubMed

Atrial septal defect (ASD) is the common congenital anomaly which requires surgical interventions. Right atrial thrombus formations after primary suture repairs of the ASD and evidences of thromboembolic complications are extremely rare. Specifically, the cases of thromboembolic complications have high mortality and morbidity risks. Two cases of giant intra-atrial thrombus formation detected in the late stage after primary repairs of ASDs are being discussed. PMID:24385998

Disli, Olcay Murat; Erdil, Nevzat; Akca, Bar?s; Otlu, Y?lmaz Omur; Battaloglu, Bektas

2013-12-01

105

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

106

Atrial fibrillation  

PubMed Central

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

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

2014-01-01

107

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

108

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

PubMed Central

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

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

2015-01-01

109

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

110

miR-218 suppresses cardiac myxoma proliferation by targeting myocyte enhancer factor 2D.  

PubMed

Cardiac myxoma is the most common type of human heart tumor, yet the molecular mechanism is still poorly understood. In the present study, we found that the level of myocyte enhancer factor 2D (MEF2D), a key regulatory protein for cardiac development, was elevated in specimens of cardiac myxoma, and was positively associated with the proliferation of myxoma cells. MEF2D suppression reduced the proliferation of myxoma cells and its tumorigenicity. Cell cycle progression was also inhibited by MEF2D suppression. miR-218, which is downregulated in myxoma, suppressed MEF2D expression by targeting its mRNA 3'UTR. Altogether, we found that miR-218/MEF2D may be an effective target for myxoma treatment. PMID:25812649

Cao, Quanxing; Dong, Pingshuan; Wang, Yanyu; Zhang, Junwei; Shi, Xinge; Wang, Yongsheng

2015-05-01

111

Oncolytic Virotherapy Synergism with Signaling Inhibitors: Rapamycin Increases Myxoma Virus Tropism for Human Tumor Cells  

Microsoft Academic Search

Myxoma virus is a rabbit-specific poxvirus pathogen that also exhibits a unique tropism for human tumor cells and is dramatically oncolytic for human cancer xenografts. Most tumor cell lines tested are permissive for myxoma infection in a fashion intimately tied to the activation state of Akt kinase. A host range factor of myxoma virus, M-T5, directly interacts with Akt and

Marianne M. Stanford; John W. Barrett; Steven H. Nazarian; Steven Werden; Grant McFadden

2007-01-01

112

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

113

Atrial fibrillation association.  

PubMed

'Atrial fibrillation is the most common cardiac rhythm problem and causes considerable misery for many people,' so says consultant cardiologist Richard Schilling, quoted on the Atrial Fibrillation Association (AFA) website. PMID:25736658

Arthur, Margaret

2015-03-01

114

Atrial fibrillation source identification.  

PubMed

Atrial Fibrillation, a common arrhythmia accompanied by an increased morbidity and mortality remains difficult to treat either with medications or invasive procedures. Targeted destruction of atrial fibrillation triggers offers the best hope for permanent resolution of the arrhythmia. In this work, identification of atrial triggers is based on the analysis of complex endocardial recordings. Here, we propose a novel algorithm to detect the source of atrial fibrillation by classifying the signals originating from the four pulmonary veins in the left atrium. PMID:22255314

Vaizurs, Raja Sarath Chandra Prasad; Sankar, Ravi; Leonelli, Fabio

2011-01-01

115

Acute Renal Infarction Presenting with Acute Abdominal Pain Secondary to Newly Discovered Atrial Fibrillation: A Case Report and Literature Review  

PubMed Central

We report an 85-year-old female with known history of recurrent diverticulitis presented with abdominal pain. It was believed that the patient again needed to be treated for another diverticulitis and was started on the routine treatment. The initial CT scan of abdomen showed renal infarcts bilaterally that were confirmed by a CT with and without intravenous contrast secondary to unknown cause. An ECG found accidentally that the patient was in atrial fibrillation, which was the attributed factor to the renal infarctions. Subsequently, the patient was started on the appropriate anticoagulation and discharged. PMID:25614841

Eltawansy, Sherif Ali; Patel, Shil; Hassanien, Samaa; Maniar, Mihir

2014-01-01

116

NRG™ RF powered transseptal needle: a useful technique for transcatheter atrial septostomy and Fontan fenestration: report of three cases  

PubMed Central

Transseptal puncture (TSP) is a frequently performed procedure for gaining access to the left atrium for catheter ablation, hemodynamic assessment of the left heart, left ventricular assist device implantation, percutaneous left atrial appendage closure or mitral valvuloplasty during childhood and adulthood. The standard technique for transseptal puncture applies mechanical pressure on the fossa ovalis with a Brockenbrough needle. However, this method is not feasible when the fossa ovalis is thick and aneurysmatic. In such patients, the radiofrequency ablation energy systems can be offered as a better alternative for TSP. Here, we aimed to demonstrate the outcome of transseptal puncture performed with an NRG™ RF powered transseptal needle in three patients. PMID:25428681

Karagöz, Tevfik; Akin, Alper; Aykan, Hayrettin Hakan

2014-01-01

117

Treatment of an 8-mm Myxoma Using Acellular Corneal Tissue  

PubMed Central

A myxoma is a benign tumor found in the heart and in various soft tissues; however, a corneal myxoma is rare. A mucinous mass of unknown etiology was observed on the left cornea of a 32-year-old male patient. We performed deep anterior lamellar keratoplasty using acellular corneal tissue and concurrent amniotic membrane transplantation. Hematoxylin and eosin staining revealed vacuolation of the parenchyma and myxoid change in the corneal tissue that occurred in the anterior half of the corneal parenchyma. We identified a myxoid stroma by Alcian blue staining and observed collagen fibers with denatured stroma by Masson trichrome staining. The patient's visual acuity improved from light perception to 20 / 200, and the intraocular pressure remained within the normal range for one year after surgery. The transplanted cornea survived successfully with well-maintained transparency, and recurrence was not observed one year after surgery. PMID:24505204

Lim, Kyung Sup; Wee, Sung Wook

2014-01-01

118

Jadidi, Impact of Atrial Fibrosis on Electrogram Characteristics in Persistent Atrial Fibrillation Inverse Relationship between Fractionated Electrograms and Atrial  

E-print Network

Jadidi, Impact of Atrial Fibrosis on Electrogram Characteristics in Persistent Atrial Fibrillation 1 Inverse Relationship between Fractionated Electrograms and Atrial Fibrosis in Persistent Atrial: Impact of fibrosis on electrograms in Atrial Fibrillation Word count: 5058 Corresponding Author: Amir S

Paris-Sud XI, Université de

119

Lead explantation late after atrial perforation.  

PubMed

This report describes the case of a patient in whom atrial perforation with penetration of the thoracic wall was diagnosed 2 years after the implantation of an Accufix lead. Despite this complication, atrial detection in the bipolar mode and ventricular pacing were normal. Digital fluoroscopy detected a fracture with extrusion of a short segment of the retention wire. The rupture of the retention wire might have been the result, but was not the cause of the perforation. PMID:8865228

Trigano, A J; Caus, T

1996-08-01

120

Electrophysiological characteristics of paroxysmal atrial fibrillation originating from superior vena cava: a clinical analysis of 30 cases  

PubMed Central

To analyze characteristics of electrocardiogram (ECG), electrophysiological intracardiac mapping and radiofrequency ablation (RF) of paroxysmal atrial fibrillation (PAF) originating from superior vena cava (SVC), aiming to investigate electrophysiological characteristics of PAF with SVC origin. Clinical data of 30 subjects (18 men and 12 women, aged, 58.6 ± 15.5 years) with PAF of SVC origin were retrospectively analyzed; All patients underwent RF during 2006.9-2012.7. ECG of AF and atrial premature contractions (APCs), procedure and fluoroscopic time, numbers of ablation sites within SVC, complications and success rate were studied. Compared with P wave of sinus rhythm (SR), APCs of SVC origin exhibited higher amplitude in lead II (0.23 ± 0.11 vs. 0.15 ± 0.06 mv), III (0.19 ± 0.09 vs. 0.13 ± 0.08 mv), AVF (0.21 ± 0.13 vs. 0.14 ± 0.10 mv), V2 (0.24 ± 0.07 vs. 0.15 ± 0.09 mv) and V3 (0.21 ± 0.09 vs. 0.12 ± 0.05 mv) (P < 0.05), as well as more biphasic polarity in lead V1 (80.0% vs. 26.6%, P < 0.05) and isoelectric in AVL (60.0% vs. 6.7%, P < 0.05). In terms of left pulmonary vein (LPV) and right pulmonary vein (RPV) electrical isolation, procedure time (14.3 ± 11.5 vs. 33.7 ± 14.2, 28.1 ± 6.8 min, P < 0.05), fluoroscopic time (9.6 ± 3.8 vs. 21.1 ± 9.3, 19.4 ± 9.7 min, P < 0.05), ablation sites (11.2 ± 3.1 vs. 37.1 ± 13.7, 31.4 ± 10.4 points, P < 0.05) of SVC isolation (SVCI) remarkably decreased compared with that of mean LPV and RPV. After the procedure, 9 patients still presented paroxymal rapid firing within the SVC in the setting of SR restoration, 2 patients developed paroxysmal atrial flutter within 1 month after completion of ablation and were controlled by antiarrhythmic drugs. The APCs and AF of SVC origin manifested distinctive ECG features, which could be helpful to distinguish SVC from other foci before ablation, the completion of SVCI required shorter procedure and fluoroscopic time, as well as less ablation points, and meanwhile, the success rate was high with less complication. PMID:25784993

Shi, Xiang-Min; Yuan, Hong-Tao; Guo, Hong-Yang; Guo, Jian-Ping; Shan, Zhao-Liang; Wang, Yu-Tang

2015-01-01

121

Partial trisomy 3p and partial monosomy 11q associated with atrial septal defect, cleft palate, and developmental delay: a case report.  

PubMed

Unbalanced translocation involving both chromosome 3p duplication and 11q deletion in the same patient is extremely rare; only 1 live-born case was reported previously. This karyotype was also detected during prenatal diagnosis of 2 different pregnancies in a Taiwanese family which were both terminated. In all 3 cases, only standard karyotyping was done to detect the abnormal karyotypes. Here, we report a 4-year-old boy with cleft palate, atrial septal defect, and hypotonia with gross and fine motor delay. Oligonucleotide-based array comparative genomic hybridization showed copy number gain from 3pter to 3p24.2 (approximately 24.5 Mb) and copy number loss from 11q25 to 11qter (approximately 5.8 Mb). This de novo unbalanced translocation event involving a terminal 3p duplication and a terminal 11q deletion provides candidate genes for further investigation of dosage effect leading to the patient's multiple phenotypic abnormalities. Genotype-phenotype correlation is difficult to make in this case due to the large number of genes involved. However, the description of such cases together with precise gene-level mapping of chromosomal breakpoints will add to further refinement of candidate genes to be investigated for terminal imbalances in 3p and 11q when more similar cases are reported. PMID:21654159

Tan, E-C; Lim, E; Cham, B; Knight, L; Ng, I

2011-01-01

122

Atrial Arrhythmias and Their Implications for Space Flight - Introduction  

NASA Technical Reports Server (NTRS)

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

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

2010-01-01

123

Comparative immunohistochemical analysis between jaw myxoma and mesenchymal cells of tooth germ.  

PubMed

The histogenesis of jaw myxoma is still debated. According to some authors it arises from the primitive mesenchymal components of developing teeth. In this study, we have studied the expression of S-100 protein and vimentin in dental follicle, dental papilla and periodontal ligament cells using monoclonal and polyclonal antibodies. Myxoma of the jaw expresses vimentin and S-100 protein. On the contrary, as compared to jaw myxoma, the normal developmental structures were immunonegative for S-100 protein but stained for vimentin. These results could indicate a difference in the derivation other than tooth mesenchyma. PMID:1594483

Lombardi, T; Samson, J; Bernard, J P; Di Felice, R; Fiore-Donno, G; Mühlhauser, J; Maggiano, N

1992-02-01

124

Contained ascending aortic rupture disguised as a right atrial mass.  

PubMed

Transesophageal echocardiography can incidentally detect cardiac masses. A right atrial mass has many possible causes, including metastatic extension from various solid organs, malignant melanoma, mediastinal cysts, hematoma, myxoma, lipoma, and artifact.Herein, we report our discovery of a right atrial mass during the initial intraoperative transesophageal echocardiographic examination of a patient who was undergoing repair of an ascending aortic aneurysm. The mass, with a smooth border and homogenous grayscale density, showed no flow during color-flow Doppler echocardiography. Further examination revealed tricuspid annular dilation and severe tricuspid insufficiency. When the mediastinum was opened, we found a large extracardiac hematoma along the right atrium within the pericardial space. These findings suggested an acute, contained rupture of the ascending aorta. After the hematoma was evacuated, imaging revealed complete resolution of the mass and reduction of tricuspid insufficiency. The patient underwent the scheduled aortic repair and was discharged from the hospital in good condition. In order to ensure an accurate diagnosis and to gain appropriate clinical guidance that can lead to a successful outcome, we suggest performing a thorough echocardiographic investigation to identify any such mass before planned surgery proceeds. PMID:18427651

Marzolino, Philip S; Reynolds, Justin H; Coselli, Joseph S; Grigore, Alina M

2008-01-01

125

Electrophysiological Mechanisms of Atrial Flutter  

PubMed Central

Atrial flutter (AFL) is a common arrhythmia in clinical practice. Several experimental models such as tricuspid regurgitation model, tricuspid ring model, sterile pericarditis model and atrial crush injury model have provided important information about reentrant circuit and can test the effect of antiarrhythmic drugs. Human atrial flutter has typical and atypical forms. Typical atrial flutter rotates around tricuspid annulus and uses the crista terminalis and sometimes sinus venosa as the boundary. The IVC-tricuspid isthmus is a slow conduction zone and the target of radiofrequency ablation. Atypical atrial flutter may arise from the right or left atrium. Right atrial flutter includes upper loop reentry, free wall reentry and figure of eight reentry. Left atrial flutter includes mitral annular atrial flutter, pulmonary vein-related atrial flutter and left septal atrial flutter. Radiofrequency ablation of the isthmus between the boundaries can eliminate these arrhythmias. PMID:16943903

Tai, Ching- Tai; Chen, Shin-Ann

2006-01-01

126

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

PubMed Central

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

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

2015-01-01

127

Supraventricular tachyarrhythmias: atrial flutter and atrial fibrillation.  

PubMed

Symptoms range from mild palpitations to overt cardiac failure and cardiogenic shock, depending on the ventricular rate and the patient's underlying cardiac status. Drug therapy is the mainstay treatment. In atrial fibrillation, digoxin is used to control the ventricular response and therefore improve cardiac function. Verapamil may also be used for this purpose. PMID:3972251

Rae, A P

1985-03-01

128

The role of mast cell tryptases in cardiac myxoma: Histogenesis and development of a challenging tumor  

PubMed Central

A number of available studies have focused on the role of mastocytes and their angiogenic factors, such as tryptase expression, in cancer growth as a major research objective. Cardiac myxoma is a rare neoplasia and is the most common primary tumor of the heart. The cellular elements of cardiac myxoma have an endothelial phenotype; however, its histogenesis remains unclear. Currently, no available studies have correlated the pathological characteristics of cardiac myxomas, such as cell differentiation and vascularization, with the angiogenic factors of mast cells. The aim of the present study was to investigate the role of mast cell tryptases on the development of cardiac myxomas and examine the histogenesis of tumoral cells. A series of 10 cardiac myxomas were examined by immunohistochemical analysis for the presence of tryptase-positive mast cells. Statistical analysis of our data demonstrated that angiogenesis and the development of pseudovascular structures were correlated with the number of tryptase-positive mast cells. Therefore, we hypothesize that cardiac myxoma cells are endothelial precursors which are able to generate mature vascular structures. Further morphological and immunophenotypic analyses of tumoral cells may corroborate such a hypothesis. PMID:24959280

DONATO, GIUSEPPE; CONFORTI, FRANCESCO; CAMASTRA, CATERINA; AMMENDOLA, MICHELE; DONATO, ANNALIDIA; RENZULLI, ATTILIO

2014-01-01

129

The role of mast cell tryptases in cardiac myxoma: Histogenesis and development of a challenging tumor.  

PubMed

A number of available studies have focused on the role of mastocytes and their angiogenic factors, such as tryptase expression, in cancer growth as a major research objective. Cardiac myxoma is a rare neoplasia and is the most common primary tumor of the heart. The cellular elements of cardiac myxoma have an endothelial phenotype; however, its histogenesis remains unclear. Currently, no available studies have correlated the pathological characteristics of cardiac myxomas, such as cell differentiation and vascularization, with the angiogenic factors of mast cells. The aim of the present study was to investigate the role of mast cell tryptases on the development of cardiac myxomas and examine the histogenesis of tumoral cells. A series of 10 cardiac myxomas were examined by immunohistochemical analysis for the presence of tryptase-positive mast cells. Statistical analysis of our data demonstrated that angiogenesis and the development of pseudovascular structures were correlated with the number of tryptase-positive mast cells. Therefore, we hypothesize that cardiac myxoma cells are endothelial precursors which are able to generate mature vascular structures. Further morphological and immunophenotypic analyses of tumoral cells may corroborate such a hypothesis. PMID:24959280

Donato, Giuseppe; Conforti, Francesco; Camastra, Caterina; Ammendola, Michele; Donato, Annalidia; Renzulli, Attilio

2014-07-01

130

Atrial fibrillation (chronic)  

PubMed Central

Introduction Atrial fibrillation is a supraventricular tachyarrhythmia characterised by the presence of fast and uncoordinated atrial activation leading to reduced atrial mechanical function. Risk factors for atrial fibrillation include increasing age, male sex, co-existing cardiac and thyroid disease, pyrexial illness, electrolyte imbalance, cancer, and co-existing infection. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral medical treatments to control heart rate in people with chronic (defined as longer than 1 week for this review) non-valvular atrial fibrillation? What is the effect of different treatment strategies (rate versus rhythm) for people with persistent non-valvular atrial fibrillation? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 23 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: beta-blockers (with or without digoxin), calcium channel blockers (with or without digoxin), calcium channel blockers (rate-limiting), digoxin, and rate versus rhythm control strategies. PMID:22075545

2011-01-01

131

[Pharmacological cardioversion with intravenous propafenone in atrial fibrillation].  

PubMed

The efficacy and safety of intravenous propafenone for conversion of recent-onset and chronic atrial fibrillation was assessed in 46 patients. 40 with atrial fibrillation associated with or without structural heart disease (mean age 63 +/- 14 years) and 6 patients with atrial fibrillation related to the Wolff-Parkinson-White syndrome (mean age 34.8 +/- 13 years). Propafenone treatment was administered at 2 mg/kg over 15 minutes under continuous electrocardiographic monitoring. In 28 of 32 (87.5%) patients with paroxysmal and/or recent-onset atrial fibrillation a stable sinus rhythm was restored within 1 hour after propafenone (mean 17 +/- 11 minutes) and in only 3 of 8 (37.5%) with chronic atrial fibrillation (p < 0.05). Conversion to sinus rhythm was obtained in 5 of 6 (83.3%) patients with atrial fibrillation related ventricular preexcitation, mean time 21 +/- 12 minutes. Propafenone had an additional effect reducing mean heart rate (141 +/- 21 to 102 +/- 15 beat per minute, p < 0.05) and the shortest preexcited R-R intervals was increased, mean 231.6 +/- 27.8 to 355 +/- 37.2 milliseconds (p < 0.001) in cases associated with ventricular preexcitation. Dizziness, hypotension and transient conduction disturbances occurred in only one patient with rheumatic valvular heart disease: EF 40%. Propafenone is an effective and safe antiarrhythmic drug for converting paroxysmal and/or recent-onset atrial fibrillation of various origins with a more limited efficacy in chronic atrial fibrillation. PMID:10932801

Velázquez Rodríguez, E; Cancino Rodríguez, C; Arias Estrada, S; Rangel Rojo, J; Hernández Morales, E; Uribe Muñoz, A

2000-01-01

132

Neuroanatomical correlates of atrial fibrillation: a longitudinal MRI study  

PubMed Central

Background and purpose To determine baseline volume and rate of volume change of whole brain, hippocampus, and entorhinal cortex in patients with atrial fibrillation. Methods We analyzed clinical and neuroimaging data collected as part of Alzheimer’s Disease Neuroimaging Initiative in the United States and Canada. Patients with atrial fibrillation were identified based on baseline clinical/cognitive assessments, and age and gender-matched controls without atrial fibrillations were selected (1:1 ratio). All participants underwent 1.5 T structural magnetic resonance imaging (MRI) at specified intervals (6 or 12 months) for 2–3 years. Results A total of 33 persons with atrial fibrillation were included. There was no difference in whole brain and ventricular volumes at baseline MRI between cases and controls. There was significantly lower entorhinal cortex volume on right (p = 0.01) and left (p = 0.01) sides in patients with atrial fibrillation. There was significantly lower volume for middle temporal lobes on right (p = 0.04) and left (p = 0.001) sides. The rate of progression of atrophy in entorhinal cortex and middle temporal lobes was not different between patients with atrial fibrillation and controls. Conclusions The association of atrial fibrillation with volume loss in entorhinal cortex and middle temporal lobes may provide new insights into pathophysiology of atrial fibrillation. PMID:25566337

Qureshi, Adnan I; Saed, Aveen; Tasneem, Nudrat; Adil, Malik M

2014-01-01

133

[A case of the giant and pedunculated thrombus formation in the left atrium with normal mitral valve].  

PubMed

Occurrence of thrombus formation in the left atrium is rare without accompanying abnormalities at the mitral valve. Only a few cases of giant and pedunculated thromboses in the left atrium have been reported in the Japanese literatures. This is a case report of giant thrombus in the left atrium treated surgically. Patient was 61 years old male suffering from palpitation. Physical examination of the heart revealed increased first sound and diastolic rumbling at the apex. ECG revealed atrial fibrillation and LVH. Echocardiography and chest CT demonstrated a huge tumor like mass in the left atrium attached to the septal area. There were no abnormalities found at mitral valvular structures or motion. Catheterization studies revealed no disturbance of valvular functions. Angiographic examination demonstrated smooth surfaced tumor mass occupied left atrium. Coronary angiography revealed significant stenosis in segments 6, 7, 9, 12 and 14. Prior to surgery, patient was diagnosed myxoma of the left atrium and ischemic heart disease. Removal of the mass and CABG were carried out at a same time. Pathology revealed giant and pedunculated globular thrombus. Contributional factors possibly growing of such huge thrombus formation explained resulting from atrial fibrillation and decreased contractile force of the hypertrophied ventricle. PMID:8753102

Ando, S; Inoue, K; Tanaka, H; Narisawa, T; Yamada, M; Takaba, T

1996-06-01

134

Myxoma Virus Encodes an ?2,3-Sialyltransferase That Enhances Virulence  

PubMed Central

A 4.7-kb region of DNA sequence contained at the right end of the myxoma virus EcoRI-G2 fragment located 24 kb from the right end of the 163-kb genome has been determined. This region of the myxoma virus genome encodes homologs of the vaccinia virus genes A51R, A52R, A55R, A56R, and B1R; the myxoma virus gene equivalents have been given the prefix M. The MA55 gene encodes a protein belonging to the kelch family of actin-binding proteins, while the MA56 gene encodes a member of the immunoglobulin superfamily related to a variety of cellular receptors and adhesion molecules. A novel myxoma virus early gene, MST3N, is a member of the eukaryotic sialyltransferase gene family located between genes MA51 and MA52. Detergent lysates prepared from myxoma virus-infected cell cultures contained a virally encoded sialyltransferase activity that catalyzed the transfer of sialic acid (Sia) from CMP-Sia to an asialofetuin glycoprotein acceptor. Analysis of the in vitro-sialylated glycoprotein acceptor by digestion with N-glycosidase F and by lectin binding suggested that the MST3N gene encodes an enzyme with Gal?1,3(4)GlcNAc ?2,3-sialyltransferase specificity for the N-linked oligosaccharide of glycoprotein. Lectin binding assays demonstrated that ?2,3-sialyltransferase activity is expressed by several known leporipoxviruses that naturally infect Sylvilagus rabbits. The sialyltransferase is nonessential for myxoma virus replication in cell culture; however, disruption of the MST3N gene caused attenuation in vivo. The possible implications of the myxoma virus-expressed sialyltransferase in terms of the host’s defenses against infection are discussed. PMID:9971821

Jackson, Ronald J.; Hall, Diana F.; Kerr, Peter J.

1999-01-01

135

Surgical treatment of primary intracardiac myxoma: 20-year experience in "shahid modarres hospital"-a tertiary university hospital-tehran, iran.  

PubMed

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

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

2015-01-01

136

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

PubMed Central

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

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

2015-01-01

137

Anticoagulation in atrial fibrillation.  

PubMed

Atrial fibrillation increases the risk of stroke, which is a leading cause of death and disability worldwide. The use of oral anticoagulation in patients with atrial fibrillation at moderate or high risk of stroke, estimated by established criteria, improves outcomes. However, to ensure that the benefits exceed the risks of bleeding, appropriate patient selection is essential. Vitamin K antagonism has been the mainstay of treatment; however, newer drugs with novel mechanisms are also available. These novel oral anticoagulants (direct thrombin inhibitors and factor Xa inhibitors) obviate many of warfarin's shortcomings, and they have demonstrated safety and efficacy in large randomized trials of patients with non-valvular atrial fibrillation. However, the management of patients taking warfarin or novel agents remains a clinical challenge. There are several important considerations when selecting anticoagulant therapy for patients with atrial fibrillation. This review will discuss the rationale for anticoagulation in patients with atrial fibrillation; risk stratification for treatment; available agents; the appropriate implementation of these agents; and additional, specific clinical considerations for treatment. PMID:24733535

Steinberg, Benjamin A; Piccini, Jonathan P

2014-01-01

138

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

139

Pseudo-ventricular tachycardia mimicking malignant arrhythmia in a patient with rapid atrial fibrillation.  

PubMed

Artifacts can simulate arrhythmias such as atrial flutter, atrial fibrillation, and ventricular tachycardia. A case of pseudo-ventricular tachycardia is outlined in a patient with newly diagnosed atrial fibrillation, which made the diagnosis a special challenge. Characteristic signs of pseudo-ventricular tachycardia are described. This case reinforces the importance of recognizing artifacts to avoid unnecessary interventions, especially in the telemetry and critical care units. PMID:24786818

Barake, Walid; Baranchuk, Adrian; Pinter, Arnold

2014-05-01

140

Potential for broad-spectrum protection against feline calicivirus using an attenuated myxoma virus expressing a chimeric FCV capsid protein.  

PubMed

It has previously been demonstrated that recombinant myxoma viruses expressing FCV capsid protein are capable of eliciting protective responses against virulent FCV challenge, following vaccination, in cats. An attempt was made to produce a bivalent myxoma recombinant expressing the capsid protein genes of both FCV strains F9 and LS015. The FCV capsid protein genes were inserted into the myxoma growth factor gene (MGF) locus, and the serine protease inhibitor (SERP 2) gene locus. Subsequent recombination between myxoma-FCV viruses resulted in a recombinant expressing a chimeric form of the capsid protein. Nonetheless, cats immunised with this myxoma-FCV recombinant demonstrate high levels of serum neutralising antibodies against both F9 and LS015 strains. Such a chimeric vaccine may provide effective protection against a wide range of FCV strains. PMID:16176851

McCabe, Victoria J; Spibey, Norman

2005-11-16

141

Detection of Herplex Simplex Virus-1 and -2 in Cardiac Myxomas  

PubMed Central

The etiology of sporadic cardiac myxomas remains elusive. The tendency for these lesions to recur following resection, their immunopathological characteristics, along with their histological and molecular profile, may implicate the presence of an infective agent in this type of tumor. In this study, we investigated the presence of herpes simplex virus (HSV) DNA in a cohort of cardiac myxomas in a tertiary referral centre. Twenty-nine formalin-fixed paraffin-embedded (FFPE) sporadic cardiac myxomas were obtained, 17 of which were shown to be informative. These were compared to 19 macroscopically and microscopically normal heart tissue specimens. The detection of HSV-1 and -2 genomic sequences was achieved with the use of a combined nested PCR-Restriction Fragment Length Polymorphism methodology. The presence of HSV-1 and/or -2 DNA was demonstrated in 6 of 17 (35%) informative sporadic cardiac myxomas, whereas no HSV DNA was detected in normal heart tissues (P < 0.01). The existence of HSV-1/2 DNA in sporadic cardiac myxomas, along with its absence from normal heart tissues, reinforces the possibility that HSV infection might be involved in the development of these lesions. Our findings raise the point of anti-HSV medication postsurgically with a potential benefit in reducing the rate of recurrences. PMID:22496616

Pateras, Ioannis S.; Evangelou, Konstantinos; Tsimaratou, Katerina; Liontos, Michalis; Sakellariou, Stratigoula; Barlogiannis, Theodoros; Karakitsos, Petros; Papalois, Apostolos; Kotsinas, Athanassios; Gorgoulis, Vassilis G.

2012-01-01

142

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

PubMed Central

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

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

2013-01-01

143

Ogilvie's Syndrome following Cardioversion for Atrial Fibrillation  

PubMed Central

Acute colonic pseudoobstruction, also known as Ogilvie's syndrome, is characterized by distension of the colon in the absence of a mechanical obstruction as evident by abdominal radiography. This syndrome is usually treated conservatively; however, medical or surgical therapies can be employed in refractory cases. Ogilvie's syndrome has been reported following cardiac events, such as myocardial infarction, heart failure, and cardiac bypass surgeries. We report the first case of Ogilvie's syndrome following synchronized electric cardioversion for atrial fibrillation. PMID:25214851

Al-Halawani, Moh'd; Thawabi, Mohammad; Abdeen, Yazan; Miller, Richard A.; Fedida, Andre A.

2014-01-01

144

Atrial-selective sodium channel block as a novel strategy for the management of atrial fibrillation  

PubMed Central

Safe and effective pharmacologic management of atrial fibrillation (AF) is one of the greatest challenges facing an aging society. Currently available pharmacologic strategies for rhythm control of AF are associated with ventricular arrhythmias and in some cases multi-organ toxicity. Consequently, drug development has focused on atrial-selective agents such as IKur blockers. Recent studies suggest that IKur block alone may be ineffective for suppression of AF and may promote AF in healthy hearts. Recent experimental studies have demonstrated other important electrophysiologic differences between atrial and ventricular cells, particularly with respect to sodium channel function, and have identified sodium channel blockers that exploit these electrophysiologic distinctions. Atrial-selective sodium channel blockers, such as ranolazine and amiodarone, effectively suppress and/or prevent the induction of AF in experimental models, while producing little to no effect on ventricular myocardium. These findings suggest that atrial-selective sodium channel block may be a fruitful new strategy for the management of AF. PMID:20201889

Antzelevitch, Charles; Burashnikov, Alexander

2010-01-01

145

[Atrial fibrillation and regular tachycardia in two young patients--are both treated with atrial fibrillation ablation?].  

PubMed

Two young patients with documented episodes of symptomatic paroxysmal atrial fibrillation have been referred for pulmonary vein isolation. Both patients had a history of concomitant regular tachycardia. in both cases pulmonaryvein isolation has not been performed but in each patient a supraventricular tachycardia (right focal atrial tachycardia/atrioventricular reentry tachycardia) could be induced and ablated instead. Concomitant supraventricular tachycardia acting as a trigger arrhythmia is frequent in young patients with atrial fibrillation without underlying cardiacdisease. In these patients a concomitant supra-ventricular tachycardia should beexcluded by electrophysiological study or ablated before pulmonary vein isolation or initiating an antiarrhythmic drug therapy. In most cases ablation of supraventricular tachycardia is safe and successful whereas the risks of ablative therapy of atrial fibrillation can not be neglected and success is moderate. PMID:24930326

von Bodman, G; Brömsen, J; Kopf, C; Füller, M; Block, M

2014-04-17

146

Transcatheter device closure of a congenital aortic-left atrial tunnel.  

PubMed

Rare cases of aortic-left atrial tunnel exist in the literature. This case report highlights the echocardiographic characterization of this vascular anomaly and provides the first description of an aortic-left atrial tunnel closed by interventional cardiac catheterization in a pediatric patient. PMID:23601836

Sun, Heather Y; Buccola, Katie Jo; Punn, Rajesh; Silverman, Norman H; Peng, Lynn F; Perry, Stanton B; Balasubramanian, Sowmya

2014-01-01

147

Efficacy of ranolazine for rhythm control in an elderly patient with paroxysmal atrial fibrillation.  

PubMed

We report the case of an elderly woman with coronary heart disease and paroxysmal atrial fibrillation. It could be hypothesized that the predisposing anatomic substrate for arrhythmogenesis in this patient derived from both age-related left atrial dilation and coexistent ischaemic heart disease. Unfortunately the usual antiarrhythmic therapy was unsafe or not feasible for this subject. Ranolazine 750 mg twice daily completely suppressed atrial fibrillation recurrences. PMID:24770828

Santillo, E; Migale, M; Postacchini, D; Fallavollita, L; Marini, L; Balestrini, F

2014-01-01

148

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

PubMed Central

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

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

2014-01-01

149

Right atrial thrombosis associated with sagittal sinus thrombosis caused by protein C-S deficiency.  

PubMed

Right atrial thrombi may develop within the right atrium or may have peripheral venous origins that, on their way to the final destination site lodge in, right atrium. Right atrial thrombosis is classified as two type: A (mobile, thin) and B (non mobile and attached to atrial wall) that they are probably of cardiac origin due to local pathology, indwelling catheter, atrial fibrillation, stasis, rheumatological or hematological disease like protein C or S deficiency. Protein C deficiency has been reported to be a risk factor for thrombosis in multiple organs as a result of inactivation of factor of Va. We describe a case of a huge right atrial thrombus with cerebral sagittal sinus thrombosis, in a protein C-S deficient patient, in which right atrial clot was successfully removed surgically and sagittal vein treated conservatively with full recovery of his central neurologic symptom. Magnetic Resonance Imaging demonstrated thrombosis in those regions. PMID:24362664

Sabzi, Feridoun; Faraji, Reza

2013-01-01

150

The immunoregulatory properties of oncolytic myxoma virus and their implications in therapeutics  

PubMed Central

Myxoma virus (MYXV) is a poxvirus with a strict rabbit-specific host-tropism for pathogenesis. The immunoregulatory factors encoded by MYXV can suppress some functions of immune effectors from other species. We review their mechanisms of action, implications in therapeutics and the potential to improve MYXV as an oncolytic agent in humans. PMID:20832500

Liu, Jia; Wennier, Sonia; McFadden, Grant

2010-01-01

151

Fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography in evaluation of residual intramuscular myxoma.  

PubMed

Intramuscular myxoma (IM) is a rare benign neoplasm. In a patient diagnosed with IM of left thigh, we report the utility of a postoperative fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography scan in assessing the efficacy of surgical excision. PMID:25589814

Zade, Anand; Ahire, Archana; Shetty, Shishir; Rai, Sujith; Bokka, Rajashekharrao; Velumani, Arokiaswamy; Kabnurkar, Rasika

2015-01-01

152

Fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography in evaluation of residual intramuscular myxoma  

PubMed Central

Intramuscular myxoma (IM) is a rare benign neoplasm. In a patient diagnosed with IM of left thigh, we report the utility of a postoperative fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography scan in assessing the efficacy of surgical excision. PMID:25589814

Zade, Anand; Ahire, Archana; Shetty, Shishir; Rai, Sujith; Bokka, Rajashekharrao; Velumani, Arokiaswamy; Kabnurkar, Rasika

2015-01-01

153

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

PubMed Central

Adoptive transfer of tumor-specific T cells has shown some success for treating metastatic melanoma. We evaluated a novel strategy to improve adoptive therapy by administering both T cells and oncolytic myxoma virus to mice with syngeneic B16.SIY melanoma brain tumors. Adoptive transfer of activated CD8+ 2C T cells that recognize SIY peptide doubled survival time, but SIY-negative tumors recurred. Myxoma virus killed B16.SIY cells in vitro, and intratumoral injection of virus led to selective and transient infection of the tumor. Virus treatment recruited innate immune cells to the tumor and induced IFN? production in the brain, resulting in limited oncolytic effects in vivo. To counter this, we evaluated the safety and efficacy of co-administering 2C T cells, myxoma virus, and either rapamycin or neutralizing antibodies against IFN?. Mice that received either triple combination therapy survived significantly longer with no apparent side effects, but eventually relapsed. Importantly, rapamycin treatment did not impair T cell-mediated tumor destruction, supporting the feasibility of combining adoptive immunotherapy and rapamycin-enhanced virotherapy. Myxoma virus may be a useful vector for transient delivery of therapeutic genes to a tumor to enhance T cell responses. PMID:21656158

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

2015-01-01

154

[Determination of the specific points in the atrial excitation sequence on the P loop of the VCG by using the parameters of a differentially amplified ECG].  

PubMed

Ninety-eight normal subjects and 31 patients with right, left or bilateral atrial enlargement were examined, with differentially-amplified atrial electrocardiogram (DAECG) and intensified atrial vectorcardiogram recorded simultaneously. Atrial complex DAECG permitted an accurate determination of the following sequence of specific atrial activation points on the P loop of vectorcardiogram: activation along the right atrium only (before the left atrium is included), the origin of left atrial activation, the termination of right atrial activation and the maximum vector of the left atrium. Determining the maximum vector according to the most distant point on the P loop is not practicable, because of its ambiguous representation of atrial activation processes. For most normal subjects and all patients, with right atrial enlargement, the maximum vector point on the P loop coincides with the termination point of right atrial activation, while in cases of left atrial enlargement it coincides with the maximum vector point on the P loop coincides with the termination point of right atrial activation, while in cases of left atrial enlargement it coincides with the maximum vector point of the left atrium. PMID:2945024

Rugenius, Iu Iu; Grigonene, L Iu; Abra?tene, B A; Sakalas, A P

1986-06-01

155

Radiofrequency catheter ablation in a patient with giant left atrium and permanent atrial fibrillation: maintenance of sinus rhythm at 1 year.  

PubMed

Radiofrequency catheter ablation of paroxysmal atrial fibrillation is now being performed routinely with acceptable safety and success rates. Ablation of chronic atrial fibrillation is still in the evolutionary stage. We report a case in which radiofrequency catheter ablation for permanent atrial fibrillation was done in a patient with rheumatic heart disease and a grossly enlarged left atrium. PMID:19240317

Rajagopal, Sriram; Rajagopal, Lakshmi; Nair, Mohan

2008-01-01

156

Myxoma virus and the Leporipoxviruses: an evolutionary paradigm.  

PubMed

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

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

2015-03-01

157

Distinct pharmacologic substrate in lidocaine-sensitive, repetitive atrial tachycardia.  

PubMed

Lidocaine-sensitive, repetitive atrial tachycardia is an uncommon arrhythmia. The electrophysiologic substrate is still unknown, and the pharmacologic responses have not been fully explored. The aim of this study was to investigate the effects of intravenous adenosine and verapamil in patients with lidocaine-sensitive atrial tachycardia. In 9 patients with repetitive uniform atrial tachycardia, the response to intravenous adenosine (12 mg), lidocaine (1 mg/kg body weight), and verapamil (10 mg) were sequentially investigated. Simultaneous 12-lead electrocardiogram (ECG) was recorded at baseline and continuously monitored thereafter. Tracings were obtained at regularly timed intervals right after the administration of each drug to evaluate changes in the arrhythmia characteristics. Repetitive atrial tachycardia was abolished by intravenous lidocaine in the 9 patients within the first 2 minutes after the end of injection. Adenosine suppressed the arrhythmia in 2 patients and shortened the runs of atrial ectopic activity in 1 patient, while verapamil was effective in 2 patients, 1 of them insensitive to adenosine and the other 1 sensitive to this agent. In 5 patients, the arrhythmia was abolished by radiofrequency ablation at different sites of the right atrium. Lidocaine-sensitive atrial tachycardia may eventually be also suppressed by adenosine and/or verapamil. This suggests that this enigmatic arrhythmia may be caused by different underlying electrophysiologic substrates and that at least in some cases, delayed afterdepolarizations seem to play a determining role. PMID:21881080

Chiale, Pablo A; Faivelis, Luciano; Garro, Hugo A; Fernández, Pablo A; Herrera Paz, Juan J; Elizari, Marcelo V

2012-06-01

158

Star in the heart  

PubMed Central

In a 50 year old woman, transthoracic echocardiography showed a left atrial mass. Transoesophageal echocardiography delineated its attachment. Additionally, cystic spaces were seen arranged concentrically in the shape of a star in the centre of the tumour. Surgical excision followed. Histopathological examination confirmed myxoma with areas of haemorrhage and necrosis. This case highlights the acoustic property of myxomas in a rare and beautiful manner and emphasises the superior transoesophageal imaging of myxomas. PMID:15084571

Krishnamoorthy, K M; Tharakan, J A; Krishnamanohar, S R

2004-01-01

159

Myxoma viral serpin, Serp-1, a unique interceptor of coagulation and innate immune pathways.  

PubMed

Serpins maintain haemostasis through regulation of serine proteinases in the thrombotic and thrombolytic pathways. Viruses encode serpins that can alter thrombotic and thrombolytic responses producing, in some cases, disseminated intravascular coagulation (DIC). However, it has not been precisely defined how viral serpins induce these profound responses. The rabbit myxoma viral serpin, Serp-1 inhibits urokinase- and tissue-type plasminogen activators (uPA and tPA), plasmin and factor Xa in vitro and exhibits remarkable anti-inflammatory activity in various animal models. The effects of Serp-1 on activation of human platelets, endothelial cells, monocytes and T cells that mediate thrombosis and innate immune responses were therefore examined. We found that Serp-1 attenuated platelet and mononuclear cell adhesion to fibronectin and collagen. Serp-1 similarly inhibited monocyte migration into the peritoneum. Serp-1 inhibition of monocyte migration was lost in uPA receptor (uPAR) deficient mice. Serp-1 bound to the plasma membrane surface and altered uPA activation of endothelial cells (p=0.001), thrombin activation of platelets (p=0.021) and phorbol ester activation of endothelial (p=0.047), monocyte (p=0.011) and Jurkat T cells (p=0.012) as measured by intracellular calcium. Modulation of cellular activation was confirmed by membrane fluidity analysis. Microarray analysis of Serp-1 treated endothelial cells revealed alterations in Inositol 1,4,5-triphosphate receptor type II (ITPR2) a calcium-regulating gene. This study demonstrates the unique capacity of a viral serpin, Serp-1 to modify adhesion, activation, gene expression and calcium homeostasis in a wide range of cells that regulate coagulation and inflammation. Endothelial cells potentially represent a pivotal regulatory point for Serp-1 anti-inflammatory activity. PMID:16525579

Viswanathan, Kasinath; Liu, Liying; Vaziri, Sepideh; Dai, Erbin; Richardson, Jakob; Togonu-Bickersteth, Babajide; Vatsya, Pracha; Christov, Alexander; Lucas, Alexandra R

2006-03-01

160

Posttranslational modification of the myxoma-virus anti-inflammatory serpin SERP1 by a virally encoded sialyltransferase  

Microsoft Academic Search

SERP-1 is a secreted serpin (serine-proteinase inhibitor) encoded by myxoma virus, a poxvirus pathogen of rabbits. SERP-1 is required for myxoma-virus virulence, and the purified protein has been shown to possess independent anti-inflammatory activity in animal models of restenosis and antigen-induced arthritis. As an inhibitor of serine proteinases, SERP-1 acts against tissue-type plasminogen activator, urokinase-type plasminogen activator, plasmin, thrombin and

Piers NASH; Michele BARRY; Bruce T. SEET; Kirstin VEUGELERS; Susy HOTA; Jody HEGER; Carley HODGKINSON; Kathryn GRAHAM; Ronald J. JACKSON; Grant MCFADDEN

2000-01-01

161

Predicting the end of an atrial fibrillation episode: the physionet challenge  

Microsoft Academic Search

The PhysioNet Challenge 2004 addresses two different goals: to separate the persistent atrial fibrillation (AF) from the paroxysmal AF (event 1) and, in case of paroxysmal AF, to identify the one-minute ECG strip just before the termination of the AF episode (event 2). Both events were approached through the separation of the atrial activity by the ventricular one in the

F. Cantini; F. Conforti; M. Varanini; F. Chiarugi; G. Vrouchos

2004-01-01

162

Successful radiofrequency catheter ablation of atrial trigeminy in a young patient  

Microsoft Academic Search

A case is reported of a 35 year old man with atrial parasystolic trigeminy. The patient presented with a 10 year history of sustained supraventricular extrasystole causing symptoms leading to several hospitalisations and continuous unemployment. He had been treated ineffectively with several drug combinations. Radiofrequency catheter ablation of a right atrial focus completely suppressed the ectopic activity. This is the

I J Dobran; V Niebch; E G Vester

1998-01-01

163

Pericardioesophageal fistula following left atrial ablation procedure.  

PubMed

We present a case of pericardioesophageal fistula formation in a 40 year old male who 23 days after undergoing a repeat ablation procedure for atrial fibrillation developed chest pressure, chills and diaphoresis. After initial labs and tests that demonstrated no evidence for acute myocardial ischemia, the patient underwent CT angiography of the chest. The study revealed pneumopericardium and a pericardial effusion. Suspicion was raised of perforation of the posterior left atrial myocardial wall with injury to adjacent esophagus. Water soluble contrast with transition to barium sulfate esophagram subsequently performed identified a perforation further affirming the postulate of a fistulous communication between the esophagus and pericardium. Transthoracic echocardiogram confirmed pericardial effusion but did not demonstrate myocardial defect. Endoscopic management was preferred and an esophageal stent was placed. Follow up esophagram showed an intact esophageal stent without evidence of extravasation. PMID:25426222

Bailey, Christopher W; Tallaksen, Robert J

2014-10-01

164

Fatal Outcome in Atrial Migration of the Tempofilter  

SciTech Connect

Purpose: To report the risk of fatal atrial migration with the Tempofilter. Methods: Among temporary filters, the high safety profile Tempofilter has been marketed as offering protection for up to 6 weeks. We implanted about 60 Tempofilters to prevent pulmonary embolism. The main indications were temporary thromboembolic risk, recurrent pulmonary embolism, and contraindication to or failure of anticoagulant therapy. Follow-up was performed regularly by plain abdominal film and Doppler ultrasound. Filters were removed about 4 weeks after placement. Results: We encountered three cases (5%) of atrial migration and one case of 5-cm cephalad displacement of the filter. Of the three patients with atrial migration, two died within 3 days of implantation, one from a massive pulmonary embolism and the other with cardiac tamponade. One patient did not show any serious complications. Conclusions: The Tempofilter may actively migrate cranially and become dangerous in the case of migration within the heart.

Rossi, Plinio; Arata, Flaminia Marcella; Bonaiuti, Paola; Pedicini, Vittorio [Department of Radiology, III Chair, University of Rome 'La Sapienza', Policlinico Umberto I, Viale Regina Elena, I-00161 Rome (Italy)

1999-05-15

165

Effect of chronic right atrial stretch on atrial electrical remodeling in patients with an atrial septal defect  

Microsoft Academic Search

Background—Adults with an atrial septal defect (ASD) frequently develop late atrial arrhythmias. We sought to characterize the pattern and persistence of atrial electrical remodeling caused by chronic right atrial (RA) stretch in this group. Methods and Results—Thirteen ASD patients without atrial arrhythmia (4210 years old; RA volume, 6516 mL) and 17 normal control subjects (4411 years old; RA volume, 388

Joseph B. Morton; Prashanthan Sanders; Jitendra K. Vohra

2003-01-01

166

18F-fluoro-deoxyglucose positron emission tomography-computed tomography in initial assessment and diagnosis of right atrial angiosarcoma with widespread visceral metastases: A rare case report and review of the literature  

PubMed Central

Cardiac angiosarcoma is the most common primary cardiac sarcoma in adults. Primary cardiac tumors are rare and have nonspecific clinical presentation, thus making its diagnosis challenging. Clinically, patients present with advanced disease demonstrating metastatic disease at initial presentation itself. It commonly metastasizes to lung, liver, brain, and bone; however metastases to lymph nodes, adrenal glands, spleen and skin has also been seen. We describe a case of right atrial angiosarcoma with extensive visceral metastases involving brain, lungs, liver, pancreas, kidney, and lymph nodes, demonstrated on contrast-enhanced 18F-fluoro-deoxyglucose positron emission tomography-computed tomography (FDG PET-CT). To the best of our knowledge metastases to pancreas and kidney have not been reported so far in the literature. With our report, we emphasize on the initial use of FDG PET-CT in workup of cardiac angiosarcoma for accurate staging and prognostication of this disease. PMID:25589807

Jain, Avani; Simon, Shelley; Elangovan, Indirani

2015-01-01

167

(18)F-fluoro-deoxyglucose positron emission tomography-computed tomography in initial assessment and diagnosis of right atrial angiosarcoma with widespread visceral metastases: A rare case report and review of the literature.  

PubMed

Cardiac angiosarcoma is the most common primary cardiac sarcoma in adults. Primary cardiac tumors are rare and have nonspecific clinical presentation, thus making its diagnosis challenging. Clinically, patients present with advanced disease demonstrating metastatic disease at initial presentation itself. It commonly metastasizes to lung, liver, brain, and bone; however metastases to lymph nodes, adrenal glands, spleen and skin has also been seen. We describe a case of right atrial angiosarcoma with extensive visceral metastases involving brain, lungs, liver, pancreas, kidney, and lymph nodes, demonstrated on contrast-enhanced (18)F-fluoro-deoxyglucose positron emission tomography-computed tomography (FDG PET-CT). To the best of our knowledge metastases to pancreas and kidney have not been reported so far in the literature. With our report, we emphasize on the initial use of FDG PET-CT in workup of cardiac angiosarcoma for accurate staging and prognostication of this disease. PMID:25589807

Jain, Avani; Simon, Shelley; Elangovan, Indirani

2015-01-01

168

An Unusual Mechanism Of Sustained Right Atrial Tachycardia  

PubMed Central

Lower loop re-entry (LLR) flutter is a rare type of atypical right atrial flutter. Most of the reported cases occurred in association with typical flutter patterns as a transient arrhythmia. Our case is unique in the fact the LLR was sustained and persisted independently. PMID:22090730

Nair, Krishna Kumar Mohanan; Namboodiri, Narayanan; Thajudeen, Anees; Valaparambil, Ajitkumar; Tharakan, Jaganmohan A

2011-01-01

169

An unusual mechanism of sustained right atrial tachycardia.  

PubMed

Lower loop re-entry (LLR) flutter is a rare type of atypical right atrial flutter. Most of the reported cases occurred in association with typical flutter patterns as a transient arrhythmia. Our case is unique in the fact the LLR was sustained and persisted independently. PMID:22090730

Nair, Krishna Kumar Mohanan; Namboodiri, Narayanan; Thajudeen, Anees; Valaparambil, Ajitkumar; Tharakan, Jaganmohan A

2011-11-01

170

[Atrial fibrillation in elderly].  

PubMed

Atrial fibrilation (AF) is frequent and a strong risk factor for ischemic stroke in elderly. Ischemic stroke in patients with AF are more severe. Vitamine K antagonist therapy is highly effective for stroke prevention but is associated with hemorrhagic risk. The new oral anticoagulants (direct thrombin inhibitor [dabigatran], and direct factor Xa inhibitors [rivaroxaban and apixaban]) have all shown non inferiority or superiority, with better safety, considering the risk of intracranial haemorrhage. On this basis, it is justified to give them in priority in the vast majority of patients with AF, the choice of the drug and the dose is individual. PMID:23272472

Arquizan, Caroline

2012-11-01

171

Management of atrial fibrillation  

PubMed Central

Atrial fibrillation (AF) is a condition of genuine clinical concern. This arrhythmia increases patient morbidity and mortality, most notably due to stroke, thromboembolism and heart failure. Consequentially, there is a strong impetus to acquire a greater understanding of its natural history and course in order to provide crucial evidence-based treatment and resource allocation in the future. The objective of this review article is to present a concise overview of the management of AF, with reference to the recent evidence-based National Institute of Clinical Excellence (NICE) National Clinical Guidelines for the management of AF. PMID:17583181

Kakar, Puneet; Boos, Christopher J; Lip, Gregory YH

2007-01-01

172

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

173

Atrial Fibrillation During an Exploration Class Mission  

NASA Technical Reports Server (NTRS)

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

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

2010-01-01

174

Left atrial tachycardia after atrial fibrillation ablation: can magnetic resonance imaging assist the ablation?  

PubMed

We present a case of a magnetic resonance imaging-assisted ablation of an atrial tachycardia in a patient with previous atrial fibrillation ablation. A 3-D reconstruction of the delayed-enhanced cardiac magnetic resonance (CMR; CMR model) was created to identify previous ablation lesions and gaps. Multiple gaps around right-sided pulmonary veins were observed. The activation map identified a dual-loop re-entry around both right-sided pulmonary veins, confirming that the substrate identified using delayed-enhanced CMR was critical to sustain the tachycardia. Ablation at this site converted to sinus rhythm. The present case shows the usefulness of delayed-enhanced CMR substrate characterization to complement activation mapping of the tachycardia and more accurately define the anatomical circuit. PMID:25547564

Bisbal, Felipe; Calvo, Mireia; Trucco, Emilce; Arbelo, Elena; Berruezo, Antonio; Mont, Lluís

2015-01-01

175

Peripheral vein contrast echocardiography in atrial septal defect.  

PubMed

This study was carried out on 233 children suspected clinically of having atrial septal defect with the aim of investigating the diagnostic capability of peripheral venous contrast echocardiography. The transfer of contrast material from the right atrium into the left atrium was evaluated as "positive contrast", while noncontrast blood, passing from the left atrium into the right atrium was termed "negative contrast". Positive contrasts were quantitated in four grades. A significant negative contrast effect was graded 3- or 4-. Three positive, 4+ and/or 3-, 4- contrast effects were considered definite evidence of an atrial septal defect. Among the cases with the above findings 92 underwent surgical closure of atrial septal defect. The procedure was successful in all patients operated; the size of the defect was large. This result demonstrates that the method applied is a safe and reliable one. However, in a group of cases without the above echocardiographic findings the presence of an atrial septal defect was detected by cardiac catheterization and angiocardiography. Therefore, we can conclude that the method applied is not a sensitive, but a specific one, for definite detection of atrial septal defect. PMID:2692260

Saraçlar, M; Ozme, S; Ozkutlu, S; Bozer, A Y; Yurdakul, Y; Pa?ao?lu, I; Oztunç, F; Ozer, S; Baysal, K; Gedik, S

1989-01-01

176

Simulating the role of anisotropy in human atrial cardioversion.  

PubMed

This computational study quantifies the effectiveness of feedback controlled low energy cardioversion in the anisotropic human atria. An established biophysical human cell model was adopted to reproduce Control and chronic atrial fibrillation (CAF) action potentials. The cell model was combined with a detailed human atrial geometry to construct a 3D realistic human atrial model. Scroll waves were simulated under Control and CAF conditions and the cardioversion parameters of stimulation strength and pacing duration were evaluated for scroll wave termination. Scroll waves were initiated at two locations in the atria to elicit the effects of scroll wave location. The role of anisotropy was highlighted by comparison to results from the isotropic case. Under Control conditions, scroll wave self-termination was rapid in the anisotropic case. Under CAF conditions, anisotropy caused the initiated scroll wave to degenerate into multiple scrolls with each evolving erratically or pinning to anatomical defects. The cardioversion successfully terminated scroll waves within 10 s, but the stimulus strength had a strong correlation to the location of the scroll wave. The low energy stimulation strength was always lower than the threshold stimulus. Anisotropy plays an important role in atrial electrical properties. Anisotropy aggravates CAF and leads to high frequency atrial pacing. The efficacy of cardioversion is significantly affected by anisotropy. PMID:24111315

Kharche, Sanjay R; Biktasheva, Irina V; Zhang, Henggui; Biktashev, Vadim N

2013-01-01

177

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

178

Infiltrative myxoma of the stifle joint and thigh in a domestic rabbit (Oryctolagus cuniculus).  

PubMed

A 5-year-old male domestic rabbit had severe swelling of the left hindlimb. Radiographs demonstrated a proliferative, infiltrative lesion involving the stifle joint, femur and soft tissues of the thigh. Osteomyelitis or neoplasia was suspected and the limb was amputated. Grossly, there was a multilobular mass comprised of cystic spaces containing yellow mucinous material. Microscopically, the mass formed coalescing lobules of stellate to rounded cells embedded in varying amounts of myxoid to collagenous matrix, and some rimmed by narrow walls of metaplastic bone and/or cartilage, and some infiltrated by plasma cells, lymphocytes, heterophils and histiocytes. Immunohistochemically, neoplastic cells expressed vimentin but not cytokeratin, sarcomeric actin, Mac387 or BLA36. Cytokeratin was not detected in normal synovial cells. The radiographic, gross and histological findings were most consistent with synovial myxoma; however, because of the extensive involvement of the limb in the absence of confirmed metastatic disease, the term infiltrative synovial myxoma was applied. PMID:22520254

Löhr, C V; Hedge, Z N; Pool, R R

2012-01-01

179

Identification of host range mutants of myxoma virus with altered oncolytic potential in human glioma cells  

Microsoft Academic Search

The authors have recently demonstrated that wild-type myxoma virus (MV) tagged with gfp (vMyxgfp) can generate a tumor-specific\\u000a infection that productively infects and clears human tumor-derived xenografts when injected intratumorly into human gliomas\\u000a transplanted into immunodeficient mice (Lun et al, 2005). To expand the understanding of MV tropism in cancer cells from a specific tissue lineage, the authors have screened

John W. Barrett; Lindsay R. Alston; Fuan Wang; Marianne M. Stanford; Philippe-Alexandre Gilbert; Xiujuan Gao; June Jimenez; Danielle Villeneuve; Peter Forsyth; Grant McFadden

2007-01-01

180

Facts about Atrial Septal Defect  

MedlinePLUS

... Links to Other Websites Information For... Media Policy Makers Facts about Atrial Septal Defect Language: English Español ( ... of this image. Close Information For... Media Policy Makers Language: English Español (Spanish) File Formats Help: How ...

181

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

182

The role of connexin40 in developing atrial conduction.  

PubMed

Connexin40 (Cx40) is the main connexin expressed in the murine atria and ventricular conduction system. We assess here the developmental role of Cx40 in atrial conduction of the mouse. Cx40 deficiency significantly prolonged activation times in embryonic day 10.5, 12.5 and 14.5 atria during spontaneous activation; the severity decreased with increasing age. In a majority of Cx40 deficient mice the impulse originated from an ectopic focus in the right atrial appendage; in such a case the activation time was even longer due to prolonged activation. Cx40 has thus an important physiological role in the developing atria. PMID:24486905

Benes, Jiri; Ammirabile, Grazia; Sankova, Barbora; Campione, Marina; Krejci, Eliska; Kvasilova, Alena; Sedmera, David

2014-04-17

183

Right atrial free wall rupture after blunt chest trauma.  

PubMed

We report the case of an 18-year-old man, victim of a car accident, presenting with severe hypotension and signs of cardiac tamponade. Transoesophageal echocardiography was suggestive of right atrial free wall rupture. The patient underwent urgent cardiac surgery for repair of right atrial rupture. The immediate clinical outcome was favourable; the patient is in good general condition at 24-month follow-up. The right atrium is rarely involved in cardiac contusion as compared to the right ventricle or other cardiac structures, owing to its anatomical location and direction of physical forces. PMID:17906483

De Maria, Elia; Gaddi, Oscar; Navazio, Alessandro; Monducci, Igor; Tirabassi, Giovanni; Guiducci, Umberto

2007-11-01

184

Left Atrial Wall Dissection: A Rare Sequela of Native-Valve Endocarditis  

PubMed Central

Left atrial wall dissection is a rare condition; most cases are iatrogenic after mitral valve surgery. A few have been reported as sequelae of blunt chest trauma, acute myocardial infarction, and invasive cardiac procedures. On occasion, infective endocarditis causes left atrial wall dissection. We report a highly unusual case in which a 41-year-old man presented with native mitral valve infective endocarditis that had caused left atrial free-wall dissection. Although our patient died within an hour of presentation, we obtained what we consider to be a definitive diagnosis of a rare sequela, documented by transthoracic and transesophageal echocardiography. PMID:25873836

Isbitan, Ahmad; Roushdy, Alaa; Shamoon, Fayez

2015-01-01

185

The polyuria of paroxysmal atrial tachycardia  

NASA Technical Reports Server (NTRS)

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

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

1974-01-01

186

Atrial flutter in grown-up congenital heart (GUCH) patients  

Microsoft Academic Search

Objective: To define occurrence, lesions and clinical characteristics of grown-up congenital heart (GUCH) patients who develop atrial flutter (AFL). Design: All GUCH patients who presented as inpatients or outpatients with documented sustained AFL between 1996 and 1998 were studied prospectively. Retrospective review of case notes for basic data relating to underlying anomaly, prior surgery and age at onset of AFL,

Wei Li; Jane Somerville

2000-01-01

187

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; Bâ, Serigne A

2013-01-01

188

“Acquired” Left Ventricular-to-Right Atrial Shunt (Gerbode Defect) after Bacterial Endocarditis  

PubMed Central

We present, with echocardiographic and intraoperative findings, a rare case of left ventricular-to-right atrial communication (Gerbode defect) after endocarditis associated with Staphylococcus aureus. (Tex Heart Inst J 1995;22:100-2) Images PMID:7787460

Velebit, Vladimir; Schöneberger, Arno; Ciaroni, Stefano; Bloch, Antoine; Maurice, Jean; Christenson, Jan T.; Simonet, François; Schmuziger, Martin

1995-01-01

189

Left circumflex coronary artery occlusion due to a left atrial appendage closure device  

PubMed Central

Nowadays, percutaneous left atrial appendage (LAA) closure is spreading, and a large number of patients with this procedure have concomitant coronary artery disease. With the presented case it could be concluded that coronary angiography is recommended before LAA closure.

Katona, András; Temesvári, András; Szatmári, András; Forster, Tamás; Fontos, Géza

2015-01-01

190

Atrial pacing for the prevention of atrial fibrillation after cardiovascular surgery  

Microsoft Academic Search

OBJECTIVEThe purpose of this study was to determine the efficacy of atrial pacing in the prevention of atrial fibrillation following cardiovascular surgery.BACKGROUNDAlthough pharmacologic therapy has been used to help prevent postoperative atrial fibrillation, it suffers from limited efficacy and adverse effects. In the nonoperative setting, novel pacing strategies have been shown to reduce recurrences of atrial fibrillation and prolong arrhythmia-free

Michael D Greenberg; Nevin M Katz; Stephen Iuliano; Barbara J Tempesta; Allen J Solomon

2000-01-01

191

Left atrial appendage thrombus in a patient in sinus rhythm with endocarditis and a severe aortic valve insufficiency.  

PubMed

A left atrial thrombus is most often associated with atrial fibrillation and/or rheumatic mitral stenosis. It is very infrequently detected in the presence of sinus rhythm. The present report describes the case of a 66-year-old woman who presented with a stroke and was subsequently found to have two potential sources of embolization, including a vegetation on the native aortic valve, with associated severe aortic insufficiency, and a left atrial appendage thrombus despite being in sinus rhythm. To the authors' knowledge, the present report is the first to describe a left atrial thrombus in sinus rhythm associated with aortic valve endocarditis. PMID:18841267

Shanks, M; Cujec, B; Choy, J B

2008-10-01

192

Who Is at Risk for Atrial Fibrillation?  

MedlinePLUS

... from the NHLBI on Twitter. Who Is at Risk for Atrial Fibrillation? Atrial fibrillation (AF) affects millions ... than 75. AF is uncommon in children. Major Risk Factors AF is more common in people who ...

193

Macro-reentrant atrial tachycardia conducting through a left superior vena cava after catheter ablation in a patient with paroxysmal atrial fibrillation.  

PubMed

A left superior vena cava can be a cause of cardiac rhythm or conduction abnormalities, and can also be the arrhythmogenic source of atrial fibrillation (AF) with connections to the coronary sinus and left atrium. In the present study, we report a case with a macro re-entrant atrial tachycardia that coursed through the left superior vena cava after a previous AF ablation, which successfully ablated paroxysmal AF. PMID:25547561

Kurotobi, Toshiya; Kino, Naoto; Tonomura, Daisuke; Shimada, Yoshihisa

2015-01-01

194

Bidirectional shunt in uncomplicated atrial septal defect  

Microsoft Academic Search

The presence of right to left shunts at atrial level in 40 patients with an uncomplicated atrial septal defect was determined by measuring the pulmonary vein to systemic artery oxygen stepdown . In six patients (group 1) a sizeable right to left shunt was found: left atrial oxygen stepdown was greater than or equal to 0.7 vol%, mean right to

E Galve; J Angel; A Evangelista; I Anivarro; G Permanyer-Miralda; J Soler-Soler

1984-01-01

195

The D-dimer assay: a possible tool in the evaluation of atrial thrombosis.  

PubMed

Atrial fibrillation (AF) is a common arrhythmia seen in clinical practice, and affects more than 4% of the population older than 60 years of age. Peripheral thromboembolism contributes significantly to the observed morbidity and mortality. Symptomatic AF, before cardioversion to normal sinus rhythm, requires either exclusion of atrial thrombi using transesophageal echocardiography (TEE) or the conventional use of three weeks of adequate anticoagulation. The exclusion of atrial thrombi by TEE, a nontomographic technique but comparable with conventional treatment of AF in outcomes, has inherent limitations due to the complex three-dimensional multilobed anatomy of the left atrial appendage, where the majority of atrial thrombi arise. Also, the conventional treatment of three weeks of therapeutic anticoagulation before cardioversion reportedly does not always eliminate atrial thrombi. Plasma D-dimer constitutes an antigen-antibody reaction to the dimeric final degradation product of a mature clot. An elevated fibrin D-dimer has a high sensitivity for intravascular thrombosis and, hence, may improve the evaluation of a patient with AF before cardioversion in addition to a TEE. A case is presented in which a positive D-dimer resulted in performing TEE to document atrial thrombosis and the complications of previous bacterial endocarditis. In the present case, this involved aortic root abscess formation and acute aortic regurgitation because of flailing of the noncoronary cusp that resulted in recurrent pulmonary edema. PMID:18548152

Ibebuogu, Uzoma N; Salah, Ali K; Malhotra, Surender; Calkins, Joe B; Thornton, John W; Mandawat, Mahendra; Robinson, Vincent J B

2008-06-01

196

A rare case of a intracardiac lipoma  

PubMed Central

Introduction Primary tumors of the heart are exceedingly rare, accounting for less than 5% of all cardiac tumors; the remaining 95% of tumors are metastatic tumors to the heart. The most common primary cardiac tumors in adults are myxomas (usually occurring in the left atrium) followed by papillary fibroelastomas and lipomas with rhabdomyoma the most common in children. Presentation of case We are presenting a case of a 74-years-old female who initially presents with dizziness. No other associated symptoms reported and initial labs were in normal range. Echocardiogram was done as part of the dizziness/syncope work up which demonstrated a large right atrial mass. Due to the size of the mass and patient being symptomatic the mass was surgically resected with complete resolution of her symptoms and pathology consistent with a lipoma. Discussion Cardiac lipomas are benign and may be associated with a spectrum of symptoms which depends upon the size and location of the lipoma; although most cardiac lipomas are found incidentally and are asymptomatic. The best radiologic study to identify and help differentiate cardiac lipoma is echocardiogram. Cardiac computerized tomography (CCT) and cardiac magnetic resonance imaging (CMR) also place a role in differentiating cardiac lipomas from other cardiac tumors/lesions. Conclusion Cardiac lipomas are benign primary tumors which have no defined age or sex distribution and present with a wide range of symptoms. Echocardiography is first line diagnosis method with CCT/CMR for better imaging before surgical intervention. Surgical resection of the symptomatic cardiac lipomas remains the mainstream treatment. PMID:25746952

Singh, Sarabjeet; Singh, Mukesh; Kovacs, Daniela; Benatar, Daniel; Khosla, Sandeep; Singh, Harpreet

2015-01-01

197

Regional Left Atrial Voltage in Patients with Atrial Fibrillation  

PubMed Central

BACKGROUND Regional differences in fibrosis, particularly related to the posterior wall and septum, may be important in atrial fibrillation (AF). Using electroanatomic mapping, voltage can be used as a measure of fibrosis. OBJECTIVES To determine if patients with AF have disproportionately lower voltage in the septal and posterior walls of the left atrium. METHODS Sinus rhythm left atrial electroanatomic maps were used in serial patients presenting for left atrial ablation of AF (8 mm tip). Patients undergoing left atrial mapping for focal atrial tachycardia (AT) were used as a comparison group (4 mm tip). Animal experiments were performed to assess the influence of ablation catheter tip size on voltage amplitude. RESULTS The posterior and septal walls exhibited the lowest voltages in both groups. Compared to the anterior wall, there was a 3.78 fold greater odds of finding a low voltage point(<0.5mV) in the septum (p<0.001) and a 3.37 fold greater odds of finding a low voltage point in the posterior wall (p<0.001) in the AF patients; the proportion of low voltage points by region were not significantly different in the AT group. In the animal model, the mean voltage obtained from an 8 mm ablation catheter was significantly higher (0.30 ± 0.17 mV) than that obtained from the same points using a 4 mm catheter (0.22 ± 0.17, p =0.05). CONCLUSIONS Regional differences in voltage are present in patients with atrial arrhythmias, with AF patients exhibiting significantly more low voltage areas in the septum and posterior walls. PMID:17275746

Marcus, Gregory M; Yang, Yanfei; Varosy, Paul D; Ordovas, Karen; Tseng, Zian H; Badhwar, Nitish; Lee, Byron K; Lee, Randall J; Scheinman, Melvin S; Olgin, Jeffrey E

2007-01-01

198

Atrial Pacing Periablation for Prevention of Paroxysmal Atrial Fibrillation  

Microsoft Academic Search

similar in the no-pacing (4.2 days; 95% CI, 1.8 to 9.5) and the atrial-pacing (1.9 days; 95% CI, 0.8 to 4.6; P5NS) groups. PAF burden was lower in the no-pacing (0.24 h\\/d; 95% CI, 0.10 to 0.56) than in the atrial-pacing (0.67 h\\/d; 95% CI, 0.30 to 1.52; P50.08) group. Paired crossover analysis in 11 patients revealed that time to

Anne M. Gillis; D. George Wyse; Stuart J. Connolly; Marc Dubuc; Francois Philippon; Raymond Yee; Pierre Lacombe; M. Sarah Rose; Charles D. Kerr

199

Surgical options in atrial fibrillation  

PubMed Central

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

Bedeir, Kareem

2015-01-01

200

A review of atrial fibrillation.  

PubMed Central

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and accounts for more physician visits and hospital days than any other cardiac rhythm disturbance. Atrial filbrillation is incresing in frequency as the population ages, and therefore, a knowledge of the clinical spectrum and available treatment regimen is essential. Here, we review the pathophysiology, clinical presentation, and current status of management. Experience is being rapidly accumulated in all of the areas discussed in the management of this important clinical entity. Images Figure 1 Figure 2 PMID:12510703

Dang, David; Arimie, Raluca; Haywood, L. Julian

2002-01-01

201

Relationship between mean platelet volume and atrial thrombus in patients with atrial fibrillation.  

PubMed

Platelets and clotting cascade play a major role in development of atrial thrombus in patients with atrial fibrillation. The mean platelet volume (MPV) reflects platelet size and is considered a marker and determinant of platelet function because larger platelets are hemostatically more reactive than platelets of normal size, increasing the propensity to thrombosis. We have investigated the relationship between MPV and left atrial thrombus in patients with persistent atrial fibrillation. A total of 205 consecutive patients (men: 67.3%, women: 32.7%; mean age: 62.3 ± 12.8) who had persistent atrial fibrillation, undergone transesophageal and transthoracic echocardiography. Study individuals were divided into two groups. Group 1 (n: 96, 46.8%): atrial fibrillation complicated with atrial thrombus and group 2 (n: 109, 53.2%): atrial fibrillation free of thrombus, which was identified by means of transesophageal echocardiogram. The MPV, platelet distribution weight, and platelet count were measured. There was no difference in terms of MPV, platelet distribution weight, and platelet count in two groups. MPV was not correlated with thrombus and spontaneous echo contrast. Left atrial thrombus was included in multivariate logistic regression analysis and only low ejection fraction was a predictor of left atrial thrombus (P = 0.04). This is first report showing that MPV is not related with left atrial thrombus in patients with atrial fibrillation. According to our result, MPV cannot be considered as an index of left atrial thrombus in patients with atrial fibrillation. PMID:20881479

Yuce, Murat; Cakici, Musa; Davutoglu, Vedat; Ozer, Orhan; Sari, Ibrahim; Ercan, Suleyman; Sucu, Murat; Dogan, Adnan; Yavuz, Fethi

2010-12-01

202

Atrial flutter ablation and risk of right coronary artery injury.  

PubMed

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

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

2015-04-01

203

Atrial Flutter Ablation and Risk of Right Coronary Artery Injury  

PubMed Central

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

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

2015-01-01

204

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

205

[Odontogenic myxoma of the maxilla in a three-year-old boy.  

PubMed

A three-year-old boy presented with a painless mass in the nasolabial fold and ipsilateral increased tearing. A diagnosis of odontogenic myxoma (OM) was established by biopsy, and the tumour was excised using a combined oral and transconjuctival approach. In small children OM occurs almost exclusively in the maxilla. Orbital involvement is very rare, and to our knowledge reconstruction with a Medpore sheet has not previously been reported. At post-operative follow-up normal eye function and an excellent cosmetic result was observed. OM should be considered in a midfacial mass. PMID:25349936

Danielsson, Lina Isabella; Jakobsen, John; Thygesen, Torben H; Fast, Søren

2014-03-24

206

Atrial fibrillation subtypes classification using the General Fourier-family Transform.  

PubMed

Atrial fibrillation patients can be classified into paroxysmal, persistent and permanent attending to the temporal pattern of this arrhythmia. The surface electrocardiogram hides this differentiation. A classification method to discriminate between the different subtypes of atrial fibrillation by using short segments of electrocardiograms recordings is presented. We will process the electrocardiograms (ECGs) using time-frequency techniques with a global accuracy of 80%. Real cases are evaluated showing promising results for an implementation in a semiautomated diagnostic system. PMID:24378383

Ortigosa, Nuria; Cano, Óscar; Ayala, Guillermo; Galbis, Antonio; Fernández, Carmen

2014-04-01

207

Double device left atrial appendage closure.  

PubMed

Aims: Percutaneous left atrial appendage (LAA) occlusion is an alternative to oral anticoagulation for the prevention of stroke in patients with non-valvular atrial fibrillation (NVAF). Due to the great anatomic variability of the LAA, complete closure may not always be obtained with a single device. We report cases in which adequate closure of the LAA was achieved with implantation of 2 devices. Methods and results: Five out of 223 consecutive patients who underwent LAA occlusion without guidance with transoesophageal echocardiography (TOE) had a second device implanted to treat significant residual leaks or uncovered parts of the LAA after first device implantation. All procedures were successful, with no complications. Two patients received two AMPLATZER Cardiac Plugs (ACP); one patient received one ACP and one AMPLATZER Vascular Plug; one patient received one AMPLATZER Septal Occluder (ASO) and one ACP prototype; and one patient received two ASOs. TOE performed at least four months after the procedure showed complete closure of the LAA in all patients, without thrombus formation on the devices. After 14 patient-years there were no strokes, peripheral thromboemboli, or device embolisations. Conclusions: When necessary, the implantation of two devices to achieve complete LAA occlusion in patients with NVAF is feasible and leads to favourable results during follow-up. Potentially, this technical innovation may widen LAA occlusion indications by permitting occlusion of LAAs with large ostia or complex anatomy. PMID:25007782

Guérios, Enio E; Gloekler, Steffen; Schmid, Michael; Khattab, Ahmed; Nietlispach, Fabian; Meier, Bernhard

2014-07-10

208

Left atrial thrombus associated with ablation for atrial fibrillation: identification with intracardiac echocardiography  

Microsoft Academic Search

ObjectivesThis study reports the incidence of, risk factors for, and management of left atrial (LA) thrombus documented by intracardiac echocardiography (ICE) during LA ablation for atrial fibrillation (AF).

Jian-Fang Ren; Francis E Marchlinski; David J Callans

2004-01-01

209

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

210

Large free-floating left atrial thrombus with normal mitral valve  

PubMed Central

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

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

2013-01-01

211

Aortic perforation by active-fixation atrial pacing lead: an unusual but serious complication.  

PubMed

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

Di Marco, Andrea; Nuñez, Elaine; Osorio, Karina; Dallaglio, Paolo; Anguera, Ignasi; Toscano, Jacobo; Sabaté, Xavier; Cequier, Angel

2014-06-01

212

Atrial septal stenting — How I do it?  

PubMed Central

A wide atrial communication is important to maintain hemodynamics in certain forms of congenital and acquired heart defects. In comparison to balloon septostomy or blade septostomy, atrial septal stenting provides a controlled, predictable, and long-lasting atrial communication. It often needs a prior Brockenbrough needle septal puncture to obtain a stable stent position. A stent deployed across a previously dilated and stretched oval foramen or tunnel form of oval foramen carries higher risk of embolization. This review provides technical tips to achieve a safe atrial septal stenting. Even though this is a “How to do it article,” an initial discussion about the indications for atrial septal stenting is vital as the resultant size of the atrial septal communication should be tailored for each indication. PMID:25684885

Sivakumar, Kothandam

2015-01-01

213

Present treatment options for atrial fibrillation  

PubMed Central

Atrial fibrillation is the commonest sustained cardiac arrhythmia. It accounts for >35% of all hospital admissions for cardiac arrhythmias in the United States. The presence of atrial fibrillation increases the mortality of a population by up to twofold. The risk of stroke increases from 1.5% in patients with atrial fibrillation from 50–59 years of age to up to 23.5% for such patients aged 80–89 years. Although the diagnosis of atrial fibrillation is usually straightforward, effective treatment is not. This article will discuss how rhythm control of atrial fibrillation can best be achieved, the controversy over the rhythm versus rate control, the maintenance of sinus rhythm with antiarrhythmic drugs after cardioversion, and prevention of thromboembolism. Finally, the recent advances in various non-pharmacological approaches for the treatment of atrial fibrillation will be highlighted. PMID:12612318

Lairikyengbam, S; Anderson, M; Davies, A

2003-01-01

214

[Relations between FANS, PPI and atrial fibrillation].  

PubMed

Recent evidence supports the existence of an association between the use of non-steroidal anti-inflammatory drugs and the risk of atrial fibrillation. Anti-inflammatory drugs are widely used for the treatment of systemic inflammatory disorders, and chronic inflammation is a well-known risk factor for the development of myocardial fibrosis. The latter accounts for atrial inhomogeneities of conduction, thus triggering and perpetuating atrial fibrillation. Atrial inflammatory remodeling may therefore be responsible for the higher incidence of atrial fibrillation among patients assuming steroidal and non-steroidal anti-inflammatory drugs because of an underlying inflammatory disorders. Alternative theories contemplate gastroesophageal reflux, which is extremely common during the use of non-steroidal anti-inflammatory drugs and may trigger atrial fibrillation, as mediating the above-mentioned association. PMID:23748686

Ricci, Fabrizio; De Caterina, Raffaele

2013-05-01

215

Atrial septal stenting - How I do it?  

PubMed

A wide atrial communication is important to maintain hemodynamics in certain forms of congenital and acquired heart defects. In comparison to balloon septostomy or blade septostomy, atrial septal stenting provides a controlled, predictable, and long-lasting atrial communication. It often needs a prior Brockenbrough needle septal puncture to obtain a stable stent position. A stent deployed across a previously dilated and stretched oval foramen or tunnel form of oval foramen carries higher risk of embolization. This review provides technical tips to achieve a safe atrial septal stenting. Even though this is a "How to do it article," an initial discussion about the indications for atrial septal stenting is vital as the resultant size of the atrial septal communication should be tailored for each indication. PMID:25684885

Sivakumar, Kothandam

2015-01-01

216

Repair of atrial septal defects on the perfused beating heart.  

PubMed

We present our experience in repairing all varieties of atrial septal defects with the aid of continuous antegrade perfusion of an empty beating heart with normothermic blood.From September 1999 through December 2008, 266 patients (140 females and 126 males; ages 3-53 yr) underwent atrial septal defect closure by this method. Of these patients, 236 had ostium secundum, 21 had sinus venosus, and 9 had ostium primum defects. Three patients also had rheumatic mitral incompetence requiring mitral valve implantation, and 2 also had mitral stenosis requiring valvuloplasty. Preoperative diagnoses were established by 2-dimensional echocardiography and color-flow Doppler study. The size of atrial septal defects ranged from 2 cm through 4.5 cm. Direct repair was performed in 52 patients, and the rest received an autologous pericardial patch. Normothermic perfusion at 4 to 5 mL/(kg.min) kept the heart beating throughout the procedure. All patients survived the procedure with no complication. Twelve patients with ostium secundum atrial septal defect were extubated on the table and discharged within 24 hours of hospitalization. They are categorized as ambulatory cases. All patients remained in sinus rhythm. One patient with a residual shunt required revision of a patch; postoperative echocardiography showed normal left ventricular function and no residual shunt. Total intensive care unit stay was less than 24 hours for all patients.The primary aim of the beating-heart technique is to avoid ischemic-reperfusion injury. It is a safe and effective technique for the closure of all varieties of atrial septal defect. PMID:19876418

Pendse, Nikhil; Gupta, Sanjeev; Geelani, Mohammed Abid; Minhas, Harpreet Singh; Agarwal, Saket; Tomar, Akhlesh; Banerjee, Amit

2009-01-01

217

Atrial fibrillation after taser exposure in a previously healthy adolescent.  

PubMed

We are reporting a previously healthy adolescent who developed atrial fibrillation after being tased. He has a structurally normal heart on echocardiogram, normal electrolyte level and thyroid function test results, and a urine toxicology screen positive for marijuana. The patient ultimately required external defibrillation to convert his cardiac rhythm to normal sinus rhythm and has had no recurrent arrhythmias since hospital discharge (approximately 1 year). This is the first reported case of atrial fibrillation developing after a Taser shot, occurring in an adolescent without other risk factors. This case illustrates the arrhythmogenic potential of a Taser in otherwise healthy young individuals, and further study of occurrence of Taser-induced arrhythmias is warranted. PMID:20016356

Multerer, Sara; Berkenbosch, John W; Das, Bibhuti; Johnsrude, Christopher

2009-12-01

218

Catheter ablation for asymptomatic atrial fibrillation?  

PubMed

Ablation therapy for atrial fibrillation (AF) has been shown to be more efficient than medical treatment alone. Long-term success of AF ablation is still around 50% after one ablation and higher after two, with a substantial amount of asymptomatic recurrences in formerly symptomatic patients. Given the lack of evidence for superiority of rhythm control over rate control in terms of stroke reduction and mortality, AF ablation remains a treatment for symptom reduction only, although ablation has never been a part of these studies. There is early evidence that ablation could decrease the long-term risk of stroke; however, prospective studies are needed to assess whether this is the case and how patients with a successful ablation can be identified. If AF ablation can be shown to improve long-term morbidity, it could also become a reasonable treatment for patients with asymptomatic AF. PMID:25666169

Kochhäuser, Simon; Verma, Atul

2015-03-01

219

Slow ventricular response atrial fibrillation related to mad honey poisoning  

PubMed Central

Mad honey poisoning which is induced by Grayanotoxin (Andromedotoxin), is also known to have adverse effects in the cardiovascular system leading to different clinical entities. This toxin is produced by a member of the Rhododendron genus of plants of two R. Luteum and R. Panticum. In this article, we presented a case of slow ventricular response atrial fibrillation complaints with nausea, vomiting, dizziness and chest pain about an hour after eating honey produced in the Black Sea Region. PMID:22923947

Osken, A.; Yaylac?, S.; Ayd?n, E.; Kocayigit, ?; Cakar, M.A.; Tamer, A.; Gündüz, H.

2012-01-01

220

Slow ventricular response atrial fibrillation related to mad honey poisoning.  

PubMed

Mad honey poisoning which is induced by Grayanotoxin (Andromedotoxin), is also known to have adverse effects in the cardiovascular system leading to different clinical entities. This toxin is produced by a member of the Rhododendron genus of plants of two R. Luteum and R. Panticum. In this article, we presented a case of slow ventricular response atrial fibrillation complaints with nausea, vomiting, dizziness and chest pain about an hour after eating honey produced in the Black Sea Region. PMID:22923947

Osken, A; Yaylac?, S; Ayd?n, E; Kocayigit, I; Cakar, M A; Tamer, A; Gündüz, H

2012-07-01

221

Tako-tsubo cardiomyopathy following catheter ablation of atrial fibrillation.  

PubMed

Tako-tsubo cardiomyopathy is characterized by reversible left ventricular dysfunction following emotional or surgical stress. Unlike the well-known complications of catheter ablation (CA) of atrial fibrillation (AF), Tako-tsubo cardiomyopathy has been rarely reported so far. We report a case of acute reversible left heart failure following successful CA of paroxysmal AF in a patient with a history of panic disorder. PMID:25355779

Karaca, Oguz; Omaygenc, Onur; Kilicaslan, Fethi

2015-02-01

222

An unusual presentation of a right atrial Chiari network.  

PubMed

In 1897, the anatomist Chiari described a structure in the right atrium connected to the Eustachian valve identified as the embryological vestige of the right valve of the sinus venosus. The discovery of a mass in the right atrium obliges the clinician to perform a broad differential diagnosis among a tumour, vegetations on the tricuspid valve, an atrial thrombus and Chiari network. We present a case of Chiari network in a 55-year-old Italian woman. PMID:18006092

Patanè, Salvatore; Anfuso, Carmelo; Marte, Filippo; Minutoli, Fabio; Di Bella, Gianluca; Coglitore, Sebastiano

2009-02-01

223

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 ...

224

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

225

Association between the European GWAS-Identified Susceptibility Locus at Chromosome 4p16 and the Risk of Atrial Septal Defect: A Case-Control Study in Southwest China and a Meta-Analysis  

PubMed Central

Atrial septal defect (ASD) is the third most frequent type of congenital heart anomaly, featuring shunting of blood between the two atria. Gene-environment interaction remains to be an acknowledged cause for ASD occurrence. A recent European genome-wide association study (GWAS) of congenital heart disease (CHD) identified 3 susceptibility SNPs at chromosome 4p16 associated with ASD: rs870142, rs16835979 and rs6824295. A Chinese-GWAS of CHD conducted in the corresponding period did not reveal the 3 susceptibility SNPs, but reported 2 different risk SNPs: rs2474937 and rs1531070. Therefore, we aimed to investigate the associations between the 3 European GWAS-identified susceptibility SNPs and ASD risk in the Han population in southwest China. Additionally, to increase the robustness of our current analysis, we conducted a meta-analysis combining published studies and our current case-control study. We performed association, linkage disequilibrium, and haplotype analysis among the 3 SNPs in 190 ASD cases and 225 age-, sex-, and ethnicity-matched healthy controls. Genotype and allele frequencies among the 3 SNPs showed statistically significant differences between the cases and controls. Our study found that individuals carrying the allele T of rs870142, the allele A of rs16835979, and the allele T of rs6824295 had a respective 50.1% (odds ratio (OR) = 1.501, 95% confidence interval (CI) = 1.122-2.009, PFDR-BH = 0.018), 48.5% (OR = 1.485, 95%CI = 1.109-1.987, PFDR-BH = 0.012), and 38.6% (OR = 1.386, 95%CI = 1.042-1.844, PFDR-BH = 0.025) increased risk to develop ASD than wild-type allele carriers in our study cohort. In the haplotype analysis, we identified a disease-risk haplotype (TAT) (OR = 1.540, 95%CI = 1.030-2.380, PFDR-BH = 0.016). Our meta-analysis also showed that the investigated SNP was associated with ASD risk (combined OR (95%CI) = 1.35 (1.24-1.46), P < 0.00001). Our study provides compelling evidence to motivate better understanding of the etiology of ASD. PMID:25875170

Dian, Ke; Ying, Binwu; Lu, Xiaojun; Hu, Xuejiao; An, Qi; Chen, Chunxia; Huang, Chunyan; Tan, Bin; Qin, Li

2015-01-01

226

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

227

Modern Treatment of Atrial Fibrillation  

PubMed Central

Atrial fibrillation (AF) is the most common type of arrhythmia and has a large global burden. In general, treatment of AF is based on medication and consists of rate and rhythm control together with anticoagulation. However, surgical treatment may be required in patients with AF combined with organic valvular heart diseases or who experience recurrence despite medication. In addition, surgical treatment plays a role in the treatment of lone AF. This article reviews the various surgical treatment options for AF. PMID:25551069

Kim, Kyung-Hwan

2014-01-01

228

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

229

Atrial Fibrillation after Noncardic Surgery  

Microsoft Academic Search

\\u000a New onset atrial fibrillation is very common after cardiac surgery and though it occurs less frequently after other types\\u000a of surgery, it is still a major clinical problem. With the large numbers of surgical procedures performed each year in the\\u000a United States, even a small incidence translates into a significant absolute number of patients.

Dhiraj D. Narula; Jonathan S. Steinberg

230

Myxoma Virus M11L Blocks Apoptosis through Inhibition of Conformational Activation of Bax at the Mitochondria  

PubMed Central

Many viruses inhibit or retard apoptosis, a strategy that subverts one of the most ancient antiviral mechanisms. M11L, a myxoma virus-encoded antiapoptotic protein, has been previously shown to localize to mitochondria and block apoptosis of virus-infected cells (H. Everett, M. Barry, S. F. Lee, X. J. Sun, K. Graham, J. Stone, R. C. Bleackley, and G. McFadden, J. Exp. Med. 191:1487-1498, 2000; H. Everett, M. Barry, X. Sun, S. F. Lee, C. Frantz, L. G. Berthiaume, G. McFadden, and R. C. Bleackley, J. Exp. Med. 196:1127-1139, 2002; and G. Wang, J. W. Barrett, S. H. Nazarian, H. Everett, X. Gao, C. Bleackley, K. Colwill, M. F. Moran, and G. McFadden, J. Virol. 78:7097-7111, 2004). This protection from apoptosis involves constitutive-forming inhibitory complexes with the peripheral benzodiazepine receptor and Bak on the outer mitochondrial membrane. Here, we extend the study to investigate the interference of M11L with Bax activation during the process of apoptosis. Myxoma virus infection triggers an early apoptotic signal that induces rapid Bax translocation from cytoplasm to mitochondria, despite the existence of various viral antiapoptotic proteins. However, in the presence of M11L, the structural activation of Bax at the mitochondrial membrane, which is characterized by the occurrence of a Bax conformational change, is blocked in both M11L-expressing myxoma-infected cells and M11L-transfected cells under apoptotic stimulation. In addition, inducible binding of M11L to the mitochondrially localized Bax is detected in myxoma virus-infected cells and in M11L/Bax-cotransfected cells as measured by immunoprecipitation and tandem affinity purification analysis, respectively. Importantly, this inducible Bax/M11L interaction is independent of Bak, demonstrated by the complete block of Bax-mediated apoptosis in myxoma-infected cells that lack Bak expression. Our findings reveal that myxoma M11L modulates apoptosis by multiple independent strategies which all contribute to the blockade of apoptosis at the mitochondrial checkpoint. PMID:16414991

Su, Jin; Wang, Gen; Barrett, John W.; Irvine, Timothy S.; Gao, Xiujuan; McFadden, Grant

2006-01-01

231

Bioelectric model of atrial fibrillation: applicability of blind source separation techniques for atrial activity estimation in atrial fibrillation episodes  

Microsoft Academic Search

In this contribution, we present the theoretical justification that give support to the suitability of blind signal separation (BSS) techniques for the estimation of the atrial activity (AA) present in ECGs of persistent atrial fibrillation (AF). The application of BSS methods to this problem needs the fulfillment of several conditions regarding AA, ventricular activity (VA) and the fashion in which

J. J. Rieta; F. Castells; C. Sanchez; D. Moratal-Perez; J. Millet

2003-01-01

232

Intracellular lactate signaling cascade in atrial remodeling of mitral valvular patients with atrial fibrillation  

PubMed Central

Background Atrial remodeling has emerged as the structural basis for the maintenance and recurrence of atrial fibrillation. Lactate signaling cascade was recently linked to some cardiovascular disorders for its regulatory functions to myocardial structural remodeling. It was hypothesized that lactate signaling cascade was involved in the maintenance and recurrence of atrial fibrillation by regulating atrial structural remodeling. Methods Biopsies of right atrial appendage and clinical data were collected from sex- and age-matched 30 persistent atrial fibrillation, 30 paroxysmal atrial fibrillation, 30 sinus rhythm patients undergoing isolated mitral valve surgery and 10 healthy heart donors. Results Atrial fibrillation groups had higher atrial lactate expression and this upregulated expression was positively correlated with regulatory indicators of atrial structural remodeling as reflected by severe oxidative stress injury and mitochondrial control of apoptosis. Conclusions The present findings suggest a potential role for lactate signaling cascade in the maintenance and recurrence of atrial fibrillation and possibly represent new targets for therapeutic intervention in this disorder. PMID:23452897

2013-01-01

233

Prevalence and spectrum of Nkx2.5 mutations associated with idiopathic atrial fibrillation  

PubMed Central

OBJECTIVE: The aim of this study was to evaluate the prevalence and spectrum of Nkx2.5 mutations associated with idiopathic atrial fibrillation (AF). METHODS: A cohort of 136 unrelated patients with idiopathic atrial fibrillation and 200 unrelated, ethnically matched healthy controls were enrolled. The coding exons and splice junctions of the Nkx2.5 gene were sequenced in 136 atrial fibrillation patients, and the available relatives of mutation carriers and 200 controls were subsequently genotyped for the identified mutations. The functional characteristics of the mutated Nkx2.5 gene were analyzed using a dual-luciferase reporter assay system. RESULTS: Two novel heterozygous Nkx2.5 mutations (p.N19D and p.F186S) were identified in 2 of the 136 unrelated atrial fibrillation cases, with a mutational prevalence of approximately 1.47%. These missense mutations co-segregated with atrial fibrillation in the families and were absent in the 400 control chromosomes. Notably, 2 mutation carriers also had congenital atrial septal defects and atrioventricular block. Multiple alignments of the Nkx2.5 protein sequences across various species revealed that the altered amino acids were completely conserved evolutionarily. Functional analysis demonstrated that the mutant Nkx2.5 proteins were associated with significantly reduced transcriptional activity compared to their wild-type counterpart. CONCLUSION: These findings associate the Nkx2.5 loss-of-function mutation with atrial fibrillation and atrioventricular block and provide novel insights into the molecular mechanism involved in the pathogenesis of atrial fibrillation. These results also have potential implications for early prophylaxis and allele-specific therapy of this common arrhythmia. PMID:23778487

Xie, Wen-Hui; Chang, Cheng; Xu, Ying-Jia; Li, Ruo-Gu; Qu, Xin-Kai; Fang, Wei-Yi; Liu, Xu; Yang, Yi-Qing

2013-01-01

234

Ranolazine for the prevention or treatment of atrial fibrillation: a systematic review.  

PubMed

The use of currently available antiarrhythmic drugs for atrial fibrillation is limited by their moderate efficacy and the considerable proarrhythmic risk. Ranolazine, an antianginal agent, has been reported to possess antiarrhythmic properties, resulting in a reduction of supraventricular and ventricular arrhythmias. We performed a systematic review of the clinical studies reporting the outcome of patients treated with ranolazine for the prevention or treatment of atrial fibrillation in various clinical settings. We searched PubMed and abstracts of major conferences for clinical studies using ranolazine, either alone or in combination with other antiarrhythmic agents for the prevention or treatment of atrial fibrillation. Ten relevant records were identified. These included both randomized trials and retrospective cohort studies concerning the use of ranolazine in different clinical settings; prevention of atrial fibrillation in patients with acute coronary syndrome, prevention as well as conversion of postoperative atrial fibrillation after coronary artery bypass grafting, conversion of recent-onset atrial fibrillation, sinus rhythm maintenance in drug-resistant recurrent atrial fibrillation and facilitation of electrical cardioversion in cardioversion-resistant patients. A beneficial, mostly modest effect of ranolazine was homogeneously reported in all clinical settings. There were no substantial proarrhythmic effects. No meta-analysis could be performed because for most of the clinical scenarios, there was only one study investigating the effect of ranolazine. Except for one large randomized trial, all the other studies were either relatively small randomized studies or retrospective cohort analyses, which in several cases lacked a control group. This systematic review indicates a modest beneficial effect of ranolazine administered for the prevention or treatment of atrial fibrillation across several clinical settings without substantial proarrhythmic risk. PMID:24662415

Dagres, Nikolaos; Iliodromitis, Efstathios K; Lekakis, John P; Simitsis, Panagiotis; Karatzas, Dimitrios; Rallidis, Loukianos S; Simeonidou, Eftihia; Anastasiou-Nana, Maria

2014-03-01

235

Left-atrial-appendage occluder migrates in an asymptomatic patient.  

PubMed

Percutaneous closure of the left atrial appendage (LAA) is a new approach to the prevention of cardioembolic events in patients with atrial fibrillation. We implanted an LAA occlusion device (Amplatzer™ Cardiac Plug) in a 70-year-old woman via a transseptal approach. Upon her discharge from the hospital, a transthoracic echocardiogram showed stable anchoring of the device; 6 months after implantation, a routine transthoracic echocardiogram revealed migration of the occluder into the left ventricular outflow tract, in the absence of symptoms. We surgically removed the device from the mitral subvalvular apparatus and closed the LAA with sutures. This case shows that percutaneous LAA occlusion can result in serious adverse events, including device migration in the absence of signs or symptoms; therefore, careful follow-up monitoring is mandatory. PMID:25120404

Pisani, Paolo; Sandrelli, Luca; Fabbrocini, Mario; Tesler, Ugo Filippo; Medici, Dante

2014-08-01

236

Transesophageal Echocardiography during Pulmonary Vein Cryoballoon Ablation for Atrial Fibrillation.  

PubMed

We describe our first 20 cases of cryoablation of atrial fibrillation (AF) using transesophageal echocardiography (TEE). Continuous procedural monitoring with TEE by a cardiologist and senior sonographer assists the electrophysiologist in performance of the cryoballoon procedure of AF. Previously using intracardiac echocardiography (ICE) we have found TEE to have better overall procedural imaging, and monitoring for pericardial effusion or thrombus formation. We have found TEE monitoring to be helpful with positioning for interatrial septal (IAS) puncture, catheter tip avoidance of the left atrial appendage (LAA), and guidance of the balloon catheter into each pulmonary vein (PV), with proper positioning within each PV orifice, and documentation of PV occlusion for the cryoballoon procedure. Procedural equipment and the cryoballoon protocol used are presented in detail. The role of TEE imaging during the procedure and in preventing potential dangers is illustrated. It is the goal of this study to demonstrate how the electrophysiology and echocardiography laboratories work together in this cryoablation procedure. PMID:24813802

Kerut, Edmund Kenneth; Hanawalt, Curtis; McKinnie, James

2015-02-01

237

[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, Özge; Moser, Julia; Steven, Daniel; Willems, Stephan

2014-12-01

238

Left atrial band: a rare congenital anomaly.  

PubMed

Left atrial fibromuscular band is a rare congenital cardiac anomaly. We present a patient with an incidental finding of left atrial band on an intra-operative transesophageal echocardiogram and characterize its appearance on two-dimensional and three-dimensional echocardiograms. PMID:25281635

Liou, Kevin; Premaratne, Manuja; Mathur, Gita

2014-01-01

239

Novel molecular targets for atrial fibrillation therapy  

Microsoft Academic Search

Atrial fibrillation is the most common type of cardiac arrhythmia, and is responsible for substantial morbidity and mortality in the general population. Current treatments have moderate efficacy and considerable risks, especially of pro-arrhythmia, highlighting the need for new therapeutic strategies. In recent years, substantial efforts have been invested in developing novel treatments that target the underlying molecular determinants of atrial

Leif Carlsson; Dobromir Dobrev

2012-01-01

240

Wavefront detection from intra-atrial recordings  

Microsoft Academic Search

The present study deals with detection of intra-atrial wavefronts from atrial activation times in adjacent bipolar electrograms. A statistic of the delays within each wave-front was calculated and served as a basis for quantifying the wavefront consistency as well as the propagation of the electrical activity along the catheter. The database consisted of 19 patients for which five electrograms were

U. Richter; M. Stridh; D. Husser; D. S. Cannom; A. K. Bhandari; A. Bollmann; L. Sornmo

2007-01-01

241

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

242

Production of Myxoma Virus Gateway Entry and Expression Libraries and Validation of Viral Protein Expression  

PubMed Central

Invitrogen’s Gateway technology is a recombination-based cloning method that allows for rapid transfer of numerous open reading frames (ORFs) into multiple plasmid vectors, making it useful for diverse high-throughput applications. Gateway technology has been utilized to create an ORF library for Myxoma virus (MYXV), a member of the Poxviridae family of DNA viruses. MYXV is the prototype virus for the genus Leporipoxvirus, and is pathogenic only in European rabbits. MYXV replicates exclusively in the host cell cytoplasm, and its genome encodes 171 ORFs. A number of these ORFs encode proteins that interfere with or modulate host defense mechanisms, particularly the inflammatory responses. Furthermore, MYXV is able to productively infect a variety of human cancer cell lines and is being developed as an oncolytic virus for treating human cancers. MYXV is therefore an excellent model for studying poxvirus biology, pathogenesis, and host tropism, and a good candidate for ORFeome development. PMID:21538302

Smallwood, Sherin E.; Rahman, Masmudur M.; Werden, Steven J.; Martino, Maria Fernanda; McFadden, Grant

2011-01-01

243

Myxoma and vaccinia virus exploit different mechanisms to enter and infect human cancer cells  

PubMed Central

Myxoma (MYXV) and vaccinia virus (VACV) have recently emerged as potential oncolytic agents that can infect and kill different human cancer cells. Although both are structurally similar, it is unknown whether the pathway(s) used by these poxviruses to enter and cause oncolysis in cancer cells are mechanistically similar. Here, we compared the entry of MYXV and VACV-WR into various human cancer cells and observed significant differences: 1- Low pH treatment accelerates fusion-mediated entry of VACV but not MYXV, 2- The tyrosine kinase inhibitor genistein inhibits entry of VACV, but not MYXV, 3- Knockdown of PAK1 revealed that it is required for a late stage downstream of MYXV entry into cancer cells, whereas PAK1 is required for VACV entry into the same target cells. These results suggest that VACV and MYXV exploit different mechanisms to enter into human cancer cells, thus providing some rationale for their divergent cancer cell tropisms. PMID:20334889

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

2010-01-01

244

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

SciTech Connect

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

Villa, Nancy Y.; Bartee, Eric [Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, Florida 32610 (United States); Mohamed, Mohamed R. [Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, Florida 32610 (United States); Department of Biochemistry, Faculty of Science, Ain Shams University, Cairo (Egypt); Rahman, Masmudur M. [Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, Florida 32610 (United States); Barrett, John W. [Department of Microbiology and Immunology, BioTherapeutics Research Group, Robarts Research Institute, University of Western Ontario, London, Ontario (Canada); McFadden, Grant, E-mail: grantmcf@ufl.ed [Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, Florida 32610 (United States)

2010-06-05

245

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, Mónica; Ramírez, Miguel A.; Cano, María J.; Párraga, Mario; Castilla, Joaquín; Pérez-Ordoyo, Luis I.; Torres, Juan M.; Bárcena, Juan

2009-01-01

246

Epicardial left atrial appendage clip occlusion also provides the electrical isolation of the left atrial appendage  

PubMed Central

OBJECTIVES The exclusion of the left atrial appendage (LAA) has been used to reduce the risk of stroke associated with atrial fibrillation (AF). While LAA exclusion has been associated with a reduced risk of stroke, the effect on the electrical activity of the LAA (a potential source of AF) remains unknown. As such, we sought to demonstrate whether surgical epicardial clip occlusion leads to the electrical isolation of the LAA. METHODS From December 2010 until August 2011, 10 patients with paroxysmal AF underwent off-pump coronary artery bypass surgery with bilateral pulmonary vein isolation and an LAA clip occlusion with a new epicardial clip. Before and after the clip was placed, pacing manoeuvres were performed to assess the electrical exit and entry blocks from the LAA. RESULTS All clips were applied successfully. The mean procedure time for the clip application was 4 ± 1 min. No complications occurred related to clip application. Prior to the pericardial closure, 18 ± 3 min after the clip placement, the LAA stimulation and pacing manoeuvres demonstrated complete electrical isolation of the LAA in all cases. CONCLUSIONS Epicardial LAA clip occlusion leads to the acute electrical isolation of the LAA and may not only provide stroke prevention but also reduce the recurrence of AF. PMID:22647971

Starck, Christoph T.; Steffel, Jan; Emmert, Maximilian Y.; Plass, Andre; Mahapatra, Srijoy; Falk, Volkmar; Salzberg, Sacha P.

2012-01-01

247

The Effects of Percutaneous Mitral Balloon Valvuloplasty on the Left Atrial Appendage Function in Patients With Sinus Rhythm and Atrial Fibrillation  

PubMed Central

Introduction: Mitral stenosis (MS) causes structural and functional abnormalities of the left atrium (LA) and left atrial appendage (LAA), and studies show that LAA performance improves within a short time after percutaneous transvenous mitral commissurotomy (PTMC). This study aimed to investigate the effects of PTMC on left atrial function by transesophageal echocardiography (TEE). Methods: We enrolled 56 patients with severe mitral stenosis (valve area less than 1.5 CM2). All participants underwent mitral valvuloplasty; they also underwent transesophageal echocardiography before and at least one month after PTMC. Results: Underlying heart rhythm was sinus rhythm (SR) in 28 patients and atrial fibrillation (AF) in remainder 28 cases. There was no significant change in the left ventricular ejection fraction (LVEF), left ventricular end diastolic dimension (LVEDD), or the left ventricular end systolic dimension (LVESD) before and after PTMC in both groups. However, both groups showed a significant decrease in the left atrial volume index (LAVI) following PTMC (P=0.032 in SR and P=0.015 in AF group). LAA ejection fraction (LAAEF) and the LAA emptying velocity (LAAEV) were improved significantly after PTMC in both groups with SR and AF (P<0.001 for both). Conclusion: Percutaneous transvenous mitral commissurotomy improves left atrial appendage function in patients with mitral stenosis irrespective of the underlying heart rhythm. PMID:25859314

Aslanabadi, Naser; Jafaripour, Iraj; Toufan, Mehrnoush; Sohrabi, Bahram; Separham, Ahmad; Madadi, Reza; Feazpour, Hossein; Asgharzadeh, Yosef; Ahmadi, Mostafa; Safaiyan, Abdolrasol; Ghafari, Samad

2015-01-01

248

Post-translational modification of the myxoma-virus anti-inflammatory serpin SERP-1 by a virally encoded sialyltransferase.  

PubMed

SERP-1 is a secreted serpin (serine-proteinase inhibitor) encoded by myxoma virus, a poxvirus pathogen of rabbits. SERP-1 is required for myxoma-virus virulence, and the purified protein has been shown to possess independent anti-inflammatory activity in animal models of restenosis and antigen-induced arthritis. As an inhibitor of serine proteinases, SERP-1 acts against tissue-type plasminogen activator, urokinase-type plasminogen activator, plasmin, thrombin and Factor Xa. In the present study, examination of SERP-1 glycosylation-site mutants showed that the N-linked glycosylation of Asn(172) was essential for SERP-1 secretion, whereas mutation of Asn(99) decreased secretion efficiency, indicating that N-linked glycosylation plays an essential role in the processing and trafficking of SERP-1. Furthermore, comparison of SERP-1 from wild-type myxoma virus and a virus containing a targeted disruption of the MST3N sialyltransferase locus demonstrated that SERP-1 is specifically modified by this myxoma-virus-encoded sialyltransferase, and is thus the first reported viral protein shown to by modified by a virally encoded glycosyltransferase. Sialylation of SERP-1 by the MST3N gene product creates a uniquely charged species of secreted SERP-1 that is distinct from SERP-1 produced from other eukaryotic expression systems, though this has no apparent effect upon the kinetics of in vitro proteinase inhibition. Rather, the role of viral sialylation of SERP-1 likely relates to masking antigenicity or targeting SERP-1 to specific sites of action in vivo. PMID:10749666

Nash, P; Barry, M; Seet, B T; Veugelers, K; Hota, S; Heger, J; Hodgkinson, C; Graham, K; Jackson, R J; McFadden, G

2000-04-15

249

The viral tropism of two distinct oncolytic viruses, reovirus and myxoma virus, is modulated by cellular tumor suppressor gene status  

PubMed Central

Replication-competent oncolytic viruses hold great potential for the clinical treatment of many cancers. Importantly, many oncolytic virus candidates, such as reovirus and myxoma virus, preferentially infect cancer cells bearing abnormal cellular signaling pathways. Reovirus and myxoma virus are highly responsive to activated Ras and Akt signaling pathways, respectively, for their specificity for viral oncolysis. However, considering the complexity of cancer cell populations, it is possible that other tumor-specific signaling pathways may also contribute to viral discrimination between normal versus cancer cells. Because carcinogenesis is a multistep process involving the accumulation of both oncogene activations and the inactivation of tumor suppressor genes, we speculated that not only oncogenes but also tumor suppressor genes may have an important role in determining the tropism of these viruses for cancer cells. It has been previously shown that many cellular tumor suppressor genes, such as p53, ATM and Rb, are important for maintaining genomic stability; dysfunction of these tumor suppressors may disrupt intact cellular antiviral activity due to the accumulation of genomic instability or due to interference with apoptotic signaling. Therefore, we speculated that cells with dysfunctional tumor suppressors may display enhanced susceptibility to challenge with these oncolytic viruses, as previously seen with adenovirus. We report here that both reovirus and myxoma virus preferentially infect cancer cells bearing dysfunctional or deleted p53, ATM and Rb tumor suppressor genes compared to cells retaining normal counterparts of these genes. Thus, oncolysis by these viruses may be influenced by both oncogenic activation and tumor suppressor status. PMID:20473328

Kim, M; Williamson, CT; Prudhomme, J; Bebb, DG; Riabowol, K; Lee, PWK; Lees-Miller, SP; Mori, Y; Rahman, MM; McFadden, G; Johnston, RN

2015-01-01

250

Selective purging of human multiple myeloma cells from autologous stem cell transplant grafts using oncolytic myxoma virus  

PubMed Central

Autologous stem cell transplantation (ASCT) and novel therapies have improved overall survival of patients with multiple myeloma; however, most patients relapse and eventually succumb to their disease. Evidence indicates that residual cancer cells contaminate autologous grafts and may contribute to early relapses after ASCT. Here, we demonstrate that ex vivo treatment with an oncolytic poxvirus called myxoma virus results in specific elimination of human myeloma cells by inducing rapid cellular apoptosis while fully sparing normal hematopoietic stem and progenitor cells (HSPCs). The specificity of this elimination is based on strong binding of the virus to myeloma cells coupled with an inability of the virus to bind or infect CD34+ HSPCs. These two features allow myxoma to readily identify and distinguish even low levels of myeloma cells in complex mixtures. This ex vivo MYXV treatment also effectively inhibits systemic in vivo engraftment of human myeloma cells into immunodeficient mice and results in efficient elimination of primary CD138+ myeloma cells contaminating patient hematopoietic cell products. We conclude that ex vivo myxoma treatment represents a safe and effective method to selectively eliminate myeloma cells from hematopoietic autografts prior to reinfusion. PMID:22516053

Bartee, Eric; Chan, Winnie S.; Moreb, Jan S.; Cogle, Christopher R.; McFadden, Grant

2012-01-01

251

A rare cause of left atrial mass: endometrial stromal sarcoma metastasis.  

PubMed

Endometrial stromal sarcomas (ESS) are rare tumors of the uterus. The metastasis of ESS to the cardiac structures is extremely infrequent. Several cases of right-sided heart metastasis have been previously reported. To our knowledge, only one similar case is available in the published studies that presented with recurrent embolic strokes due to left atrial metastasis of ESS. In this report, we describe a 53-year-old woman with endometrial stromal sarcoma; she was referred to our hospital with subacute onset of severe dyspnea and a left atrial mass causing severe mitral stenosis. PMID:24658562

Ekmekci, Ahmet; Ozcan, Kazim Serhan; Canga, Yigit; Karatas, Baran

2014-01-01

252

Isolated atrial amyloidosis and the importance of molecular classification  

PubMed Central

Amyloid is identified microscopically as an amorphous extracellular hyaline material that exhibits “apple-green” birefringence with Congo red stains. Amyloid is not a chemically distinct entity, and currently available molecular methods are capable of identifying over 20 amyloidogenic precursor proteins. Some of the more common diseases associated with amyloidosis include plasma cell dyscrasias, chronic inflammatory disorders, hereditary-familial mutations involving transthyretin, Alzheimer's disease, and so-called “senile” or age-related amyloidosis. The amyloid deposits in these various diseases may be isolated to a single organ such as the heart or brain, or the amyloidosis may be systemic. The senile types of cardiac amyloidosis can result from overproduction of atrial natriuretic factor or from accumulation of otherwise normal or wild-type transthyretin. We present the case of an 83-year-old hospitalized woman with known atrial fibrillation and previous pacemaker implantation who had cardiac arrest unresponsive to attempted resuscitation. Autopsy disclosed prominent amyloidosis involving the left atrium, and subsequent molecular studies identified the amyloidogenic material as alpha atrial natriuretic factor. Since the clinical management and genetic implications of the various diseases associated with amyloidosis are markedly different, we stress the importance of molecular classification whenever possible. PMID:24082415

Podduturi, Varsha; Armstrong, Danielle R.; Hitchcock, Michael A.; Roberts, William C.

2013-01-01

253

Left atrial ball thrombus diagnosed by two-dimensional echocardiography.  

PubMed

The diagnosis of the ball thrombus in the left atrium has been very difficult by conventional clinical techniques. In the present case, two-dimensional echocardiography successfully demonstrated a spherical tumor moving in unpredictable directions in the left atrium. M-mode echocardiography did not clearly identify the tumor because of the limited visual width and spatial orientation of the technique; however, simultaneous recordings of the M-mode echocardiogram with phonocardiogram, carotid pulse wave, and electrocardiogram provided some diagnostic clues to the occlusive left atrial tumor. In the absence mitral valve occlusion by the tumor, a logarithmic correlation between the ejection time and the preceding R-R interval, and a negative lines correlation between Q to the first sound interval and the preceding R-R interval were found. In the beat following the appearance of the tumor in the mitral orifice, the sudden shortening of the ejection time and the prolongation of Q to the first sound interval were noted. Both of these findings are indirect evidence of decreased left ventricular filling associated with an elevated left atrial pressure resulting from the sudden mitral orifice obstruction by the tumor. Detailed analysis of the data obtained by the conventional noninvasive techniques could provide critical clues for the diagnosis of the occlusive left atrial tumor. PMID:7386368

Sunagawa, K; Orita, Y; Tanaka, S; Kikuchi, Y; Nakamura, M; Hirata, T

1980-07-01

254

Acceleration of ventricular rate by amiodarone in atrial fibrillation associated with the Wolff-Parkinson-White syndrome  

PubMed Central

Amiodarone has proved to be a valuable drug in atrial fibrillation associated with the Wolff-Parkinson-White syndrome. When it was administered to a patient with this syndrome in atrial fibrillation, who had previously suffered an inferior myocardial infarction, the ventricular rate accelerated from 170 to 230 beats/minute. This unusual case emphasises the need for full electrophysiological assessment of patients with the Wolff-Parkinson-White syndrome for whom amiodarone treatment is being considered. Imagesp1000-a PMID:6812745

Sheinman, Bryan D; Evans, Tom

1982-01-01

255

Percutaneous closure of atrial septal defects leads to normalisation of atrial and ventricular volumes  

Microsoft Academic Search

BACKGROUND: Percutaneous closure of atrial septal defects (ASDs) should potentially reduce right heart volumes by removing left-to-right shunting. Due to ventricular interdependence, this may be associated with impaired left ventricular filling and potentially function. Furthermore, atrial changes post-ASD closure have been poorly understood and may be important for understanding risk of atrial arrhythmia post-ASD closure. Cardiovascular magnetic resonance (CMR) is

Karen SL Teo; Benjamin K Dundon; Payman Molaee; Kerry F Williams; Angelo Carbone; Michael A Brown; Matthew I Worthley; Patrick J Disney; Prashanthan Sanders; Stephen G Worthley

2008-01-01

256

The WATCHMAN left atrial appendage closure device for atrial fibrillation.  

PubMed

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

Möbius-Winkler, Sven; Sandri, Marcus; Mangner, Norman; Lurz, Phillip; Dähnert, Ingo; Schuler, Gerhard

2012-01-01

257

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 : ...

258

Cardiac Cycle Dependent Left Atrial Dynamics: Implications for Catheter Ablation of Atrial Fibrillation  

PubMed Central

Background Left atrial volume (LAV) determines prognosis and response to therapy in atrial fibrillation. Integration of electro-anatomical maps with 3D-images rendered from CT and MRI is used to facilitate atrial fibrillation ablation. Objectives We measured LAV changes and regional motion during the cardiac cycle that might affect the accuracy of image integration and determined their relationship to standard LAV measurements. Methods MRI was performed in thirty patients with paroxysmal atrial fibrillation. Left atrial time-volume curves were generated and used to divide the left atrial function (LAEF) into pumping (PEF) and conduit (CEF) fractions and to determine the maximum LAV (LAMAX) and the pre-atrial contraction volume (PACV). LAV was measured using an MRI angiogram and traditional geometric models from echocardiography (area-length and ellipsoid). The in-plane displacement of the pulmonary veins, anterior left atrium, mitral annulus, and left atrial appendage was measured. Results LAMAX was 107±36ml and occurred at 42±5% of the RR interval. PACV was 86 ±34ml and occurred at 81±4% of the RR interval. LAEF was 45±10% and PEF was 31±10%. LAV measurements made from the MRI angiogram, area-length and ellipsoid models underestimated LAMAX by 21±25ml, 16±26ml, and 35±22ml, respectively. The anterior LA, mitral annulus, and left atrial appendage were significantly displaced during the cardiac cycle (8.8±2.0mm, 13.2±3.8mm, and 10.2±3.4mm, respectively); the pulmonary veins were not. Conclusions LAV changes significantly during the cardiac cycle and substantial regional variation in left atrial motion exists. Standard measurements of left atrial volume significantly underestimate LAMAX when compared to the gold standard measure of 3D-volumetrics. PMID:18486563

Patel, Amit R.; Fatemi, Omid; Norton, Patrick T.; West, J. Jason; Helms, Adam S.; Kramer, Christopher M.; Ferguson, John D.

2008-01-01

259

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

260

Heterogeneous atrial wall thickness and stretch promote scroll waves anchoring during atrial fibrillation  

PubMed Central

Aims Atrial dilatation and myocardial stretch are strongly associated with atrial fibrillation (AF). However, the mechanisms by which the three-dimensional (3D) atrial architecture and heterogeneous stretch contribute to AF perpetuation are incompletely understood. We compared AF dynamics during stretch-related AF (pressure: 12cmH2O) in normal sheep hearts (n = 5) and in persistent AF (PtAF, n = 8)-remodelled hearts subjected to prolonged atrial tachypacing. We hypothesized that, in the presence of stretch, meandering 3D atrial scroll waves (ASWs) anchor in regions of large spatial gradients in wall thickness. Methods and results We implemented a high-resolution optical mapping set-up that enabled simultaneous epicardial- and endoscopy-guided endocardial recordings of the intact atria in Langendorff-perfused normal and PtAF (AF duration: 21.3 ± 11.9 days) hearts. The numbers and lifespan of long-lasting ASWs (>3 rotations) were greater in PtAF than normal (lifespan 0.9 ± 0.5 vs. 0.4 ± 0.2 s/(3 s of AF), P< 0.05). Than normal hearts, focal breakthroughs interacted with ASWs at the posterior left atrium and left atrial appendage to maintain AF. In PtAF hearts, ASW filaments seemed to span the atrial wall from endocardium to epicardium. Numerical simulations using 3D atrial geometries (Courtemanche-Ramirez-Nattel human atrial model) predicted that, similar to experiments, filaments of meandering ASWs stabilized at locations with large gradients in myocardial thickness. Moreover, simulations predicted that ionic remodelling and heterogeneous distribution of stretch-activated channel conductances contributed to filament stabilization. Conclusion The heterogeneous atrial wall thickness and atrial stretch, together with ionic and anatomic remodelling caused by AF, are the main factors allowing ASW and AF maintenance. PMID:22227155

Yamazaki, Masatoshi; Mironov, Sergey; Taravant, Clément; Brec, Julien; Vaquero, Luis M.; Bandaru, Krishna; Avula, Uma Mahesh R; Honjo, Haruo; Kodama, Itsuo; Berenfeld, Omer; Kalifa, Jérôme

2012-01-01

261

Successful treatment of drug-resistant atrial tachycardia and intractable congestive heart failure with permanent coupled atrial pacing.  

PubMed

Temporary coupled atrial stimulation slowed the ventricular rate by nearly 50% in an adolescent patient with intractable congestive heart failure and focal repetitive atrial tachycardia that was resistant to drug treatment. Because of the success with the temporary pacemaker, a specially designed permanent pacemaker was implanted to provide coupled atrial stimulation. The necessary electrophysiologic conditions for ventricular slowing by coupled atrial pacing are: (1) an atrial effective refractory period shorter than that of the atrioventricular junction, and (2) depolarization of the ectopic atrial pacemaker by the responses to coupled atrial stimulation. During a 4 year follow-up period the treatment resulted in elimination of the tachycardia, followed by return of the heart size to normal and complete clinical recovery. Coupled atrial stimulation can provide effective treatment in selected patients with disabling drug-resistant atrial tachycardia in whom this mode of therapy is shown to be effective by careful electrophysiologic studies. PMID:623025

Arbel, E R; Cohen, H C; Langendorf, R; Glick, G

1978-02-01

262

Atrial fibrillation in endurance-trained athletes  

Microsoft Academic Search

BackgroundEndurance exercise training produces multiple cardiac adaptations including changes in electrophysiological function that may make endurance-trained athletes more vulnerable to atrial fibrillation (AF). This possible association is not recognised by many practising cardiologists and sports physicians. Consequently, we performed a literature review to examine the relationship between atrial fibrillation and endurance exercise training among athletes. PubMed was searched from January

A. V. Sorokin; C. G. S. Araujo; S. Zweibel; P. D. Thompson

2011-01-01

263

Antithrombotic Therapy for Atrial Fibrillation and Cardioversion  

Microsoft Academic Search

\\u000a Thromboembolism, especially the cerebrovascular events, due to atrial fibrillation leads to significant morbidity and mortality.\\u000a A fundamental part of the management of any patient with atrial fibrillation is stratification of this risk, and deciding\\u000a upon suitable antithrombotic therapy. Currently, the cornerstone of anticoagulation in high risk patients is the warfarin\\u000a therapy. However, despite its efficacy, warfarin has many practical limitations,

Carmel M. Halley; Allan L. Klein

264

Familial idiopathic atrial fibrillation with bradyarrhythmia  

Microsoft Academic Search

A 10-year-old boy is reported who presented with idiopathic atrial fibrillation and bradyarrhythmia. After history of intrauterine and postnatal bradycardia, atrial fibrillation was first documented electrocar-diographically at 16 months of age. An underlying structural heart disease was not evident. At the age of 10 years, implantation of a permanent ventricular demand pacemaker was indicated after syncope due to severe bradyarrhythmia.

H. Bertram; T. Paul; F. Beyer; H. C. Kallfelz

1996-01-01

265

Spontaneous onset of atrial fibrillation  

NASA Astrophysics Data System (ADS)

Most commonly, atrial fibrillation is triggered by rapid bursts of electrical impulses originating in the myocardial sleeves of pulmonary veins (PVs). However, the nature of such bursts remains poorly understood. Here, we propose a mechanism of bursting consistent with the extensive empirical information about the electrophysiology of the PVs. The mechanism is essentially non-local and involves the spontaneous initiation of non-sustained spiral waves in the distal end of the muscle sleeves of the PVs. It reproduces the experimentally observed dynamics of the bursts, including their frequency, their intermittent character, and the unusual shape of the electrical signals in the pulmonary veins that are reminiscent of so-called early afterdepolarizations (EADs).

Zemlin, Christian W.; Mitrea, Bogdan G.; Pertsov, Arkady M.

2009-06-01

266

Management of right atrial hemangioma in a patient with antithrombin deficiency.  

PubMed

Hereditary antithrombin (AT) deficiency is an autosomal dominant inheritance disorder. Patients with AT deficiency have a high risk of thromboembolism, and intraoperative cardiopulmonary bypass management is difficult. We present the case of a 53-year-old man who was diagnosed with AT deficiency and who underwent an open heart operation for a right atrial hemangioma. We administered AT-III concentrate perioperatively to maintain his AT-III level up to 80% to establish cardiopulmonary bypass and prevent thromboembolic events postoperatively. The right atrial hemangioma was successfully excised after right atriotomy. The patient had an uneventful postoperative course and was discharged on postoperative day 14. PMID:25742857

Kitahara, Hiroto; Kudo, Mikihiko; Okamoto, Kazuma; Inaba, Yu; Sasaki, Aya; Shimizu, Hideyuki

2015-03-01

267

Left Atrial Coronary Perfusion Territories in Isolated Sheep Hearts: Implications for Atrial Fibrillation Maintenance  

PubMed Central

BACKGROUND The role played by coronary perfusion in the maintenance of AF electrical sources that anchor to the posterior wall of the left atrium (PLA) has been incompletely investigated. OBJECTIVE We hypothesized that the PLA-pulmonary vein region is perfused by branches originating from both the right and left coronary arteries, and evaluated whether such branches could serve as conduits to chemically ablate restricted PLA regions. METHODS In Langendorff-perfused sheep hearts, we identified the right and left anterior atrial arteries (RAAA and LAAA), and branches of the left circumflex artery (LCX) as main coronary artery branches perfusing the atria. During sustained AF, we injected 20 ml boluses of cold Tyrode’s solution (4°C) into each artery to determine changes in dominant frequency (DF). The injection that yielded the largest DF decrease indicated the coronary branch to be subsequently perfused with ethanol. We selectively injected ethanol into the LAAA (n=4), the LCX (n=4) or the RAAA (n=1). RESULTS Six out of 9 AF cases rapidly terminated upon ethanol perfusion. In those hearts and in 8 additional preparations (n=17), Congo Red or Evans Blue were subsequently perfused into the remaining atrial branches. The perfusion territories were classified as follows: Triple vessel PLA perfusion (n=4), LAAA dominant PLA perfusion (n=5), balanced double vessel PLA perfusion (n=5) and LCX or RAAA dominant (n=3). CONCLUSIONS The PLA coronary perfusion relies on a variable contribution of right and left coronary branches. Regional irrigation of ethanol in well-delineated PLA perfusion territories enabled ablation of high frequency sites during AF. PMID:20621203

Yamazaki, Masatoshi; Morgenstern, Sherry; Klos, Matthew; Campbell, Katherine; Buerkel, Daniel; Kalifa, Jérôme

2010-01-01

268

Extracellular Matrix Remodeling in Atrial Fibrosis: Mechanisms and Implications in Atrial Fibrillation  

PubMed Central

Atrial fibrosis has been strongly associated with the presence of heart diseases/arrhythmias, including congestive heart failure (CHF) and atrial fibrillation (AF). Inducibility of AF as a result of atrial fibrosis has been the subject of intense recent investigation, since it is the most commonly encountered arrhythmia in adults and can substantially increase the risk of premature death. Rhythm and rate control drugs as well as surgical interventions are used as therapies for AF; however, increased attention has been diverted to mineralocorticoid receptor (MR) antagonists including spironolactone as potential therapies for human AF because of their positive effects on reducing atrial fibrosis and associated AF in animal models. Spironolactone has been shown to exert positive effects in human patients with heart failure; however, the mechanisms and effects in human atrial fibrosis and AF remain undetermined. This review will discuss and highlight developments on (i) the relationship between atrial fibrosis and AF, (ii) spironolactone, as a drug targeted to atrial fibrosis and AF, as well as (iii) the distinct and common mechanisms important for regulating atrial and ventricular fibrosis, inclusive of the key extracellular matrix regulatory proteins involved. PMID:19751740

Pellman, Jason; Lyon, Robert C.; Sheikh, Farah

2009-01-01

269

Cardioembolic Stroke in Atrial Fibrillation-Rationale for Preventive Closure of the Left Atrial Appendage  

PubMed Central

Atrial fibrillation is the most common cardiac arrhythmias, and a major cause of morbidity and mortality due to cardioembolic stroke. The left atrial appendage is the major site of thrombus formation in non-valvular atrial fibrillation. Loss of atrial systole in atrial fibrillation and increased relative risk of associated stroke point strongly toward a role for stasis of blood in left atrial thrombosis, although thrombus formation is multifactorial, and much more than blood flow irregularities are implicated. Oral anticoagulation with vitamin-K-antagonists is currently the most effective prophylaxis for stroke in atrial fibrillation. Unfortunately, this treatment is often contraindicated, particularly in the elderly, in whom risk of stroke is high. Moreover, given the risk of major bleeding, there is reason to be skeptical of the net benefit when warfarin is used in those patients. This work reviews the pathophysiology of cardioembolic stroke and critically spotlights the current status of preventive anticoagulation therapy. Various techniques to exclude the left atrial appendage from circulation were discussed as a considerable alternative for stroke prophylaxis. PMID:19997539

Leithäuser, Boris

2009-01-01

270

Takotsubo cardiomyopathy presenting as postoperative atrial fibrillation.  

PubMed

Takotsubo cardiomyopathy (TC) is a condition which was first acknowledged in Japan and is characterized by a reversible systolic dysfunction of the apical or mid segments of the left ventricle. Typically affecting women in the post-menopausal population, it is triggered by intense emotional, physical or medical stress. Also known as apical ballooning syndrome or stress cardiomyopathy, TC derives its name from the left ventricular angiographic appearance of a 'Takotsubo', literally translated as an 'octopus fishing trap' in Japanese. Patients often describe chest pain, have ischemic electrocardiogram (ECG) changes and positive cardiac enzymes mimicking an acute coronary syndrome. Obstructive coronary artery disease is excluded with prompt cardiac catheterization. We present the case of a 78-year-old lady, post gynecological surgery, presenting with palpitations and ECG confirming fast atrial fibrillation. Despite spontaneous cardioversion, she went on to develop ECG changes and cardiac enzyme elevations suggestive of an acute myocardial infarction. Cardiac catheterization was performed and confirmed the diagnosis of TC. It highlights an atypical presentation of TC, which can present initially as an arrhythmia in the postoperative phase as a consequence of the supraphysiological effects of elevated circulating plasma catecholamines. It reiterates the importance of prompt diagnosis and treatment to prevent cardiac decompensation in a condition poorly understood. PMID:20739768

Shah, N R; Wallis, W

2010-01-01

271

Nonobstructive asymmetrical septal hypertrophy and ostium secundum-type atrial septal defect.  

PubMed

We report a 36-year-old woman with hypertrophic cardiomyopathy with asymmetric septal hypertrophy without outflow tract obstruction associated with an ostium secundum-type atrial septal defect with significant hemodynamic repercussion. Diagnosis was established with transesophageal echocardiography. This is the second case of this rare association reported in the literature and the first evaluated by transesophageal echocardiography. PMID:11153019

Hernández-Reyes, P; Espinola-Zavaleta, N; Vargas-Barrón, J; Romero-Cárdenas, A; Roldán-Gómez, J; Keirns, C

2000-11-01

272

Cardiovascular magnetic resonance and PET-CT of left atrial paraganglioma  

PubMed Central

Cardiac paragangliomas are among the rarest primary cardiac tumors. We present a case of left atrial paraganglioma in a patient who presented with symptoms and signs of catecholamine excess in which cardiovascular magnetic resonance in multiple orientations and PET-CT played an important role in the diagnosis and tissue characterization. PMID:20047692

2010-01-01

273

Cardiovascular magnetic resonance and PET-CT of left atrial paraganglioma  

Microsoft Academic Search

Cardiac paragangliomas are among the rarest primary cardiac tumors. We present a case of left atrial paraganglioma in a patient who presented with symptoms and signs of catecholamine excess in which cardiovascular magnetic resonance in multiple orientations and PET-CT played an important role in the diagnosis and tissue characterization.

Anderanik Tomasian; Chi Lai; Stefan Ruehm; Mayil S Krishnam

2010-01-01

274

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

PubMed

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

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

2015-03-01

275

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

PubMed

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. PMID:21658227

Spiesschaert, Bart; McFadden, Grant; Hermans, Katleen; Nauwynck, Hans; Van de Walle, Gerlinde R

2011-01-01

276

Suppression of collagen-induced arthritis with a serine proteinase inhibitor (serpin) derived from myxoma virus.  

PubMed

Many viruses encode virulence factors to facilitate their own survival by modulating a host's inflammatory response. One of these factors, secreted from cells infected with myxoma virus, is the serine proteinase inhibitor (serpin) Serp-1. Because Serp-1 had demonstrated anti-inflammatory properties in arterial injury models and viral infections, it was cloned and evaluated for therapeutic efficacy in collagen-induced arthritis (CIA). Clinical severity was significantly lower in the Serp-1 protocols (p<0.0001) and blinded radiographs indicated that the Serp-1 group had significantly less erosions than the controls (p<0.01). Delayed-type hypersensitivity was lower in the Serp-1 group but antibody titers to type II collagen were not significantly altered. Recipients had minimal histopathologic synovial changes and did not develop neutralizing antibodies to Serp-1. These results indicate that Serp-1 impedes the pathogenesis of CIA and suggests that the therapeutic potential of serine proteinase inhibitors in inflammatory joint diseases, such as rheumatoid arthritis, should be investigated further. PMID:24845791

Brahn, Ernest; Lee, Sarah; Lucas, Alexandra; McFadden, Grant; Macaulay, Colin

2014-08-01

277

Myxoma Virus Oncolysis of Primary and Metastatic B16F10 Mouse Tumors In Vivo  

PubMed Central

Myxoma virus (MV) is a rabbit-specific poxvirus, whose unexpected tropism to human cancer cells has led to studies exploring its potential use in oncolytic therapy. MV infects a wide range of human cancer cells in vitro, in a manner intricately linked to the cellular activation of Akt kinase. MV has also been successfully used for treating human glioma xenografts in immunodeficient mice. This study examines the effectiveness of MV in treating primary and metastatic mouse tumors in immunocompetent C57BL6 mice. We have found that several mouse tumor cell lines, including B16 melanomas, are permissive to MV infection. B16F10 cells were used for assessing MV replication and efficacy in syngeneic primary tumor and metastatic models in vivo. Multiple intratu-moral injections of MV resulted in dramatic inhibition of tumor growth. Systemic administration of MV in a lung metastasis model with B16F10LacZ cells was dramatically effective in reducing lung tumor burden. Combination therapy of MV with rapamycin reduced both size and number of lung metastases, and also reduced the induced antiviral neutralizing antibody titres, but did not affect tumor tropism. These results show MV to be a promising virotherapeutic agent in immunocompetent animal tumor models, with good efficacy in combination with rapamycin. PMID:17998900

Stanford, Marianne M; Shaban, Mae; Barrett, John W; Werden, Steven J; Gilbert, Philippe-Alexandre; Bondy-Denomy, Joe; MacKenzie, Lisa; Graham, Kevin C; Chambers, Ann F; McFadden, Grant

2015-01-01

278

[Role of the TRF test in the study of atrial dysrhythmia].  

PubMed

The aim of this retrospective study of 43 patients (32 females) aged 26 to 84 years old (mean 62 +/- 14,5) was to assess the value of the TRF test in cases with normal static endocrine levels and isolated arrhythmias: 25 atrial fibrillations, 3 atrial flutters, 10 sinus tachycardias, 2 junctional tachycardias, 2 focal atrial tachycardias and 1 atrial extrasystoles. There was underlying cardiac disease in 24 patients. Thyroid function was assessed by T4, T3 and the TRF test. There was no relationship between cardiac disease and arrhythmias with the levels of TSH 25 minutes after TRF. The reactivity to TRF was low: 5,8 +/- 5,6 microU/ml. Nineteen patients were hyperthyroid (TSH at O and 25 min: 1,7 +/- 0,5 and 2 +/- 1 microU/ml respectively), in the following three eventualities: - Clinical hyperthyroidism and raised hormonal levels, the TRF confirmed the diagnosis in 10 out of 11 cases; - Clinical hyperthyroidism and normal hormone levels: the TRF confirmed the diagnosis in 8 out of 14 cases; - Normal clinical examination and normal hormone levels: the TRF test showed a hyperthyroid reaction in 1 out of 18 cases. T3 and T4 measurements are often misleading. The TRF test with 2 blood samples would appear to be essential, especially in patients over 60 years of age. The hyperthyroid population was older (68,5 +/- 8 years) and the mean values of the thyroid investigations (T3, T4 and STH at 25 minutes) were significant. Underlying cardiac disease was detected in over half these cases. Atrial fibrillation was the commonest arrhythmia. Each case of arrhythmia, whether or not related to hyperthyroidism, justifies echocardiography. PMID:6420863

Chamontin, B; Guittard, J; Salvador, M

1983-09-01

279

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

280

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

SciTech Connect

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

Chandra, S.; Grimm, R.A. [Cleveland Clinic Foundation, Cleveland, Ohio 44195 (United States); Katz, R. [Naval Undersea Warfare Center, New London, Connecticut 06320 (United States); Thomas, J.D. [Cleveland Clinic Foundation, Cleveland, Ohio 44195 (United States)

1996-06-01

281

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

282

Relation Between Ligament of Marshall and Adrenergic Atrial Tachyarrhythmia  

Microsoft Academic Search

Background—The mechanism of the adrenergic atrial tachyarrhythmia is unclear. We hypothesize that the ligament of Marshall (LOM) is sensitive to adrenergic stimulation and may serve as a source of the adrenergic atrial tachyarrhythmia. Methods and Results—We performed computerized mapping studies in isolated-perfused canine left atrial tissues from normal dogs (n59) and from dogs with chronic atrial fibrillation (AF) induced by

Rahul N. Doshi; Tsu-Juey Wu; Masaaki Yashima; Young-Hoon Kim; James J. C. Ong; Ji-Min Cao; Chun Hwang; Payam Yashar; Michael C. Fishbein; Hrayr S. Karagueuzian; Peng-Sheng Chen

2010-01-01

283

Right atrial thrombi in children with cancer and indwelling catheters  

Microsoft Academic Search

OBJECTIVE: To determine the prevalence of right atrial thrombi in children with cancer and indwelling catheters. STUDY DESIGN: We systematically examined 156 children with cancer and indwelling catheters for the presence of a right atrial thrombus when they underwent routine screening of cardiac function by two-dimensional echocardiography. RESULTS: Thirteen children (8.8%) had right atrial thrombi. Of the 13 children, 6

David N. Korones; Carol J. Buzzard; Barbara L. Asselin; J. Peter Harris

1996-01-01

284

Management and prevention of atrial fibrillation after cardiovascular surgery  

Microsoft Academic Search

Atrial arrhythmias occur frequently after cardiac surgery. This article discusses the incidence of postoperative atrial arrhythmia as well as its prognosis, potential mechanisms of pathogenesis, and management. Prophylactic therapy for postoperative atrial arrhythmia is recommended because of the frequency of occurrence and the ease with which therapies can often be implemented. Treatments with pharmacologic and nonpharmacologic modalities are described. Management

David B. Bharucha; Peter R. Kowey

2000-01-01

285

Cost Effectiveness of Therapies for Atrial Fibrillation: A Review  

Microsoft Academic Search

Atrial fibrillation is the most common supraventricular tachyarrhythmia encountered in clinical practice, affecting over 5% of persons over the age of 65 years. A common pathophysiological mechanism for arrhythmia development is atrial distention and fibrosis induced by hypertension, coronary artery disease or ventricular dysfunction. Less frequently, atrial fibrillation is caused by mitral stenosis or other provocative factors such as thyrotoxicosis,

Mark P. Teng; Edward Catherwood; Daniel P. Melby

2000-01-01

286

Information Learned from Animal Models of Atrial Fibrillation  

PubMed Central

Synopsis Animal models of atrial fibrillation have taught us about mechanisms of this common disease. A variety of animal models exist, including models of lone atrial fibrillation and models of atrial fibrillation in the setting of heart failure, aging or pericardial inflammation. This chapter reviews these various models. PMID:19111763

Finet, J. Emanuel; Rosenbaum, David S.; Donahue, J. Kevin

2009-01-01

287

Angiotensin II Antagonist Prevents Electrical Remodeling in Atrial Fibrillation  

Microsoft Academic Search

Background—The blockade of angiotensin II (Ang II) formation has protective effects on cardiovascular tissue; however, the role of Ang II in atrial electrical remodeling is unknown. The purpose of this study was to investigate the effects of candesartan and captopril on atrial electrical remodeling. Methods and Results—In 24 dogs, the atrial effective refractory period (AERP) was measured before, during, and

Hideko Nakashima; Koichiro Kumagai; Hidenori Urata; Naoki Gondo; Munehito Ideishi; Kikuo Arakawa

288

Right juxtaposition and a tunnel between the atrial appendages in a patient with atrial septal defect and pulmonary valve stenosis.  

PubMed

A 13-month-old boy with a diagnosis of atrial septal defect and pulmonary valve stenosis was admitted for corrective surgery. Right juxtaposition of the atrial appendages with a tunnel between the atrial appendages was detected during the surgery. The patient was operated successfully and had an uneventful recovery. Once right juxtaposition of the atrial appendages has been identified, the possibility of a "tunnel" communication between the appendages must be considered and ruled out. PMID:25548354

Karaçelik, Mustafa; Karagöz, U?ur; Doyurgan, Onur; Özdemir, Rahmi; Öztürk, Pelin; Sariosmano?lu, Osman Nejat

2015-01-01

289

The association between job strain and atrial fibrillation in Swedish men  

PubMed Central

Objectives The purpose of this study was to investigate whether psychosocial stress defined as high strain based on the job demand–control model increases risk for atrial fibrillation. Methods The present study comprised 6035 men born between 1915 and 1925 and free from previous coronary heart disease, atrial fibrillation and stroke at baseline (1974–1977). Work-related psychosocial stress was measured using a job-exposure matrix for the job demand–control model based on occupation at baseline. The participants were followed from baseline examination until death, hospital discharge or 75?years of age, using the Swedish national register on cause of death and the Swedish hospital discharge register for any registration for atrial fibrillation, resulting in the identification of 436 cases. Data were analysed with Cox regression models with atrial fibrillation as the outcome using high strain as the explanatory variable adjusted for age, smoking, body mass index, hypertension, diabetes and socioeconomic status. Results There was an increased risk for atrial fibrillation in relation to high strain (HR 1.32, 95% CI 1.003 to 1.75). When the four categories of the job-strain model were included and low strain was used as reference, the risk for high strain decreased (HR 1.23, 95% CI 0.84 to 1.82). Conclusions Exposure to occupational psychosocial stress defined as high strain may be associated with increased risk for atrial fibrillation. The observed increase in risk is small and residual confounding may also be present. PMID:25523937

Torén, Kjell; Schiöler, Linus; Söderberg, Mia; Giang, Kok Wai; Rosengren, Annika

2015-01-01

290

A pox on thee! Manipulation of the host immune system by myxoma virus and implications for viral–host co-adaptation  

Microsoft Academic Search

The poxviruses have evolved a diverse array of proteins which serve to subvert innate and adaptive host responses that abort or at least limit viral infections. Myxoma virus and its rabbit host are considered to represent an ideal poxvirus–host system in which to study the effects of these immunomodulatory proteins. Studies of laboratory rabbits (Oryctolagus cuniculus) infected with gene knockout

Martha C Zúñiga

2002-01-01

291

Atrial septal defect: anatomoechocardiographic correlation.  

PubMed

This study was undertaken to enhance understanding of the anatomic abnormalities involved in atrial septal defect (ASD) based on the anatomoechocardiographic comparison of equivalent specimens of ASD and the echocardiograms of patients with this anomaly. Of the 72 heart specimens, two had common atrioventricular canal (2.8%) and one had absence of right atrioventricular connection (1.4%). In all, 46 (63.8%) had fossa ovalis type ASD, two (2.8%) had true ostium secundum type ASD, two (2.8%) had ostium primum type ASD, two (2.8%) had superior sinus venosus type ASD, and two (2.8%) had inferior sinus venosus type ASD. One (1.4%) specimen had a coronary venous sinus type ASD and 14 (19.4%) had mixed type ASD. Of the 144 patients evaluated with echocardiography 15 (10.4%) had common atrioventricular canal, one (0.7%) had right absence of atrioventricular connection, 105 (72.9%) had ostium secundum type ASD (fossa ovalis), 10 (7%) had mixed type ASD, 9 (6.2%) had superior venous sinus type ASD, two (1.4%) had ostium primum type ASD, and two (1.4%) had true fossa ovalis type ASD. This series leads us to conclude that the key to successful management of ASD depends on understanding echocardiographic images in terms of anatomic specimens to provide appropriate evaluations for therapeutic decisions and establishment of prognoses. PMID:16950475

Muñóz-Castellanos, Luis; Espinola-Zavaleta, Nilda; Kuri-Nivón, Magdalena; Ruíz, José Francisco; Keirns, Candace

2006-09-01

292

Atrial fibrillation in the elderly.  

PubMed

Atrial fibrillation (AF) is the most common arrhythmia in older adults with a prevalence of 9 % in adults aged 80 years or older. AF patients have a five times greater risk of developing stroke than the general population. Using anticoagulants for stroke prevention in the elderly becomes a challenge because both stroke and bleeding complications increase with age. CHA?DS?-VASc and HAS-BLED scores are currently used as stroke and bleeding risk evaluations. When the HAS-BLED score is 3 or higher, caution and efforts to correct reversible risk factors are advised. Regardless of the HAS-BLED score, warfarin or novel oral anticoagulants are a IIa recommendation for CHA?DS?-VASc of 1, except for a score of 1 for females, and a IA recommendation for the score of 2 or higher. Aspirin is no longer recommended for AF thromboprophylaxis. In an elderly patient, lenient rate control is preferred over rhythm control owing to fewer adverse drugs effects and hospitalizations. When rhythm control is needed, dronedarone is a new antiarrhythmic drug that can be considered in patients who have paroxysmal AF and no history of heart failure. Although less efficacious than amiodarone, dronedarone has a fewer thyroid, neurologic, dermatologic, and ocular side effects than amiodarone. PMID:23709402

Nantsupawat, Teerapat; Nugent, Kenneth; Phrommintikul, Arintaya

2013-08-01

293

Atrial natriuretic peptides in plasma.  

PubMed

Measurement of cardiac natriuretic peptides in plasma has gained a diagnostic role in the assessment of heart failure. Plasma measurement is though hampered by the marked instability of the hormones, which has led to the development of analyses that target N-terminal fragments from the prohormone. These fragments are stable in plasma and represent surrogate markers of the actual natriuretic hormone. Post-translational processing of the precursors, however, is revealing itself to be a complex event with new information still being reported on proteolysis, covalent modifications, and amino acid derivatizations. In this mini-review, we summarize measurement of the principal cardiac hormone, e.g. atrial natriuretic peptide (ANP) and its precursor fragments. We also highlight some of the analytical pitfalls and problems and the concurrent clinical "proof of concept". We conclude that biochemical research into proANP-derived peptides is still worthy of attention and that new biological insight may change our chemical perception of the markers. PMID:25158019

Goetze, Jens P; Hansen, Lasse H; Terzic, Dijana; Zois, Nora E; Albrethsen, Jakob; Timm, Annette; Smith, Julie; Soltysinska, Ewa; Lippert, Solvej K; Hunter, Ingrid

2015-03-30

294

Safety and efficacy of advanced atrial pacing therapies for atrial tachyarrhythmias in patients with a new implantable dual chamber cardioverter-defibrillator  

Microsoft Academic Search

ObjectivesThis study evaluated the safety and efficacy of atrial pacing therapies for the treatment and prevention of atrial tachycardia (AT) or atrial fibrillation (AF) in a new dual chamber implantable cardioverter defibrillator (ICD).

Anne M Gillis; Christina Unterberg-Buchwald; Herwig Schmidinger; Santini Massimo; Kevin Wolfe; Deborah J Kavaney; Mary F Otterness; Stefan H Hohnloser

2002-01-01

295

Atrial Fibrosis Helps Select the Appropriate Patient and Strategy in Catheter Ablation of Atrial Fibrillation:A DE-MRI  

E-print Network

16 Atrial Fibrosis Helps Select the Appropriate Patient and Strategy in Catheter Ablation of Atrial MRI for AF Patient Selection and Ablation Approach. Introduction: Left atrial (LA) fibrosis used delayed enhancement MRI (DE-MRI) to stratify AF patients based on pre-ablation fibrosis and also

Utah, University of

296

Transgenic Insights Linking Pitx2 and Atrial Arrhythmias  

PubMed Central

Pitx2 is a homeobox transcription factor involved in left–right signaling during embryogenesis. Disruption of left–right signaling in mice within its core nodal/lefty cascade, results in impaired expression of the last effector of the left–right cascade, Pitx2, leading in many cases to absence or bilateral expression of Pitx2 in lateral plate mesoderm (LPM). Loss of Pitx2 expression in LPM results in severe cardiac malformations, including right cardiac isomerism. Pitx2 is firstly expressed asymmetrically in the left but not right LPM, before the cardiac crescent forms, and subsequently, as the heart develops, becomes confined to the left side of the linear heart tube. Expression of Pitx2 is remodeled during cardiac looping, becoming localized to the ventral portion of the developing ventricular chambers, while maintaining a distinct left-sided atrial expression. The importance of Pitx2 during cardiogenesis has been illustrated by the complex and robust cardiac defects observed on systemic deletion of Pitx2 in mice. Lack of Pitx2 expression leads to embryonic lethality at mid-term, and Pitx2-deficient embryos display isomeric hearts with incomplete closure of the body wall. However, whereas the pivotal role of Pitx2 during cardiogenesis is well sustained, its putative role in the fetal and adult heart is largely unexplored. Recent genome-wide association studies have identified several genetic variants highly associated with atrial fibrillation (AF). Among them are genetic variants located on chromosome 4q25 adjacent to PITX2. Since then several transgenic approaches have provided evidences of the role of the homeobox transcription factor PITX2 and atrial arrhythmias. Here, we review new insights into the cellular and molecular links between PITX2 and AF. PMID:22701438

Franco, Diego; Chinchilla, Ana; Aránega, Amelia E.

2012-01-01

297

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

298

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

299

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; Györke, Sandor; Cardounel, Arturo J.; Carnes, Cynthia A.

2012-01-01

300

[Treatment of atrial fibrillation: when to use drugs or to perform ablation].  

PubMed

Treatment of atrial fibrillation is still an ongoing issue, due to the continuous development of new therapeutic options. As regards pharmacological prophylaxis, dronedarone, a non-iodinated derivative of amiodarone, has recently been evaluated in patients affected by atrial fibrillation and demonstrated a good safety and efficacy profile; it could be particularly beneficial in patients with advanced age, hypertension, diabetes, previous stroke, or left atrial enlargement, due to its association with lower mortality and hospital admissions, while it is not indicated in patients with advanced heart failure. Much more has been developed in the field of ablation, leading to a huge variability in technical approach and patient characteristics. In general, ablation can be considered an effective procedure for appropriately selected patients and shows an acceptable safety profile when performed by trained operators. On the basis of the available evidence, ablation should be the first choice in young patients with lone atrial fibrillation, and a second choice (after failed pharmacological prevention) in older patients or when a mild structural heart disease coexists, particularly when the arrhythmic burden is high and the patient is symptomatic; in patients with a major heart disease, ablation can be considered on a case by case basis. PMID:21416820

Lunati, Maurizio; Pedretti, Stefano

2010-10-01

301

Treating brain tumor–initiating cells using a combination of myxoma virus and rapamycin  

PubMed Central

Background Intratumoral heterogeneity in glioblastoma multiforme (GBM) poses a significant barrier to therapy in certain subpopulation such as the tumor-initiating cell population, being shown to be refractory to conventional therapies. Oncolytic virotherapy has the potential to target multiple compartments within the tumor and thus circumvent some of the barriers facing conventional therapies. In this study, we investigate the oncolytic potential of myxoma virus (MYXV) alone and in combination with rapamycin in vitro and in vivo using human brain tumor–initiating cells (BTICs). Methods We cultured fresh GBM specimens as neurospheres and assayed their growth characteristics in vivo. We then tested the susceptibility of BTICs to MYXV infection with or without rapamycin in vitro and assessed viral biodistribution/survival in vivo in orthotopic xenografts. Results The cultured neurospheres were found to retain stem cell markers in vivo, and they closely resembled human infiltrative GBM. In this study we determined that (i) all patient-derived BTICs tested, including those resistant to temozolomide, were susceptible to MYXV replication and killing in vitro; (ii) MYXV replicated within BTICs in vivo, and intratumoral administration of MYXV significantly prolonged survival of BTIC-bearing mice; (iii) combination therapy with MYXV and rapamycin improved antitumor activity, even in mice bearing “advanced” BTIC tumors; (iv) MYXV treatment decreased expression of stem cell markers in vitro and in vivo. Conclusions Our study suggests that MYXV in combination with rapamycin infects and kills both the BTICs and the differentiated compartments of GBM and may be an effective treatment even in TMZ-resistant patients. PMID:23585629

Zemp, Franz J.; Lun, Xueqing; McKenzie, Brienne A.; Zhou, Hongyuan; Maxwell, Lori; Sun, Beichen; Kelly, John J.P.; Stechishin, Owen; Luchman, Artee; Weiss, Samuel; Cairncross, J. Gregory; Hamilton, Mark G.; Rabinovich, Brian A.; Rahman, Masmudur M.; Mohamed, Mohamed R.; Smallwood, Sherin; Senger, Donna L.; Bell, John; McFadden, Grant; Forsyth, Peter A.

2013-01-01

302

Inhibitory specificity of the anti-inflammatory myxoma virus serpin, SERP-1.  

PubMed

SERP-1 is a myxoma virus-encoded serpin, secreted from infected cells, that is required for virulence and has anti-inflammatory activity. We report that purified recombinant SERP-1 forms SDS-stable complexes with urokinase-type plasminogen activator (uPA), tissue-type plasminogen activator (tPA), plasmin, thrombin, and factor Xa. N-terminal sequencing confirmed Arg319-Asn320 as the site of reaction. Mutation of these residues to Ala-Ala abolished inhibitory activity but had no effect on the specific cleavage at Thr315-Leu316 seen with elastase and with cathepsin G. Kinetic analysis of the reactions with uPA, tPA, plasmin, thrombin, Xa, and C1s showed second-order rate constants to vary over 3 logs, from kinh = 3 x 10(5) M-1 s-1 with thrombin to approximately 600 M-1 s-1 with C1s, while steady-state inhibition constants ranged from KI = 10 pM with thrombin to approximately 100 nM with C1s. Stoichiometries of inhibition varied between SI = 1.4 +/- 0.1 for uPA to SI = 13 +/- 3 for thrombin. Analysis of the variations in inhibition kinetics shows that when serpins act at low concentrations, comparable with the target protease or with KI (as appears likely for SERP-1 in vivo), inhibitory specificity becomes less dominated by kinh and is increasingly dependent on partitioning within the branched reaction mechanism and on the lifetime of the inhibited complex. PMID:9694848

Nash, P; Whitty, A; Handwerker, J; Macen, J; McFadden, G

1998-08-14

303

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

PubMed Central

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

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

2013-01-01

304

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

305

Modulation of the Myxoma Virus Plaque Phenotype by Vaccinia Virus Protein F11  

PubMed Central

Vaccinia virus (VACV) produces large plaques consisting of a rapidly expanding ring of infected cells surrounding a lytic core, whereas myxoma virus (MYXV) produces small plaques that resemble a focus of transformed cells. This is odd, because bioinformatics suggests that MYXV carries homologs of nearly all of the genes regulating Orthopoxvirus attachment, entry, and exit. So why does MYXV produce foci? One notable difference is that MYXV-infected cells produce few of the actin microfilaments that promote VACV exit and spread. This suggested that although MYXV carries homologs of the required genes (A33R, A34R, A36R, and B5R), they are dysfunctional. To test this, we produced MYXV recombinants expressing these genes, but we could not enhance actin projectile formation even in cells expressing all four VACV proteins. Another notable difference between these viruses is that MYXV lacks a homolog of the F11L gene. F11 inhibits the RhoA-mDia signaling that maintains the integrity of the cortical actin layer. We constructed an MYXV strain encoding F11L and observed that, unlike wild-type MYXV, the recombinant virus disrupted actin stress fibers and produced plaques up to 4-fold larger than those of controls, and these plaques expanded ?6-fold faster. These viruses also grew to higher titers in multistep growth conditions, produced higher levels of actin projectiles, and promoted infected cell movement, although neither process was to the extent of that observed in VACV-infected cells. Thus, one reason for why MYXV produces small plaques is that it cannot spread via actin filaments, although the reason for this deficiency remains obscure. A second reason is that leporipoxviruses lack vaccinia's capacity to disrupt cortical actin. PMID:22514354

Irwin, Chad R.

2012-01-01

306

Histological evaluation of intratumoral myxoma virus treatment in an immunocompetent mouse model of melanoma  

PubMed Central

Two recombinant myxoma viruses (MYXV expressing a fluorescent protein [MYXV-Tred] and MYXV-Tred encoding murine interleukin-15 [MYXV-IL15]) were evaluated for therapeutic effects in an aggressive B16F10 melanoma model in immunocompetent mice. It was hypothesized that continuous expression of IL-15 within a tumor would recruit cytotoxic effector cells to induce an antitumor immune response and improve treatment efficacy. Weekly intratumoral injections were given to evaluate the effect of treatment on the median survival time of C57BL/6 mice bearing established B16F10 melanomas. Mice that received MYXV-Tred or MYXV-IL15 lived significantly longer than mice given treatment controls. Unexpectedly, the median survival time of MYXV-IL15-treated mice was similar to that of MYXV-treated mice. At 1, 2, and 4 days postinoculation, viral plaque assays detected replicating MYXV-Tred and MYXV-IL15 within treated tumors. At these time points in MYXV-IL15-treated tumors, IL-15 concentration, lymphocyte grades, and cluster of differentiation-3+ cell counts were significantly increased when compared to other treatment groups. However, viral titers, recombinant protein expression, and lymphocyte numbers within the tumors diminished rapidly at 7 days postinoculation. These data indicate that treatment with recombinant MYXV should be repeated at least every 4 days to maintain recombinant protein expression within a murine tumor. Additionally, neutrophilic inflammation was significantly increased in MYXV-Tred- and MYXV-IL15-treated tumors at early time points. It is speculated that neutrophilic inflammation induced by intratumoral replication of recombinant MXYV contributes to the antitumoral effect of MYXV treatment in this melanoma model. These findings support the inclusion of neutrophil chemotaxins in recombinant poxvirus oncolytic virotherapy.

Doty, Rosalinda A; Liu, Jia; McFadden, Grant; Roy, Edward J; MacNeill, Amy L

2015-01-01

307

Cellular factors promoting resistance to effective treatment of glioma with oncolytic myxoma virus.  

PubMed

Oncolytic virus therapy is being evaluated in clinical trials for human glioma. While it is widely assumed that the immune response of the patient to the virus infection limits the utility of the therapy, investigations into the specific cell type(s) involved in this response have been performed using nonspecific pharmacologic inhibitors or allogeneic models with compromised immunity. To identify the immune cells that participate in clearing an oncolytic infection in glioma, we used flow cytometry and immunohistochemistry to immunophenotype an orthotopic glioma model in immunocompetent mice after Myxoma virus (MYXV) administration. These studies revealed a large resident microglia and macrophage population in untreated tumors, and robust monocyte, T-, and NK cell infiltration 3 days after MYXV infection. To determine the role on the clinical utility of MYXV therapy for glioma, we used a combination of knockout mouse strains and specific immunocyte ablation techniques. Collectively, our experiments identify an important role for tumor-resident myeloid cells and overlapping roles for recruited NK and T cells in the clearance and efficacy of oncolytic MYXV from gliomas. Using a cyclophosphamide regimen to achieve lymphoablation prior and during MYXV treatment, we prevented treatment-induced peripheral immunocyte recruitment and, surprisingly, largely ablated the tumor-resident macrophage population. Virotherapy of cyclophosphamide-treated animals resulted in sustained viral infection within the glioma as well as a substantial survival advantage. This study demonstrates that resistance to MYXV virotherapy in syngeneic glioma models involves a multifaceted cellular immune response that can be overcome with cyclophosphamide-mediated lymphoablation. PMID:25336188

Zemp, Franz J; McKenzie, Brienne A; Lun, Xueqing; Reilly, Karlyne M; McFadden, Grant; Yong, V Wee; Forsyth, Peter A

2014-12-15

308

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

309

[The concise history of atrial fibrillation].  

PubMed

The author reviews the history of atrial fibrillation, the most common sustained cardiac arrhythmia. The chaotic irregularity of arterial pulse was clearly acknowledged by most of physicians of the ancient China, Egypt and Greece. William Harvey (1578-1657), who first described the circulatory system appropriately, was probably the first to describe fibrillation of the auricles in animals in 1628. The French "clinical pathologist", Jean Baptist de Sénac (1693-1770) was the first who assumed a correlation between "rebellious palpitation" and stenosis of the mitral valve. Robert Adams (1791-1875) also reported in 1827 the association of irregular pulses and mitral stenosis. The discovery of digitalis leaf in 1785 by William Withering (1741-1799) brought relief to patients with atrial fibrillation and congestive heart failure by reducing the ventricular rate. From an analysis of simultaneously recorded arterial and venous pressure curves, the Scottish Sir James Mackenzie (1853-11925) demonstrated that a presystolic wave cannot be seen during "pulsus irregularis perpetuus", a term very first used by Heinrich Ewald Hering (1866-1948). Arthur Cushny (1866-1926) noted the similarity between pulse curves in clinical "delirium cordis" and those in dogs with atrial fibrillation. The first human ECG depicting atrial fibrillation was published by Willem Einthoven (1860-1927) in 1906. The proof of a direct connection between absolute arrhythmia and atrial fibrillation was established by two Viennese physicians, Carl Julius Rothberger and Heinrich Winterberg in 1909. Sir Thomas Lewis (1881-1945), the father of modem electrocardiography, studied electrophysiological characteristics of atrial fibrillation and has shown that its basic perpetuating mechanism is circus movement of electrical impulse (re-entry). After him, the major discoveries relating to the pathophysiology and clinical features of atrial fibrillation in the 20th century stemmed from Karel Frederick Wenckebach (1864-1940), Gordon Moe (1915-1989), Bernhard Lown (*1921) and Maurits Allessie. Over the past ten years, awareness has increased of transcatheter radiofrequency and cryoablation of non-valvular atrial fibrillation and the battle against formation of intraatrial thrombi for preventing cerebral thromboembolism. PMID:19069037

Fazekas, Tamás

2007-01-01

310

Lunar influence on atrial fibrillation?  

PubMed

The most popular periodicities in biology and medicine-the circadians and circannuals-stem undoubtedly from the Earth's rotation and its revolution around the sun. The problem is how to explain the existence of circaseptan, i.e. 5-9-day, and other infradian rhythms. They may correspond to the lunar cycles and their 2nd to 6th harmonics. To test such hypothesis, the calendar dates of 127 attacks of atrial fibrillation in one male subject (M.M.) between 1980 and 1994 were transformed into the days numbered 0-29 for the synodic, and 0-26 for tropic lunar cycle. The daily frequencies obtained in this way were smoothed by moving averages of three successive days each. Considerable fluctuations of frequencies of attacks during both cycles were visible by inspection of the corresponding graphs, called lunar plexograms. Thus, a conspicuous nadir is found under the full moon in the synodic cycle, and a marked peak shortly after the extreme southern position of the moon in the tropic cycle. Halberg's cosinor analysis testing the presence of the 1st to 6th harmonic of either lunar cycle rejected the null hypothesis at the alpha = 0.05 level for all harmonics. Accordingly, the occurrence of attacks was cycling with the period lengths of synodic and tropic lunar cycles, and with those of their 1/2-1/6 period lengths, i.e. with a cluster of approximately circa(di)-septan rhythms. This conclusion is supported by similar findings obtained earlier for various medical and biological events. PMID:9181092

Mikulecky, M; Valachova, A

1996-08-01

311

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

312

First experience of percutaneous radio-frequency ablation for atrial flutter and atrial fibrillation in a patient with HeartMate II left ventricular assist device  

Microsoft Academic Search

We report the first case of percutaneous radio-frequency (RF) ablation procedure in a patient implanted with a HeartMate II\\u000a left ventricular assist device for refractory heart failure. This procedure was performed for poorly tolerated recurrent atrial\\u000a arrhythmias. No harmful consequence happened during or after the procedure despite the potential electromagnetic interferences\\u000a existing between the RF delivery and the functioning of

Philippe Maury; Clement Delmas; Charlotte Trouillet; Mark S. Slaughter; Olivier Lairez; Michel Galinier; Jerome Roncalli; David Bertrand; Lydie Mathevet; Alexandre Duparc; Michelle Salvador; Marc Delay; Camille Dambrin

2010-01-01

313

Left atrial appendage closure for thromboembolism prevention in patients with atrial fibrillation: advances and perspectives  

PubMed Central

Atrial fibrillation (AF) is a frequent cause of stroke. More than 90% of thrombi were found in the left atrial appendage (LAA) in non-valvular AF. Transcatheter LAA closure has been developed as a novel approach to reduce the risk of stroke in patients with AF over the last decade. In this article, we review the recent advances and propose the possible challenges regarding the LAA closure for thromboembolism prevention in patients with AF. PMID:25713737

Kong, Bin; Liu, Yu; Huang, He; Jiang, Hong

2015-01-01

314

Association of atrial tachyarrhythmias with atrial septal defect, Ebstein's anomaly and Fontan patients.  

PubMed

The number of adults with congenital heart disease is increasing as medical and surgical palliation for congenital heart lesions improves. With this comes long-term complications of congenital heart disease such as the increased risk of atrial tachyarrhythmias. Atrial septal defect, Ebstein's anomaly and post-Fontan patient subsets are particularly important to focus on due to their unique characteristics and association with atrial tachyarrhythmias. Reviews, randomized controlled trials, and meta-analyses were obtained using electronic search strategies such as Medline and the Cochrane Library. References of electronically obtained studies were then used to obtain additional relevant studies. Sources were deemed relevant if they discussed the relationship between atrial septal defects/Ebstein's anomaly/Fontan procedure and atrial tachyarrhythmias in respect to incidence, mechanism, recurrence or treatment. Selected sources were then stratified on the basis of quality. Patients in these subsets of congenital heart disease are at increased risk of atrial tachyarrhythmias for a variety of reasons when compared with the general population. It is necessary for pediatric and adult cardiologists alike to understand these differences, as well as their implications in diagnosis and management of such occurrences. PMID:21809970

Loomba, Rohit S; Chandrasekar, Suraj; Sanan, Prateek; Shah, Parinda H; Arora, Rohit R

2011-07-01

315

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

316

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

317

Lacosamide-induced atrial tachycardia in a child with hypoplastic left-heart syndrome: the importance of assessing additional proarrhythmic risks.  

PubMed

Antiepileptic medications have been reported to cause disturbances in cardiac conduction. Lacosamide decreases seizure burden by modulating sodium channels. Although it has been demonstrated to have few side effects, there have been reports of clinically significant cardiac conduction disturbances. We report the case of a child with hypoplastic left-heart syndrome and well-controlled multifocal atrial tachycardia who developed haemodynamically significant atrial tachycardia after receiving two doses of lacosamide. PMID:25046031

Loomba, Rohit S; Singh, Anoop K; Kovach, Joshua; Gudausky, Todd M

2015-04-01

318

Filtering role of the atrioventricular node in atrial fibrillations.  

PubMed

Experiments on rabbit heart preparations were carried out with the aim of studying the causal relation between the signals at the input and at the output of the atrioventricular node (AVN) during atrial fibrillations (AF). Electrograms were recorded simultaneously from the posterior and anterior inputs and from the output of AVN, together with cellular action potentials from one or two structures of the node. AVN is shown to play the role of a filtering unit for the excitatory waves passing from the atria to the ventricles during AF. The random and fragmentary character of the atrial excitatory front during AF causes summation of excitatory waves, local and manifested re-entry, and conduction along competitive pathways. These processes accompany both the successful conduction through AVN and the blocking of the excitation at different levels in the node. The filtration process takes place mainly in the AN- and N-zones of the node. In the NH-zone conduction does not differ compared to that in the case of spontaneous rhythm. The results obtained show that conduction through AVN during AF does not take place through triggering of specific mechanisms, but through a complex combination of the mechanisms characterizing the deteriorated conduction under extreme conditions. PMID:4050465

Mazgalev, T

1985-01-01

319

Digital resolution enhancement of intracardiac excitation maps during atrial fibrillation.  

PubMed

Atrial fibrillation (AF) is often successfully treated by catheter ablation. Those cases of AF that do not readily succumb to ablation therapy would benefit from improved methods for mapping the complex spatial patterns of tissue activation that typify recalcitrant AF. To this end, the purpose of our study was to investigate the use of numerical deconvolution to improve the spatial resolution of activation maps provided by 2-D arrays of intra-cardiac recording electrodes. We simulated tissue activation patterns and their corresponding electric potential maps using a computational model of cardiac electrophysiology, and sampled the maps over a grid of locations to generate a mapping data set. Following cubic spline interpolation, followed by edge-extension and windowing, we deconvolved the data and compared the results to the model current density fields. We performed a similar analysis on voltage-sensitive dye maps obtained in isolated sheep hearts. For both the synthetic data and the voltage-sensitive dye maps, we found that deconvolution led to visually improved map resolution for arrays of 10 × 10 up to 30 × 30 electrodes placed within a few mm of the atrial surface when the activation patterns included 3-4 features that spanned the recording area. Root mean square error was also reduced by deconvolution. Deconvolution of arrays of intracardiac potentials, preceded by appropriate interpolation and edge processing, leads to potentially useful improvements in map resolution that may allow more effective assessment of the spatiotemporal dynamics of tissue excitation during AF. PMID:25022983

Palmer, Keryn B; Thompson, Nathaniel C; Spector, Peter S; Kalifa, Jérôme; Bates, Jason H T

2015-04-01

320

Fracture and migration of a pacemaker atrial lead retention wire found by fluoroscopic screening in an asymptomatic patient.  

PubMed

We present the case of a woman who had an Accufix atrial "J" pacemaker lead implanted in 1990. Subsequently, Telectronics Pacing Systems recalled two models of the atrial leads after problems with fracture and malfunction were reported. One of these models was used in our case. Fifty-two months after implantation, following recommended fluoroscopic screening, our patient was found to have a complete fracture of the "J" retention wire with one fragment protruding from the sheath in the right atrium and another fragment of the wire lodged in the right ventricle. The pacemaker had continued to function normally and there was no clinical evidence to suggest such a potentially disastrous fracture. Our report emphasizes the importance of fluoroscopic screening of all patients with atrial leads involved in the recall. PMID:8701379

Mucha, E; Catalano, P; Myers, T

1996-08-01

321

Inflammation-induced atrial fibrillation: pathophysiological perspectives and clinical implications.  

PubMed

Although atrial fibrillation (AF) is the most common type of cardiac arrhythmia, its etiology is unknown in nearly 10% of cases. Growing evidence suggests that inflammation plays a significant role in the onset and recurrence of AF. The role of inflammation in the pathogenesis of AF has important clinical implications of which many practitioners are unfamiliar. In this article, we describe a case of a 29-year-old male, who presents the emergency department with inflammation-induced AF, secondary to acute appendicitis. The latter condition was initially missed due to the unclear link between both presentations. By the time the AF was pharmacologically managed, the inflamed appendix perforated, resulting in unnecessary pain and suffering. After the perforated appendix was drained and removed surgically, the patient recovered well, and a follow up echocardiogram was normal. Here we give a brief overview of the pathophysiological perspective linking AF to inflammation and subsequent clinical considerations in patient management. PMID:25453387

Al-Zaiti, Salah S

2015-01-01

322

Atrial Fibrillation: Experimental and Theoretical Developments  

Microsoft Academic Search

The previous review dealing with this area in Cardiac Electrophysiology Review focused on possible approaches to developing improved pharmacological and non-pharmacological therapy of atrial ~brillation (AF) based on underlying fundamental mechanisms. Since the publication of this previous review, two new antiarrhythmic drugs for AF have approached clinical introduction. Dofetilide is an IKr blocker that is effective for AF and can

1999-01-01

323

Initial experience of cryoballoon catheter ablation for atrial fibrillation in Hong Kong.  

PubMed

OBJECTIVE. To report the initial experience in using cryoballoon catheter ablation in the treatment of atrial fibrillation in Hong Kong. DESIGN. Single-centre, prospective case series. SETTING. Regional hospital, Hong Kong. PATIENTS. Sixteen patients (mean age, 55 years; standard deviation, 14 years; 11 males) with paroxysmal (n=12) or persistent (n=4) atrial fibrillation. INTERVENTIONS. Pulmonary vein isolation by ablation with a 28-mm cryoballoon catheter. MAIN OUTCOME MEASURES. Safety, effectiveness, and learning curve of this procedure. RESULTS. Of 67 pulmonary veins, 61 (91%) could be successfully isolated with the cryoballoon alone. The remaining pulmonary veins were isolated with additional ablation using an 8-mm tip cryocatheter. One phrenic nerve palsy developed during right middle pulmonary vein ablation, which resolved. Another patient endured a minor guidewire dissection of the right inferior pulmonary vein. The mean (standard deviation) procedural and fluoroscopic times were 231 (32) and 62 (18) minutes, respectively. On comparing the first nine and last seven procedures, there was a significant improvement in procedural time (mean [standard deviation], 244 [32] vs 213 [24] minutes; P=0.04) and in the fluoroscopic time (70 [21] vs 51 [7] minutes; P=0.038). With a median follow-up of 21 months, nine (75%) of the 12 patients with paroxysmal atrial fibrillation and one (25%) of those four with persistent atrial fibrillation had no recurrence, without the use of anti-arrhythmic drugs. CONCLUSIONS. Pulmonary vein isolation by cryoballoon catheter ablation is safe and effective in treating patients with paroxysmal, but not for patients with persistent atrial fibrillation. A relatively short learning curve of around 10 cases was deemed appropriate. PMID:21979476

Chan, N Y; Choy, C C; Lau, C L; Lo, Y K; Chu, P S; Yuen, H C; Mok, N S; Tsui, P T; Lau, S T

2011-10-01

324

A flash from the past: a case on long term follow-up of a "corridor" operation.  

PubMed

An electrophysiological study in a patient with a previous corridor operation was performed because of syncope. The atrial electrograms showed the persistence of the sinus rhythm in the right atrial corridor despite an organized atrial fibrillation in the left atrium. The first case described of a long term follow-up in a corridor operation, one of the first described surgical approach for the treatment of atrial fibrillation, that gave the beginning to the non-pharmacological approach of this arrhythmia. PMID:23174503

Ricciardi, Danilo; Sarkozy, Andrea; Wauters, Kristel; Brugada, Pedro

2013-01-01

325

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, André; Kohler, Ilmar; Danzmann, Luiz Cláudio

2014-01-01

326

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

327

Inter-Subject Variability in Human Atrial Action Potential in Sinus Rhythm versus Chronic Atrial Fibrillation  

PubMed Central

Aims Human atrial electrophysiology exhibits high inter-subject variability in both sinus rhythm (SR) and chronic atrial fibrillation (cAF) patients. Variability is however rarely investigated in experimental and theoretical electrophysiological studies, thus hampering the understanding of its underlying causes but also its implications in explaining differences in the response to disease and treatment. In our study, we aim at investigating the ability of populations of human atrial cell models to capture the inter-subject variability in action potential (AP) recorded in 363 patients both under SR and cAF conditions. Methods and Results Human AP recordings in atrial trabeculae (n?=?469) from SR and cAF patients were used to calibrate populations of computational SR and cAF atrial AP models. Three populations of over 2000 sampled models were generated, based on three different human atrial AP models. Experimental calibration selected populations of AP models yielding AP with morphology and duration in range with experimental recordings. Populations using the three original models can mimic variability in experimental AP in both SR and cAF, with median conductance values in SR for most ionic currents deviating less than 30% from their original peak values. All cAF populations show similar variations in GK1, GKur and Gto, consistent with AF-related remodeling as reported in experiments. In all SR and cAF model populations, inter-subject variability in IK1 and INaK underlies variability in APD90, variability in IKur, ICaL and INaK modulates variability in APD50 and combined variability in Ito and IKur determines variability in APD20. The large variability in human atrial AP triangulation is mostly determined by IK1 and either INaK or INaCa depending on the model. Conclusion Experimentally-calibrated human atrial AP models populations mimic AP variability in SR and cAF patient recordings, and identify potential ionic determinants of inter-subject variability in human atrial AP duration and morphology in SR versus cAF. PMID:25157495

Sánchez, Carlos; Bueno-Orovio, Alfonso; Wettwer, Erich; Loose, Simone; Simon, Jana; Ravens, Ursula; Pueyo, Esther; Rodriguez, Blanca

2014-01-01

328

Ranolazine safely decreases ventricular and atrial fibrillation in Timothy syndrome (LQT8).  

PubMed

Long QT eight (LQT8), otherwise known as Timothy syndrome (TS), is a genetic disorder causing hyper-activation of the L-type calcium channel Cav 1.2. This calcium load and the resultant increase in the QT interval provide the substrate for ventricular arrhythmias. We previously presented a case in a patient with TS who had a profound decrease in his burden of ventricular arrhythmias after institution of an L-type calcium channel blocker. Although this patient's arrhythmia burden had decreased, he displayed an increasing burden of atrial fibrillation and still had bouts of ventricular fibrillation requiring defibrillator therapy. Basic research has recently shown that ranolazine, a multipotent ion-channel blocker, may be of benefit in patients with LQT8 syndrome. This case report details the decrease of atrial fibrillation and ventricular fibrillation events in our LQT8 patient with the addition of ranolazine. PMID:20883512

Shah, Dipak P; Baez-Escudero, Jose L; Weisberg, Ian L; Beshai, John F; Burke, Martin C

2012-03-01

329

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

PubMed

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

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

2014-04-01

330

Right atrial appendage thrombus found in a patient in normal sinus rhythm with normal right ventricular systolic function.  

PubMed

A 79-year-old woman underwent transesophageal echocardiography to evaluate the severity of her mitral regurgitation prior to urgent bypass. Evaluation of the right-sided chambers was notable for a mass in the right atrial appendage (RAA). Surgical excision and pathologic examination proved this to be a thrombus. This is the first reported case of a RAA thrombus in a patient with normal sinus rhythm and normal right ventricular (RV) function. It illustrates that complete transesophageal studies may sometimes demonstrate incidental findings, and that right atrial thrombus can (rarely) be found in patients in sinus rhythm with normal RV function. PMID:23190046

Falcone, Adam M; Matter, Gregory J; Schussler, Jeffrey M

2013-03-01

331

Characterization and functional analysis of Serp3: a novel myxoma virus-encoded serpin involved in virulence.  

PubMed

Myxoma virus (MV), a member of the family Poxviridae, is the causative agent of myxomatosis, a fatal disease of the European rabbit. The MV genome is a linear, double-stranded DNA molecule that encodes several factors important for evasion of the host immune system. Sequencing the right-end region of the MV genome identified an 801 bp open reading frame (ORF) encoding a polypeptide that belongs to the serpin superfamily. To date, two MV-encoded serpins have been characterized: SERP-1 binds to several targets and is an anti-inflammatory molecule, whereas Serp2 is essential for virus virulence and has both anti-inflammatory and anti-apoptotic effects. Thus, Serp3 is the third MV-encoded serpin. DNA sequence analysis of Serp3 indicated a similarity to poxvirus late promoters, which was confirmed by mRNA expression analysis. Serp3 has an atypical serpin motif and has significant sequence deletions as compared to most cellular and viral serpins. However, molecular modelling studies suggested that Serp3 can retain the overall serpin fold. Insertional inactivation of the serp3 ORF led to a significant attenuation of virulence in vivo (as measured by the increase in survival of infected rabbits) and limited dissemination of the virus to secondary sites of infection. In rabbits infected with a Serp3 deletion mutant (MV-Serp3(-)), the main histopathological feature is the absence of secondary myxomas. Both wild-type MV and MV-Serp3(-) replicate at comparable levels in vivo. Serp3 may represent a significant virulence factor of MV and probably acts in synergy with other viral proteins. PMID:11369885

Guerin, J L; Gelfi, J; Camus, C; Delverdier, M; Whisstock, J C; Amardeihl, M F; Py, R; Bertagnoli, S; Messud-Petit, F

2001-06-01

332

Randomized Study Comparing Combined Pulmonary Vein-Left Atrial Junction Disconnection and Cavotricuspid Isthmus Ablation Versus Pulmonary Vein-Left Atrial Junction Disconnection Alone in Patients Presenting With Typical Atrial Flutter and Atrial Fibrillation  

Microsoft Academic Search

Background—Atrial flutter (AFL) and atrial fibrillation (AF) frequently coexist in the same patient. Recently it has been demonstrated that the triggers for both AF and AFL may originate in the pulmonary veins (PVs). We hypothesized that in patients with both AF and typical AFL, pulmonary vein-left atrial junction (PV-LAJ) disconnection may eliminate both arrhythmias. Methods and Results—Consecutive patients with documented

Oussama Wazni; Nassir F. Marrouche; David O. Martin; A. Marc Gillinov; Walid Saliba; Eduardo Saad; Allan Klein; Mandeep Bhargava; Dianna Bash; Robert Schweikert; Demet Erciyes; Ahmad Abdul-Karim; Johannes Brachman; Jens Gunther; Ennio Pisano; Domenico Potenza; Raffaele Fanelli; Andrea Natale

2010-01-01

333

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

PubMed

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

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

2015-01-01

334

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

335

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

PubMed

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

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

2013-08-01

336

[Intrabronchial migration and extraction of a fragment of an Accufix J-shaped atrial pacing catheter].  

PubMed

The authors report a case of exteriorisation and migration of a fragment of a J-shaped atrial Accufix Telectronix (Stimarec Class IV) responsible for a bronchial penetration without clinical repercussion. A systematic control chest X-ray detected this complication. The position of the metallic fragment was determined by chest CT scan and bronchial fibroscopy between the inferior right lobar bronches and artery confirming bronchial perforation. Rigid bronchoscopy with direct visualisation enabled extraction of the foreign body without complications. PMID:9181039

Lefez, C; Reybet-Degat, O; Wolf, J E; Louis, P; Favre, J P; David, M

1997-02-01

337

Hemodynamic Forces Regulate Developmental Patterning of Atrial Conduction  

PubMed Central

Anomalous action potential conduction through the atrial chambers of the heart can lead to severe cardiac arrhythmia. To date, however, little is known regarding the mechanisms that pattern proper atrial conduction during development. Here we demonstrate that atrial muscle functionally diversifies into at least two heterogeneous subtypes, thin-walled myocardium and rapidly conducting muscle bundles, during a developmental window just following cardiac looping. During this process, atrial muscle bundles become enriched for the fast conduction markers Cx40 and Nav1.5, similar to the precursors of the fast conduction Purkinje fiber network located within the trabeculae of the ventricles. In contrast to the ventricular trabeculae, however, atrial muscle bundles display an increased proliferation rate when compared to the surrounding myocardium. Interestingly, mechanical loading of the embryonic atrial muscle resulted in an induction of Cx40, Nav1.5 and the cell cycle marker Cyclin D1, while decreasing atrial pressure via in vivo ligation of the vitelline blood vessels results in decreased atrial conduction velocity. Taken together, these data establish a novel model for atrial conduction patterning, whereby hemodynamic stretch coordinately induces proliferation and fast conduction marker expression, which in turn promotes the formation of large diameter muscle bundles to serve as preferential routes of conduction. PMID:25503944

Mikawa, Takashi

2014-01-01

338

Atrial fixation leads--a visual aid confirming actual fixation.  

PubMed

Various active fixation mechanisms are available for atrial lead implantation. Confirmation of actual fixation of the lead tip in the myocardium is sometimes difficult with standard techniques such as fluoroscopy. Our observation of organized clockwise/counterclockwise motions of the fixation stylet in synchrony with atrial systole confirms adequate positioning of the Accufix model #330-801 atrial lead in the right atrial appendage, which is helpful when the screw is difficult to visualize under fluoroscopy. This observation was confirmed in nine patients. PMID:1372408

Conti, J B; Curtis, A B

1992-02-01

339

Recent Clinical and Experimental Advances in Atrial Fibrillation  

PubMed Central

Atrial fibrillation (AF) is the most common arrhythmia in clinical settings (Fuster et al., 2001), and it is often associated with congestive heart diseases (Issac et al., 2007). Many studies in both laboratory and clinical settings have sought to analyze the mechanisms of AF, develop treatments based on these mechanisms, and examine atrial remodeling in chronic AF. The aim of this paper is to analyze recent findings regarding the atrial remodeling that occurs in AF. In particular, we will describe the electrical and structural changes that involve atrial myocytes and the extracellular matrix. We will also describe the general classification and basic pathophysiology of AF and its surgical treatments. PMID:22347664

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

2011-01-01

340

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

341

Fluctuations in the titre of antibody to a soluble antigen of myxoma virus in field populations of rabbits, Oryctolagus cuniculus (L.), in Australia  

PubMed Central

Results are presented on tests carried out over the past 5 years to measure the antibody titre of various rabbit populations to a soluble antigen of myxoma virus. In an unexpectedly high percentage of immune rabbits the antibody fell below measurable titres, and later rose to measurable titres without the advent of an observable epizootic of myxomatosis. The re-stimulation of the immune response is discussed in terms of re-infection and virus reactivation. PMID:4518348

Williams, R. T.; Dunsmore, J. D.; Sobey, W. R.

1973-01-01

342

Left Atrial Anatomy Relevant to Catheter Ablation  

PubMed Central

The rapid development of interventional procedures for the treatment of arrhythmias in humans, especially the use of catheter ablation techniques, has renewed interest in cardiac anatomy. Although the substrates of atrial fibrillation (AF), its initiation and maintenance, remain to be fully elucidated, catheter ablation in the left atrium (LA) has become a common therapeutic option for patients with this arrhythmia. Using ablation catheters, various isolation lines and focal targets are created, the majority of which are based on gross anatomical, electroanatomical, and myoarchitectual patterns of the left atrial wall. Our aim was therefore to review the gross morphological and architectural features of the LA and their relations to extracardiac structures. The latter have also become relevant because extracardiac complications of AF ablation can occur, due to injuries to the phrenic and vagal plexus nerves, adjacent coronary arteries, or the esophageal wall causing devastating consequences. PMID:25057427

Sánchez-Quintana, Damián; Cabrera, José Angel; Saremi, Farhood

2014-01-01

343

Challenges in the classification of atrial fibrillation  

PubMed Central

The incidence and prevalence of atrial fibrillation (AF) are increasing worldwide. AF is of public health importance as it accounts for substantial morbidity, mortality, and health-care costs. AF may be transient initially, but many patients have progressive disease marked by increasing frequency and duration of episodes. Various classification schemes for AF have been proposed, although current guidelines are based on temporal rhythm-based patterns. We discuss existing schemes for the classification of AF, focusing on the advantages and limitations of the pattern-based scheme, in the context of new knowledge about AF pathophysiology, AF patterns, and clinical outcomes. Furthermore, we address gaps in knowledge that present opportunities to re-examine the current pattern-based classification of AF. A future classification scheme should ideally combine elements such as the risk of stroke, an assessment of symptoms, and the impairment of the atrial substrate. PMID:20567238

Lubitz, Steven A.; Benjamin, Emelia J.; Ruskin, Jeremy N.; Fuster, Valentin; Ellinor, Patrick T.

2011-01-01

344

[Innovative techniques in atrial fibrillation therapy].  

PubMed

Pulmonary vein isolation (PVI) is the established cornerstone in most catheter-based ablation treatment strategies for atrial fibrillation (AF); however, it is still a challenge to create contiguous, transmural and permanent ablation lesions using radiofrequency current in combination with three-dimensional mapping systems. To overcome these limitations, innovative spiral mapping and ablation catheters as well as balloon-based ablation catheters incorporating alternative energy sources, such as cryoenergy and laser were developed and evaluated and have proved their potential for safe and clinically effective PVI. In addition, novel ablation strategies, such as identification and ablation of AF-inducing foci and/or AF-perpetuating rotors using either endocardial or epicardial mapping systems were introduced and are currently under clinical evaluation. The identification and modulation of atrial ganglionic plexi (GP) and, therefore, of the autonomous nervous system is another additive ablation approach which requires further clinical evaluation. PMID:25585587

Metzner, A; Wissner, E; Fink, T; Ouyang, F; Kuck, K-H

2015-02-01

345

Atrial-like cardiomyocytes from human pluripotent stem cells are a robust preclinical model for assessing atrial-selective pharmacology  

PubMed Central

Drugs targeting atrial-specific ion channels, Kv1.5 or Kir3.1/3.4, are being developed as new therapeutic strategies for atrial fibrillation. However, current preclinical studies carried out in non-cardiac cell lines or animal models may not accurately represent the physiology of a human cardiomyocyte (CM). In the current study, we tested whether human embryonic stem cell (hESC)-derived atrial CMs could predict atrial selectivity of pharmacological compounds. By modulating retinoic acid signaling during hESC differentiation, we generated atrial-like (hESC-atrial) and ventricular-like (hESC-ventricular) CMs. We found the expression of atrial-specific ion channel genes, KCNA5 (encoding Kv1.5) and KCNJ3 (encoding Kir 3.1), in hESC-atrial CMs and further demonstrated that these ion channel genes are regulated by COUP-TF transcription factors. Moreover, in response to multiple ion channel blocker, vernakalant, and Kv1.5 blocker, XEN-D0101, hESC-atrial but not hESC-ventricular CMs showed action potential (AP) prolongation due to a reduction in early repolarization. In hESC-atrial CMs, XEN-R0703, a novel Kir3.1/3.4 blocker restored the AP shortening caused by CCh. Neither CCh nor XEN-R0703 had an effect on hESC-ventricular CMs. In summary, we demonstrate that hESC-atrial CMs are a robust model for pre-clinical testing to assess atrial selectivity of novel antiarrhythmic drugs. PMID:25700171

Devalla, Harsha D; Schwach, Verena; Ford, John W; Milnes, James T; El-Haou, Said; Jackson, Claire; Gkatzis, Konstantinos; Elliott, David A; Chuva de Sousa Lopes, Susana M; Mummery, Christine L; Verkerk, Arie O; Passier, Robert

2015-01-01

346

Sequential Hybrid Procedure for Persistent Atrial Fibrillation  

PubMed Central

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

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

2015-01-01

347

Non-Pharmacological Therapy for Atrial Fibrillation: Managing the Left Atrial Appendage  

PubMed Central

The prevalence of atrial fibrillation (AF) is increasing in parallel with an ageing population leading to increased morbidity and mortality. The most feared complication of AF is stroke, with the arrhythmia being responsible for up to 20% of all ischemic strokes. An important contributor to this increased risk of stroke is the left atrial appendage (LAA). A combination of the LAA's unique geometry and atrial fibrillation leads to low blood flow velocity and stasis, which are precursors to thrombus formation. It has been hypothesized for over half a century that excision of the LAA would lead to a reduction in the incidence of stroke. It has only been in the last 20–25 years that the knowledge and technology has been available to safely carry out such a procedure. We now have a number of viable techniques, both surgical and percutaneous, which will be covered in this paper. PMID:22666618

Luis, Sushil Allen; Roper, Damian; Incani, Alexander; Poon, Karl; Haqqani, Haris; Walters, Darren L.

2012-01-01

348

Extracavitary Manifestation of Primary Effusion Lymphoma as a Right Atrial Mass  

PubMed Central

Primary effusion lymphoma (PEL) is a subset of large B cell lymphomas and has been mostly associated with human immunodeficiency virus infection. Rare cases have been reported in organ transplant recipients and chronic hepatitis C patients. It typically presents as an effusion in the pleural and pericardial spaces but rarely disseminates. However, involvement of the gastrointestinal tract, lymph nodes and bone marrow has been reported. Diagnosis is based on characteristic clinical, histopathological and immunohistochemical features. We present a case with a right atrial mass which tested positive for human herpes virus 8 (HHV-8), CD20, CD30 and lambda light chains and negative for CD138, kappa light chain, PAX5, Epstein-Barr virus, latent membrane protein 1, CD2, CD3, CD8 and CD56. Bilateral pleural effusions and pericardial effusions were noted which tested positive for HHV-8, CD30 and CD45. The patient responded well to the R-EPOCH regimen with complete resolution of the effusions and a significant decrease in the size of the right atrial mass. This case report illustrates the atypical manifestation of PEL as a right atrial mass. PMID:23569445

Marak, Creticus P.; Ponea, Ana M.; Shim, Chang; Shaheen, Shagufta; Guddati, Achuta K.

2013-01-01

349

Extracavitary manifestation of primary effusion lymphoma as a right atrial mass.  

PubMed

Primary effusion lymphoma (PEL) is a subset of large B cell lymphomas and has been mostly associated with human immunodeficiency virus infection. Rare cases have been reported in organ transplant recipients and chronic hepatitis C patients. It typically presents as an effusion in the pleural and pericardial spaces but rarely disseminates. However, involvement of the gastrointestinal tract, lymph nodes and bone marrow has been reported. Diagnosis is based on characteristic clinical, histopathological and immunohistochemical features. We present a case with a right atrial mass which tested positive for human herpes virus 8 (HHV-8), CD20, CD30 and lambda light chains and negative for CD138, kappa light chain, PAX5, Epstein-Barr virus, latent membrane protein 1, CD2, CD3, CD8 and CD56. Bilateral pleural effusions and pericardial effusions were noted which tested positive for HHV-8, CD30 and CD45. The patient responded well to the R-EPOCH regimen with complete resolution of the effusions and a significant decrease in the size of the right atrial mass. This case report illustrates the atypical manifestation of PEL as a right atrial mass. PMID:23569445

Marak, Creticus P; Ponea, Ana M; Shim, Chang; Shaheen, Shagufta; Guddati, Achuta K

2013-01-01

350

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

351

Detection of occult paroxysmal atrial fibrillation.  

PubMed

This work introduces a novel approach to the detection of brief episodes of paroxysmal atrial fibrillation (PAF). The proposed detector is based on four parameters which characterize RR interval irregularity, P-wave absence, f-wave presence, and noise level, of which the latter three are determined from a signal produced by an echo state network. The parameters are used for fuzzy logic classification where the decisions involve information on prevailing signal quality; no training is required. The performance is evaluated on a large set of test signals with brief episodes of PAF. The results show that episodes with as few as five beats can be reliably detected with an accuracy of 0.88, compared to 0.82 for a detector based on rhythm information only (the coefficient of sample entropy); this difference in accuracy increases when atrial premature beats are present. The results also show that the performance remains essentially unchanged at noise levels up to [Formula: see text] RMS. It is concluded that the combination of information on ventricular activity, atrial activity, and noise leads to substantial improvement when detecting brief episodes of PAF. PMID:25502852

Petr?nas, Andrius; Sörnmo, Leif; Lukoševi?ius, Ar?nas; Marozas, Vaidotas

2015-04-01

352

[Medicinal rhythm control in atrial fibrillation].  

PubMed

Medicinal antiarrhythmic therapy is either used in the acute setting to convert atrial fibrillation to sinus rhythm or as chronic medication to preserve sinus rhythm if a rhythm control strategy is followed. The choice of the antiarrhythmic agent is based on the presence or absence of structural heart disease. In addition, oral anticoagulation should be established according to current guidelines. In the acute setting the armamentarium comprises flecainide, propafenone, vernakalant and amiodarone. Usually, combination therapy with an atrioventricular (AV) node slowing drug (a beta blocker or verapamil) is used. For chronic rhythm control a class IC drug, such as sotalol, dronedarone and amiodarone is given depending on the comorbidities. In the absence of structural heart disease, rare episodes of paroxysmal atrial fibrillation can be treated by a pill-in-the-pocket strategy, i.e. self-administered pharmacological cardioversion with flecainide or propafenone. Despite recent advances in catheter ablation of atrial fibrillation, medical rhythm control continues to play an important role due to its ubiquitous availability and relatively easy use. The risk for proarrhythmia has to be evaluated in all patients. PMID:24549989

Nowak, Bernd; Fürnkranz, Alexander

2014-03-01

353

Atrial fibrillation: effects beyond the atrium?  

PubMed Central

Atrial fibrillation (AF) is the most common sustained clinical arrhythmia and is associated with significant morbidity, mostly secondary to heart failure and stroke, and an estimated two-fold increase in premature death. Efforts to increase our understanding of AF and its complications have focused on unravelling the mechanisms of electrical and structural remodelling of the atrial myocardium. Yet, it is increasingly recognized that AF is more than an atrial disease, being associated with systemic inflammation, endothelial dysfunction, and adverse effects on the structure and function of the left ventricular myocardium that may be prognostically important. Here, we review the molecular and in vivo evidence that underpins current knowledge regarding the effects of human or experimental AF on the ventricular myocardium. Potential mechanisms are explored including diffuse ventricular fibrosis, focal myocardial scarring, and impaired myocardial perfusion and perfusion reserve. The complex relationship between AF, systemic inflammation, as well as endothelial/microvascular dysfunction and the effects of AF on ventricular calcium handling and oxidative stress are also addressed. Finally, consideration is given to the clinical implications of these observations and concepts, with particular reference to rate vs. rhythm control. PMID:25587048

Wijesurendra, Rohan S.; Casadei, Barbara

2015-01-01

354

Symptomatic improvement after radiofrequency catheter ablation for typical atrial flutter  

PubMed Central

OBJECTIVE—To assess the changes in quality of life, arrhythmia symptoms, and hospital resource utilisation following catheter ablation of typical atrial flutter.?DESIGN—Patient questionnaire to compare the time interval following ablation with a similar time interval before ablation.?SETTING—Tertiary referral centre.?PATIENTS—63 consecutive patients were studied. Four patients subsequently underwent an ablate and pace procedure, two died of co-morbid illnesses, and two were lost to follow up. The remaining 55 patients form the basis of the report.?RESULTS—Patients were followed for a mean (SD) of 12 (9.5) months. Atrial flutter ablation resulted in an improvement in quality of life (3.8 v 2.5, p < 0.001) and reductions in symptom frequency score (2.0 v 3.5, p < 0.001) and symptom severity score (2.0 v 3.8, p < 0.001) compared with preablation values. There was a reduction in the number of patients visiting accident and emergency departments (11% v 53%, p < 0.001), requiring cardioversion (7% v 51%, p < 0.001), or being admitted to hospital for a rhythm problem (11% v 56%, p < 0.001). Subgroup analysis confirmed that patients with atrial flutter and concomitant atrial fibrillation before ablation and those with atrial flutter alone both derived significant benefit from atrial flutter ablation. Patients with concomitant atrial fibrillation had an improvement in quality of life (3.5 v 2.5, p < 0.001) and reductions in symptom frequency score (2.3 v 3.5, p < 0.001) and symptom severity score (2.2 v 3.7, p < 0.001) compared with preablation values.?CONCLUSIONS—Ablation of atrial flutter is recommended both in patients with atrial flutter alone and in those with concomitant atrial fibrillation.???Keywords: atrial flutter; radiofrequency ablation; quality of life PMID:11454833

O'Callaghan, P; Meara, M; Kongsgaard, E; Poloniecki, J; Luddington, L; Foran, J; Camm, A; Rowland, E; Ward, D

2001-01-01

355

Right atrial lesions do not improve the efficacy of a complete left atrial lesion set in the surgical treatment of atrial fibrillation, but they do increase procedural morbidity  

PubMed Central

Objective Some have suggested the superiority of biatrial versus left atrial lesions. We sought to analyze our experience. Methods We retrospectively reviewed 305 consecutive patients from 2007 to 2011. Rhythm success was defined as freedom from atrial fibrillation (AF) or flutter determined by 12-lead electrocardiograms at 3-month intervals. Lesions sets were pulmonary vein isolation (PVI), left-extended (PVI + mitral valve annulus [MV] lesion ± left atrial appendage lesion [LAA]) or biatrial-extended (right atrial ablation + PVI + MV ± LAA). Results The success rates of PVI, left-extended, and biatrial-extended lesions were as follows: at 3 months, 56.7%, 74.7%, and 79.4% (P = .003); at 6 months, 56.9%, 72.9%, and 74.6% (P = .02); at 9 months, 54.6%, 72.5%, and 83.3% (P < .001); and at 12 months, 52.6%, 76.1%, and 80.0% (P < .001). Biatrial lesions had a higher rate of pacemaker placement than did left atrial lesions (16.5% vs 7.5%; P = .02). When we grouped patients by left lesion (PVI, PVI + MV, PVI + MV + LAA) irrespective of right atrial ablation, success was as follows: 3 months, 57.9%, 71.1%, and 87.8% (P < .01); 6 months, 58.1%, 71.6%, and 77.6% (P = .03); 9 months, 55.9%, 71.3%, and 89.6% (P < .01); and 12 months, 54.1%, 74.7%, and 83.7% (P < .01). Conclusions PVI is associated with lower rhythm success than an extended left atrial lesion set. The addition of a right atrial lesion to an extended left atrial lesion set does not improve efficacy, but it does increase the rate of pacemaker placement for sinus dysfunction. Adding an LAA lesion may confer additional efficacy when added to a lesion set that includes PVI + MV. PMID:23321126

Soni, Lori K.; Cedola, Sophia R.; Cogan, Jacob; Jiang, Jeffrey; Yang, Jonathan; Takayama, Hiroo; Argenziano, Michael

2014-01-01

356

Angiotensin?Converting Enzyme?2 Overexpression Improves Atrial Remodeling and Function in a Canine Model of Atrial Fibrillation  

PubMed Central

Background Atrial fibrosis is an important factor in initiating and maintaining atrial fibrillation. The purpose of this study was to test the hypothesis that atrial angiotensin?converting enzyme?2 (ACE2) overexpression might inhibit atrial collagen accumulation and improve atrial remodeling in a canine atrial pacing model. Methods and Results Thirty?two mongrel dogs of both genders were divided randomly into 4 groups: sham?operated, control, gene therapy with adenovirus?enhanced green fluorescent protein (Ad?EGFP), and gene therapy with Ad?ACE2. All of the dogs in the control, Ad?EGFP, and Ad?ACE2 groups were paced at 450 bpm for a period of 14 days. The dogs in the sham group were instrumented without pacing. After 2 weeks, all of the dogs underwent a thoracotomy operation and received epicardial gene painting. On post–gene transfer day 21, the animals underwent electrophysiology, histology, and molecular studies. The percentage of fibrosis in the Ad?ACE2 group was markedly lower than the percentage in the control and Ad?EGFP groups. Compared with the other groups, ACE2 expression was increased significantly in the Ad?ACE2 group. Compared with the sham and Ad?ACE2 groups, the expression levels of transforming growth factor??1 and Smad3 were significantly higher in the Ad?EGFP and control groups; however, the expression levels of Smad7 were lower in the atrial tissue as detected by Western blot and reverse transcription polymerase chain reaction. Conclusions Our results demonstrate that the overexpression of ACE2 inhibits atrial collagen accumulation and improves left atrial remodeling and function in a canine model of atrial fibrillation. Thus, targeted gene ACE2 therapy provides a promising approach for the treatment of atrial fibrillation. PMID:25792125

Zhou, Tingquan; Wang, Zhenglong; Fan, Jinqi; Chen, Shaojie; Tan, Zhen; Yang, Hanxuan; Yin, Yuehui

2015-01-01

357

Late-diastolic forward flow in the aorta induced by left atrial contraction.  

PubMed

Late-diastolic forward flow is a well-described phenomenon detectable by Doppler echocardiography in the pulmonary trunk. It is supported by a restrictive right ventricular diastolic function and by a low end-diastolic pulmonary artery pressure. A similar phenomenon for the left ventricle and the aorta has not been described. We report a case of a preterm infant with aortic stenosis and endocardial fibroelastosis, who underwent balloon valvuloplasty. Restrictive left ventricular diastolic filling led to high left atrial pressure (27 mm Hg) and a very pathologic ratio of early-to-late peak velocities (2.6) for an infant of 29 weeks' gestation. In combination with a low diastolic aortic pressure (24 mm Hg) caused by moderate aortic regurgitation after intervention, a late-diastolic forward flow was detectable in the aorta during left atrial contraction with pulsed Doppler echocardiography. PMID:10980091

Ewert, P; Nagdyman, N; Daehnert, I; Dittrich, S; Abdul-Khaliq, H; Berger, F; Lange, P E

2000-09-01

358

Right atrial appendage pacing in cardiac resynchronization therapy – haemodynamic consequences of interatrial conduction delay  

PubMed Central

The present case report describes a patient with an artificial mitral valve and dual chamber pacemaker implanted due to perioperative complete atrio-ventricular block. One year later an upgrade to cardiac resynchronization therapy (CRT) combined with ICD function was performed due to significant progression of heart failure symptoms. Beneficial effects of CRT are demonstrated, but unfavourable haemodynamic consequences of right atrial appendage pacing are also underlined. Important interatrial conduction delay during atrial paced rhythm resulted in a significant time difference between optimal sensed and paced atrio-ventricular delay (AVD). This report provides a practical outline how to determine the interatrial delay and the sensed-paced AVD offset under echocardiography in patients treated with CRT. PMID:22291812

D?browska-Kugacka, Alicja; Lewicka, Ewa; Faran, Anna; Koz?owski, Dariusz; Kempa, Maciej; Raczak, Grzegorz

2011-01-01

359

Reproducibility of Treadmill Exercise Data in Patients with Atrial Fibrillation  

Microsoft Academic Search

Serial submaximal treadmill tests are often used to evaluate the efficacy of therapy in patients with atrial fibrillation. Since the response to serial tests can be influenced by a ‘learning phenomenon’, we performed maximal exercise tests on 9 patients (mean age 63 ± 4 years) with chronic atrial fibrillation. Points of analysis for the initial and follow-up treadmill exercise tests

Mark D. Kraemer; Michael Sullivan; Edwin Atwood; Susan Forbes; Jonathan Myers; Victor Froelicher

1989-01-01

360

Surgical Closure of the Left Atrial Appendage – A Beneficial Procedure?  

Microsoft Academic Search

Background: Closure of the fibrillating left atrial appendage (LAA) has been recommended during valve surgery to decrease the risk of arterial embolism. However, patients undergoing surgical LAA closure have not systematically been reevaluated for complete LAA obliteration. Methods and Results: During a 12-month period, we studied 6 consecutive patients with paroxysmal (n = 3) or permanent (n = 3) atrial

Birke Schneider; Claudia Stöllberger; Hans H. Sievers

2005-01-01

361

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

362

Voltage-sensitive optical mapping for atrial fibrillation ablation treatment  

Microsoft Academic Search

In recent years radiofrequency energy sources have been utilized in patients with atrial fibrillation to ablate atrial tissue and restore normal sinus rhythm. Radiofrequency ablations significantly minimize time in surgery, and hence postoperative complications, but as yet do not duplicate the ablation transmurality achieved by \\

Michael D. Furman; J. D. Simonotto; T. M. Beaver; M. L. Spano; W. L. Ditto; Gang Liu; K. M. Kavanagh

2003-01-01

363

Effect of Dronedarone on Cardiovascular Events in Atrial Fibrillation  

Microsoft Academic Search

Background Dronedarone is a new antiarrhythmic drug that is being developed for the treatment of patients with atrial fibrillation. Methods We conducted a multicenter trial to evaluate the use of dronedarone in 4628 patients with atrial fibrillation who had additional risk factors for death. Patients were ran- domly assigned to receive dronedarone, 400 mg twice a day, or placebo. The

Stefan H. Hohnloser; Harry J. G. M. Crijns; Martin van Eickels; Christophe Gaudin; Richard L. Page; Christian Torp-Pedersen; Stuart J. Connolly; J. W. Goethe

2010-01-01

364

Atrial-Selective Sodium Channel Blockers: Do They Exist?  

PubMed Central

The risk of developing severe ventricular arrhythmias and/or organ toxicity by currently available drugs used to treat atrial fibrillation (AF) has prompted the development of atrial-selective antiarrhythmic agents. Until recently the principal focus has been on development of agents that selectively inhibit the ultra-rapid delayed rectifier outward potassium channels (IKur), taking advantage of the presence of these channels in atria but not ventricles. Recent experimental studies have demonstrated important atrioventricular differences in biophysical properties of the sodium channel and have identified sodium channel blockers such as ranolazine and chronic amiodarone that appear to take advantage of these electrophysiologic distinctions and act to specifically or predominantly depress sodium channel-mediated parameters in “healthy” canine atria versus ventricles. Atrial-selective/predominant sodium channel blockers such as ranolazine effectively suppress AF in experimental models of AF involving canine isolated right atrial preparations at concentrations that produce little to no effect on ventricular electrophysiologic parameters. These findings point to atrial-selective sodium channel block as a new strategy for the management of AF. The present review examines our current understanding of atrioventricular distinctions between atrial and ventricular sodium channels and our understanding of the basis for atrial selectively of the sodium channel blockers. A major focus will be on the ability of the atrial-selective sodium channel blocking properties of these agents, possibly in conjunction with IKur and/or IKr blocking properties, to suppress and prevent the reinduction of AF. PMID:18670368

Burashnikov, Alexander; Antzelevitch, Charles

2008-01-01

365

Alternative energy sources for atrial ablation: judging the new technology  

Microsoft Academic Search

n 1987 Dr James Cox introduced a new operation for treating atrial fibrillation. The Maze procedure cre- ated several incisions throughout both the left and right atria. These incisions were designed to block the multiple macroreentrant circuits felt to be responsible for atrial fibrillation. Over the years Dr Cox and his group had developed a successful paradigm for introducing opera-

Ralph J. Damiano

2010-01-01

366

[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

367

Differences in intracellular calcium homeostasis between atrial and ventricular myocytes  

Microsoft Academic Search

The role that Ca2+ plays in ventricular excitation contraction coupling is well defined and much is known about the marked differences in the spatiotemporal properties of the systolic Ca2+ transient between atrial and ventricular myocytes. However, to date there has been no systematic appraisal of the Ca2+ homeostatic mechanisms employed by atrial cells and how these compare to the ventricle.

A. P. Walden; K. M. Dibb; A. W. Trafford

2009-01-01

368

Gender Differences of Electrophysiological Characteristics in Focal Atrial Tachycardia  

Microsoft Academic Search

Gender differences of supraventricular tachycardias such as atrioventricular nodal re- entry, atrioventricular re-entry, and atrial fibrillation have been reported. There is little evidence of the effect of gender on focal atrial tachycardia (FAT). The study consisted of 298 patients who were referred to this institution for radiofrequency catheter ablation of FAT from October 1992 to April 2008 and included 156

Yu-Feng Hu; Jin-Long Huang; Tsu-Juey Wu; Satoshi Higa; Chun-Ming Shih; Ching-Tai Tai; Yenn-Jiang Lin; Shih-Lin Chang; Li-Wei Lo; Tuan Ta-Chuan; Chien-Jong Chang; Wen-Chin Tsai; Pi-Chang Lee; Hsuan-Ming Tsao; Sugako Ishigaki; Asuka Oyakawa; Shih-Ann Chen

2009-01-01

369

Association of Left Atrial Fibrosis Detected by Delayed-Enhancement  

E-print Network

Association of Left Atrial Fibrosis Detected by Delayed-Enhancement Magnetic Resonance Imaging to determine the association between left atrial (LA) fibrosis, detected using delayed-enhanced mag- netic, and not individual LA pathophysiological proper- ties. We aimed to determine the association between LA fibrosis

Utah, University of

370

Challenges Encountered During Closure of Atrial Septal Defects  

Microsoft Academic Search

Since the introduction of transcatheter interventional occlusion of atrial septal defects (ASDs) by King and coworkers, the device closure has become the standard treatment of selected atrial defects. Although it has become routine for standard clinical practice, increasing knowledge of intracardiac anatomy, modification of implantation techniques, and improvements in device designs are making this treatment modality increasingly applicable to a

W. Knirsch; A. Dodge-Khatami; E. Valsangiacomo-Buechel; M. Weiss; F. Berger

2005-01-01

371

Atrial Arrhythmias in Astronauts. Summary of a NASA Summit  

NASA Technical Reports Server (NTRS)

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

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

2011-01-01

372

Atrial fibrillation and gastroesophageal reflux disease: From the cardiologist perspective  

PubMed Central

We have read with interest the paper by Roman C. and colleagues discussing the relationship between gastroesophageal reflux disease and atrial fibrillation. The review is presenting the available evidence for the common pathogenic mechanisms. However, from a cardiologist perspective, some available data were not highlighted in the review, cardiovascular involvement in gastroesophageal reflux is less assessed. Hypertension, obesity or diabetes mellitus are substrate for left atrial remodeling that initiate and sustained atrial fibrillation development. One of the pathophysiologic mechanisms in atrial fibrillation is the presence of a trigger. Gastroesophageal reflux could be only a trigger for this arrhythmia. We believe that atrial fibrillation should be considered as possible extraesophageal syndrome in the gastroesophageal reflux classification. PMID:25780320

Floria, Mariana; Drug, Vasile Liviu

2015-01-01

373

Blood Pressure Control versus Atrial Fibrillation Management in Stroke Prevention.  

PubMed

Hypertension is one of the major risk factors for atrial fibrillation which in turn is the most prevalent concomitant condition in hypertensive patients. While both these pathological conditions are independent risk factors for stroke, the association of hypertension and atrial fibrillation increases the incidence of disabling strokes. Moreover, documented or silent atrial fibrillation doubles the rate of cardiovascular death. Lowering blood pressure is strongly recommended, particularly for primary stroke prevention. However, a relatively small percentage of hypertensive patients still achieve the recommended blood pressure goals. The management of atrial fibrillation with respect to stroke prevention is changing. New oral anticoagulants represent a major advancement in long-term anticoagulation therapy in non valvular atrial fibrillation. They have several benefits over warfarin, including improved adherence to the anticoagulation therapy. This is an important issue since non-adherence to stroke prevention medications is a risk factor for first and recurrent strokes. PMID:25893476

Savoia, Carmine; Sada, Lidia; Volpe, Massimo

2015-06-01

374

Biatrial multisite mapping of atrial premature complexes triggering onset of atrial fibrillation  

Microsoft Academic Search

Pulmonary veins are considered to be the most common origin of the focal activity that triggers the onset of atrial fibrillation (AF). However, little is known about the importance of ectopic activity located outside the pulmonary veins. This study included 45 patients (8 women and 37 men, mean age 55 ± 12 years) with paroxysmal (n = 25) and persistent

Claus Schmitt; Gjin Ndrepepa; Stefan Weber; Sebastian Schmieder; Sonja Weyerbrock; Michael Schneider; Martin R Karch; Isabel Deisenhofer; Jürgen Schreieck; Bernhard Zrenner; Albert Schömig

2002-01-01

375

Atrial Mapping and Radiofrequency Catheter Ablation in Patients With Idiopathic Atrial Fibrillation Electrophysiological Findings and Ablation Results  

Microsoft Academic Search

Background—Knowledge of the electrophysiological substrates and the cure of atrial fibrillation (AF) is still unsatisfac- tory. The goal of this study was to evaluate the electrophysiological features of idiopathic AF and their relationship to the results of radiofrequency (RF) catheter ablation of AF and the safety and effectiveness of this procedure. Methods and Results—Sixteen patients with idiopathic AF underwent atrial

Fiorenzo Gaita; Riccardo Riccardi; Marco Scaglione; Lucia Garberoglio; Renzo Antolini; Michele Kirchner; Filippo Lamberti; Elena Richiardi

376

Race-Ethnic Differences in Patent Foramen Ovale, Atrial Septal Aneurysm, and Right Atrial Anatomy Among Ischemic Stroke Patients  

Microsoft Academic Search

Background and Purpose—Stroke remains a substantial cause of mortality and morbidity in the United States. Racial differences in stroke incidence and mortality persist with well-known excesses among blacks. Information on stroke among Hispanics is limited. In particular, little is known about whether patent foramen ovale (PFO), atrial septal aneurysm (ASA), and other atrial anomalies associated with cryptogenic stroke differ among

Carlos J. Rodriguez; Shunichi Homma; Ralph L. Sacco; Marco R. Di Tullio; Robert R. Sciacca; J. P. Mohr

2010-01-01

377

Temporal dependence of the return of atrial mechanical function on the mode of cardioversion of atrial fibrillation to sinus rhythm  

Microsoft Academic Search

In conclusion, among patients with a clinical duration of AF of ?5 weeks, recovery of atrial mechanical function appears related to the mode of cardioversion: a more prompt return of atrial mechanical function was seen in patients undergoing successful pharmacologic cardioversion versus those undergoing successful electrical cardioversion after unsuccessful pharmacologic cardioversion.

Warren J. Manning; David I. Silverman; Sarah E. Katz; Marilyn F. Riley; Rosalie M. Doherty; Jiyl T. Munson; Pamela S. Douglas

1995-01-01

378

Disturbed Left Atrial Function is Associated with Paroxysmal Atrial Fibrillation in Hypertension  

PubMed Central

Background Hypertension is the most prevalent and modifiable risk factor for atrial fibrillation. The pressure overload in the left atrium induces pathophysiological changes leading to alterations in contractile function and electrical properties. Objective In this study our aim was to assess left atrial function in hypertensive patients to determine the association between left atrial function with paroxysmal atrial fibrillation (PAF). Method We studied 57 hypertensive patients (age: 53±4 years; left ventricular ejection fraction: 76±6.7%), including 30 consecutive patients with PAF and 30 age-matched control subjects. Left atrial (LA) volumes were measured using the modified Simpson's biplane method. Three types of LA volume were determined: maximal LA(LAVmax), preatrial contraction LA(LAVpreA) and minimal LA volume(LAVmin). LA emptying functions were calculated. LA total emptying volume = LAVmax?LAVmin and the LA total EF = (LAVmax-LAVmin )/LAVmax, LA passive emptying volume = LAVmax? LAVpreA and the LA passive EF = (LAVmax-LAVpreA)/LAVmax, LA active emptying volume = LAVpreA?LAVmin and LA active EF = (LAVpreA-LAVmin )/LAVpreA. Results The hypertensive period is longer in hypertensive group with PAF. LAVmax significantly increased in hypertensive group with PAF when compared to hypertensive group without PAF (p=0.010). LAAEF was significantly decreased in hypertensive group with PAF as compared to hypertensive group without PAF (p=0.020). A' was decreased in the hypertensive group with PAF when compared to those without PAF (p = 0.044). Conclusion Increased LA volume and impaired LA active emptying function was associated with PAF in untreated hypertensive patients. Longer hypertensive period is associated with PAF. PMID:24676227

Tenekecioglu, Erhan; Agca, Fahriye Vatansever; Ozluk, Ozlem Arican; Karaagac, Kemal; Demir, Serafettin; Peker, Tezcan; Kuzeytemiz, Mustafa; Senturk, Muhammed; Y?lmaz, Mustafa

2014-01-01

379

[Update on current care guideline: atrial fibrillation].  

PubMed

The prevalence and incidence of atrial fibrillation (AF) are increasing rapidly. Key recommendations in management of AF include prompt administration of oral anticoagulation to all patients with elevated risk of thromboembolic complications, proper use of antiarrhythmic drugs and invasive therapies in highly symptomatic patients and adequate rate control in patients with permanent AF. The selection between warfarin and the novel oral anticoagulants (apixaban, dabigatran, rivaroxaban) is based on careful evaluation of the benefits and disadvantages of the drugs in a given patient. PMID:25016666

Raatikainen, Pekka; Askonen, Kari; Halinen, Matti; Huikuri, Heikki; Koistinen, Juhani; Parikka, Hannu; Puurunen, Marja; Virtanen, Vesa

2014-01-01

380

Cor Triatriatum Sinister Identified after New Onset Atrial Fibrillation in an Elderly Man  

PubMed Central

A 73-year-old man with new onset atrial fibrillation with rapid ventricular response underwent transthoracic echocardiography that revealed an echogenic linear structure along the left atrium, suggestive of cor triatriatum sinister (CTS). CTS was confirmed with transesophageal echocardiography which demonstrated a proximal accessory atrium receiving pulmonary venous flow separated from a distal true atrium by a fibromuscular membrane with a large fenestration allowing flow between the chambers. In CTS, the left atrium is divided into proximal and distal chambers by a fenestrated fibromuscular septum. This cardiac anomaly accounts for 0.1% of cases of congenital heart disease and rarely presents in adults. CTS is primarily diagnosed with echocardiography and is associated with left atrial enlargement and development of atrial fibrillation. Treatment options depend on size of the communication between proximal and distal chambers, the gradient across the membrane, and the position of pulmonary veins. In some instances, surgical resection of the membrane that divides the left atrium is warranted. PMID:25614746

Zepeda, Ignacio A.; Morcos, Peter; Castellanos, Luis R.

2014-01-01

381

Recurrent atrial tachyarrhythmia triggered by percutaneous balloon rhizotomy of the trigeminal nerve.  

PubMed

Stimulation of sensory branches of the trigeminal nerve is known to cause sudden bradycardia (trigeminocardiac reflex). However we report a case where percutaneous balloon rhizotomy of the trigeminal ganglion provoked atrial tachyarrhythmias during two separate treatments. On both occasions the patient was treated with antiarrhythmic drugs and reverted to sinus rhythm within days. Our case demonstrates that surgery involving the trigeminal nerve may cause variable cardiovascular effects that are often clinically significant. Possible mechanisms and management of arrhythmias in this setting are discussed. PMID:15264739

Fowler, S J; Featherston, M

2004-06-01

382

Cyclical stretch induces structural changes in atrial myocytes  

PubMed Central

Atrial fibrillation (AF) often occurs in the presence of an underlying disease. These underlying diseases cause atrial remodelling, which make the atria more susceptible to AF. Stretch is an important mediator in the remodelling process. The aim of this study was to develop an atrial cell culture model mimicking remodelling due to atrial pressure overload. Neonatal rat atrial cardiomyocytes (NRAM) were cultured and subjected to cyclical stretch on elastic membranes. Stretching with 1 Hz and 15% elongation for 30 min. resulted in increased expression of immediate early genes and phosphorylation of Erk and p38. A 24-hr stretch period resulted in hypertrophy-related changes including increased cell diameter, reinduction of the foetal gene program and cell death. No evidence of apoptosis was observed. Expression of atrial natriuretic peptide, brain natriuretic peptide and growth differentiation factor-15 was increased, and calcineurin signalling was activated. Expression of several potassium channels was decreased, suggesting electrical remodelling. Atrial stretch-induced change in skeletal ?-actin expression was inhibited by pravastatin, but not by eplerenone or losartan. Stretch of NRAM results in elevation of stress markers, changes related to hypertrophy and dedifferentiation, electrical remodelling and cell death. This model can contribute to investigating the mechanisms involved in the remodelling process caused by stretch and to the testing of pharmaceutical agents. PMID:23617620

De Jong, Anne Margreet; Maass, Alexander H; Oberdorf-Maass, Silke U; De Boer, Rudolf A; Van Gilst, Wiek H; Van Gelder, Isabelle C

2013-01-01

383

Cyclical stretch induces structural changes in atrial myocytes.  

PubMed

Atrial fibrillation (AF) often occurs in the presence of an underlying disease. These underlying diseases cause atrial remodelling, which make the atria more susceptible to AF. Stretch is an important mediator in the remodelling process. The aim of this study was to develop an atrial cell culture model mimicking remodelling due to atrial pressure overload. Neonatal rat atrial cardiomyocytes (NRAM) were cultured and subjected to cyclical stretch on elastic membranes. Stretching with 1 Hz and 15% elongation for 30 min. resulted in increased expression of immediate early genes and phosphorylation of Erk and p38. A 24-hr stretch period resulted in hypertrophy-related changes including increased cell diameter, reinduction of the foetal gene program and cell death. No evidence of apoptosis was observed. Expression of atrial natriuretic peptide, brain natriuretic peptide and growth differentiation factor-15 was increased, and calcineurin signalling was activated. Expression of several potassium channels was decreased, suggesting electrical remodelling. Atrial stretch-induced change in skeletal ?-actin expression was inhibited by pravastatin, but not by eplerenone or losartan. Stretch of NRAM results in elevation of stress markers, changes related to hypertrophy and dedifferentiation, electrical remodelling and cell death. This model can contribute to investigating the mechanisms involved in the remodelling process caused by stretch and to the testing of pharmaceutical agents. PMID:23617620

De Jong, Anne Margreet; Maass, Alexander H; Oberdorf-Maass, Silke U; De Boer, Rudolf A; Van Gilst, Wiek H; Van Gelder, Isabelle C

2013-06-01

384

Imaging atrial arrhythmic intracellular calcium in intact heart  

PubMed Central

Abnormalities in intracellular Ca2+ signaling have been proposed to play an essential role in the pathophysiology of atrial arrhythmias. However, a direct observation of intracellular Ca2+ in atrial myocytes during atrial arrhythmias is lacking. Here, we have developed an ex vivo model of simultaneous Ca2+ imaging and electrocardiographic recording in cardiac atria. Using this system we were able to record atrial arrhythmic intracellular Ca2+ activities. Our results indicate that atrial arrhythmias can be tightly linked to intracellular Ca2+ waves and Ca2+ alternans. Moreover, we applied this strategy to analyze Ca2+ signals in the hearts of WT and knock-in mice harboring a ‘leaky’ type 2 ryanodine receptor (RyR2-R2474S). We showed that sarcoplasmic reticulum (SR) Ca2+ leak increases the susceptibility to Ca2+ alternans and Ca2+ waves increasing the incidence of atrial arrhythmias. Reduction of SR Ca2+ leak via RyR2 by acute treatment with S107 reduced both Ca2+ alternans and Ca2+ waves, and prevented atrial arrhythmias. PMID:24041536

Xie, Wenjun; Santulli, Gaetano; Guo, Xiaoxiao; Gao, Melanie; Chen, Bi-Xing; Marks, Andrew R.

2014-01-01

385

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

386

Emergency surgical approach to device emboli due to migration of the atrial septal defect occluder  

PubMed Central

Introduction Atrial septal defect (ASD) transcatheter occlusion techniques are now established as the preferred method and have become an alternative to surgery under extracorporeal circulation. In this study, we aimed to present our emergency surgical approach to cases of device embolization due to migration of the atrial septal defect occluder. Material and methods Between June 2009 and June 2011, 6 patients underwent emergency operations due to device emboli secondary to migration of the transcatheter atrial septal defect occluder during the early period. Mean age was 25.5 years (15–45) and 3 of the patients were female (50%). The diagnosis was made via transthoracic echocardiography (TTE) preoperatively. Results All of these 6 patients underwent emergency operations. Mean postoperative intensive care unit (ICU) stay was 2.2 days and mean hospital stay was 6 days. No early or late postoperative mortality was seen. Mean postoperative follow-up time was 19.3 months (range: 5–28 months). Early- and late-period TTE examinations showed no residual interatrial shunting. One patient developed a right atrial thrombus in the postoperative 22nd month as a complication of long-term follow-up. He was treated with anticoagulant therapy for 6 months with complete resolution at the TTE. Conclusions Transcatheter occlusion of secundum type ASD provides prominent clinical improvement, as well as a regression in dimensions of cardiac chambers. Nevertheless, this technique has drawbacks such as distal migration and residual shunts. Consequently, we think that unfavorable anatomy and device diameter are major issues in device migration. Oversizing also increases the migration risk. PMID:25097575

Yetkin, Ufuk; Akyildiz, Zehra Ilke; Gokalp, Orhan; Tetik, Omer; Lafci, Banu; Ergene, Oktay; Gurbuz, Ali

2014-01-01

387

Abnormal heart rate variability and atrial fibrillation after aortic surgery  

PubMed Central

Introduction Complete denervation of transplanted heart exerts protective effect against postoperative atrial fibrillation; various degrees of autonomic denervation appear also after transection of ascending aorta during surgery for aortic aneurysm. Objective This study aimed to evaluate if the level of cardiac denervation obtained by resection of ascending aorta could exert any effect on postoperative atrial fibrillation incidence. Methods We retrospectively analysed the clinical records of 67 patients submitted to graft replacement of ascending aorta (group A) and 132 with aortic valve replacement (group B); all episodes of postoperative atrial fibrillation occurred during the 1-month follow-up have been reported. Heart Rate Variability parameters were obtained from a 24-h Holter recording; clinical, echocardiographic and treatment data were also evaluated. Results Overall, 45% of patients (group A 43%, group B 46%) presented at least one episode of postoperative atrial fibrillation. Older age (but not gender, abnormal glucose tolerance, ejection fraction, left atrial diameter) was correlated with incidence of postoperative atrial fibrillation. Only among a subgroup of patients with aortic transection and signs of greater autonomic derangement (heart rate variability parameters below the median and mean heart rate over the 75th percentile), possibly indicating more profound autonomic denervation, a lower incidence of postoperative atrial fibrillation was observed (22% vs. 54%). Conclusion Transection of ascending aorta for repair of an aortic aneurysm did not confer any significant protective effect from postoperative atrial fibrillation in comparison to patients with intact ascending aorta. It could be speculated that a limited and heterogeneous cardiac denervation was produced by the intervention, creating an eletrophysiological substrate for the high incidence of postoperative atrial fibrillation observed. PMID:25859868

Compostella, Leonida; Russo, Nicola; D’Onofrio, Augusto; Setzu, Tiziana; Compostella, Caterina; Bottio, Tomaso; Gerosa, Gino; Bellotto, Fabio

2015-01-01

388

Psoriasis, electrocardiographic characteristics, and incidence of atrial fibrillation.  

PubMed

Psoriasis patients have an increased incidence of cardiovascular disease. Atrial fibrillation is the most common cardiac arrhythmia and is associated with increased morbidity and risk of stroke. In this study, we assessed the association between psoriasis, electrocardiographic characteristics, and incident atrial fibrillation. Two cohorts were studied to address this question. First, the electrocardiograms of 169 subjects with psoriasis and coronary heart disease were reviewed and matched to patients without psoriasis. The Framingham risk score for atrial fibrillation was calculated to predict incident atrial fibrillation. Second, a larger cohort of 2,078 patients with psoriasis was matched to 6,234 patients without psoriasis. In the first group, psoriasis patients had no significantly different electrocardiographic characteristics, but a trend towards a decreased predicted incidence of atrial fibrillation using the Framingham risk score (12.8 vs. 14.6 % over a 10-year period, P = 0.06), suggesting that patients with psoriasis do not have a higher prevalence of risk factors for atrial fibrillation based on established risk scores. In the second group, the 5-year incidence of atrial fibrillation among patients with psoriasis was 2.5, vs. 3.3 % for matched controls (P = 0.4). The rates of atrial fibrillation per 1,000 person-years ranged from 4.8 events/1,000 person-years for mild psoriasis to 5.4 for patients with moderate/severe psoriasis. On multivariable analysis, there remained no association between mild psoriasis (adjusted HR 1.32, 95 % CI 0.91-1.89) or moderate-to-severe psoriasis (adjusted HR 1.27, 95 % CI 0.54-3.03) and incident atrial fibrillation. PMID:24166719

Armstrong, April W; Azizi, Sameen; Wu, Julie; Harskamp, Caitlin T; Farrow, Jason; Johnson, Mary Ann N; Klem, Kristopher; Anderson, David; Armstrong, Ehrin J

2013-12-01

389

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, Frédéric; Hocini, Mélèze; Haïssaguerre, Michel; Jaïs, Pierre

2012-01-01

390

Right Atrial Metastatic Melanoma with Unknown Primaries  

PubMed Central

A 54-year-old male with history of anemia and rheumatoid arthritis presented with a three-month history of dyspnea on exertion and lower extremity edema. Patient was referred for a transthoracic echocardiogram that revealed a large right atrial mass with reduced ejection fraction of 40% and an incidental large liver mass. Subsequent cardiac MRI revealed a lobulated right atrial mass measuring 5.4?cm × 5.3?cm with inferior vena cava compression and adjacent multiple large liver lesions confirmed to be malignant melanoma through biopsy. Interestingly, no primaries were found in the patient. PET/CT imaging displayed hypermetabolic masses within the right atrium and liver that likely represent metastases, as well as bilateral pleural effusions, most likely due to heart failure. Preoperative coronary angiogram demonstrated perfusion to the mass by a dense network of neovasculature arising from the mid right coronary artery. The cardiac melanoma was surgically removed, and the right atrium was reconstructed with a pericardial patch. After surgery, all cardiac chambers appeared normal in size and function with associated moderate tricuspid regurgitation. The patient is currently being administered ipilimumab for systemic therapy of metastatic melanoma.

Kuriakose, Robin; Melvani, Rakhi; Gangadharan, Venkataramanan; Cowley, Michael

2015-01-01

391

Sample size estimates for atrial fibrillation endpoints.  

PubMed

This article reviews the current sample size requirements for studies evaluating the efficacy of atrial therapies. Sample sizes for several study designs and endpoints are presented. However, emphasis is given to studies conducted in patients with implantable devices in the light of new available data from recent trials involving such patients. Studies utilizing mortality require >5,000 patients followed for at least 2 years. Symptomatic episode recurrence represents a possible alternate endpoint but still requires >400 patients followed for 1 year. Parallel design studies for device atrial fibrillation (AF) burden and frequency endpoints were found to be of little value because they would require thousands of patients. In contrast, cross-over studies utilizing device AF burden or AF frequency endpoints provide the best option in terms of sample size and study duration. A 30% therapy efficacy (reduction in AF burden or frequency) can be detected with just a little over 100 patients followed for 6 months. Therefore, cross-over studies with device-based endpoints are a viable option to evaluate and screen possible new rhythm control treatments before evaluating their effect on clinical outcome variables that may require larger trials with longer follow-up times. PMID:15851141

Warman, Eduardo N; Grammatico, Andrea; Padeletti, Luigi

2004-07-01

392

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

PubMed Central

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

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

2012-01-01

393

Left atrial appendage occlusion by invagination and double suture technique.  

PubMed

Left atrial appendage (LAA) plays a crucial role as a source of atrial thrombus in patients with atrial fibrillation (AF). Thus, the need to close LAA becomes evident in patients with AF who undergo concomitant mitral valve surgery. Unfortunately, it has been reported a high rate of unsuccessful LAA occlusion, regardless of the technique employed.We propose a safe and simple method for LAA occlusion consisting in invagination of the appendage into the left atrium, followed by two sutures (purse string suture around the base of the LAA and a reinforce running suture). PMID:21684756

Hernandez-Estefania, Rafael; Levy Praschker, Beltran; Bastarrika, Gorka; Rabago, Gregorio

2012-01-01

394

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

395

[Interrelation between typical atrial flutter and atrial fibrillation: two sides of the same coin].  

PubMed

A range of clinical studies have shown that typical atrial flutter (AFI) is often accompanied by attacks of atrial fibrillation (AFib), and vice versa. Probably, these two forms of cardiac arrhythmia have common electrophysiological mechanisms. The combination of both forms is highly resistible to pharmacotherapy. Hybrid therapy including conservative treatment with antiarrhythmic drugs, catheter radiofrequency ablation and electrocardiostimulation is used widely and more effective in treatment of AFI accompanied by AFib. Up-to-date knowledge of heart electrophysiology has allowed substantial advancement in understanding interrelations between these two frequent arrhythmias, and made it possible to improve the results of treatment. However, it is not quite clear yet if there is an interconnection between the etiology of AFib and that of AFI, and what therapeutic strategy should be applied to patients with the combination of AFI and AFib. PMID:17601036

Khubulava, G G; Didenko, M V

2007-01-01

396

Development of a transgenic goat model wih cardiac-specific overexpression of transforming growth factor - {beta} 1 to study the relationship between atrial fibrosis and atrial fibrillation  

Technology Transfer Automated Retrieval System (TEKTRAN)

Studies on patients, large animal models and transgenic mouse models have shown a strong association of atrial fibrosis with atrial fibrillation (AF). However, it is unclear whether there is a causal relationship between atrial fibrosis and AF or whether these events appear as a result of independen...

397

Migration and right atrial perforation of an Accufix atrial lead retention wire following partial lead removal during myomectomy.  

PubMed

A 36-year-old man with a history of hypertrophic obstructive cardiomyopathy presented to the emergency room with "stabbing" chest pain. He had undergone dual-chamber pacemaker implantation in 1993 using an atrial lead (Accufix; Telectronics; Englewood, Colo) and a myomectomy in 1996 during which the distal portion of the atrial lead was removed. Digital fluoroscopy revealed that the retention wire had migrated out of the remaining atrial lead and perforated the right atrium. The retention wire was successfully removed percutaneously. The need for complete removal of the retention wire in the Accufix lead at the time of open-heart surgery is emphasized. PMID:9726760

Gerstenfeld, E P; Balarajan, Y; Cooke, R; Mittleman, R S

1998-08-01

398

Myxoma Virus M064 Is a Novel Member of the Poxvirus C7L Superfamily of Host Range Factors That Controls the Kinetics of Myxomatosis in European Rabbits  

PubMed Central

The myxoma virus (MYXV) carries three tandem C7L-like host range genes (M062R, M063R, and M064R). However, despite the fact that the sequences of these three genes are similar, they possess very distinctive functions in vivo. The role of M064 in MYXV pathogenesis was investigated and compared to the roles of M062 and M063. We report that M064 is a virulence factor that contributes to MYXV pathogenesis but lacks the host range properties associated with M062 and M063. PMID:22379095

Liu, Jia; Wennier, Sonia; Moussatche, Nissin; Reinhard, Mary; Condit, Richard

2012-01-01

399

Population pharmacokinetics of vernakalant hydrochloride injection (RSD1235) in patients with atrial fibrillation or atrial flutter.  

PubMed

Vernakalant hydrochloride is a novel, predominantly atrial-selective antiarrhythmic drug that effectively and rapidly terminates atrial fibrillation (AF). Plasma vernakalant concentration data from 5 phase 2 and 3 clinical trials of vernakalant in patients with AF or atrial flutter and a phase 1 study in healthy volunteers were used to construct a population pharmacokinetic model. Plasma vernakalant concentration-time data were best fit by a 2-compartment mammillary model, with rapid first-order elimination from the central compartment. Median systemic clearance was 0.35 L/h/kg (or 28 L/h for an 80-kg patient), with intersubject variability estimated to be 40%. Clearance was significantly influenced by CYP2D6 genotype, age, serum creatinine concentration, and subject status (patient vs volunteer). The intercompartmental clearance was also influenced by subject status, whereas the volumes of the central compartment and peripheral compartment were unaffected by any covariates. Based on the final pharmacokinetic model, the area under the plasma vernakalant concentration-time curve from 0 to 90 minutes was estimated to be 15% higher in CYP2D6 poor metabolizers than extensive metabolizers, with age and serum creatinine having much smaller influences on exposure. These data suggest that dose adjustments based on patient characteristics, including use of concomitant drugs, are unnecessary for intravenous vernakalant. PMID:21659624

Mao, Zhongping Lily; Townsend, Robert W; Gao, Yuying; Wheeler, Jeffrey J; Kastrissios, Helen; Keirns, James

2012-07-01

400

Developing an atrial activity-based algorithm for detection of atrial fibrillation.  

PubMed

In this study we propose a novel atrial activity-based method for atrial fibrillation (AF) identification that detects the absence of normal sinus rhythm (SR) P-waves from the surface ECG. The proposed algorithm extracts nine features from P-waves during SR and develops a statistical model to describe the distribution of the features. The Expectation-Maximization algorithm is applied to a training set to create a multivariate Gaussian Mixture Model (GMM) of the feature space. This model is used to identify P-wave absence (PWA) and, in turn, AF. An optional post-processing stage, which takes a majority vote of successive outputs, is applied to improve classier performance. The algorithm was tested on 20 records in the MIT-BIH Atrial Fibrillation Database. Classification combining seven beats showed a sensitivity of 99.28%, a specificity of 90.21%. The presented algorithm has a classification performance comparable to current Heartrate-based algorithms yet is rate-independent and capable of making an AF determination in a few beats. PMID:25569895

Ladavich, Steven; Ghoraani, Behnaz

2014-01-01

401

Arterial-atrial coupling in untreated hypertension.  

PubMed

Abstract Recently, there has been growing interest in an interplay of vascular mechanics and heart function (arterial-ventricular-atrial coupling). The contribution of arterial stiffness (AS) to left atrial (LA) enlargement is unclear. The aim of this study was to verify whether the association between carotid AS and LA volume in untreated arterial hypertension is independent of such confounders as age, sex, body mass index (BMI), blood pressure, left ventricular hypertrophy (LVH), left ventricular (LV) diastolic and systolic function. The study included 133 patients, among them 107 individuals with hypertension (51 men and 56 women, mean age 56.8 ± 10.3 years) and 26 matched controls. Each patient was subjected to echocardiography, ultrasonographic measurement of mean carotid intima-media thickness (IMT) and echo-tracking assessment of AS and wave reflection. LA volume was calculated by ellipsoid method. The indexed LA volume showed significant linear correlations with age (r = 0.32; p < 0.05), BMI (r = 0.21; p < 0.05), pulse pressure (r = 0.26; p < 0.05), B-type natriuretic peptide (r = 0.64; p < 0.05), LV end-diastolic volume (r = 0.42; p < 0.05), LV mass index (LVMI; r = 0.58; p < 0.05), septum thickness (r = 0.40; p < 0.05), posterior wall thickness (r = 0.34; p < 0.05), early filling wave of mitral inflow (E; r = 0.30; p < 0.05), early diastolic myocardial velocity of mitral annulus (e'; r = - 0.22; p < 0.05), E/e' ratio (r = 0.45; p < 0.05), IMT (r = 0.26; p < 0.05) and augmentation index (AI; r = 0.27; p < 0.05). Progressive multivariate analysis identified LVMI, age, AI and BMI as independent determinants of indexed LA volume in patients with arterial hypertension. The study showed the significant relationship between wave reflection expressed by AI and LA structural remodeling, which supports the hypothesis of arterial-atrial coupling in hypertension. PMID:25545339

Jaroch, Joanna; Rzyczkowska, Barbara; Boci?ga, Zbigniew; ?oboz-Rudnicka, Maria; Kruszy?ska, Ewa; Rychard, Wojciech; Dudek, Krzysztof; Por?ba, Rafa?; ?oboz-Grudzie?, Krystyna

2015-04-01

402

Patient's Guide to Antithrombotic Therapy in Atrial Fibrillation  

MedlinePLUS

... kinds of blood thinners used in atrial brillation? Aspirin Clopidogrel (Plavix) Warfarin (Coumadin) Dabigatran (Pradaxa) Rivaroxaban (Xarelto) ... main features of these blood thinners? Antiplatelet drugs (aspirin, clopidogrel [Plavix]) Aspirin is taken as a pill ...

403

Predictors of fracture in the Accufix Atrial "J" lead.  

PubMed

The Accufix atrial lead has a "J"-shaped retention wire at the distal end that has been reported to fracture. Our findings suggest that the more deformed the J, the higher the incidence of fracture. PMID:9230172

Saliba, B C; Ardesia, R J; John, R M; Venditti, F J; Schoenfeld, M H

1997-07-15

404

A Contemporary Review on the Genetic Basis of Atrial Fibrillation  

PubMed Central

Atrial fibrillation is the most common sustained cardiac arrhythmia, and affected individuals suffer from increased rates of heart failure, stroke, and death. Despite the enormous clinical burden that it exerts on patients and health care systems, contemporary treatment strategies have only modest efficacy that likely stems from our limited understanding of its underlying pathophysiology. Epidemiological studies have provided unequivocal evidence that the arrhythmia has a substantial heritable component. Subsequent investigations into the genetics underlying atrial fibrillation have suggested that there is considerable interindividual variability in the pathophysiology characterizing the arrhythmia. This heterogeneity may partly account for the poor treatment efficacy of current therapies. Subdividing atrial fibrillation into mechanistic subtypes on the basis of genotype illustrates the heterogeneous nature of the arrhythmia and may ultimately help guide treatment strategies. A pharmacogenetic approach to the management of atrial fibrillation may lead to dramatic improvements in treatment efficacy and improved patient outcomes PMID:24932358

2014-01-01

405

Radial approach: a new concept in surgical treatment for atrial fibrillation I. Concept, anatomic and physiologic bases and development of a procedure  

Microsoft Academic Search

Background. The maze procedure cures atrial fibrillation; however, it isolates the pulmonary vein area and results in discordant activation in certain adjacent left atrial segments, which affects left atrial function. To preserve a more physiologic atrial transport function, we developed a new concept of surgical treatment for atrial fibrillation—the radial approach. The atrial incisions radiate from the sinus node toward

Takashi Nitta; Richard Lee; Richard B Schuessler; John P Boineau; James L Cox

1999-01-01

406

Stroke and atrial fibrillation: is stroke prevention treatment appropriate beforehand?  

PubMed Central

OBJECTIVE—To undertake a pilot study before conducting a large European multicentre prospective study, to determine the proportion of patients with atrial fibrillation who were not receiving antithrombotic treatment before stroke onset, and their characteristics.?DESIGN AND PATIENTS—The stroke in atrial fibrillation ensemble (SAFE) I study was an observational study conducted in 213 patients with atrial fibrillation consecutively admitted in 1997 to three European centres for an acute stroke or transient ischaemic attack (TIA). It was determined whether they were receiving prior antithrombotic treatment.?RESULTS—Atrial fibrillation was known before stroke in 148 patients (69.5%). Of 213 patients, 34 (16.0%) were receiving anticoagulation treatment before stroke, but only six had an international normalised ratio between 2.0 and 3.5; 65 (30.5%) were receiving antiplatelet treatment; and three (1.4%) were receiving both anticoagulation and antiplatelet treatment. Of 137 patients eligible for oral anticoagulation, 108 (78.8%) did not receive treatment. Of 142 patients eligible for any antithrombotic treatment, 62 (43.7%) were not treated. The logistic regression analysis, assuming anticoagulation treatment as a dependent variable, found digoxin treatment, absence of arterial hypertension, mitral stenosis, and cardioversion as independent factors. Assuming any antithrombotic treatment as a dependent variable, previously known atrial fibrillation, lower age, being a non-smoker, and absence of arterial hypertension were found to be independent factors.?CONCLUSION—More than half of the patients with atrial fibrillation admitted for acute stroke or TIA were not receiving any antithrombotic treatment beforehand. New onset atrial fibrillation and contraindications account for a minority of non-prescriptions; thus, other reasons should be identified to improve stroke prevention in the community.???Keywords: stroke; atrial fibrillation; anticoagulant treatment; antiplatelet treatment PMID:10525509

Deplanque, D; Corea, F; Arquizan, C; Parnetti, L; Mas, J; Gallai, V; Leys, D; the, S

1999-01-01

407

Atrial pacing leads: the clinical contribution of steroid elution.  

PubMed

Although the original atrial pacing leads were passive fixation and J shaped for right atrial appendage placement, the subsequent development of the active fixation screw-in lead found favor because of a perceived low incidence of lead dislodgment and a wider selection of atrial pacing sites. A bipolar atrial lead study was undertaken to compare the long-term atrial implant data in 215 patients. Study leads comprised one passive fixation, steroid-eluting lead (Medtronic CapSure SP, 119 patients) and three nonsteroid-eluting leads; two active fixation (Medtronic BISPING model 4058, 30 patients; and Telectronics ACCUFIX model 330-801, 44 patients) and one passive fixation (Telectronics ENCOR model 330-854, 22 patients). Bipolar atrial voltage stimulation thresholds and electrograms were measured using the Telectronics META DDDR immediately postimplantation, and at 1-, 3-, 6-, 12-, and 18-month follow-up. There were 135 males and the mean age 68 years. The incidence of lead dislodgment was 4% for active fixation and 2% for passive fixation. All nonsteroid leads showed a typical rise in stimulation threshold with the highest being the ACCUFIX followed by the BISPING and ENCOR. The steroid-eluting CapSure SP, however, demonstrated a flat response with 98% of leads at 18 months having a value < or = 1.3 volts allowing voltage programming to 2.5 volts (2:1 safety ratio). Telemeted electrograms showed no differences for all leads at all visits. For low voltage atrial pacing with a low incidence of dislodgment and satisfactory atrial sensing, the steroid-eluting passive fixation lead is superior to all nonsteroid-eluting leads. PMID:7491303

Mond, H G; Hua, W; Wang, C C

1995-09-01

408

Advances in Imaging for Atrial Fibrillation Ablation  

PubMed Central

Over the last fifteen years, our understanding of the pathophysiology of atrial fibrillation (AF) has paved the way for ablation to be utilized as an effective treatment option. With the aim of gaining more detailed anatomical representation, advances have been made using various imaging modalities, both before and during the ablation procedure, in planning and execution. Options have flourished from procedural fluoroscopy, electroanatomic mapping systems, preprocedural computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and combinations of these technologies. Exciting work is underway in an effort to allow the electrophysiologist to assess scar formation in real time. One advantage would be to lessen the learning curve for what are very complex procedures. The hope of these developments is to improve the likelihood of a successful ablation procedure and to allow more patients access to this treatment. PMID:22091384

D'Silva, Andrew; Wright, Matthew

2011-01-01

409

Cocaine causes atrial Purkinje fiber damage.  

PubMed

Comparisons of atrial tissues from Syrian hamster offspring born from cocaine-treated mothers during the last days of pregnancy with sham-treated ones demonstrate irreversible focal ischemic damage in the Purkinje myofibers and minor endocardial damages as well as minute cardiomyocyte vacuolization. These defects are consistent with the pharmacotoxicity of cocaine or its metabolites. The damaged Purkinje myocytes apparently remain in contact with adjacent cardiomyocytes but undergo autolytic process similar to that found in autoschizic cell death. Adjacent cell type(s) appear to segregate or engulf the injured cells. Data collected in this report demonstrate why clinical bradyarrhythmias, arrhythmias, or sudden death as cardiac arrest can be found in pre- and postnatal cocaine-abused babies as well as those found in young individuals caused by acute or chronic cocaine abuse. PMID:20192706

Gilloteaux, Jacques; Ekwedike, Nelson N

2010-04-01

410

Bleeding risk prediction models in atrial fibrillation.  

PubMed

Novel, nonvitamin K antagonist oral anticoagulants (OACs) have demonstrated similar or superior efficacy to warfarin for ischemic stroke prevention in patients with atrial fibrillation (AF). As the prevalence of AF rises in a growing elderly population, these agents are becoming central to the routine practice of clinicians caring for these patients. Though the benefits are clear, the decision to treat the elderly patient with AF with long-term oral OACs is often a dilemma for the clinician mindful of the risk of major bleeding. Several bleeding risk prediction models have been created to help the clinician identify patients for whom the risk of bleeding is high, and would potentially outweigh the benefits of OAC therapy. In this review, we discuss the features of 8 bleeding risk prediction models, including the recently described HEMORR2HAGES, HAS-BLED, and ATRIA models, and approaches to assessing bleeding risk in clinical practice. PMID:24264434

Thomas, Isac C; Sorrentino, Matthew J

2014-01-01

411

The role of rotors in atrial fibrillation  

PubMed Central

Despite significant advances in our understanding of atrial fibrillation (AF) mechanisms in the last 15 years, ablation outcomes remain suboptimal. A potential reason is that many ablation techniques focus on anatomic, rather than patient-specific functional targets for ablation. Panoramic contact mapping, incorporating phase analysis, repolarization and conduction dynamics, and oscillations in AF rate, overcomes many prior difficulties with mapping AF. This approach provides evidence that the mechanisms sustaining human AF are deterministic, largely due to stable electrical rotors and focal sources in either atrium. Ablation of such sources (Focal Impulse and Rotor Modulation: FIRM ablation) has been shown to improve ablation outcome compared with conventional ablation alone; independent laboratories directly targeting stable rotors have shown similar results. Clinical trials examining the role of stand-alone FIRM ablation are in progress. Looking forward, translating insights from patient-specific mapping to evidence-based guidelines and clinical practice is the next challenge in improving patient outcomes in AF management. PMID:25713729

Swarup, Vijay; Narayan, Sanjiv M.

2015-01-01

412

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

413

Telocytes in human isolated atrial amyloidosis: ultrastructural remodelling  

PubMed Central

Abstract The human heart can be frequently affected by an organ-limited amyloidosis called isolated atrial amyloidosis (IAA). IAA is a frequent histopathological finding in patients with long-standing atrial fibrillation (AF). The aim of this paper was to investigate the ultrastructure of cardiomyocytes and telocytes in patients with AF and IAA. Human atrial biopsies were obtained from 37 patients undergoing cardiac surgery, 23 having AF (62%). Small fragments were harvested from the left and right atrial appendages and from the atrial sleeves of pulmonary veins and processed for electron microscopy (EM). Additional fragments were paraffin embedded for Congo-red staining. The EM examination certified that 17 patients had IAA and 82% of them had AF. EM showed that amyloid deposits, composed of characteristic 10-nm-thick filaments were strictly extra-cellular. Although, under light microscope some amyloid deposits seemed to be located within the cardiomyocyte cytoplasm, EM showed that these deposits are actually located in interstitial recesses. Moreover, EM revealed that telopodes, the long and slender processes of telocytes, usually surround the amyloid deposits limiting their spreading into the interstitium. Our results come to endorse the presumptive association of AF and IAA, and show the exclusive, extracellular localization of amyloid fibrils. The particular connection of telopodes with amyloid deposits suggests their involvement in isolated atrial amyloidosis and AF pathogenesis. PMID:21040457

Mandache, E; Gherghiceanu, M; Macarie, C; Kostin, S; Popescu, L M

2010-01-01

414

Atrial fibrillation with small subcortical infarcts  

PubMed Central

OBJECTIVES—To evaluate the characteristics of cardioembolic small (maximum lesion diameter<1.5 cm) subcortical infarcts (SSI) in patients with atrial fibrillation (AF).?METHODS—Twenty seven patients with chronic AF and an isolated SSI established by CT/MRI in the anterior circulation (SSI-AF group) were evaluated and their characteristics compared with those of 45 age matched (±1 year) patients with SSI, but no arterial or cardiac embolic source (SSI-control group). Using the criterion of the presence or absence of established risk factors (hypertension or diabetes mellitus) for small artery disease (SAD), the SSI-AF group we also subdivided into two groups, SSI-AF-SAD+ (n=22) and SSI-AF-SAD? (n=5) and their characteristics compared.?RESULTS—Although the lack of any significant difference in the distribution of hypertension and diabetes mellitus between the SSI-AF and SSI-control groups emphasises SAD as a common cause of infarct in SSI-AF, the presence of AF—together with the higher frequency of neuropsychological disturbances in the SSI-AF group versus the SSI-control group (15% v 2%; p=0.066)—favours cardioembolism as a potential cause of infarct in several patients. The characteristic factors seen more often in the SSI-AF-SAD? group compared with the SSI-AF-SAD+ group were secondary haemorrhagic transformation, faciobrachial pure motor weakness, subinsular involvement, and better recovery of neurological deficits.?CONCLUSIONS—The study suggests that either SAD or cardioembolism can be the cause of SSI in patients with AF. Atrial fibrillation is not always coincidental in patients with SSI and a clinical lacunar stroke. Certain clinical and radiological findings may be useful in differentiating cardioembolism from SAD in patients with SSI.?? PMID:11181856

Jung, D; Devuyst, G; Maeder, P; Bogousslavsky, J

2001-01-01

415

Left ventricular fibrosis in atrial fibrillation.  

PubMed

Excessive atrial fibrosis is involved in the pathogenesis of atrial fibrillation (AF), but little is known of left ventricular (LV) fibrotic status in patients with AF. In the present study, we investigated the presence of abnormal LV fibrosis in AF, its effect on cardiac function, a possible association with arterial stiffness (i.e., systemic cardiovascular fibrosis), and the parameters of endothelial activation, dysfunction, and damage. We also studied whether LV fibrosis could be linked to the future risk of AF onset. In a cross-sectional study, the severity of LV fibrosis was assessed by echocardiographic acoustic densitometry in patients with permanent AF (n = 49), patients with paroxysmal AF (n = 44), AF-free "disease controls" (n = 42) and "healthy controls" (n = 48). Arterial stiffness (pulse wave velocity), plasma markers of endothelial activation (E-selectin), endothelial damage/dysfunction (von Willebrand factors), and microvascular endothelial function (laser Doppler flowmetry) were quantified. In a longitudinal study, 93 patients with pacemakers (22 with AF) were followed up for ?1 year to assess the predictive value of LV fibrosis for the development of new-onset AF. More severe LV fibrosis was present in both paroxysmal and permanent AF than in the AF-free controls (p <0.001), with more LV fibrosis in permanent than in paroxysmal AF (p = 0.002). The severity of LV fibrosis in AF wais independently associated with diastolic dysfunction (p = 0.03), but not with LV contractility, arterial stiffness, or endothelial damage/dysfunction. In conclusion, LV fibrosis might contribute to LV diastolic dysfunction and the high prevalence of heart failure with preserved ejection fraction in subjects with AF. PMID:23332595

Shantsila, Eduard; Shantsila, Alena; Blann, Andrew D; Lip, Gregory Y H

2013-04-01

416

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

417

Preexisting atrial fibrillation and cardiac complications after liver transplantation.  

PubMed

Atrial fibrillation (AF) is the most common cardiac arrhythmia, and it is associated with increased cardiovascular morbidity and all-cause mortality. Our aim was to determine the impact of preexisting AF on patients undergoing liver transplantation (LT). A retrospective case-control study was performed. Records from patients who underwent LT between January 2005 and December 2008 at Mayo Clinic Florida were reviewed. Patients with preexisting AF were identified and matched to patients who did not have a diagnosis of AF. Thirty-two of 717 LT recipients (4.5%) had AF before LT. These patients were compared to a control group of 63 LT recipients. Pre-LT left ventricular hypertrophy (P?=?0.03), a history of congestive heart failure (P?=?0.04), and a history of stroke or transient ischemic attack (P?=?0.03) were significantly more prevalent in patients with AF versus controls. Intraoperative adverse cardiac events (P?=?0.02) and AF-related adverse postoperative events (P?

Bargehr, Johannes; Trejo-Gutierrez, Jorge F; Patel, Tushar; Rosser, Barry; Aranda-Michel, Jaime; Yataco, Maria L; Taner, C Burcin

2015-03-01

418

Elevated platelet microparticle levels in valvular atrial fibrillation.  

PubMed

Platelet activation occurs in peripheral blood of patients with rheumatic mitral stenosis (MS) and atrial fibrillation (AF) and could be related to abnormal thrombogenesis. However, the plasma level of platelet microparticles (PMPs), a marker of platelet activation, in patients with valvular AF remains unresolved. We performed a case control study of 20 patients with chronic rheumatic MS and chronic long AF and 10 healthy volunteers who were in sinus rhythm. Peripheral plasma levels of PMP were assessed by quantifying CD41-positive microparticles by flow cytometry. The mitral valve area was calculated by means of the Doppler pressure half-time method. The levels of circulating PMP were elevated significantly in valvular AF patients when compared with controls (12.36+/-5.51 x 10(5)/ml versus 7.56+/-0.86 x 10(5)/ml, P=0.011). Correlation analysis demonstrated that there was a significantly direct relationship between the severity of MS and PMP levels (r=-0.507, P=0.004). We conclude that in patients with rheumatic MS and AF, there is evidence of platelet activation detected by high PMP levels which have a significantly direct relationship with the severity of MS. PMID:19941743

Azzam, Hanan; Zagloul, Maged

2009-12-01

419

High 18F-FDG Uptake in a Systemic Right Ventricle After Atrial Switch.  

PubMed

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

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

2015-05-01

420

Atrial myocarditis as a cause of sinus arrest in a dog.  

PubMed

A 10-year-old male cairn terrier cross was presented with a history of myxomatous mitral valve disease diagnosed six months previously and with a four-week history of intermittent collapse. On 24 hour electrocardiograph (Holter) analysis, periods of no discernable electrical cardiac activity, which coincided with three collapsing episodes, were identified. Unfortunately, on re-presentation for removal of the Holter monitor, the dog collapsed and died. A post-mortem examination was conducted, and histology of the right and left atrium showed evidence of myocarditis. This is the first reported case, to our knowledge, of collapse because of electrical asystole in a dog with atrial myocarditis. PMID:17425699

Woolley, R; Blundell, R; Else, R; Corcoran, B; Devine, C; French, A

2007-08-01

421

Presentation of atrial fibrillation following oral dexamethasone treatment in a NF2 patient.  

PubMed

Atrial fibrillation (A-fib) is the most common cardiac arrhythmia which is associated with an increased risk of mortality secondary to stroke and coronary artery disease. Intravenous glucocorticoid therapy (such as dexamethasone and hydrocortisone) is frequently used peri-operatively in patients undergoing cardiac surgery to prevent A-fib. Dexamethasone is also frequently used in patients with single or bilateral vestibular schwannomas (VS), to reduce tumor swelling both before and after radiation treatment. We describe a case of A-fib in a 50 year-old female patient with neurofibromatosis type 2 (NF-2), who was prescribed dexamethasone for post-radiation tumor edema. PMID:24888793

Hebb, Andrea L O; Imran, Syed Ali; Morris, David P; Bance, Manohar; Walling, Simon

2014-01-01

422

Surgical Extraction of an Embolized Atrial Septal Defect Occluder Device into Pulmonary Artery after Percutaneous Closure  

PubMed Central

An atrial septal defect is the most common type of congenital heart disease among adults. Surgical repair or percutaneous closure of the defect is the treatment options. Even though percutaneous closure seems to be less risky than surgical repair, it may result in fatal complications like device embolism, cardiac perforation and tamponade. Herein we report a case of the embolism of a device into the pulmonary artery after one hour of percutaneous closure in which the embolized device was surgically removed and the defect was closed with a pericardial patch. PMID:23614100

Kaygin, Mehmet Ali; Ipek, Emrah; Ulusoy, Fatih Rifat; Erkut, Bilgehan

2013-01-01

423

A rare manifestation of atrial fibrillation in the presence of Wolff-Parkinson-White syndrome: tachycardia-induced cardiomyopathy.  

PubMed

We report a 68-year-old man who presented with heart failure and atrial fibrillation (AF) with rapid ventricular response and wide QRS complexes. Tachycardia-induced cardiomyopathy (TIC) due to persistent AF developing on the basis of Wolff-Parkinson-White (WPW) syndrome was considered. Signs and symptoms of heart failure improved with restoration of sinus rhythm. This case suggested that persistent AF in a patient with WPW syndrome is one of the rare causes of TIC. PMID:24643151

De?irmencio?u, Aleks; Karaku?, Gültekin; Baysal, Erkan; Zencirci, Ertu?rul; Cakmak, Nazmiye

2014-03-01

424

Lone atrial fibrillation: electrophysiology, risk factors, catheter ablation and other non-pharmacologic treatments.  

PubMed

Atrial fibrillation occurring in the absence of cardiovascular disease in individuals younger than 60 years is known as lone atrial fibrillation. Nearly 1-12% of atrial fibrillation is considered to be lone atrial fibrillation. As our understanding of atrial fibrillation grows, we wonder as to whether there is such as thing as "lone" atrial fibrillation? We know that male sex, obesity, obstructive sleep apnea, alcohol consumption and endurance sports increase the risk of developing lone atrial fibrillation. Family history of atrial fibrillation increases the risk strongly and there are several recognized mutations that are causative of lone atrial fibrillation. Common triggers for origin of atrial fibrillation are the pulmonary veins. The atrial substrate provides the reentry circuits for perpetuating the arrhythmia. The autonomic nervous system is a key modulator and allows the continuation of the atrial fibrillation. Catheter ablation has been very effective in the treatment of this condition. The ablation procedure involves isolation of the pulmonary veins, antrum, complex fractionated electrograms and other sites. Alternatively surgical techniques can be used to isolate the pulmonary veins and surgical techniques have evolved to minimally invasive procedures and these are as effective as catheter ablation. Early intervention improves the left atrial remodeling and may lead to fewer recurrences. PMID:25175093

Kanmanthareddy, Arun; Emert, Martin P; Pimentel, Rhea C; Reddy, Yeruva Madhu; Bommana, Sudharani; Atkins, Donita; Tadakamalla, Rachana; Lakkireddy, Thanmay; Lakkireddy, Dhanunjaya

2015-01-01

425

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

PubMed

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

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

2015-03-01

426

Myxoma viral serpin, Serp-1, inhibits human monocyte adhesion through regulation of actin-binding protein filamin B.  

PubMed

Serp-1 is a secreted myxoma viral serine protease inhibitor (serpin) with proven, highly effective, anti-inflammatory defensive activity during host cell infection, as well as potent immunomodulatory activity in a wide range of animal disease models. Serp-1 binds urokinase-type plasminogen activator (uPA) and the tissue-type PA, plasmin, and factor Xa, requiring uPA receptor (uPAR) for anti-inflammatory activity. To define Serp-1-mediated effects on inflammatory cell activation, we examined the association of Serp-1 with monocytes and T cells, effects on cellular migration, and the role of uPAR-linked integrins and actin-binding proteins in Serp-1 cellular responses. Our results show that Serp-1 associates directly with activated monocytes and T lymphocytes, in part through interaction with uPAR (P<0.001). Serp-1, but not mammalian serpin PA inhibitor-1 (PAI-1), attenuated cellular adhesion to the extracellular matrix. Serp-1 and PAI-1 reduced human monocyte and T cell adhesion (P<0.001) and migration across endothelial monolayers in vitro (P<0.001) and into mouse ascites in vivo (P<0.001). Serp-1 and an inactive Serp-1 mutant Serp-1(SAA) bound equally to human monocytes and T cells, but a highly proinflammatory mutant, Serp-1(Ala(6)), bound less well to monocytes. Serp-1 treatment of monocytes increased expression of filamin B actin-binding protein and reduced CD18 (beta-integrin) expression (P<0.001) in a uPAR-dependent response. Filamin colocalized and co-immunoprecipitated with uPAR, and short interference RNA knock-down of filamin blocked Serp-1 inhibition of monocyte adhesion. We report here that the highly potent, anti-inflammatory activity of Serp-1 is mediated through modification of uPAR-linked beta-integrin and filamin in monocytes, identifying this interaction as a central regulatory axis for inflammation. PMID:19052145

Viswanathan, Kasinath; Richardson, Jakob; Togonu-Bickersteth, Babajide; Dai, Erbin; Liu, Liying; Vatsya, Pracha; Sun, Yun-ming; Yu, Jeff; Munuswamy-Ramanujam, Ganesh; Baker, Henry; Lucas, Alexandra R

2009-03-01

427

Pharmacological manipulation of the akt signaling pathway regulates myxoma virus replication and tropism in human cancer cells.  

PubMed

Viruses have evolved an assortment of mechanisms for regulating the Akt signaling pathway to establish a cellular environment more favorable for viral replication. Myxoma virus (MYXV) is a rabbit-specific poxvirus that encodes many immunomodulatory factors, including an ankyrin repeat-containing host range protein termed M-T5 that functions to regulate tropism of MYXV for rabbit lymphocytes and certain human cancer cells. MYXV permissiveness in these human cancer cells is dependent upon the direct interaction between M-T5 and Akt, which has been shown to induce the kinase activity of Akt. In this study, an array of compounds that selectively manipulate Akt signaling was screened and we show that only a subset of Akt inhibitors significantly decreased the ability of MYXV to replicate in previously permissive human cancer cells. Furthermore, reduced viral replication efficiency was correlated with lower levels of phosphorylated Akt. In contrast, the PP2A-specific phosphatase inhibitor okadaic acid promoted increased Akt kinase activation and rescued MYXV replication in human cancer cells that did not previously support viral replication. Finally, phosphorylation of Akt at residue Thr308 was shown to dictate the physical interaction between Akt and M-T5, which then leads to phosphorylation of Ser473 and permits productive MYXV replication in these human cancer cells. The results of this study further characterize the mechanism by which M-T5 exploits the Akt signaling cascade and affirms this interaction as a major tropism determinant that regulates the replication efficiency of MYXV in human cancer cells. PMID:20106927

Werden, Steven J; McFadden, Grant

2010-04-01

428

Surgical Ablation of Atrial Fibrillation during Mitral-Valve Surgery.  

PubMed

Background Among patients undergoing mitral-valve surgery, 30 to 50% present with atrial fibrillation, which is associated with reduced survival and increased risk of stroke. Surgical ablation of atrial fibrillation has been widely adopted, but evidence regarding its safety and effectiveness is limited. Methods We randomly assigned 260 patients with persistent or long-standing persistent atrial fibrillation who required mitral-valve surgery to undergo either surgical ablation (ablation group) or no ablation (control group) during the mitral-valve operation. Patients in the ablation group underwent further randomization to pulmonary-vein isolation or a biatrial maze procedure. All patients underwent closure of the left atrial appendage. The primary end point was freedom from atrial fibrillation at both 6 months and 12 months (as assessed by means of 3-day Holter monitoring). Results More patients in the ablation group than in the control group were free from atrial fibrillation at both 6 and 12 months (63.2% vs. 29.4%, P<0.001). There was no significant difference in the rate of freedom from atrial fibrillation between patients who underwent pulmonary-vein isolation and those who underwent the biatrial maze procedure (61.0% and 66.0%, respectively; P=0.60). One-year mortality was 6.8% in the ablation group and 8.7% in the control group (hazard ratio with ablation, 0.76; 95% confidence interval, 0.32 to 1.84; P=0.55). Ablation was associated with more implantations of a permanent pacemaker than was no ablation (21.5 vs. 8.1 per 100 patient-years, P=0.01). There were no significant between-group differences in major cardiac or cerebrovascular adverse events, overall serious adverse events, or hospital readmissions. Conclusions The addition of atrial fibrillation ablation to mitral-valve surgery significantly increased the rate of freedom from atrial fibrillation at 1 year among patients with persistent or long-standing persistent atrial fibrillation, but the risk of implantation of a permanent pacemaker was also increased. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00903370 .). PMID:25774765

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

2015-04-01

429

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. PMID:25352505

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

2014-01-01

430

Usefulness of dronedarone in patients with atrial arrhythmias.  

PubMed

Dronedarone is a novel class III antiarrhythmic drug with moderate efficacy in preventing atrial arrhythmias. However, only few data from the real-world use of dronedarone with limited electrocardiographic monitoring are available. The investigators report the incidence, timing, and reasons for discontinuation of dronedarone; maintenance of sinus rhythm; and atrial arrhythmia recurrence patterns in 120 consecutive patients with atrial fibrillation (AF; n = 91) or non-isthmus-dependent atrial flutter (n = 29) treated with dronedarone (400 mg twice daily). Rhythm control was assessed with serial 7-day Holter electrocardiography after 4 weeks and after 6 to 9 months. After drug initiation, dronedarone was discontinued in 19 patients (16%) because of inefficacy (n = 7 [6%]) or adverse events (n = 12 [10%]). At 4 weeks, 44 patients (37%) had stopped taking dronedarone because of inefficacy (n = 27 [23%]) or adverse events (n = 17 [14%]). After 6 to 9 months, 25 patients (21%) had discontinued dronedarone because of clinical inefficacy (n = 16 [13%]) or adverse events (n = 9 [8%]). Overall, dronedarone was still used after 6 to 9 months in 32 patients (27%). Maintenance of sinus rhythm was achieved in 40 patients (33%) after 4 weeks and in 24 patients (20%) after 6 to 9 months. Reversal from persistent to paroxysmal arrhythmias was observed in 23 patients, (29%) whereas progression from paroxysmal to persistent arrhythmias occurred in 6 patients (15%). Conversion from AF to non-isthmus-dependent atrial flutter was noted in 10 patients (13%). In conclusion, dronedarone is associated with frequent adverse events and moderate antiarrhythmic efficacy requiring discontinuation in most patients within the first 9 months of use, and there is a prevalent reversal from persistent to paroxysmal but also from paroxysmal to persistent atrial arrhythmias and from AF to non-isthmus-dependent atrial flutter. PMID:23465099

Löbe, Susanne; Salmáš, Jozef; John, Silke; Kornej, Jelena; Husser, Daniela; Hindricks, Gerhard; Bollmann, Andreas

2013-05-01

431

Determinants of Left Atrial Appendage Volume in Stroke Patients without Chronic Atrial Fibrillation  

PubMed Central

Background Left atrial appendage (LAA) volume has been shown to be increased in patients with acute cryptogenic stroke. Atrial fibrillation (AF) is a well-recognized risk factor but it is not the only one associated with LAA enlargement. The aim of the study was to clarify the multifactorial etiology of LAA enlargement in cardiogenic stroke/TIA patients without AF. Methods Altogether 149 patients with suspected cardioembolic stroke/TIA (47 females; mean age 61 years) underwent cardiac CT. Diagnosed AF on admittance was an exclusion criteria but 24-hour Holter ambulatory ECG revealed paroxysmal AF (PAF) in 20 patients. Body surface area adjusted LAA volume was evaluated. Eighteen different variables were registered including general characteristics, definite and potential causal risk factors for ischemic stroke/TIA, clinical echoparameters and CT based cardiac volumetric and adipose tissue measurements. A stepwise linear regression analysis was performed to achieve a model adjusted for the number of predictors of LAA volume increase. Results In linear regression analysis, the best model accounted for 30% of the variability in LAA volume, including PAF (19%) and enlarged left atrial volume (6%), enlarged left ventricle end-systolic diameter (3%) and decreased pericardial adipose tissue (2%). No multi-colinearity between variables was observed. In addition to PAF, no other definitive or potential causal risk factors could account for the LAA volume in these patients. Conclusions LAA volume increase seems to be poorly associated with currently known stroke/TIA risk factors, except for AF. Targeting more comprehensive ECG monitoring for stroke patients with increased LAA volume should be considered. PMID:24595515

Taina, Mikko; Sipola, Petri; Muuronen, Antti; Hedman, Marja; Mustonen, Pirjo; Kantanen, Anne-Mari; Jäkälä, Pekka; Vanninen, Ritva

2014-01-01

432

Relationship of functional mitral regurgitation to new-onset atrial fibrillation in acute myocardial infarction  

Microsoft Academic Search

Background\\/objectiveThe role of factors that increase left atrial pressure or cause acute left atrial dilatation is frequently emphasised in the pathogenesis of atrial fibrillation (AF) in patients with acute myocardial infarction (AMI). This study was designed to test the hypothesis that functional mitral regurgitation (FMR) occurring after AMI may promote AF by producing left atrial volume overload.SettingIntensive care unit of

Fadel Bahouth; Diab Mutlak; Moran Furman; Anees Musallam; Haim Hammerman; Jonathan Lessick; Saleem Dabbah; Shimon Reisner; Yoram Agmon; Doron Aronson

2010-01-01

433

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

434

Removal of the protruding retention wire via a femoral approach while leaving the active-fixation atrial "J" lead in situ: a technique for the management of class III atrial "J" leads.  

PubMed

The Telectronics Accufix Atrial "J" pacing lead poses a mechanical risk to patients of retention wire fracture and protrusion. Standard lead extraction techniques include percutaneous approaches, which are associated with significant risk of morbidity and mortality, and open procedures, which necessitate thoracotomy. In nine patients referred with Class III retention wire fractures, attempts were made to snare the protruding retention wire from a femoral approach using snare devices and bioptomes. In six cases, the retention wire was successfully removed, leaving the lead body in place. In four patients with lead function that was able to be evaluated, the atrial lead remained functional after the procedure. There were no complications. Snare removal of the protruding retention wire via a femoral approach should be considered as an option in the management of patients with Class III Accufix leads. PMID:8904544

Ganz, L I; Meyerovitz, M F; Kandarpa, K; Mitchell, G F

1996-10-01

435

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 from atrial fibrillation. Our method is based on dictionary learning. It ex- tends both the average activity. Index Terms-- ECG, atrial fibrillation, monochannel source separation, dictionary learning

Paris-Sud XI, Université de

436

Early discharge of patients with new-onset atrial fibrillation after cardiovascular surgery  

Microsoft Academic Search

Background Atrial fibrillation is one of the most frequent complications after cardiovascular surgery. It may result in thromboembolic events, hemodynamic deterioration, and an increased length and cost of hospitalization. Methods We retrospectively studied 504 consecutive adult patients undergoing cardiovascular surgery to determine whether patients with new-onset postoperative atrial fibrillation could be safely discharged in atrial fibrillation after ventricular rate had

Allen J. Solomon; Peter C. Kouretas; Richard A. Hopkins; Nevin M. Katz; Robert B. Wallace; Robert L. Hannan

1998-01-01

437

Clinical efficacy and safety of atrial defibrillation using biphasic shocks and current nonthoracotomy endocardial lead configurations  

Microsoft Academic Search

We undertook a prospective randomized clinical trial evaluating efficacy and safety of internal atrial defibrillation in patients with drug-refractory atrial fibrillation (AF). Consecutive patients with paroxysmal or chronic AF were randomly tested with 3 internal atrial defibrillation lead configurations and biphasic shocks. Patients with implanted cardiac pacemakers were tested with the right atrium (RA) and left pulmonary artery or coronary

Sanjeev Saksena; Atul Prakash; Luc Mangeon; Sankar Varanasi; Theophilos Kolettis; Philip Mathew; Paul De Groot; Rahul Mehra; Ryszard B. Krol

1995-01-01

438

Effect of Clopidogrel Added to Aspirin in Patients with Atrial Fibrillation  

Microsoft Academic Search

Background Vitamin K antagonists reduce the risk of stroke in patients with atrial fibrillation but are considered unsuitable in many patients, who usually receive aspirin instead. We investigated the hypothesis that the addition of clopidogrel to aspirin would reduce the risk of vascular events in patients with atrial fibrillation. Methods A total of 7554 patients with atrial fibrillation who had

2009-01-01