These are representative sample records from Science.gov related to your search topic.
For comprehensive and current results, perform a real-time search at Science.gov.
1

Recurrent atrial myxoma.  

PubMed

We have chosen this case of sporadic atrial myxoma for our presentation because it had a particular evolution, with recurrence at 8 years after surgical excision (echocardiography was performed every year) and a particular diagnostic means - at echocardiographic follow-up, the patient being asymptomatic. This presentation, together with a review of literature included in the article, emphasizes the importance of a careful postoperative follow-up of the patients and the existence of some particular aspects of the evolution and symptomatology of recurrent atrial myxoma. PMID:16366135

Macarie, C; Stoica, E; Chioncel, O; Carp, A; Gherghiceanu, D; Stiru, O; Zarma, L; Herlea, V

2004-01-01

2

Atrial myxoma related myocardial infarction: Case report and review of the literature  

PubMed Central

Atrial myxomas are the commonest primary cardiac tumors and usually affect the left atrium. Patients with atrial myxomas present with intracardiac obstruction, embolization to the pulmonary and systemic circulation, or constitutional symptoms. The coronary arteries’ involvement in myxomatous embolization, although rare, has been described to cause acute myocardial infarction (AMI). We report a case of atrial myxoma associated MI and present the clinical and echocardiographic features of this presentation followed by review of the English literature for the association of atrial myxomas and acute myocardial infarctions (AMI). PMID:24954990

Al Zahrani, Ibrahim Mohammed; Alraqtan, Abdulaziz; Rezk, Ahmed; Almasswary, Adel; Bella, Abdelhaleem

2014-01-01

3

Atypical atrial myxomas in two asymptomatic patients: a case report  

PubMed Central

Background Atypical cardiac myxomas are a rare occurrence and may present with a variety of clinical manifestations depending on the morphology and location. Case presentation Two cases of cardiac myxomas atypically located in asymptomatic patients, diagnosed by transthoracic and transoesophageal echocardiography, are presented. In the first case a myxoma is located under the anterior mitral valve leaflet and in the second case a myxoma is located in the right atrium. Conclusion We emphasize the leading role of transthoracic and transoesophageal echocardiography in the diagnosis of intracavitary cardiac tumours. PMID:19737417

Charokopos, Nicholas A; Rouska, Efthymia; Pliakos, Christodoulos; Pagourelias, Efstathios D; Artemiou, Panagiotis; Foroulis, Christoforos; Papadopoulos, Nikolaos

2009-01-01

4

[Excision of a left atrial myxoma through right minithoracotomy in a patient with multiple myeloma; report of a case].  

PubMed

We present a case of a 63-year-old female who underwent an excision of a left atrial myxoma. Previously, she had been diagnosed with multiple myelomas and received radiation therapy and chemotherapy. A left atrial myxoma was found at an annual medical check-up. The myxoma was removed via a right minithoracotomy with peripheral cannulation to minimize bleeding complications and surgical site infection. She was transferred to the referring hospital on postoperative day 7 due to recurrence of multiple myelomas. She was doing well 14 months after the operation. Right minithoracotomy is a useful approach to minimizing the risks of bleeding and infection in patients with multiple myelomas. PMID:25434550

Koyama, Yutaka; Goto, Yoshihiro; Ogawa, Shinji; Baba, Hiroshi; Okawa, Yasuhide

2014-12-01

5

Surgical Treatment of Atrial Myxomas  

PubMed Central

Twenty atrial myxomas were resected in 20 patients with the use of cardiopulmonary bypass, from the beginning of July 1966 through the end of June 1985, at Severance Hospital, Seoul, Korea. Nineteen patients had left atrial myxomas; 1 had a right atrial myxoma. Left atrial myxomas arose from the intra-atrial septum in 17 patients and from the left atrial appendage in 2 patients. The right atrial myxoma arose from the fossa ovalis. The 13 female and 7 male patients ranged in age from 14 to 63 years. Symptoms most often reported on presentation were those associated with mitral valve obstruction; other symptoms were associated with systemic embolization. The 1st 4 patients were tested with angiocardiography alone, and 3 of these were misdiagnosed. The last 16 were tested by angiocardiography, M-mode echocardiography, and 2-dimensional echocardiography, alone or in various combinations, and there were no further misdiagnoses. In our experience, 2-dimensional echocardiography was the most accurate method of diagnosing cardiac tumors. In 19 patients, surgical approach was through a median sternotomy; in the 20th patient, approach was through a left thoracotomy, due to a preoperative misdiagnosis of mitral stenosis. No intraoperative embolizations or deaths occurred. On follow-up of 17 patients during periods ranging from 6 months to 6 years, we had no late deaths, and only 2 patients suffered late complications: 1 had sudden right hemiparesis caused by an embolus 4 months after surgery (this improved upon conservative treatment); and 1 had a recurrence of tumor 3 years after surgery (the new myxoma was successfully resected). We conclude that patients who have undergone complete excision of benign myxomas now have an excellent prognosis, with minimal risk of intraoperative embolization and late recurrence. We conclude also that 2-dimensional echocardiography is an extremely accurate tool both in early diagnosis of intracardiac myxomas and in late follow-up after resection. (Texas Heart Institute Journal 1989;16:81-6) Images PMID:15227218

Cho, Bum Koo; Lee, Doo Yun; Pezzella, A. Thomas; Hong, Sung Nok; Hong, Pill Whoon

1989-01-01

6

[Case report and review of a voluminous right atrial myxoma revealed by heart failure].  

PubMed

Right atrial myxoma is a rare disease and its clinical presentation is not specific. The usual mode of revelation is heart failure. The most frequent complications are pulmonary embolism and atrioventricular valve obstruction by the tumor. A 49-year-old woman was admitted to intensive care unit for heart failure. The echocardiogram showed a voluminous right atrial myxoma, appending to the interatrial septum. Its surgical excision under extracorporeal circulation was successfully performed. Histology confirmed the final diagnosis of myxoma. No complication was observed at 6 months follow-up. PMID:19875096

Lepillier, A; Chaib, A; Bougouin, W; Joffre, J; Durand, E; Salvi, S; Bruneval, P; Danchin, N

2010-02-01

7

A case of multi-system signs and symptoms unified under the diagnosis of atrial myxoma.  

PubMed

Patients often present to the Emergency Department (ED) with a constellation of seemingly unassociated complaints. It is a clinical challenge not only to address all signs and symptoms that concern the patient but to reconcile these incongruous findings into one all-encompassing diagnosis. We present the case of a 48-year-old man who manifested neurologic, cardiac, and constitutional signs and symptoms in the ED. Through historic clues, physical examination findings, and electrocardiogram, we obtained an urgent cardiac ultrasound that demonstrated a large left atrial myxoma. This one disease entity was able to explain all of the patient's diverse findings. PMID:18657933

West, Brian T; Kaluza, Amy

2011-05-01

8

Successful surgical resection of infected left atrial myxoma in a case complicated with disseminated intravascular coagulation and multiple cerebral infarctions: case report  

PubMed Central

Cardiac myxoma is the most common primary cardiac tumour, but infected cardiac myxoma is relatively rare. Infected cardiac myxoma is very fragile, and has a potential to lead to catastrophic disorder with systemic bacteremia, systemic mycotic embolism, and disseminated intravascular coagulation (DIC). We present here the successful surgical treatment of a case of infected left atrial myxoma with septic shock, DIC and cerebral infarction without hemorrahage. Collective review of 58 reported cases with infected cardiac myxoma revealed that surgical treatment for it were still challenging and its result was poor. Until date, only one successful surgical treatment for a case complicated by DIC and cerebral infarctions has been reported, and our report describes second such case of successful resection. Even though this report is limited to a case, only aggressive and prompt surgical intervention could relieve the intractable conditions in such a patient with extremely high risk. PMID:21569401

2011-01-01

9

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

10

Left atrial myxoma with papillary fibroelastoma-like features  

PubMed Central

Although rare, papillary fibroelastoma (PFE) of the heart valves and atrial myxoma represent the two most common cardiac tumors. Coexistence of these two lesions has been documented in rare case reports. We describe the case of a 77-year-old man who presented with slightly progressive chest pain associated with dyspnea, fatigue and edema of the lungs. Transthoracic echocardiography detected a left atrial mass that has been successfully excised. Histopathological examination showed a neoplasm combining features of both atrial myxoma and PFE. However, close evaluation of the latter showed microscopic foci of myxomatous tissue within papillary cores, indicating that the PFE-like component has developed around preexisting myxomatous tissue that served as a nidus for papillary fronds, probably by a process of fibrinous microthrombosis, organization and endothelialisation. This unusual case may shed light on the pathogenesis of the PFE pattern. PMID:21487526

Agaimy, Abbas; Strecker, Thomas

2011-01-01

11

Left atrial myxoma with papillary fibroelastoma-like features.  

PubMed

Although rare, papillary fibroelastoma (PFE) of the heart valves and atrial myxoma represent the two most common cardiac tumors. Coexistence of these two lesions has been documented in rare case reports. We describe the case of a 77-year-old man who presented with slightly progressive chest pain associated with dyspnea, fatigue and edema of the lungs. Transthoracic echocardiography detected a left atrial mass that has been successfully excised. Histopathological examination showed a neoplasm combining features of both atrial myxoma and PFE. However, close evaluation of the latter showed microscopic foci of myxomatous tissue within papillary cores, indicating that the PFE-like component has developed around preexisting myxomatous tissue that served as a nidus for papillary fronds, probably by a process of fibrinous microthrombosis, organization and endothelialisation. This unusual case may shed light on the pathogenesis of the PFE pattern. PMID:21487526

Agaimy, Abbas; Strecker, Thomas

2011-03-01

12

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

13

[Left atrial myxoma evidenced by silent acute myocardial infarction].  

PubMed

A 64-year-old female patient was in-hospital admitted due to a traumatic femoral fracture. A routinely performed ECG showed signs of anterior acute myocardial infarction, clinically silent, and pathological levels of myocardial serum enzyme were recorded. The echocardiographic-Doppler examination confirmed the LV dyssynergy of contraction and, unexpectedly, revealed a large peduncolated and mobile mass in left atrium, connected to the interatrial septum and prolapsing in left ventricle, referable to myxoma. In the clinical history of the patient, a previous cerebral transitory ischemic attack was present (probably due to myxomatous embolization), but no any other cardiovascular symptoms. The patient successfully underwent coronary angiography, which showed no coronary artery disease, and cardiac surgery for tumoral removal. On the basis of clinical and instrumental data, also acute myocardial infarction may be considered a very likely consequence of a intracoronary embolus. Systemic embolization from left atrial myxomas are frequent; however, the involvement of coronary tree, with clinical manifestations and diagnosis during life, is extremely rare. Complete lack of symptoms due to atrial myxoma and myocardial infarction, and the fortuitous diagnosis of both diseases are peculiar findings of the reported case. Many systemic embolizations from myxomas, although sources of tissue damages, may likely occur without symptoms and may be unrecognized during acute period. PMID:8682228

Lattanzi, F; Paci, A M; Topi, A; Squarcini, G; Topi, P L

1995-10-01

14

A large left atrial myxoma causing multiple cerebral infarcts.  

PubMed

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

Kebede, Saba; Edmunds, Eiry; Raybould, Adrian

2013-01-01

15

Left atrial myxoma associated with systemic AA amyloidosis.  

PubMed

A 76-year-old woman presenting with generalized amyloidosis of the AA-type protein was found to have a left atrial myxoma. Retrospective estimation of the concentration of SAA protein, a serum precursor of AA amyloid, before and after surgical removal of the myxoma, showed that the SAA protein had disappeared after the operation. A common manifestation of myxoma is the development of a severe inflammatory syndrome that sometimes simulates rheumatic fever or bacterial endocarditis. However, to our knowledge, it has never been described in association with amyloidosis. We suggest that atrial myxoma should be added the list of neoplastic and inflammatory diseases predisposing to AA amyloidosis. PMID:2916891

Wens, R; Goffin, Y; Pepys, M B; Kutnowski, M; Van Beers, D; Decoodt, P; Verbanck, M

1989-02-01

16

Fragmentation of a right atrial myxoma presenting as a pulmonary embolism.  

PubMed

We report here a tricky case of right atrial myxoma with a pulmonary localization mimicking pulmonary thromboembolism. The diagnosis on imaging investigation was delayed because of its atypical appearance. This case report emphasizes the leading role of transthoracic and transesophageal echocardiography in the management of this condition. In autopsy series, the incidence of primary tumors of the heart is evaluated at 0.0017% to 0.19%.(1) Nearly half of them are myxoma.(1, 2) Myxoma are more frequently observed in adults and are commonly localized in the left atrium. Signs and symptoms are comparable to those arising in other cardiovascular and systemic conditions, including variable cardiac murmur, uneasiness, blackout, systemic embolism, cardiac insufficiency, lasting fever, or sudden death.(3) Rare cases of pulmonary embolism have been described. We report here an atypical case of right atrial myxoma with a pulmonary localization mimicking pulmonary embolus. PMID:10625833

Idir, M; Oysel, N; Guibaud, J P; Labouyrie, E; Roudaut, R

2000-01-01

17

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

18

Left ventricular myxoma: a case report  

PubMed Central

Cardiac myxoma, the most common primary heart tumor, is located mainly in the left atrium. We reported a rare case of left ventricular myxoma incidentally found on echocardiography in an asymptomatic 60-year-old male. The tumor was carefully resected without fragmentation. The patient had an uneventful recovery and was discharged home on the 4th postoperative day. Surgical resection of this type of cardiac myxoma is recommended due to the rarity of tumor location. PMID:25469121

Qin, Wei; Wang, Liming; Chen, Xin; Liu, Peisheng; Wang, Rui

2014-01-01

19

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

20

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

PubMed Central

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

Habbab, Louay; Alfaraidi, Haifa; Lamy, Andre

2014-01-01

21

Left Atrial Myxoma with versus without Cerebral Embolism: Length of Symptoms, Morphologic Characteristics, and Outcomes  

PubMed Central

The aim of this study was to evaluate the embolic sequelae of left atrial myxomas and their influence on diagnosis, treatment, and prognosis. Seventy-eight patients were retrospectively investigated. According to their symptoms and neurologic-imaging findings, these patients were classified into 2 groups: embolism (15 patients, 19%) and nonembolism (63 patients, 81%). The time from the first onset of symptoms to diagnosis (that is, the duration of symptoms) was significantly longer in the embolism group than in the nonembolism group (105 ± 190 vs 23 ± 18 d; P <0.01). The myxomas were divided into 2 types on the basis of clinicopathologic findings: type 1, with an irregular or villous surface and a soft consistency, and type 2, with a smooth surface and a compact consistency. There were 42 patients with type 1 myxoma and 36 with type 2. Type 1 myxoma was more frequently found in the embolism group (12 patients, 29%) than was type 2 myxoma (3 patients, 8%). The difference was significant (P=0.04). There were 2 perioperative deaths in the nonembolism group. No recurrence of cardiac myxoma or death was recorded in either group during follow-up. In the embolism group, neurologic symptoms were relieved by surgery, and no subsequent neurologic event was reported. Because surgical resection is highly effective in left atrial myxoma, we should strive for early diagnosis in order to shorten the duration of symptoms and to avoid worse neurologic damage in patients in whom an embolic event is the initial manifestation. PMID:25593521

Zheng, Zhi; Guo, Guojun; Xu, Li; Lei, Lei; Wei, Xiang

2014-01-01

22

Left Atrial Myxoma and Concomitant Atherosclerotic Coronary Artery Disease  

PubMed Central

Here we describe the case of a 71-year-old female patient who was admitted to our department with acute coronary syndrome. Trans-thoracic echocardiography evaluation to assess left ventricular functions incidentally detected a left atrial mass attached to the inter-atrial septum together with a left ventricular segmental wall motion abnormality due to acute anterior myocardial infarction. Coronary angiography revealed diffuse coronary artery disease. Because early surgery was not advised due to the high mortality risk, successful coronary angioplasty and stenting was performed in this emergecy situation. It may be informative to study the images from the echocardiography prior to angiography in this study as well as to determine the anticipated signs that may affect the treatment options for similar patients.

Kocaturk, Hasan; Karaman, Adem; Bayram, Ednan; Çolak, Mehmet Cengiz; Yurtman, Volkan

2009-01-01

23

[A case of tricuspid valvular myxoma in a child].  

PubMed

A six-year old boy had hospitalization because of cardiac murmur and syncope attack. Laboratory data including immunoglobulin and erythrocyte sedimentation rate were normal, but echocardiography and cardioangiography indicated tricuspid valvular myxoma in the right atrium. The tumor was successfully removed with the septal tricuspid valve using the cardiopulmonary bypass. The tumor was 18 x 20 x 12 mm in size and pathological findings showed a myxoma originated from tricuspid valve. Now he shows normal cardiac function and no recurrent sign of tumor. There has been reported a few cases of valvular myxoma in Japan. However, this is the first case which was successfully resected by surgery. PMID:1613293

Shibata, Y; Kobayashi, A; Sakata, K; Sugimura, S

1992-04-01

24

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

25

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

26

Sphenoid Sinus Myxoma: Case Report and Literature Review  

PubMed Central

Objectives: We present the first known case in the English-language literature of a myxoma arising in the sphenoid sinus. By describing the patient's clinical course and the salient features of this rare neoplasm, we seek to increase the awareness of the presentation, histological features, and treatment considerations for myxomas of the head and neck. In the process, we intend to describe the work-up of isolated sphenoid sinus lesions and focus on the varying and evolving techniques for surgical access to the sphenoid sinus. Study Design and Methods: Case report and literature review. Results: We describe the clinical course of a patient with a myxoma of the sphenoid sinus. The patient underwent an external sphenoethmoidectomy through a lateral rhinotomy approach with medial maxillectomy under MRI-guidance. He remains without evidence of recurrent disease after 8 months. Conclusions: Myxomas of the head and neck are rare neoplasms. Their infiltrative nature and tendency to recur demand an aggressive surgical approach that may be accomplished with minimal morbidity using currently available image-guided techniques. PMID:21603497

Moore, Brian A.; Wine, Todd; Burkey, Brian B.; Amedee, Ronald G.; Butcher, R. Brent

2008-01-01

27

Pathology Case Study: Multiple Myxomas and Thyroid Cancer  

NSDL National Science Digital Library

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

Virji, Mohamed; Wang, Jianzhou

2008-04-08

28

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

29

Cardiac Myxoma Diagnosed by Signs of Purpuric Macules on Both Palms and Soles  

PubMed Central

Cardiac myxoma, the most prevalent primary cardiac tumor, is rare. The clinical features of this tumor are principally intracardiac obstruction, extracardiac embolism, and general symptoms including fever, myalgia, arthralgia. Although cutaneous manifestations in patients with cardiac myxoma are frequent, in rare cases, cutaneous signs have been clues to the correct diagnosis. We report a 42-year-old male who presented with recurrent multiple purpuric patches on both palms and soles for 4 months. Histopathological finding showed a myxomatous embolus in the arteriole in the lower dermis. Echocardiogram demonstrated the presence of a left atrial myxoma with a provisional diagnosis of left atrial myxoma. In our patient, skin examinations and histopathological finding led us to the diagnosis of cardiac myxoma. PMID:22879718

Lee, Hyo Jin; Park, Jeung Young; Kim, Young Sik; Choi, Jong Soo; Kim, Ki-Hong; Bae, Young Kyung

2012-01-01

30

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

31

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

32

PRKAR1A in the development of cardiac myxoma: a study of 110 cases including isolated and syndromic tumors.  

PubMed

Cardiac myxoma usually occurs as a solitary mass, but occasionally develops as part of a familial syndrome, the Carney complex (CNC). Two thirds of CNC-associated cardiac myxomas exhibit mutations in PRKAR1A. PRKAR1A mutations occur in both familial and sporadic forms of CNC but have not been described in isolated (nonsyndromic) cardiac myxomas. A total of 127 consecutive cardiac myxomas surgically resected at Mayo Clinic (1993 to 2011) from 110 individuals were studied. Clinical, radiologic, and pathologic findings were reviewed. Of these, 103 patients had isolated cardiac myxomas, and 7 patients had the tumor as a component of CNC. Age and sex distributions were different for CNC (mean 26 y, range 14 to 44 y, 71% female) and non-CNC (mean 62 y, range 18 to 92 y, 63% female) patients. PRKAR1A immunohistochemical analysis (IHC) was performed, and myxoma cell reactivity was graded semiquantitatively. Bidirectional Sanger sequencing was performed in 3 CNC patients and 29 non-CNC patients, to test for the presence of mutations in all coding regions and intron/exon boundaries of the PRKAR1A gene. IHC staining showed that all 7 CNC cases lacked PRKAR1A antigenicity and that 33 (32%) isolated cardiac myxomas were similarly nonreactive. Of tumors subjected to sequencing analysis, 2 (67%) CNC myxomas and 9 (31%) non-CNC myxomas had pathogenic PRKAR1A mutations. No germline mutations were found in 4 non-CNC cases tested. PRKAR1A appears to play a role in the development of both syndromic and nonsyndromic cardiac myxomas. Routine IHC evaluation of cardiac myxomas for PRKAR1A expression may be useful in excluding a diagnosis of CNC. PMID:24618615

Maleszewski, Joseph J; Larsen, Brandon T; Kip, Nefize Sertac; Castonguay, Mathieu C; Edwards, William D; Carney, J Aidan; Kipp, Benjamin R

2014-08-01

33

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

34

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

35

Intradural extramedullary spinal nerve sheath myxoma: a report of two cases.  

PubMed

Nerve sheath myxoma, a myxoid variant of schwannoma, is a dermal tumor that usually occurs in the upper extremities, head and neck region, or trunk; occasionally, however, it has also been reported to develop in the spinal canal. Here, we describe two cases of intraspinal nerve sheath myxoma. Case 1 was a 74-year-old man with left hypochondrial pain. Gadolinium-enhanced magnetic resonance imaging (MRI) of his spine revealed a well-demarcated intradural extramedullary tumor with peripheral enhancement at the Th8 level. Case 2 was a 58-year-old man with lower back and left buttock pain. Gadolinium-enhanced MRI revealed a well-demarcated intradural extramedullary tumor with peripheral enhancement at the Th12-L1 level. Both cases were clinically diagnosed as schwannoma. Histological studies revealed characteristic myxoid lobules which were separated by fibrous septa or bands of more compact cellular area. The tumor cells were diffusely positive for S-100 and focally positive for Schwann/2E, which reacts with Schwann cells and myelin in the peripheral nervous system. The positive reaction to Schwann/2E confirmed the occurrence of peripheral nerve sheath differentiation. Nerve sheath myxoma should be included in differential diagnosis of spinal canal tumors. PMID:23306964

Yamato, Mariko; Ikota, Hayato; Hanakita, Junya; Iizuka, Yoichi; Nakazato, Yoichi

2014-01-01

36

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

37

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

38

Radiological characteristics and management of intramuscular myxoma of the temporal muscle: case report.  

PubMed

The patient was a 51-year-old male with a 3-year history of a slow-growing, asymptomatic, subcutaneous mass in the left temporal region. Magnetic resonance imaging revealed a well-defined extracranial lesion with heterogeneous enhancement and without invasion of the skull. A variety of soft tissue tumors were included in the differential diagnosis. The patient underwent total resection of the tumor, and a diagnosis of intramuscular myxoma was confirmed histologically. There was no evidence of recurrence at 6-month follow-up. The present case is the first characterization of the radiological appearance of intramuscular myxoma in the temporal muscle. I emphasize that increased awareness of this rare lesion and a careful clinical and radiological preoperative assessment are crucial in determining an appropriate treatment strategy for patients with a soft tissue tumor of the head. PMID:24418787

Higashida, Tetsuhiro

2014-12-15

39

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

40

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

41

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

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.

Limdiwala, Piyush; Shah, Jigna

2015-01-01

43

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.

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

2015-01-01

44

Spindle cell sarcoma of the left atrium: an extremely rare and challenging tumour often masquerading as left atrial myxoma.  

PubMed

Spindle-cell sarcoma of the left atrium is an extremely rare diagnosis, with only 4 cases reported in the literature worldwide. We report on a 42-year-old man, who presented to the emergency department with dyspnea and decreased exercise tolerance. A computed tomography chest scan showed a large mass in the left atrium. Echocardiography demonstrated a significant gradient across the mitral valve. The patient had the mass excised in the operating room. He did well postoperatively. Eight months later, a repeat cardiac magnetic resonance imaging scan showed a recurrence. Right pneumonectomy was performed to ensure margins were clear. Although he has done well after surgery, his prognosis remains guarded. PMID:25547565

Kholaif, Naji; O'Neill, Blair J

2015-01-01

45

Right ventricular myxoma in a patient with tetralogy of Fallot  

PubMed Central

INTRODUCTION Cardiac myxoma is the most common primary cardiac tumour in adulthood and may present in the context of Carney's complex. PRESENTATION OF CASE A 32-year-old male with a history of repaired tetralogy of Fallot in childhood was admitted with severe pulmonary valve regurgitation and a mobile mass in the right ventricle. The patient underwent pulmonary valve replacement and mass excision. Pathology examination showed myxoma. DISCUSSION In the majority of cases myxomas originate in the atria, nevertheless they can also be found in a ventricular cavity. Myxoma is a prevalent feature of Carney's complex, an inherited, autosomal disease, characterised by multiple tumours in several organs. Tetralogy of Fallot has also been described in association with Carney's complex. CONCLUSION Coexistence of tetralogy of Fallot with a cardiac ventricular myxoma in a patient not affected from Carney's complex or other familial syndrome. PMID:25437648

Mitropoulos, Fotios; Giannakoulas, George; Kallifatidis, Alexandros; Kanakis, Meletios; Kiaffas, Maria; Chatzis, Andrew C.

2014-01-01

46

The mysterious pathways of cardiac myxomas: a review of histogenesis, pathogenesis and pathology.  

PubMed

Cardiac myxoma is the most common benign cardiac tumour, localized generally in the left atrium. The majority of cardiac myxomas occur sporadically, while a relatively small proportion of cases develop as a part of Carney complex syndrome. Currently, the histogenesis of myxoma is poorly understood; however, the mesenchymal and endothelial properties of myxoma cells suggest that a clearer understanding of tumour origins can be achieved through a detailed investigation of heart development and endocardial histogenesis. Growing evidence appears to indicate the reactivated expression in cardiac myxoma of genes encoding heart precursor markers, although the exact mechanisms have not yet been described. In this paper we review the most recent scientific literature concerning cardiac embryology and relate this to recent advances in our understanding of the histogenesis of cardiac myxoma. Moreover, given that much of the literature regarding myxoma is of single case reports, we review progress in our knowledge of the pathology and pathogenesis of this condition. PMID:25297937

Di Vito, Anna; Mignogna, Chiara; Donato, Giuseppe

2015-02-01

47

Nonseptal right atrial aneurysm: case report and review of literature.  

PubMed

An aneurysm of the portion of the right atrium classically referred to as the subeustachian sinus is reported in a 75-year-old man with cardiac amyloidosis, AL phenotype, related to underlying multiple myeloma. A review of literature confirms the rarity of nonseptal right atrial aneurysms and their propensity to involve the subeustachian area of the right atrium which may be an intrinsic area of weakness in the atrial wall. The coincident amyloidosis in our current case suggests that hemodynamic factors may have played a role in the development of the aneurysm. PMID:19375357

Mersbach, Kathryn; Mehra, Aditya; Jaworski, Joseph; Fyfe, Billie

2010-01-01

48

A case of paroxysmal atrial fibrillation following low voltage electrocution  

PubMed Central

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

2013-01-01

49

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

PubMed Central

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

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

2014-01-01

50

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

51

Extragnathic odontogenic sinonasal myxoma with mitotic features  

PubMed Central

We present the first-ever documented evidence of mitotic figures in a case of sinonasal myxoma diagnosed in a 37 year-old gentleman. A 37 year-old gentleman was referred to the Otolaryngology clinic with left nasal discharge for six months. Preoperative images demonstrated obstruction of the left nasal airway with complete opacification of the left maxillary sinus, obscuration of the osteomeatal complex, as well as expansion and thinning of the medial wall of the maxillary antrum. The patient underwent diagnostic Funtional Endoscopic Sinus Surgery (FESS), therapeutic left Caldwell-Luc antrostomy, and revision FESS following recurrence. The patient was symptom-free at routine follow-up post-op. There has been much debate as to whether the absence of mitotic features in a specimen is absolutely necessary in order to confirm the diagnosis. We postulate that the presence of mitoses is an unusual diagnostic feature in extensive sinonasal myxoma. PMID:24960748

Onyekwelu, O; DeZoysa, O; Watts, S

2012-01-01

52

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

53

A rare case of obstructive right atrial lipoma.  

PubMed

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

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

2014-10-01

54

Correction of right to left shunt by transcatheter treatment of pulmonary stenosis and atrial septal defect: a case report  

PubMed Central

Co-occurrence of atrial septal defect and pulmonary valve stenosis is a rare entity for adult population. It is possible to correct both the pulmonary stenosis and the defect in the atrial septum by transcatheter methods. We present a case of right to left shant due to severe pulmonary stenosis and atrial defect which was successfully corrected by transcatheter pulmonary valvuloplasty and closure of the atrial septal defect. PMID:24995113

Durmus, Ismet; Turan, Oguzhan Ekrem; Hosoglu, Yusuf; Orem, Cihan; Kutlu, Merih

2014-01-01

55

Low-dose lacosamide-induced atrial fibrillation: Case analysis with literature review???  

PubMed Central

Lacosamide (LCM) is a novel antiepileptic drug (AED) approved by the FDA for adjunctive treatment of partial epilepsy with and without secondary generalization. Lacosamide dose-dependent dysrhythmias (PR-interval prolongation, AV block, and atrial fibrillation/flutter) have been reported. This case represents the first instance of LCM-induced atrial fibrillation following a low loading dose (200 mg). Risk factors for atrial fibrillation are addressed and discussed in the context of this case. Full cardiac history is recommended prior to patients being initiated on LCM. Cardiac monitoring may be required for at-risk patients on LCM. Clinicians need to be cognizant of this potential adverse effect.

Kaufman, Kenneth R.; Velez, Arnaldo E.; Wong, Stephen; Mani, Ram

2012-01-01

56

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

PubMed Central

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

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

2014-01-01

57

Cellular myxoma of the lumbar spine  

PubMed Central

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

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

2013-01-01

58

Aortic valve myxoma at the extreme age: a review of literature.  

PubMed

Primary cardiac tumours are a rare finding, with cardiac myxoma and fibroelastoma representing the majority of these tumours. Cardiac myxomas are most commonly found in the left atrium but are rarely found with attachment to the cardiac valves. The authors describe a case of aortic myxoma found in an 81-year-old man presented with peripheral arterial disease. CT angiogram of the thorax was performed to find the source of emboli and it showed a mass attached to the aortic valve and protruding into the aorta. Details of the location and texture were studied on transoesophageal echocardiography. Preoperative coronary angiography showed coronary artery disease and the patient underwent successful coronary artery bypass grafting and simultaneous resection of the mass. Histopathology revealed the mass as a myxoma. PMID:24642215

Javed, Arshad; Zalawadiya, Sandip; Kovach, Julie; Afonso, Luis

2014-01-01

59

QT prolongation and T-wave alternans during catheter ablation of atrial fibrillation: a case report.  

PubMed

We report a case of a 63-year-old woman who developed profound QT prolongation, T-wave alternans, and spontaneous ventricular fibrillation during catheter ablation of atrial fibrillation. A thorough search into the possible mechanisms identified the use of sevoflurane, an inhalational gas anesthetic as the culprit. The patient was converted to propofol anesthesia and her QT interval normalized promptly. PMID:24620846

Saini, Aditya; Shah, Hemal; Saba, Samir

2014-03-01

60

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

61

The Fas-Mediated Apoptotic Pathway in Cardiac Myxoma  

Microsoft Academic Search

Cardiac myxoma is the most common primary tumor of the heart. The existence of apoptosis in cardiac myxoma has been demonstrated. The purpose of this investigation was to elucidate the pathway of apoptosis and the cell cycle in cardiac myxomas. This study had 2 parts: investigation of a cultured cardiac myxoma cell line and the analysis of data from 20

Cheng-Chung Liu; Shih-Ming Jung; Augusto Orlandi; Ta-Sen Yeh; Yu-Shen Lin; Tzu-Fang Shiu; Hsueh-Hua Wu; Jaw-Ji Chu; Pyng-Jing Lin; Pao-Hsien Chu

2010-01-01

62

Atrial Flutter  

MedlinePLUS

... Atrial Flutter Back to Heart Diseases & Disorders Atrial Flutter Atrial flutter ( AFL ) is a common abnormal heart ... an animation on Atrial Flutter What is Atrial Flutter ? The electrical system of the heart is the ...

63

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

64

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

65

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

66

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.

Kiresur, Mohammad Asif; Hemavathy, Sathyavanthan

2014-01-01

67

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

PubMed

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

Kovács, Tibor

2014-10-19

68

Case report series of left atrial thrombus formation in patients on dabigatran therapy.  

PubMed

Dabigatran etexilate mesylate, a direct thrombin inhibitor, has been approved in the United States as an alternative to warfarin for the prevention of stroke and systemic thromboembolism in patients with nonvalvular atrial fibrillation. The authors report 2 cases of development of large left atrial thrombi and unfortunate occurrence of thromboembolic events in patients with chronic atrial fibrillation, despite these patients being compliant with recommended dabigatran therapy. The authors postulate that certain unique pharmacologic characteristics of the drug may be disadvantageous toward providing a therapeutic level of anticoagulation in all patients and may provide an explanation of occurrence of these thrombotic events, namely, (1) a competitive, reversible, and incomplete inhibition of only one coagulation factor (thrombin), as opposed to warfarin that leads to noncompetitive inhibition of multiple coagulation factors, (2) a short half-life (12-17 hours) and linear pharmacodynamics related to drug levels that conceivably causes an hourly variation of the level of anticoagulation, (3) a much lower incidence of supratherapeutic anticoagulation ("overshoot") with dabigatran as compared with warfarin, and (4) a reported increase in the coagulation factors that follows long-term use of dabigatran. Also, the absence of routine monitoring to test the therapeutic efficacy of the drug prevents diagnosis of cases where anticoagulation remains subtherapeutic. These factors could explain occurrence of the thrombotic and thromboembolic events in our cases. PMID:23803980

Sharma, Sanjiv; Singh, Sarabjeet; Sandhu, Rasham; Monterroso, Mark; Bhambi, Neil; Sharma, Rohan

2014-01-01

69

[Recurrent right atrium thrombus in long term follow-up after repair of atrial septal defect; report of a case].  

PubMed

A 76-year-old woman with recurrent ball-like thrombus in right atrium after primary repair of atrial septal defect (ASD) and tricuspid annuloplasty was successfully treated by surgical resection and strict management of anticoagulation and antiarrhythmics. A routine follow-up echocardiography, 27 months after initial operation, showed a swinging ball mass looks like a myxoma in the right atrium. Intra-operative findings showed the mass attached the free wall of right atrium with a 5 mm stalk, which was far from the ASD patch, initial suture lines, and the tricuspid annulus. Histological examination revealed the round and smooth mass was thrombus. She was successfully discharged 13 days after the 2nd operation without any complaint. A postoperative laboratory check demonstrated normal coagulability. Despite the patient was prescribed warfarin potassium and aspirin, the follow-up echocardiography at 3 months showed a recurrent thrombus in the right atrium. However the strict anticoagulation therapy with warfarin potassium and aspirin induced thrombolysis and prevent any embolic event, 1 month later. It is important to continue a strict anticoagulant therapy and prevent arrhythmia to avoid recurrence thrombus. PMID:21766715

Uchida, W; Yoshikawa, M; Teramoto, C; Kawaguchi, O

2011-07-01

70

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

71

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

72

A thalassaemia intermedia case with concomitant left atrial thrombus.  

PubMed

Although marked improvements have been observed in the life expectancy of patients with thalassaemia by regular blood transfusion and strict iron chelation therapies in recent years, these patients still have to deal with several complications, mainly cardiovascular. One of the life-threatening complications is the chronic hypercoagulable state and thromboembolic events which develop due to haemostatic alterations in patients with thalassaemia, although they are more frequently seen in those with thalassaemia intermedia. Many thromboembolic complications, mainly deep venous thrombosis and cerebral thrombosis, have been reported in thalassaemia. However, intracardiac thrombosis is rarely seen. In this manuscript, we presented a case that underwent splenectomy 6?years ago but not regularly attended the control visits and presented to our clinic with gradually increasing exercise dyspnoea for 2?months. PMID:24951612

Sahin, Cem; Basaran, Ozcan; Topal, Yasar; Akin, Fatih

2014-01-01

73

The Coincidence of Fetal Magnetocardiography and Direct Electrocardiography in a Case of Fetal Atrial Flutter due to Intracardiac Tumor  

Microsoft Academic Search

Objective: To demonstrate the coincidence of fetal magnetocardiography (FMCG) and fetal direct electrocardiography (FDECG) in a case of fetal atrial flutter (AF). Methods: FMCG and FDECG using a fetal scalp electrode were recorded in the case of fetal AF at 41 weeks’ gestation. Results: FMCG revealed fetal AF with 2:1 atrioventricular block, which was also documented by FDECG using a

Takayoshi Hosono; Takeshi Kanagawa; Yoshihide Chiba; Akihiko Kandori; Keiji Tsukada

2002-01-01

74

A large pediculated myxoma of the left ventricle causing outflow obstruction in a young man.  

PubMed

We report a case of a large mobile myxoma of the left ventricle that caused obstruction of the outflow tract. Transthoracic and transesophageal echocardiography defined the extent and location of the mass providing crucial information for surgical treatment, which was successful. PMID:17624730

Vasquez, Julio C; Rosales, Edmundo; Dueñas, Roy; Rotta, Aida; Montesinos, Efrain; Delarosa, Jacob

2007-12-01

75

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

76

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

77

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

PubMed

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

Kohli, Vikas

2015-02-01

78

Thiamine-responsive megaloblastic anemia syndrome with atrial standstill: a case report.  

PubMed

Thiamine-responsive megaloblastic anemia (TRMA) syndrome is an uncommon autosomal recessive disorder. The disease is caused by mutations in the gene, SLC19A2, encoding a high-affinity thiamine transporter, which disturbs the active thiamine uptake into cells. Major features include megaloblastic anemia, diabetes mellitus, and sensorineural deafness. Cardiac malformations with conduction defects and/or dysrhythmias, have also been described in some patients. To our knowledge, only 13 TRMA patients with cardiac defects have been reported. Here, we describe the first case of TRMA syndrome with atrial standstill, probably caused by a 2 base-pair deletion in exon 4 (1147delGT) of the gene SLC19A2. PMID:21285901

Aycan, Zehra; Ba?, Veysel Nijat; Cetinkaya, Semra; A?ladio?lu, Sebahat Yilmaz; Kendirci, Havva Nur Peltek; Senocak, Filiz

2011-03-01

79

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

PubMed Central

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

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

2014-01-01

80

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

81

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

82

A fatal case of atrioesophageal fistula following radiofrequency ablation of left atrium and pulmonary veins for atrial fibrillation.  

PubMed

Atrial fibrillation (AF) is associated with significant morbidity and mortality. Hemodynamic compromise and formation of thrombi within the fibrillating atrium or atrial appendage can occur. Surgical treatment aims to eliminate dysrhythmia-triggering foci in the pulmonary veins and posterior left atrium by radiofrequency ablation techniques using ohmic heat. As medical treatment may be ineffective, radiofrequency catheter ablation is increasingly being used by interventional cardiac electrophysiologists for AF. Serious complications have been observed among patients who have undergone radiofrequency ablation, atrioesophageal fistula being a very rare example. This case describes a 43-year-old man who died after the development of an atrioesophageal fistula following radiofrequency ablation of the left atrium and pulmonary veins for treatment of AF. PMID:24661792

Rajapaksha, W R A S; Cunningham, Kristopher S; Rose, Toby H

2014-01-01

83

Infective endocarditis or myxoma? Description of a patient with new diagnosis of congestive heart failure.  

PubMed

Infective endocarditis (IE) is an inflammatory disease which interests heart endothelium and mostly heart valves. IE is not a uniform disease, but presents in a variety of different forms that makes the diagnosis difficult. Echocardiography is a crucial diagnostic tool for the diagnosis, especially in those patients who have no typical symptoms as in the case here presented, in which the possibility of a myxoma was also considered. PMID:23167154

Testa, Marzia; Lombardo, Enrico; Avogadri, Enrico; Agostini, Marco; Forte, Giuseppe; Piccolo, Salvatore; Feola, Mauro

2012-06-01

84

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

85

Atrial tachycardias following atrial fibrillation ablation.  

PubMed

One of the most important proarrhythmic complications after left atrial (LA) ablation is regular atrial tachycardia (AT) or flutter. Those tachycardias that occur after atrial fibrillation (AF) ablation can cause even more severe symptoms than those from the original arrhythmia prior to the index ablation procedure since they are often incessant and associated with rapid ventricular response. Depending on the method and extent of LA ablation and on the electrophysiological properties of underlying LA substrate, the reported incidence of late ATs is variable. To establish the exact mechanism of these tachycardias can be difficult and controversial but correlates with the ablation technique and in the vast majority of cases the mechanism is reentry related to gaps in prior ablation lines. When tachycardias occur, conservative therapy usually is not effective, radiofrequency ablation procedure is mostly successful, but can be challenging, and requires a complex approach. PMID:25308808

Saghy, Laszlo; Tutuianu, Cristina; Szilagyi, Judith

2015-01-01

86

Atrial fibrillation in the elderly  

PubMed Central

This review discusses atrial fibrillation according to the guidelines of Brazilian Society of Cardiac Arrhythmias and the Brazilian Cardiogeriatrics Guidelines. We stress the thromboembolic burden of atrial fibrillation and discuss how to prevent it as well as the best way to conduct cases of atrial fibrillatios in the elderly, reverting the arrhythmia to sinus rhythm, or the option of heart rate control. The new methods to treat atrial fibrillation, such as radiofrequency ablation, new oral direct thrombin inhibitors and Xa factor inhibitors, as well as new antiarrhythmic drugs, are depicted. PMID:22916053

Franken, Roberto A.; Rosa, Ronaldo F.; Santos, Silvio CM

2012-01-01

87

Atrial fibrillation, the arrhythmia of the elderly, causes and associated conditions.  

PubMed

Atrial fibrillation (AF) is a common clinical problem, particularly in the elderly, and in patients with organic heart disease. A small percentage of patients, have a potentially reversible cause. Atrial fibrillation is in most patients (approximately 70%) associated with chronic organic heart disease including valvular heart disease, coronary artery disease, hypertension, particularly if left ventricular hypertrophy is present, hypertrophic cardiomyopathy, dilated cardiomyopathy and congenital heart disease and most commonly in adults, atrial septal defect. As in many chronic conditions, determining whether AF is the result or is unrelated to the underlying heart disease, remains unclear. The list of possible etiologies also include cardiac amyloidosis, hemochromatosis and endomyocardial fibrosis. Other heart diseases, such as mitral valve prolapse (with or without mitral regurgitation), calcification of the mitral annulus, atrial myxoma, pheochomocytoma and idiopathic dilated right atrium, present a higher incidence of AF. The relationship between these findings and the arrhythmia are still unclear. Atrial fibrillation may occur in the absence of detectable organic heart disease, the so-called "lone AF", in about 30% of cases. The term "lone AF" or "idiopathic AF" implies the absence of any detectable etiology including hyperthyroidism, chronic obstructive lung disease, overt sinus node dysfunction, and overt or concealed preexcitation (Wolf-Parkinson-White syndrome), only to mention a few of other rare causes of AF. In every instance of recently discovered AF, thyrotoxicosis should be ruled out. The autonomous nervous system may contribute to the occurrence of AF in some patients. Atrial fibrillation occurs commonly in patients with valvular heart disease, particularly when it involves the mitral valve. The occurrence of AF is unrelated to the severity of mitral stenosis but is more common in patients with enlarged left atrium and congestive heart failure. In patients with coronary artery disease, Af occurs predominantly in older patients, males and patients with left ventricular dysfunction. Important predictive factors of AF include hypertension, left ventricular hypertrophy and diabetes. However, the relation between AF and hypertension remains unclear. The risk of the development of AF, in an individual patient, is often difficult to assess but increasing age, presence of valvular heart disease and congestive heart failure, increase the risk of AF. PMID:12101796

Levy, Samuel

2002-03-01

88

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

89

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

90

Importance of Close Follow-Up in the Fetus with Premature Atrial Contractions Accompanied by Atrial Septal Aneurysm: A Case Report  

PubMed Central

Rhythms that derive from parts of atria other than the sinus node are called premature atrial contractions (PACs). Vast majority of fetal PACs are idiopathic. Fetal PACs usually have a good prognosis and disappear spontaneously during pregnancy or after delivery. Development of fetal tachycardia or fetal bradycardia is rarely reported during follow-up of fetuses diagnosed with PACs. To the best of our knowledge, coexistence of tachycardia and bradycardia leading to hemodynamic impairment has not yet been reported. We present a fetus diagnosed with PACs and atrial septal aneurysm (ASA) on the 23rd week of gestation proceeding to fetal bradycardia and fetal tachycardia and consequently hemodynamic impairment. We suggest closer follow-up of fetuses with PACs accompanied by ASA. PMID:24455349

Yozgat, Yilmaz; Kilic, Ayhan; Karadeniz, Cem; Ozdemir, Rahmi; Doksoz, Onder; Mese, Timur; Unal, Nurettin

2013-01-01

91

Atrial fibrillation.  

PubMed

The management of atrial fibrillation has evolved greatly in the past few years, and many areas have had substantial advances or developments. Recognition of the limitations of aspirin and the availability of new oral anticoagulant drugs that overcome the inherent drawbacks associated with warfarin will enable widespread application of effective thromboprophylaxis with oral anticoagulants. The emphasis on stroke risk stratification has shifted towards identification of so-called truly low-risk patients with atrial fibrillation who do not need antithrombotic therapy, whereas oral anticoagulation therapy should be considered in patients with one or more risk factors for stroke. New antiarrhythmic drugs, such as dronedarone and vernakalant, have provided some additional opportunities for rhythm control in atrial fibrillation. However, the management of the disorder is increasingly driven by symptoms. The availability of non-pharmacological approaches, such as ablation, has allowed additional options for the management of atrial fibrillation in patients who are unsuitable for or intolerant of drug approaches. PMID:22166900

Lip, Gregory Y H; Tse, Hung Fat; Lane, Deirdre A

2012-02-18

92

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 ...

93

Abdominal pain, atherosclerosis, and atrial fibrillation. The case for mesenteric ischemia.  

PubMed

DT, a 63-year-old white male with insulin-dependent diabetes mellitus and severe peripheral vascular disease, was admitted with a five-day history of vague abdominal pain and diarrhea. On the day of admission he vomited three times, was noted to have a bloody stool, and came to the emergency room. DT denied hematemesis, fever, or chills. He had bilateral leg amputations and had sustained three myocardial infarctions, the last one 15 months before this admission. He had never experienced symptoms of abdominal angina. Of significance was his history of congestive heart failure, mitral regurgitation, and atrial fibrillation. His medications on admission included digoxin 0.25mg per day, furosemide 40mg per day, and NPH insulin 15 units per day. On admission to the hospital his oral temperature was 38 degrees C, pulse was 90/min, respiratory rate was 24/min, and blood pressure was 134/80mmHg. Abdominal examination revealed a distended abdomen with hypoactive bowel sounds and mild tenderness. Chest x ray revealed cardiomegaly. The electrocardiogram demonstrated atrial fibrillation. A plain film of the abdomen was positive for gallstones and edema of the bowel wall (thumb-printing). Laboratory results included blood urea nitrogen 48mg%, creatinine 1.2mg%, hemoglobin 18g/dl, and hematocrit 52.9%. White blood cell count was 11,900 cells/cc with 33% polymorphonuclear leukocytes, 47% bands, 8% lymphocytes, 11% monocytes, and 1% atypical lymphocytes. The prime considerations for differential diagnosis were mesenteric ischemia and infectious gastroenteritis. While it was appreciated that mesenteric ischemia, if present, might warrant surgical intervention, the risk of anesthesia itself in this patient was felt by his attending physicians to exceed 30%. Furthermore, the clinical findings were only "suggestive" of mesenteric eschemia. They were certainly not "diagnostic." In view of this dilemma, a consultation with the Division of Clinical Decision Making was requested. PMID:7169938

Cormier, R E; Chase, B A; Peterson, G S; Pauker, S G

1982-01-01

94

Post-traumatic fulminant paradoxical fat embolism syndrome in conjunction with asymptomatic atrial septal defect: a case report and review of the literature  

PubMed Central

Introduction Fat embolism syndrome with respiratory failure after intramedullary nailing of a femur fracture is a rare but serious complication in trauma patients. Case presentation We present the case of a 20-year-old Caucasian man who experienced paradoxical cerebral fat embolism syndrome with fulminant progression after intramedullary nailing of a femur fracture, in conjunction with a clinically asymptomatic atrial septal defect in a high position resulting in a right-to-left shunt. Conclusion Fat embolism syndrome may occur as a fulminant complication following femoral fracture repair in the presence of a concomitant atrial septal defect with right-to-left shunt. Thus, in patients with cardiac right-to-left shunts, femurs should not be nailed intramedullary, not even in cases of isolated injuries. PMID:21477362

2011-01-01

95

Myxoma Virus: Propagation, Purification, Quantification, and Storage  

PubMed Central

Myxoma virus (MYXV) is a member of the Poxviridae family and prototype for the genus Leporipoxvirus. It is pathogenic only for European rabbits (Oryctolagus cuniculus), in which it causes a lethal disease called myxomatosis, and for two North American species, Sylvilagus audubonni and Sylvilagus nuttalli, in which it causes a less severe disease. MYXV replicates exclusively in the cytoplasm of the host cell, and its genome encodes 171 open reading frames. A number of these genes encode proteins that can interfere with or modulate host defense mechanisms, and several show promise in a clinical setting. Serp-1, for example, is in clinical trials for treatment of acute unstable coronary syndromes, and M-T7 has been shown to inhibit inflammatory responses in rabbit models of balloon angioplasty arterial injury. Additionally, although MYXV is not infectious in humans, it is able to productively infect a number of human cancer cell lines, but not normal human cells, and has also been shown to increase survival time in mouse models of human glioma. These characteristics suggest that MYXV could prove to be a viable therapeutic agent in a variety of clinical settings, including as an anti-inflammatory or anti-immune therapy, or as an oncolytic agent. MYXV is also an excellent model for poxvirus biology, pathogenesis, and host tropism studies. It is easily propagated in a number of cell lines, including adherent cells and suspension cultures, and minimal purification is required to provide a stock useful for in vivo and in vitro studies. PMID:20440681

Smallwood, Sherin E.; Rahman, Masmudur M.; Smith, Dorothy W.; McFadden, Grant

2010-01-01

96

Cryoballoon ablation for iatrogenic left atrial tachycardia  

PubMed Central

Percutaneous and surgical left atrial ablation has been widely used to treat paroxysmal and persistent atrial fibrillation. However, left atrial ablation may result in left atrial tachycardia due to an iatrogenic substrate created by the ablation lesion sets. Ablation of these iatrogenic arrhythmias can be technically challenging, requiring prolonged procedures and the use of three-dimensional electroanatomical mapping systems. In some cases, the atrial tachycardia may terminate during mapping, or may degenerate into atrial fibrillation during the procedure before adequate mapping. Some patients also have several arrhythmia circuits, each requiring separate mapping, which may be time consuming. The present article reports the cases of three patients in whom a large cryoballoon was used to empirically ablate the pulmonary vein antral region, which is important for the initiation and maintenance of these arrhythmias. PMID:23620703

Dhillon, Paramdeep S; Chen, Zhong; Sunni, Nadia; Norman, Mark; Ward, David E

2012-01-01

97

Ultrastructure of the cardiac myxoma and the papillary tumour of heart valves  

PubMed Central

The ultrastructure of a cardiac myxoma has been studied and compared with that of a `papillary tumour of heart'. The histochemistry of the myxoma was studied at the same time. The predominant myxoma cell contains intracytoplasmic fibrils similar to those occurring in cells (`myofibroblasts') found in granulation tissue, deep within thrombi, and in the subendocardial layer of the heart. It also contains numerous secretory granules which appear to discharge their contents into the pericellular matrix. The material adjacent to the myxoma cell is shown by histochemistry to contain hyaluronic acid and chondroitin sulphate acidic mucins while the surrounding stroma contains sialomucins. The ultrastructure and histochemistry of the cardiac myxoma are very similar to those of the `papillary tumour of heart' which is widely regarded as non-neoplastic and formed by growth of a Lambl's excrescence. Hence these findings do not resolve the classical controversy as to whether the cardiac myxoma is neoplastic or thrombotic in origin. Images PMID:4724494

Stovin, P. G. I.; Heath, Donald; Khaliq, S. U.

1973-01-01

98

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

99

Large Thrombus Formation from Right Atrial Incision Site after Closure of Atrial Septal Defect  

PubMed Central

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

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

2013-01-01

100

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

PubMed

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

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

2014-10-01

101

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

102

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

103

Atrial fibrillation.  

PubMed

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

104

Brain Embolism Secondary to Cardiac Myxoma in Fifteen Chinese Patients  

PubMed Central

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

Long, Youming; Gao, Cong

2014-01-01

105

Right atrial cardiac rhabdomyoma with premature foramen ovale restriction: A case report  

PubMed Central

Fetal cardiac rhabdomyoma is the most common cardiac tumor in fetuses. However, this benign tumor can cause hemodynamic repercussions and intrauterine fetal mortality. The present study reports a case of rare fetal cardiac rhabdomyoma located in the right atrium, accompanied by premature restriction of the foramen ovale and moderate pericardial effusion, as determined by tomographic ultrasound imaging (TUI). Fetal mortality subsequently occurred late in the second trimester of pregnancy and the diagnosis was confirmed by pathology. The present study discusses the occurrence and diagnosis of this rare abnormality. TUI mode with spatio-temporal image correlation offline imaging provides the physician with clear views of abnormal intracardiac structures in the beating heart. With improvements in sonographic technology, the diagnosis of fetal cardiac rhabdomyoma may be easier and more accurate in the clinical arena. PMID:25364426

LI, YI-DAN; HE, YI-HUA; LI, ZHI-AN; WEI, PING

2014-01-01

106

Symptomatic Bradycardia Caused By Premature Atrial Contractions Originating From Right Atrial Appendage  

PubMed Central

Premature atrial contraction is a common form of supraventricular arrhythmias. In rare cases, severe symptoms other than palpitation may occur. In this report, we present a patient with symptomatic bradycardia which developed secondary to blocked premature atrial contractions and was successfully treated with radiofrequency ablation. PMID:23840105

Alper, AT; Gungor, B; Turkkan, C; Tekkesin, AI

2013-01-01

107

Atrial Fibrillation and Stroke  

MedlinePLUS

NINDS Atrial Fibrillation and Stroke Information Page Table of Contents (click to jump to sections) What is Atrial Fibrillation and Stroke? Is there any treatment? What is the prognosis? What research ...

108

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

109

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

PubMed

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; Ak?n, Alper; Aykan, Hayrettin Hakan

2014-01-01

110

Dedifferentiation of atrial cardiomyocytes as a result of chronic atrial fibrillation.  

PubMed Central

Chronic atrial fibrillation was induced in goats by electrical pacing. After 9 to 23 weeks of sustained atrial fibrillation, the morphology of the atrial structures was examined. The majority of the cardiomyocytes exhibited marked changes in their cellular substructures, with the replacement of sarcomeres by glycogen as the main characteristic. Using immuno-histochemical staining procedures, we assessed the expression and organization of contractile and cytoskeletal proteins in these cases and compared them with the expression and organization of these proteins in normal atria. Part of the atrial cardiomyocytes acquired a dedifferentiated phenotype, as deduced from the re-expression of alpha-smooth muscle actin, the disappearance of cardiotin, and the staining patterns of titin, which resembled those of embryonic cardiomyocytes. From these results we conclude that chronic atrial fibrillation induces myocardial dedifferentiation. This model of chronic atrial fibrillation in goats offers the possibility to study the time course of changes in cardiac structure during sustained atrial fibrillation and after cardioversion. Images Figure 1 Figure 2 Figure 3 Figure 5 Figure 6 Figure 7 PMID:9327732

Ausma, J.; Wijffels, M.; van Eys, G.; Koide, M.; Ramaekers, F.; Allessie, M.; Borgers, M.

1997-01-01

111

Calcified right atrial thrombus in HIV infected patient  

PubMed Central

Calcified right atrial thrombi are rare cardiac masses that may be complicated by pulmonary embolism. Although they can be discovered by a transthoracic echocardiography, they may need histological examination to differentiate them from other cardiac masses. We report a case of a 44-year-old woman who presented with a calcified right atrial thrombus and progressive dyspnoea. PMID:23819008

Mwita, Julius Chacha; Goepamang, Monkgogi; Mkubwa, Jack Joseph; Gunness, Teeluck Kumar; Reebye, Deshmukh; Motumise, Kelebogile

2013-01-01

112

Delayed left atrial wall dissection after mitral valve replacement.  

PubMed

We report two unusual cases of left atrial wall dissection creating a left atrial pseudoaneurysm associated with regurgitation a few months after mitral valve replacement. We emphasize the important role of transesophageal echocardiography in the diagnosis. The two patients successfully underwent surgery. PMID:10978990

Idir, M; Deville, C; Roudaut, R

2000-04-01

113

Totally Thoracoscopic Ablation for Treatment of Atrial Fibrillation after Atrial Septal Defect Device Closure  

PubMed Central

Atrial septal defect (ASD) is one of the most common congenital heart defects in adults. Surgical repair is the most common treatment approach, but device closure has recently become widely performed in accordance with the trend toward less invasive surgical approaches. Although surgery is recommended when ASD is accompanied by atrial fibrillation, this study reports a case in which a complete cure was achieved by closure of a device and totally thoracoscopic ablation. PMID:25207227

Kim, Young Su; Jeong, Dong Seop; Kang, I-seok; On, Young Keun

2014-01-01

114

Neural mechanisms of atrial arrhythmias  

Microsoft Academic Search

The past 5 years have seen great advances in the knowledge of neural mechanisms of atrial arrhythmogenesis. Direct autonomic nerve recordings demonstrate that simultaneous sympathovagal discharges and intrinsic cardiac nerve activities are common triggers of paroxysmal atrial tachycardia and atrial fibrillation. While activity of the autonomous nervous system (ANS) is crucial in triggering paroxysmal atrial fibrillation, a high incidence of

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

2011-01-01

115

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.

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

2015-01-01

116

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

117

Implementation of antithrombotic management in atrial fibrillation  

PubMed Central

The aim of the study was to assess the extent to which published recommendations on the antithrombotic management of atrial fibrillation had been adopted into clinical practice in a busy district general hospital, and the impact of clinical audit on subsequent management. In the initial audit, 185 consecutive patients with atrial fibrillation were studied using their case notes to identify any further clinical risk factors for stroke. A management algorithm stratified patients with atrial fibrillation into high, moderate, or low risk of stroke according to the individual stroke risk factors. For patients at high risk, the correct treatment is warfarin unless there are specific contraindications. For patients at moderate risk, the correct management is aspirin unless there are specific contraindications. Patients at low risk should receive no thromboprophylaxis. The clinical risks of stroke and thromboprophylaxis on discharge from hospital were recorded. An extensive education programme on stroke prevention in atrial fibrillation was undertaken. Six months later a further 185 consecutive patients with atrial fibrillation were audited. Overall, a large proportion (306/370; 83%) of patients were at high risk of stroke. In the initial audit, antithrombotic management was correct in 89 patients (48%). In the follow up audit, antithrombotic management was correct in 135 patients (73%) (p < 0.00001). If this improvement in management were extrapolated to all hospital patients in the United Kingdom, approximately 1400 strokes/year could be avoided. Despite broad consensus in recent publications, antithrombotic management of atrial fibrillation remains imperfect, with many patients exposed to unnecessarily high risk of stroke.???Keywords: atrial fibrillation; anticoagulation PMID:11085769

McNulty, S; Hutchinson, D; Hardy, K

2000-01-01

118

What Is Atrial Fibrillation?  

MedlinePLUS

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

119

Exercise intolerance due to sustained atrial bigeminy with short coupling interval.  

PubMed

Atrial bigeminy is a supraventricular arrhythmia rarely associated with severe symptoms. We report the case of a 22-year-old woman with no prior cardiac disease presenting with exercise intolerance since several months. No apparent heart disease other than a spontaneous conducted atrial bigeminy with a short coupling interval was found. At bicycle ergometric testing, symptoms occurred, because of an inadequate increase in pulse rate, due to sustained atrial bigeminy. At electrophysiological study, an ectopic atrial focus at the right atrial septum was successfully ablated. PMID:21894810

Jansen, Katrijn; Blommaert, Dominique; Deceuninck, Olivier

2011-08-01

120

Molecular characterisation of virulence graded field isolates of myxoma virus  

PubMed Central

Background Myxoma virus (MV) has been endemic in Europe since shortly after its deliberate release in France in 1952. While the emergence of more resistant hosts and more transmissible and attenuated virus is well documented, there have been relatively few studies focused on the sequence changes incurred by the virus as it has adapted to its new host. In order to identify regions of variability within the MV genome to be used for phylogenetic studies and to try to investigate causes of MV strain attenuation we have molecularly characterised nine strains of MV isolated in Spain between the years 1992 and 1995 from wide ranging geographic locations and which had been previously graded for virulence by experimental infection of rabbits. Results The findings reported here show the analysis of 16 genomic regions accounting for approximately 10% of the viral genomes. Of the 20 genes analysed 5 (M034L, M069L, M071L, M130R and M135R) were identical in all strains and 1 (M122R) contained only a single point mutation in an individual strain. Four genes (M002L/R, M009L, M036L and M017L) showed insertions or deletions that led to disruption of the ORFs. Conclusions The findings presented here provide valuable tools for strain differentiation and phylogenetic studies of MV isolates and some clues as to the reasons for virus attenuation in the field. PMID:20187925

2010-01-01

121

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

122

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

123

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

124

Atrial selectivity of antiarrhythmic drugs  

PubMed Central

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

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

2013-01-01

125

Association of echocardiographic atrial size and atrial fibrosis in a sequential model of congestive heart failure and atrial fibrillation  

Microsoft Academic Search

BackgroundCardioversion (CV) success of atrial fibrillation (AF) inversely correlates to the size of the left atrium (LA). Atrial fibrillation and its most important risk factor, congestive heart failure (CHF), both induce atrial structural enlargement and fibrosis. To investigate the effect of AF and CHF on atrial dilatation and fibrosis, and to estimate whether echocardiographically determined atrial size may be used

Christian Knackstedt; Felix Gramley; Thomas Schimpf; Karl Mischke; Markus Zarse; Jurgita Plisiene; Michael Schmid; Johann Lorenzen; Dirk Frechen; Philipp Neef; Peter Hanrath; Malte Kelm; Patrick Schauerte

2008-01-01

126

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

127

Exploiting periodicity to extract the atrial activity in atrial arrhythmias  

NASA Astrophysics Data System (ADS)

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

Llinares, Raul; Igual, Jorge

2011-12-01

128

Incidence and predictors of atrial flutter in the general population  

Microsoft Academic Search

OBJECTIVESThe goal of our study was to determine the incidence and predictors of atrial flutter in the general population.BACKGROUNDAlthough atrial flutter can now be cured, there are no reports on its epidemiology in unselected patients.METHODSThe Marshfield Epidemiological Study Area (MESA), a database that captures nearly all medical care among its 58,820 residents was used to ascertain all new cases of

Juan Granada; William Uribe; Po-Huang Chyou; Karen Maassen; Robert Vierkant; Peter N Smith; John Hayes; Elaine Eaker; Humberto Vidaillet

2000-01-01

129

Surgical ablation for atrial fibrillation.  

PubMed

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

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

2012-11-01

130

P wave morphology in guiding the ablation strategy of focal atrial tachycardias and atrial flutter.  

PubMed

Focal atrial tachycardias arise preferentially from specific locations within the atria. Careful analysis of the P wave can provide useful information about the chamber and likely site of origin within that chamber. Macro-reentrant atrial flutter also tends to occur over a limited number of potential circuits. In this case, the ECG usually gives a guide to the chamber of origin, but unless it shows a specific morphology it is less useful in delineating the circuit involved. Nonetheless, prior knowledge of the likely chamber of origin helps to plan the ablation strategy. PMID:25308814

Lee, Justin M S; Fynn, Simon P

2015-01-01

131

Alterations in atrial perfusion during atrial fibrillation.  

PubMed

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

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

2014-10-01

132

Obesity and atrial fibrillation.  

PubMed

Atrial fibrillation (AF) is an increasing public health problem, often described as the epidemic of the new millennium. The rising health economic impact of AF, its association with poor quality of life and independent probability of increased mortality, has recently been highlighted. Although population ageing is regarded as an important contributor to this epidemic, obesity and its associated cardiometabolic comorbidities may represent the principal driving factor behind the current and projected AF epidemic. Obesity-related risk factors, such as hypertension, vascular disease, obstructive sleep apnea and pericardial fat, are thought to result in atrial electro-structural dysfunction. In addition, insulin resistance, its associated abnormalities in nutrient utilization and intermediary metabolic by-products are associated with structural and functional abnormalities, ultimately promoting AF. Recent elucidation of molecular pathways, including those responsible for atrial fibrosis, have provided mechanistic insights and the potential for targeted pharmacotherapy. In this article, we review the evidence for an obesity-related atrial electromechanical dysfunction, the mechanisms behind this and its impact on AF therapeutic outcomes. In light of the recently described mechanisms, we illustrate proposed management approaches and avenues for further investigations. PMID:23879190

Abed, H S; Wittert, G A

2013-11-01

133

Atrial Fibrillation: Nonpharmacologic Approaches  

Microsoft Academic Search

Various nonpharmacologic interventions are available for patients with atrial fibrillation (AF) who are refrac- tory to standard drug therapy. Atrioventricular junc- tional ablation and permanent pacing is a very effective therapy for patients with AF and a poorly controlled ventricular response. The surgical MAZE procedure has been performed on small numbers of patients but is remarkably successful in restoring and

David S. Cannom

134

Atrial fibrillation: nonpharmacologic approaches  

Microsoft Academic Search

Various nonpharmacologic interventions are available for patients with atrial fibrillation (AF) who are refractory to standard drug therapy. Atrioventricular junctional ablation and permanent pacing is a very effective therapy for patients with AF and a poorly controlled ventricular response. The surgical MAZE procedure has been performed on small numbers of patients but is remarkably successful in restoring and maintaining sinus

David S Cannom

2000-01-01

135

Emergency management of atrial fibrillation  

PubMed Central

Atrial fibrillation is the most common cardiac arrhythmia managed by emergency and acute general physicians. There is increasing evidence that selected patients with acute atrial fibrillation can be safely managed in the emergency department without the need for hospital admission. Meanwhile, there is significant variation in the current emergency management of acute atrial fibrillation. This review discusses evidence based emergency management of atrial fibrillation. The principles of emergency management of acute atrial fibrillation and the subset of patients who may not need hospital admission are reviewed. Finally, the need for evidence based guidelines before emergency department based clinical pathways for the management of acute atrial fibrillation becomes routine clinical practice is highlighted. PMID:12840118

Wakai, A; O'Neill, J

2003-01-01

136

Atrial activity selection for atrial fibrillation ECG recordings.  

PubMed

In this paper we apply independent component analysis (ICA) followed by second order blind identification (SOBI) to an atrial fibrillation (AF) 12-lead electrocardiogram (ECG) recording in order to extract the source that represents atrial activity (AA) (ICA-SOBI method). Still, there is no assurance that only one source obtained from this method will contain AA, and thus we aim to select the most representative source of AA. The novelty in this paper is the proposal of three parameters to select the most representative source of AA. These parameters are correlation coefficient with lead V1 (CV1), peak factor (PF) and spectral concentration (SC). The first two parameters are introduced as new indicators, addressing features overlooked by the SC even when they are present in AA during AF. For synthesized data, at least two of the three parameters select the same representation of AA in 93.3% of the cases. For real data (218 ECG recordings), we observe that PF presents, in 89.5% of the cases, values between 2 and 4.5 for the selected sources, ensuring a well-defined range of values for AA. The actual values of CV1 and SC were scattered throughout their possible ranges (0-1 for CV1 and 0.08-0.7 for SC), and the correlation coefficient between these variables was found to be ?=0.58. We compared our results with three known algorithms: QRST cancellation, principal components analysis (PCA) and ICA-SOBI. The results obtained from this comparison show that our proposed methods to select the best representation of AA in general outperform the three above-mentioned algorithms. PMID:24034755

Donoso, Felipe I; Figueroa, Rosa L; Lecannelier, Eduardo A; Pino, Esteban J; Rojas, Alejandro J

2013-10-01

137

Magnetic resonance imaging of intramuscular myxoma with histological comparison and a review of the literature  

Microsoft Academic Search

ObjectiveTo evaluate the magnetic resonance (MR) features of intramuscular myxoma (IM) compared with its pathological findings.DesignTwo radiologists retrospectively reviewed records and imaging studies of patients with histologically proven IM. Two radiologists also analyzed by consensus all the MR studies (pre- and post-contrast T1-weighted and T2-weighted sequences) and a pathologist reviewed the available histological material.PatientsSeventeen patients with 18 histologically proven IM

A. Luna; S. Martinez; E. Bossen

2005-01-01

138

Partial sequencing of recent Portuguese myxoma virus field isolates exhibits a high degree of genetic stability.  

PubMed

To study genetic changes underlying myxoma virus evolution in its new host, the European rabbit (Oryctolagus cuniculus), we sequenced selected genomic regions of nine recent virulent field strains and a live attenuated vaccine strain ("MAV", Germany). DNA was extracted from cell culture passaged myxoma virus. A total of 4863 bp (approximately 3% of the genome) of 10 regions spanning 12 genes of the myxoma viruses was sequenced and compared to the original virulent strain "Lausanne" and its attenuated field derivative strain "6918". The field strains displayed a maximum of three (strains C43, C95) and a minimum of one (strains CD01, CD05) nucleotide substitutions. These were distributed through all analysed coding regions, except gene M022L (major envelope protein), where all strains were identical to "Lausanne" and "6918". Two new single nucleotide insertions were observed in some of the field strains: within the intergenic region M014L/M015L and within gene M009L, where it leads to a frameshift. These insertions were located after homopolymeric regions. The vaccine strain displayed 37 nucleotide substitutions, predominantly (95%) located in genes M022L and M036L. Interestingly, regions M009L and M014L/M015L of the vaccine were not amplified successfully, suggesting major genomic changes that could account for its attenuated phenotype. Our results support a high degree of genetic stability of myxoma virus over the past five decades. None of the analysed genome regions by its own seems sufficient for the genetic characterisation of field strains. PMID:19709821

Muller, A; Silva, E; Abrantes, J; Esteves, P J; Ferreira, P G; Carvalheira, J C; Nowotny, N; Thompson, G

2010-01-01

139

Atrial fibrillation in the elderly.  

PubMed

Atrial fibrillation is the most common sustained arrhythmia seen in clinical practice. Although it occurs in any age patients, its frequency increases with age and is very common in the elderly. Atrial fibrillation causes substantial symptoms and morbidity and is an important cause of thromboembolism and stroke. The two approaches for therapy in those patients with intermittent or persistent atrial fibrillation are (1) maintenance of sinus rhythm with an antiarrhythmic drug or nonpharmacologic therapy, and (2) maintenance of atrial fibrillation with rate control. At the present time there are no data about the best approach and therapy must therefore be individualized. PMID:10093772

Podrid, P J

1999-02-01

140

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

141

Atrial fibrillation: catheter ablation.  

PubMed

Catheter ablation of atrial fibrillation (AF) has evolved dramatically over the last several years. The initial efforts in the catheter-based management of AF targeted the atrial substrate in an effort to mimic the maze procedure. After the pulmonary veins (PV) were shown to be critical in the initiation and perpetuation of AF, the focus then shifted to a trigger approach in which the PVs and other foci were targeted for ablation. The pendulum then appeared to swing back toward the substrate approach after it was shown that left atrial circumferential ablation afforded improved outcomes in patients with paroxysmal and persistent AF. It has become clear that there are several possible approaches in the catheter ablation of AF, each with its strengths and limitations. It is also becoming evident that not all patients will respond to a single ablation technique and that the ablation protocol is best tailored to suit the individual patient. This article strives to present an evidence-based review of the many techniques, and then offer a practical guide to the catheter ablation of AF. PMID:17053976

Chugh, Aman; Morady, Fred

2006-06-01

142

[Diagnosis of atrial septal defect using magnetic resonance imaging].  

PubMed

We studied the morphological features of defects of the interatrial septum using magnetic resonance imaging (MRI) to determine the sizes of defects and other abnormalities. MR images were obtained in 28 patients with atrial septal defect, including five cases with complicated anomalies (two with Ebstein's anomaly, one pentalogy of Fallot, and one anomalous pulmonary vein connection and azygos continuation). Images were also obtained in the control subjects including seven normal volunteers and 142 patients with various acquired heart diseases. The diagnosis of atrial septal defect was established by cardiac catheterization, angiography and two-dimensional echocardiography prior to the MRI studies, and in 14 patients, the diagnosis was confirmed by surgery. The MRI unit had a superconducting magnet and operated at 0.25 or 0.50 Tesla. A spin echo pulse sequence was used with an echo time of 40 or 60 msec. At the beginning of this study, non-gated MRI images were obtained in the 28 controls and in three patients with atrial septal defect. Nongated MRI could not image the anatomical structure of the interatrial septa of 12 of the 28 controls, or any of the three patients with atrial septal defect. Nongated MRI was, therefore, inadequate for visualizing cardiac anatomy. Gated MRI images were obtained in 141 controls and in 25 patients with atrial septal defect. Gated MRI revealed the interatrial septum, interventricular septum, atrioventricular septum, mitral valve, tricuspid valve and other intracardiac structures in most subjects. In 17 control subjects (12%), however, there was a very faint signal from the central portion of the interatrial septum. In these instances, there was a gradual fading of the signal of the interatrial septum, so that they could be distinguished from the atrial septal defect. The sudden disappearance of the signal from the interatrial septum was observed by gated MRI in all 25 patients with atrial septal defect. The sizes of the defects by MRI coincided with the findings at surgery in all 14 patients. MRI showed right atrial dilatation, right ventricular hypertrophy and dilatation, and pulmonary artery dilatation in most of the patients having atrial septal defect. Complex anomalies associated with atrial septal defect were also clearly shown by MRI, such as displacement of the tricuspid leaflets in two patients with Ebstein's anomaly, and anomalous pulmonary venous connection and persistent left superior vena cava in one patient. These results indicated that gated MRI is a valuable noninvasive method of diagnosing atrial septal defect and complicating anomalies. PMID:3506607

Sakakibara, M; Kobayashi, S; Imai, H; Watanabe, S; Masuda, Y; Inagaki, Y

1987-12-01

143

Combined percutaneous treatment of atrial septal defect and pulmonic or aortic stenosis in adult patients  

PubMed Central

Combined atrial septal defect and pulmonic or aortic stenosis are relatively uncommon conditions in adult patients, with few reported cases of percutaneous treatment. We present two patients with secundum type atrial septal defect and concomitant pulmonic or aortic stenosis and their treatment by transcatheter techniques. PMID:22427776

Linhartova, Katerina; Antonova, Petra; Adlova, Radka; Alan, David; Veselka, Josef

2010-01-01

144

Facts about Atrial Septal Defect  

MedlinePLUS

... to Other Websites Information For... Media Policy Makers Facts about Atrial Septal Defect Language: English Español (Spanish) Share Compartir Click here to view a larger image Click here to view a larger image Pronounced ey-tree-uhl sep-tl dee-fekt An atrial septal ...

145

Atypical right atrial flutter patterns  

Microsoft Academic Search

Background—The purpose of our study was to define the incidence and mechanisms of atypical right atrial flutter. Methods and Results—A total of 28 (8%) of 372 consecutive patients with atrial flutter (AFL) had 36 episodes of sustained atypical right AFL. Among 24 (67%) of 36 episodes of lower loop reentry (LLR), 13 (54%) of 24 episodes had early breakthrough at

Yanfei Yang; Jie Cheng; Andy Bochoeyer

2001-01-01

146

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

147

Pericardioesophageal Fistula Following Left Atrial Ablation Procedure  

PubMed Central

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.

2014-01-01

148

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

149

Left atrial spontaneous echo contrast in patients with permanent pacemakers.  

PubMed Central

OBJECTIVE: To determine the relations between left atrial appendage function, spontaneous echo contrast, and thromboembolism in patients with different modes of permanent pacemakers. PATIENTS AND METHODS: 88 patients with pacemaker implantation and 25 healthy controls in sinus rhythm had transoesophageal echocardiographic examination of the left atrial appendage. Left atrial size, appendage area, peak filling and emptying velocities of the atrial appendage, and the presence or absence of spontaneous echo contrast and thromboembolism were determined. The results in 63 patients with ventricular pacing (group 1, subdivided into subgroup 1A: 42 patients with sinus rhythm, and subgroup 1B: 21 patients with atrial fibrillation) were compared with those in 25 patients with synchronous pacing (group 2), and 25 normal control subjects (group 3). RESULTS: Patients with ventricular pacing had two distinct appendage flow patterns: well defined biphasic filling and emptying waves in subgroup 1A, and irregular very low filling and emptying waves in subgroup 1B. The ejection fraction of the left atrial appendage in subgroup 1A was significantly better than that in subgroup 1B (mean (SD) 40.6 (12.0)% v 7.6 (5.0)%, P < 0.0001). The spontaneous echo contrast was observed in 90% of subgroup 1B patients but in only 19% in subgroup 1A (P < 0.05) and was not found in groups 2 and 3 (P < 0.0001). There was a trend for increased prevalence of spontaneous echo contrast in subgroup 1A v group 2 (P = 0.053). Thrombi were detected in two cases, and cardiogenic embolism occurred in one case in subgroup 1B. All patients with spontaneous echo contrast had ventricular pacing. Multivariate analysis showed that atrial fibrillation was associated with occurrence of spontaneous echo contrast in patients with ventricular pacing (P = 0.005). CONCLUSIONS: The left atrial appendage ejection fraction was lower with ventricular pacing than with synchronous pacing. With ventricular pacing there was a trend towards increased prevalence of left atrial spontaneous echo contrast in patients in sinus rhythm, and a significantly increased prevalence in patients with atrial fibrillation. Images PMID:9391288

Lee, T. M.; Su, S. F.; Chien, K. L.; Lin, Y. J.; Chen, W. J.; Chen, M. F.; Liau, C. S.; Lee, Y. T.

1997-01-01

150

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

151

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

152

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

153

Unusual presentation of localized gingival enlargement associated with a slow-growing odontogenic myxoma  

PubMed Central

Unusual presentation of localized gingival enlargement associated with a subjacent tumoural pathology is reported. The patient was a 55-year-old black male, whose chief complaint was a progressive gingival overgrowth for more than ten years, in the buccal area of the anterior left mandible. According to the clinical features and the radiological diagnosis of odontogenic keratocyst, a conservative surgery with enucleation and curettage was performed. Tissue submitted for histopathological analysis rendered the diagnosis of odontogenic myxoma. After 12-month of follow-up, no evidence of recurrence was found. Clinicians should be cautious when facing any gingival enlargement to avoid diagnostic pitfalls and to indicate the appropriate treatment. PMID:23722914

Miranda Rius, Jaume; Nadal, Alfons; Lahor, Eduard; Mtui, Beatus; Brunet, Lluís

2013-01-01

154

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

PubMed Central

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

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

2012-01-01

155

Outcomes of Medicare Beneficiaries Undergoing Catheter Ablation for Atrial Fibrillation  

PubMed Central

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

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

2012-01-01

156

Giant mediastinal teratoma presenting with paroxysmal atrial fibrillation.  

PubMed

Mediastinum is a common site where benign tumors, like teratomas, can develop. Usually, these lesions do not cause any symptoms and the diagnosis is reached accidentally. As they enlarge they may cause symptoms by compressing the nearby structures of the thorax, mostly the trachea and the bronchi. Extrinsic compression of the heart or the great vessels appears to be a very rare occurrence. Atrial fibrillation as the first clinical presentation of left atrial compression by a giant mediastinal teratoma is extremely uncommon and very few cases have been described in the English literature. PMID:21075832

Asteriou, Christos; Barbetakis, Nikolaos; Kleontas, Athanassios; Konstantinou, Dimitrios

2011-02-01

157

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

158

Aetiology and risk stratification of patients presenting with atrial fibrillation.  

PubMed

Atrial fibrillation (AF) is the most common sustained arrhythmia in the World, occurring in approximately 0.4% of the general population. The purpose of the present study was to see the aetiology, presenting symptoms and risk stratification of hospital admitted patients with atrial fibrillation. It was conducted in the department of cardiology, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2008 to January 2009. A total of 100 patients with atrial fibrillation were enrolled in this study. Out of them, male were 40(40%) and female 60(60%); age range 22-79 years. Most common presenting symptoms were palpitation (80%) & dyspnoea (70%). Chronic rheumatic heart disease (CRHD) (63%) was found in most cases followed by IHD (13%), hypertension (11%). Among CRHD, mitral stenosis was 50%, and mixed mitral valve disease was 8%. Risk stratification of patients with AF for future thromboembolism revealed high risk factors were present in 60% cases, moderate in 25% cases, and weaker risk factors in 15% cases. According to CHADS2 score, most of the patients belonged to moderate risk group (47%) and 32% in low risk group. Chronic rheumatic heart disease is one of the major causes of atrial fibrillation in hospital admitted patients & risk stratification revealed that most of the patients were in risk for future stroke. PMID:23715353

Islam, M S; Mahmood, M; Safiuddin, M; Siddique, M A; Banerjee, S K; Islam, M N; Azad, A K; Arafat, S M; Rumki, R S

2013-04-01

159

Congenital left atrial appendage aneurysm associated with a systemic embolism.  

PubMed

A 20 year-old woman presented with systemic embolisation. On subsequent investigation, she was diagnosed with a congenital left atrial appendage aneurysm. Few case reports are reported in the literature. This cardiac malformation presents a diagnostic challenge in patients with cardiomegaly. PMID:24854482

Tidake, Abhay; Gangurde, Pranil; Mahajan, Ajay

2015-03-01

160

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

161

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

162

The Modern Surgical Management of Atrial Fibrillation  

Microsoft Academic Search

Atrial fibrillation is the most common arrhythmia disorder. Its incidence is especially high among patients with valvular heart dis- ease. Patients with atrial fibrillation are at a six-fold increased risk of stroke and a two-fold increased risk of mortality. Medical management for rhythm control of patients with atrial fibrillation is suboptimal and no better than simple rate management. How -

ANIL K. GEHI; DAVID H. ADAMS; FARZAN FILSOUFI

163

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

164

Fetal bradycardia in the first trimester: an unusual presentation of atrial extrasystoles.  

PubMed

We report a fetus with fetal bradycardia at 13 weeks of gestation secondary to atrial extrasystoles. The fetus subsequently developed paroxysmal supraventricular tachycardia and hydrops fetalis. The cardiac arrhythmia recovered spontaneously without any medical intervention. This case illustrates that atrial ectopic beats can present in the first trimester with fetal bradycardia. Rapidly evolving hydrops fetalis secondary to supraventricular tachycardia can develop, warranting close monitoring with weekly heart rate assessment. Fetal bradycardia secondary to atrial extrasystole should be differentiated from first trimester sinus bradycardia and those associated with major structural cardiac abnormality, which have a high fetal loss rate. PMID:12424759

Wong, S F; Chau, K T; Ho, L C

2002-11-01

165

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

166

Serp2, an Inhibitor of the Interleukin-1?-Converting Enzyme, Is Critical in the Pathobiology of Myxoma Virus  

PubMed Central

Recently, myxoma virus was shown to encode an additional member of the serpin superfamily. The viral gene, called serp2, was cloned, and the Serp2 protein was shown to specifically bind to interleukin-1? (IL-1?)-converting enzyme (ICE), thus inhibiting the cleavage of pro-IL-1? by the protease (F. Petit, S. Bertagnoli, J. Gelfi, F. Fassy, C. Boucraut-Baralon, and A. Milon, J. Virol. 70:5860–5866, 1996). Here, we address the role of Serp2 in the development of myxomatosis, a lethal infectious disease of the European rabbit. A Serp2 mutant myxoma virus was constructed by disruption of the single-copy serp2 gene and insertion of the Escherichia coli gpt gene serving as the selectable marker. A revertant virus was obtained by replacing the E. coli gpt gene by the intact serp2 open reading frame. The Serp2? mutant virus replicated with wild-type kinetics both in rabbit fibroblasts and a rabbit CD4+ T-cell line (RL5). Moderate reduction of cell surface levels of major histocompatibility complex I was observed after infection with wild-type or Serp2? mutant myxoma virus, and both produced white pocks on the chorioallantoic membrane of the chick embryo. After the infection of European rabbits, the Serp2? mutant virus proved to be highly attenuated compared to wild-type myxoma virus, as demonstrated by the clinical course of myxomatosis and the survival rates of infected animals. Pathohistological examinations revealed that infection with wild-type myxoma virus resulted in a blockade of the inflammatory response at the vascular level. In contrast, rapid inflammatory reactions occurred upon infection with the Serp2? mutant virus. Furthermore, lymphocytes in lymph nodes derived from animals inoculated with Serp2 mutant virus were shown to rapidly undergo apoptosis. We postulate that the virulence of myxoma virus in the European rabbit can be partially attributed to an impairment of host inflammatory processes and to the prevention of apoptosis in lymphocytes. The weakening of host defense is directly linked to serp2 gene function and is likely to involve the inhibition of IL-1?-converting-enzyme-dependent pathways. PMID:9733819

Messud-Petit, Frederique; Gelfi, Jacqueline; Delverdier, Maxence; Amardeilh, Marie-France; Py, Robert; Sutter, Gerd; Bertagnoli, Stephane

1998-01-01

167

Laser Atrial Septostomy: An Engineering Problem  

NASA Astrophysics Data System (ADS)

The purpose of this study was to develop a reproducible method for atrial septostomy in live animals, which would be independent of both atrial septal thickness and left atrial size. Seven mongrel dogs monitored electrocardiographically were anesthetized and instrumented with systemic and pulmonary arterial lines. A modified Mullin's transseptal sheath was advanced under fluoroscopic control to interrogate the left atrium and atrial septum. A 400 micron regular quartz or a laser heated metallic tip fiber was passed through the sheath up to the atrial septum. Lasing of the atrial septum was done with an Argon laser at power output of 5 watts. In three dogs, an atrial septosomy catheter was passed to the left atrium through the laser atrial septostomy and balloon atrial septostomy was performed. The laser atrial septostomy measured 3 x 5 mm in diameter. This interatrial communication could be enlarged with a balloon septostomy to over one cm in diameter. Hemodynamic and electrocardiographic monitoring were stable during the procedure. Engineering problems included: 1) radioluscency of the laser fibers thus preventing fluoroscopic localization of the fiber course; and 2) the inability to increase lateral vaporization of the atrial septum. It is concluded that further changes in the lasing fibers need to be made before the method can be considered for clinical use.

Ben-Shachar, Giora; Cohen, Mark H.; Riemenschneider, Thomas A.; Beder, Stanley D.

1987-04-01

168

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

169

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

170

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

171

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.

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

2015-01-01

172

Recurrent syncope after left atrial appendage occlusion.  

PubMed

We present the case of a 72-year-old woman with permanent atrial fibrillation and contraindication to long-term oral anticoagulant therapy who underwent left atrial appendage (LAA) occlusion. A 24-mm Amplatzer Cardiac Plug (St Jude Medical) device was deployed. The inferior part of the external disc of the device appeared to be over the posterior leaflet of the mitral valve but no significant mitral stenosis or mitral regurgitation was detected before deployment. After the procedure the patient suffered several syncopes when she tried to stand up. A transesophageal echocardiography (TEE) was performed and no significant differences on the device position were detected, it was not possible to perform the TEE in a stand-up position due to the patient symptoms (hypotension, tachycardia, dizziness, and loss of consciousness). After discussion with the surgical team, surgical removal of the device and surgical exclusion of LAA was performed. The symptoms disappeared and the patient was discharged. In the best of our knowledge, this is the first time that recurrent syncope has been described as a complication of LAA occlusion. © 2014 Wiley Periodicals, Inc. PMID:25044597

Cruz-Gonzalez, Ignacio; Perez-Rivera, Jose-Angel; Bethencourt, Armando

2015-02-01

173

Ablation of Focal Atrial Fibrillation  

Microsoft Academic Search

In the past decades management of atrial fibrillation (AF) has been based mainly on drug therapy. New insights into the pathophysiology of AF initiation and maintenance have provided the background for the design of catheter based procedures. The crucial role of the pulmonary veins (PVs) as triggers of AF paved the way for successful mapping and ablation. Electrical isolation of

Eduardo B. Saad; Nassir F. Marrouche; Andrea Natale

2002-01-01

174

Experimental infection of specific pathogen-free New Zealand White rabbits with five strains of amyxomatous myxoma virus.  

PubMed

Myxomatosis is a specific disease of the European rabbit (Oryctolagus cuniculus) due to a virus belonging to the genus Leporipoxvirus. Forty-seven years after its deliberate introduction into Europe, the clinical aspects and the epizootiology of myxomatosis have changed. Two forms (nodular and amyxomatous) of the disease have been identified to date. A comparative study was made of the clinical signs, pathogenesis and gross lesions observed in male specific pathogen-free New Zealand White rabbits inoculated with five strains of amyxomatous myxoma virus. All five strains induced the characteristic amyxomatous myxomatosis clinical syndrome with clinical signs that differed only in intensity. The varying clinical intensity, together with the results of virological examination question the virulence of at least three of the five strains. Genomic analysis confirmed that the five strains came from the Lausanne strain introduced in 1952 in France and not from an unnoticed introduction of a Californian strain of myxoma virus. No link was found between the amyxomatous myxoma virus strains and the SG33 vaccine strain. 1999 Harcourt Publishers Ltd. PMID:10542126

Marlier, D; Cassart, D; Boucraut-Baralon, C; Coignoul, F; Vindevogel, H

1999-11-01

175

Serum cholesterol levels and postoperative atrial fibrillation  

PubMed Central

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

2014-01-01

176

Associations between the atrial electromechanical interval, atrial remodelling and outcome of catheter ablation in paroxysmal atrial fibrillation  

Microsoft Academic Search

ObjectiveThe atrial electromechanical (PA–PDI) interval was reported to be a useful predictor of new-onset atrial fibrillation (AF) and the occurrence of AF after coronary artery bypass surgery. The aim of this study was to investigate the associations of the electromechanical interval with atrial substrate properties and the outcome of catheter ablation in paroxysmal AF patients.Methods132 paroxysmal AF patients who had

Tze-Fan Chao; Shih-Hsien Sung; Kang-Ling Wang; Yenn-Jiang Lin; Shih-Lin Chang; Li-Wei Lo; Yu-Feng Hu; Ta-Chuan Tuan; Kazuyoshi Suenari; Cheng-Hung Li; Kuo-Chang Ueng; Tsu-Juey Wu; Shih-Ann Chen

2010-01-01

177

Atrial tachycardias occurring late after open heart surgery.  

PubMed

Atrial tachycardias are common after open heart surgery. Most commonly these are macro-reentrant including cavotricuspid isthmus dependent atrial flutter, incisional right atrial flutter and left atrial flutter. Focal atrial tachycardias occur less frequently. The specific type of atrial tachycardia highly depends on the type of surgical incision. Catheter ablation can be very effective, however requires a thorough understanding of anatomy and surgical technique. PMID:25308810

Kohari, Maria; Pap, Robert

2015-01-01

178

Inverted left atrial appendage in an infant during cardiac surgery.  

PubMed

Inverted left atrial appendage is an unusual complication associated with congenital cardiac surgery. Inversion of the left atrial appendage may occur during the surgical procedure or afterwards. The left atrial appendage may invert iatrogenically or as a result of the negative pressure during placement or removal of the left atrial vent or during deairing manoeuvres. This event can be life-threatening because of the mass effect of the atrial appendage within the left atrial cavity. PMID:24774963

Onan, Ismihan S; Haydin, Sertac; Yeniterzi, Mehmet

2015-03-01

179

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

180

Transverse conduction capabilities of the crista terminalis in patients with atrial flutter and atrial fibrillation  

Microsoft Academic Search

OBJECTIVESIn this study, the transverse conduction capabilities of the crista terminalis (CT) were determined during pacing in sinus rhythm in patients with atrial flutter and atrial fibrillation.BACKGROUNDIt has been demonstrated that the CT is a barrier to transverse conduction during typical atrial flutter. Mapping studies in animal models provide evidence that this is functional. The influence of transverse conduction capabilities

Burghard Schumacher; Werner Jung; Harald Schmidt; Christoph Fischenbeck; Thorsten Lewalter; Andreas Hagendorff; Heyder Omran; Christian Wolpert; Berndt Lüderitz

1999-01-01

181

Acute Effects of Dual-Site Right Atrial Pacing in Patients With Spontaneous and Inducible Atrial Flutter and Fibrillation  

Microsoft Academic Search

Objectives. We tested the ability of dual-site right atrial pacing to prevent atrial fibrillation (AF) or atrial flutter induced by eingle-site atrial pacing and correlated its efficacy with clinical patient characteristics, atrial activation times and refractory periods.Background. Prevention of recurrent AF with long-term dual-site right atrial pacing has been demonstrated in our previous studies. However, the mechanism of antiarrhythmic benefit

Atul Prakash; Sanjeev Saksena; Ryszard B Krol; Anand N Munsif; Irakli Giorgberidze; Philip Mathew; Rahul Mehra

1997-01-01

182

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

183

Treatment of atrial fibrillation in a district general hospital  

Microsoft Academic Search

OBJECTIVE--To assess current strategies used to investigate and manage acute atrial fibrillation in hospital. DESIGN--Prospective survey of all acute admissions over 6 months. SETTING--District general hospital serving a population of 230,000 in north east Glasgow. SUBJECTS--2686 patients admitted as emergency cases over 6 months. RESULTS--Of the 2686 patients, 170 (age range 38-95, mean (SD) 73.5 (10.6) years; 70 men (41%)

G. Y. Lip; K. N. Tean; F. G. Dunn

1994-01-01

184

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

185

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

186

Atrial fibrillation in the elderly  

Microsoft Academic Search

Opinion statement  Atrial fibrillation (AF) is the most common sustained arrhythmia in adults, and its incidence and prevalence increase progressively\\u000a with age. As a result, AF-associated morbidity and mortality increase with age. Therefore, because even asymptomatic AF markedly\\u000a increases the risk of stroke and other embolic events, aggressive treatment is warranted in order to avoid the potentially\\u000a devastating sequelae of this

Jane Chen; Michael W. Rich

2003-01-01

187

Different atrial regional patterns of activation during atrial fibrillation: is there any relationship with the anatomy?  

PubMed

Right atrial (RA) mapping has been recently more carefully examined in patients with idiopathic atrial fibrillation (AF) in order to improve radiofrequency (RF) catheter-mediated ablation lines to control recurrences. The aim of this study was to map right atrial activation during AF to analyze relationship between anatomy and atrial activation for specific sites. Twenty-four patients with recurrent, drug-refractory, paroxysmal AF underwent an extensive mapping of the RA before attempting RF linear lesion catheter ablation. A typical pattern of atrial activation was recorded in all patients which was consistent with a more regular activity on the trabeculated right atrium (type I AF) and a more fragmented and complex activation on the posterior and the anterior septum (type II and III AF). This paper helps to understand the influence of the anatomic barriers to atrial activation during atrial fibrillation. PMID:11889960

Montenero, A S; Franciosa, P; Mangiameli, D; Bruno, N; Cartoni, D; Bartolini, P; Barbaro, V; Zumbo, F

2001-01-01

188

Blocked atrial bigeminy presenting with bradycardia.  

PubMed

Blocked premature atrial contractions can cause bradycardia by resetting sinoatrial node and prolonging the RR intervals. Herein, we report the management of a patient with frequent premature atrial contractions in bigeminal pattern. The patient presented with symptomatic bradycardia and was successfully treated with propafenone. PMID:22469245

Akdeniz, Celal; Tanidir, Ibrahim Cansaran; Tuzcu, Volkan

2012-01-01

189

Refractory atrial fibrillation effectively treated with ranolazine  

PubMed Central

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

Vaishnav, Aditi; Vaishnav, Avani; Lokhandwala, Yash

2014-01-01

190

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

191

Giant right atrial diverticulum with thrombus formation.  

PubMed

A 28-year-old man was referred to our hospital with a giant right atrial diverticulum. The mass of the right atrial diverticulum compressed the right atrium and right ventricle, and thrombus formation was suspected. The diverticulum was surgically excised and the patient remained asymptomatic a year later. PMID:24887889

Sato, Yoshiyuki; Satokawa, Hirono; Yamamoto, Akihiro; Yokoyama, Hitoshi; Maehara, Kazuhira

2015-03-01

192

Giant right atrial thrombi treated with thrombolysis  

PubMed Central

The present report describes giant atrial thrombi that were treated with thrombolysis in a community hospital. Two patients with giant atrial thrombi whose treatment involved complications are presented. Both patients developed cardiogenic shock and were treated unsuccessfully with thrombolysis. Because thrombolysis of giant thrombi may be ineffective, patients in this situation may require surgery. PMID:18401474

Ruiz-Bailén, Manuel; López-Caler, Carmen; Castillo-Rivera, Ana; Rucabado-Aguilar, Luis; Cuadra, José Ángel Ramos; Toral, Juan Lara; Cabezas, Cristobal Lozano; Guerrero, Juan Carlos Fernández

2008-01-01

193

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

194

Metastatic liposarcoma of the heart. Case series and brief literature review.  

PubMed

Secondary cardiac tumors are 20-40 times more frequent than primary lesions. Primary cardiac lesions are represented by myxomas when related to benign tumors, and by sarcomas in terms of malignant disease. Metastases to the heart from liposarcomas are very rare. We present three cases of secondary liposarcomas involving the left atrium, the right atrium, and the pericardium. PMID:23436031

Pino, P G; Zampi, G; Pergolini, A; Pero, G; Polizzi, V; Sbaraglia, F; Minardi, G; Musumeci, F

2013-12-01

195

Risk of thromboembolic events in patients with atrial flutter  

Microsoft Academic Search

Based on multiple studies, clear, guided anticoagulation therapy is recommended for patients with atrial fibrillation. The value of anticoagulation therapy in patients with atrial flutter, however, is less well established. Little is known about the incidence of thromboembolism in patients with atrial flutter. We evaluated the risk of thromboembolism in 191 consecutive unselected patients referred for treatment of atrial flutter.

Karlheinz Seidl; Bernd Hauer; Nicola G Schwick; Dietmar Zellner; Ralf Zahn; Jochen Senges

1998-01-01

196

Development of ST Elevation Myocardial Infarction and Atrial Fibrillation after an Electrical Injury  

PubMed Central

Electrical energy is a type of energy that is commonly used in daily life. Ventricular premature beats, ventricular tachycardia, ventricular fibrillation, atrial tachycardia, atrial fibrillation, bundle branch blocks, and AV block are arrhythmic complications that are encountered in case of electric shocks. Myocardial infarction is one of the rarely seen complications of electric shocks yet it has fatal outcomes. Coronary arteries were detected to be normal in most of the patients who had myocardial infarction following an electric shock. So, etiology of myocardial infarction is thought to be unrelated to coronary atherosclerosis in these cases. Coronary artery vasospasm is thought to be the primary etiological cause. In our case report, we presented a patient who developed ST elevation MI with atrial fibrillation after an electric shock.

Gursul, Erdal; Bayata, Serdar; Aksit, Ercan; Ugurlu, Basak

2015-01-01

197

Treatment of lone atrial fibrillation: minimally invasive pulmonary vein isolation, partial cardiac denervation and excision of the left atrial appendage  

PubMed Central

Since 1999, my colleagues and I have diligently pursued a minimally invasive surgical, beating-heart, left atrial isolation technique that is offered to patients with lone atrial fibrillation (AF). We began clinical cases in 2003. In 2005, we reported our initial experience with video-assisted bilateral pulmonary vein (PV) isolation and left atrial appendage (LAA) exclusion for the minimally invasive treatment of AF (Wolf technique). From our experience in over 1,000 cases there have been many lessons learned in the evaluation, selection and minimally invasive surgical treatment of patients with lone AF. In our experience we have had zero mortality and no conversions to sternotomy. Recently we reviewed 157 patients who are now 1 to 9 years out from the Wolf technique. The patients’ ages ranged from 15 to 87 years old. The AF-free rate for paroxysmal AF was 92%, for persistent AF 85%, and for long-standing persistent AF 75%. The follow-up included 7-day continuous monitoring. There were no deaths (personal review). The Wolf technique is a safe and effective treatment for selected patients with lone AF. PMID:24516806

2014-01-01

198

Treatment of lone atrial fibrillation: minimally invasive pulmonary vein isolation, partial cardiac denervation and excision of the left atrial appendage.  

PubMed

Since 1999, my colleagues and I have diligently pursued a minimally invasive surgical, beating-heart, left atrial isolation technique that is offered to patients with lone atrial fibrillation (AF). We began clinical cases in 2003. In 2005, we reported our initial experience with video-assisted bilateral pulmonary vein (PV) isolation and left atrial appendage (LAA) exclusion for the minimally invasive treatment of AF (Wolf technique). From our experience in over 1,000 cases there have been many lessons learned in the evaluation, selection and minimally invasive surgical treatment of patients with lone AF. In our experience we have had zero mortality and no conversions to sternotomy. Recently we reviewed 157 patients who are now 1 to 9 years out from the Wolf technique. The patients' ages ranged from 15 to 87 years old. The AF-free rate for paroxysmal AF was 92%, for persistent AF 85%, and for long-standing persistent AF 75%. The follow-up included 7-day continuous monitoring. There were no deaths (personal review). The Wolf technique is a safe and effective treatment for selected patients with lone AF. PMID:24516806

Wolf, Randall K

2014-01-01

199

Atrial Fibrillation After Radiofrequency Ablation of Type I Atrial Flutter Time to Onset, Determinants, and Clinical Course  

Microsoft Academic Search

Background—The occurrence of atrial fibrillation after ablation of type I atrial flutter remains an important clinical problem. To gain further insight into the pathogenesis and significance of postablation atrial fibrillation, we examined the time to onset, determinants, and clinical course of atrial fibrillation after ablation of type I flutter in a large patient cohort. Methods and Results—Of 110 consecutive patients

Hakan Paydak; John G. Kall; Martin C. Burke; Donald Rubenstein; Douglas E. Kopp; Ralph J. Verdino; David J. Wilber

2010-01-01

200

Early cardioversion of atrial fibrillation and atrial flutter guided by transoesophageal echocardiography A single centre 8·5-year experience  

Microsoft Academic Search

Aims To analyse the safety and impact on maintenance of sinus rhythm of transoesophageal echocardiographically guided early cardioversion associated with short-term anticoagulation in a large series of patients with atrial fibrillation and atrial flutter. Methods and Results Patients who were candidates for cardioversion were eligible for inclusion if they had atrial fibrillation or atrial flutter lasting longer than 2 days

G. Corrado; M. Santarone; S. Beretta; G. Tadeo; L. M. Tagliagambe; G. Foglia-Manzillo; M. Spata; E. Miglierina; F. Acquati

201

Ablating Persistent Atrial Fibrillation Successfully  

PubMed Central

The ablation of persistent atrial fibrillation (AF) poses many challenges compared to ablation for paroxysmal AF, including greater procedural complexity, longer procedural time, unclear endpoints, increased patient comorbidity with a greater risk of procedural complications, and lower success rate. Nevertheless, using a combination of patient selection, careful procedural planning of both ablation strategy and endpoints, and by setting realistic patient expectations, successful ablation may be achieved. Further improvements will come from continued technical advances as well as from greater mechanistic understanding of persistent AF, including the physiologically-targeted ablation of localized rotors and focal sources that have recently been shown to maintain human AF. PMID:22828755

Krummen, David E.; Narayan, Sanjiv M.

2012-01-01

202

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

PubMed

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

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

2012-01-01

203

Recurrent right atrial thrombosis due to Behçet disease.  

PubMed

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

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

2014-10-01

204

Hemostasis of Left Atrial Appendage Bleed With Lariat Device  

PubMed Central

New devices designed for minimally invasive closure of the left atrial appendage (LAA) may be a viable alternative for patients in whom anticoagulation is considered high risk. The Lariat (Sentreheart, Redwood City, CA), which is currently FDA-approved for percutaneous closure of tissue, requires both trans-septal puncture and epicardial access. However it requires no anticoagulation after the procedure. Here we describe a case of effusion and tamponade during a Lariat procedure with successful completion of the case and resolution of the effusion. PMID:25408569

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

2014-01-01

205

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

PubMed Central

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

Lewis, Gareth; Yusuf, Shamil

2014-01-01

206

Pericardial Effusion and Atrial Thrombosis: A Rare Complication of Childhood Leukemia  

PubMed Central

Background Acute lymphoblastic leukemia (ALL) is the most common malignancy diagnosed in children. Extramedullary leukemia including hepatosplenomegaly, lymphadenopathy, and mediastinal mass are the clinical presentations of T-cell ALL. Pericardial effusion and atrial mass are rare presentations of pediatric leukemia. Case Presentation We report a 15-year-old girl with T-cell ALL, who presented initially with pericardial effusion and cardiac tamponade and subsequently developed right atrial mass. The mediastinal and right atrial masses were excised by surgical procedure as a treatment strategy for prevention of arrhythmia and sudden death. Conclusion T-cell ALL can present with pericardial and mediastinal involvement as an initial manifestation. Pericardiocenthesis and systemic anticancer chemotherapy without local chemotherapy should be considered in these cases. PMID:23056870

Zareifar, Soheila; Cheriki, Sirous; Namdari, Maral; Farahmandfar, Mohammadreza; Jannati, Ahmad

2012-01-01

207

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

208

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

209

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. Cancer Res; 74(24); 7260-73. ©2014 AACR. PMID:25336188

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

2014-12-15

210

Myxoma Virus Oncolytic Efficiency Can Be Enhanced Through Chemical or Genetic Disruption of the Actin Cytoskeleton  

PubMed Central

Myxoma virus (MYXV) is one of many animal viruses that exhibit oncolytic properties in transformed human cells. Compared to orthopoxviruses like vaccinia (VACV), MYXV spreads inefficiently, which could compromise its use in treating tumors and their associated metastases. The VACV F11 protein promotes virus exit and rapid spread by inhibiting Rho signalling, which results in a disruption of cortical actin. We have previously shown that although MYXV lacks an F11 homolog, the F11L gene can be introduced into MYXV promoting the spread of this Leporipoxvirus in natural host cells. Here we show that the F11-encoding (F11L+) MYXV strain replicates to higher levels in a number of human cancer cells. We also show that F11L+ MYXV induces better tumor control and prolonged survival of mice bearing MDA-MB-231 cancer cells. Furthermore, we show that this virus also spreads more efficiently from the site of growth in one injected tumor, to a second untreated tumor. While we focused mostly on the use of a modified MYXV we were able to show that the effects of F11 on MYXV growth in cancer cells could be mimicked through the use of pharmacological inhibition or siRNA-mediated silencing of key regulators of cortical actin (RhoA, RhoC, mDia1, or LIMK2). These data suggest that it may be possible to increase the oncolytic efficacy of wild-type MYXV using chemical inhibitors of RhoA/C or their downstream targets. Furthermore, since all viruses must overcome barriers to exit posed by structures like cortical actin, these findings suggest that the oncolytic activity of other viruses may be enhanced through similar strategies. PMID:24391902

Irwin, Chad R.; Favis, Nicole A.; Agopsowicz, Kate C.; Hitt, Mary M.; Evans, David H.

2013-01-01

211

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

212

Prenatal features of Costello syndrome: Ultrasonographic findings and atrial tachycardia  

PubMed Central

Objective Delineate prenatal features of Costello syndrome (caused by HRAS mutations) which consists of mental retardation, facial, cardiovascular, skin, and musculoskeletal anomalies, and tumor predisposition. Methods Literature and new cases classified as Group I (pre-HRAS), Group II (HRAS confirmed), and Group III (HRAS confirmed in natural history study, plus three contributed cases). Results Polyhydramnios occurred in most (mean 79%) pregnancies of cases in Groups I (98), II (107), and III (17), advanced paternal age and prematurity were noted in approximately half. Less frequent were nuchal thickening, ascites, shortened long bones, abnormal hand posture, ventriculomegaly, macrosomia, and macrocephaly. Fetal arrhythmia occurred in 9 cases (6 supraventricular or unspecified tachycardia, 1 unspecified arrhythmia, 2 premature atrial contractions, PACs); excluding 3 new cases and 2 with PACs, the estimated prenatal frequency is 4/222 (2%). Conclusion Costello syndrome can be suspected prenatally when polyhydramnios is accompanied by nuchal thickening, hydrops, shortened long bones, abnormal hand posture, ventriculomegaly, large size, and macrocephaly, and especially fetal atrial tachycardia. Consideration should be given for timely prenatal diagnostic studies for confirmative HRAS gene mutations, and for maternal treatment of serious fetal arrhythmia. PMID:19382114

Lin, Angela E.; O’Brien, Barbara; Demmer, Laurie A.; Almeda, Kristina K.; Blanco, Cynthia L.; Glasow, Patrick F.; Berul, Charles I.; Hamilton, Robert; Innes, A. Micheil; Lauzon, Julie L.; Sol-Church, Katia; Gripp, Karen W.

2015-01-01

213

Atrial Fibrillation - Multiple Languages: MedlinePlus  

MedlinePLUS

... this page, please enable JavaScript. Atrial Fibrillation - Multiple Languages Arabic (???????) Bosnian (Bosanski) Chinese - Simplified (????) Chinese - ... Characters not displaying correctly on this page? See language display issues . Return to the MedlinePlus Health Information ...

214

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 : ...

215

Left atrial dissection: an almost unknown entity.  

PubMed

Left atrial dissection is an exceedingly rare but potentially fatal complication of cardiac surgery. It is most commonly associated with mitral valve surgery, including both replacement and repair, with a reported incidence rate of 0.16%. However, other cardiac surgical or catheter-based interventional procedures are also known as potential predisposing factors. The time of presentation from the cause of dissection varies extremely, ranging from immediate occurrence up to 20 years later. The dissection forms a large cavity between the endocardium and epicardium of the left atrium, causing obliteration of the left atrial cavity and resultant haemodynamic compromise, which almost always requires immediate surgical intervention. In contrast, left atrial dissection without haemodynamic instability can often be managed non-operatively with satisfactory outcomes. This article reviews this rare but relevant clinical entity to further elucidate the incidence, pathogenesis, clinical course, management and outcome of left atrial dissection. PMID:25260895

Fukuhara, Shinichi; Dimitrova, Kamellia R; Geller, Charles M; Hoffman, Darryl M; Tranbaugh, Robert F

2015-01-01

216

Simultaneously Presented Acute Ischemic Stroke and Non-ST Elevation Myocardial Infarction in a Patient with Paroxysmal Atrial Fibrillation  

PubMed Central

Although atrial fibrillation is the most frequent cause of embolic stroke, coronary embolism from atrial fibrillation is a very rare cause of acute myocardial infarction. Therefore, simultaneously presented acute ischemic stroke and acute myocardial infarction due to atrial fibrillation in the same patient has not been documented. The present report describes the case of a 58-year-old man with paroxysmal atrial fibrillation who initially presented with a large cerebral infarction due to embolic occlusion of the left middle cerebral artery. Four hours after the diagnosis of cerebral embolism, he was subsequently diagnosed with acute myocardial infarction due to concurrent coronary embolism. He underwent successful coronary revascularization with a drug-eluting stent. The possibility of combined coronary embolism as a rare etiology should be kept in mind when a patient with acute embolic stroke presents, especially when there is evidence of acute myocardial infarction. PMID:24363753

Kim, Hack-Lyoung; Seo, Jae-Bin; Chung, Woo-Young; Zo, Joo-Hee; Kim, Myung-A

2013-01-01

217

An echocardiographic assessment of atrial mechanical behaviour.  

PubMed

Relations between movement of the atrioventricular ring and changes in left atrial and ventricular dimensions were studied by echocardiography and compared with apexcardiography and Doppler mitral flow velocity traces in 20 healthy controls and in patients with left ventricular hypertrophy (n = 28) or dilatation (n = 16). During left ventricular systole the atrioventricular ring, a structure common to ventricle and atrium, moved towards the ventricular apex, thus increasing left atrial volume. This action matched pulmonary venous return because it was in phase with the transverse left atrial dimension measured from aortic root to posterior left atrial wall. During early diastole, the mitral ring moved rapidly towards the atrium as transmitral flow accelerated. This requires a force directed from ventricle to atrium, likely to be the result of elastic recoil arising from compression of the ventricular myocardium or stretching of the atrial myocardium during ventricular systole. Two additional mechanisms of ventricular filling with atrial systole were recognised: (a) an increase in ventricular volume as the atrioventricular ring moved upwards and (b) transverse left ventricular expansion by pressure driven transmitral flow. The former is undetectable by Doppler from the apex; it accounted for 10% of ventricular filling in the healthy controls, but for significantly less in those with ventricular dilatation. In left ventricular hypertrophy, left ventricular filling was maintained by both mechanisms compensating for the reduced increase in volume early in diastole. Interactions between the atrium and ventricle are functionally important during ventricular systole, early diastole, and in atrial systole. They are not included in the traditional separation of atrial function into reservoir, conduit, and pump functions. PMID:1825173

Jones, C J; Song, G J; Gibson, D G

1991-01-01

218

Atrial fibrillation - where do we stand today?  

Microsoft Academic Search

Olsson SB (University Hospital, Lund, Sweden). Atrial fibrillation - where do we stand today? J Intern Med 2001; 250: 19-28. 2 The basic underlying mechanisms behind atrial fibrillation (AF), the most abundant therapy demanding cardiac dysrhythmia, have until recently being largely unknown. Once established, AF is not only self-perpetuating but also self-destructive, prompting rapid treatment against possible initiating mechanisms. Recent

S. B. O LSSON

2001-01-01

219

Blocked atrial bi/trigeminy in utero evolving in supraventricular tachycardia after birth.  

PubMed

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

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

2012-01-01

220

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

PubMed Central

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

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

2012-01-01

221

Pulmonary vasorelaxant activity of atrial peptides.  

PubMed

Pulmonary vascular relaxant effects of the 28-amino acid atrial natriuretic peptide and atriopeptins I, II and III (21, 23 and 24 amino acid peptides, respectively) were studied in isolated blood vessels and in perfused rat lungs. In isolated tissue studies, intrapulmonary arteries were more responsive to the relaxant effects of atrial peptides than the main pulmonary artery or aorta. In perfused lung preparations, each of the four atrial peptides produced dose-dependent pulmonary vasodilation of PGF2 alpha or hypoxia-induced pulmonary vasoconstriction. Atriopeptin I was the least potent pulmonary vasodilator peptide in all studies. Pretreatment of perfused lungs with various peptidase inhibitors, including the angiotensin converting enzyme inhibitors, captopril and MK-521, the carboxypeptidase inhibitor, 1,10-phenanthroline, and the aminopeptidase inhibitor, bestatin, variably potentiated the pulmonary vasodilator activities of the atrial peptides. The results demonstrate that atrial peptides released from the right heart into the pulmonary circulation can have potent vasorelaxant effects in the pulmonary vascular bed and further suggest that upon passage through the lung atrial peptides may undergo metabolic degradation that alters their pulmonary vasodilator activities. PMID:1966900

Numan, N A; Gillespie, M N; Altiere, R J

1990-01-01

222

Anti-thrombotic therapy in patients with atrial fibrillation and intracranial hemorrhage.  

PubMed

Patients with atrial fibrillation have an increased risk of ischemic stroke that can be dramatically lowered by treatment with anticoagulants. The annual rate of major bleeds with warfarin averages about 2%. The rates of intracerebral and intracranial bleeds are significantly reduced with the use of the novel direct oral anticoagulants (DOACs) compared with warfarin. Treatment of anticoagulation-related intracerebral hemorrhage is based on the results of case series and small trials. Resumption of anticoagulation in patients with atrial fibrillation who had an intracerebral bleed depends on the etiology and location of the bleeding and the absolute rate of stroke in the absence of anticoagulation. PMID:25091395

Diener, Hans-Christoph; Stanford, Sophia; Abdul-Rahim, Azmil; Christensen, Louisa; Hougaard, Kristina Dupont; Bakhai, Ameet; Veltkamp, Roland; Worthmann, Hans

2014-09-01

223

Recurrent Patterns of Atrial Depolarization During Atrial Fibrillation Assessed by Recurrence Plot Quantification  

Microsoft Academic Search

The aim of this study was to determine the presence of organization of atrial activation processes during atrial fibrillation (AF) by assessing whether the activation sequences are wholly random or are governed by deterministic mechanisms. We performed both linear and nonlinear analyses based on the cross correlation function (CCF) and recurrence plot quantification (RPQ), respectively. Recurrence plots were quantified by

F. Censi; V. Barbaro; P. Bartolini; G. Calcagnini; A. Michelucci; G. F. Gensini; S. Cerutti

2000-01-01

224

Convolutive Multiband Blind Separation to dissociate atrial from ventricular activity in atrial fibrillation  

Microsoft Academic Search

In order to use the ECG as a tool for the characterization of atrial fibrillation (AF), we need to dissociate atrial activity (AA) from ventricular activity. On the other hand, the reduced number of leads recorded from a Holter system limits the necessary spatial diversity required by Blind Source Separation (BSS) techniques to accurately extract the AA. In this work,

C. Vaya; J. J. Rieta; R. Alcaraz

2009-01-01

225

Modification of the maze procedure for atrial flutter and atrial fibrillation  

Microsoft Academic Search

The operative technique of the maze III procedure for the treatment of patients with medically refractory atrial flutter and atrial fibrillation is described in a sequential fashion. The accompanying diagrams of the procedure are illustrated from the view of the operating surgeon. (J THORAC CARDIOVASC SURG 1995;110:485-95)

James L. Cox; Robert D. B. Jaquiss; Richard B. Schuessler; John P. Boineau

1995-01-01

226

Modification of the maze procedure for atrial flutter and atrial fibrillation  

Microsoft Academic Search

The original maze procedure that was described for the treatment of patients with atrial fibrillation was followed by an unacceptable incidence of two problems: (1) the frequent inability to generate an appropriate sinus tachycardia in response to maximal exercise and (2) occasional left atrial dysfunction. In an effort to overcome these problems, we modified the original technique (maze I) twice.

James L. Cox; John P. Boineau; Richard B. Schuessler; Robert D. B. Jaquiss; Demetrios G. Lappas

1995-01-01

227

Epicardial Ablation of Focal Atrial Tachycardia Arising From Left Atrial Appendage in Children  

PubMed Central

Focal left atrial tachycardia (FLAT) although a common cause of supraventricular tachycardia(SVT) among children, the one's arising from left atrial appendage (LAA) present a unique challenge for successful ablation because of anatomical location. We present two children with FLAT arising from the epicardial LAA, successfully mapped and ablated through percutaneuous epicardial approach. PMID:25057221

Hanumandla, Abdhija; Kaur, Daljeet; Shah, Mandar; Calambur, Narasimhan

2014-01-01

228

Implementation of a novel interpolating method to epicardial potential mapping for atrial fibrillation study.  

PubMed

Epicardial potential mapping is an efficient way to visualize the potential distribution on the epicardial surface. We found in our previous study, that the traditional linear interpolation used for the epicardial mapping may cause errors and distortions in reconstruction of the electric activities on the epicardial surface especially during the atrial fibrillation. In this study, we devoted on the implementation of a 3D interpolating method, and verified it in comparison with another interpolating method as well as studying of the mechanism of vagal atrial fibrillation (AF). In case studying, we analyzed the epicardial data from seven canine cardiac models using this method and found the macro-re-entry during the sustainable AF is more likely due to the dispersion of refractoriness in the myocardium and does not demonstrated the focal patterns at the beginning of AF. This indicated that the electrophysiological characteristics of myocardium might have been changed during the paroxysmal atrial fibrillation (PAF). PMID:20303076

Lu, Weijia; Yang, Cuiwei; Fang, Zuxiang; Liu, Xingpeng; Zhu, Xin; Wei, Daming

2010-04-01

229

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

230

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

231

Patient's Guide to Antithrombotic Therapy in Atrial Fibrillation  

MedlinePLUS

... in atrial brillation? Aspirin Clopidogrel (Plavix) Warfarin (Coumadin) Dabigatran (Pradaxa) Rivaroxaban (Xarelto) AMERICAN COLLEGE OF CHEST PHYSICIANS ... with atrial brillation. Oral anticoagulant drugs (warfarin [Coumadin], dabigatran [Pradaxa], Rivaroxaban [Xarelto]) Warfarin (Coumadin) has been used ...

232

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

PubMed Central

Incessant focal atrial tachycardia may be encountered in the pediatric age group although it is rarely seen. Ablation using radiofrequency or cryothermal energy is the preferred method for drug-resistant cases. Recently, 3D electroanatomic mapping systems have been increasingly used for mapping and ablation. In this report, we presented, for the first time, a pediatric case with incessant focal atrial tachycardia originating from the non-coronary aortic sinus and ablated using 3D electroanatomic mapping system. PMID:25408566

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

2014-01-01

233

Cavotricuspid Isthmus Ablation and Subcutaneous Monitoring Device Implantation in a 2-Year-Old Baby with 2 SCN5A Mutations, Sinus Node Dysfunction, Atrial Flutter Recurrences, and Drug Induced Long-QT Syndrome: A Tricky Case of Pediatric Overlap Syndrome?  

PubMed

We describe the case of 2-year-old baby with compound heterozygosity for paternal and maternal alleles mutation of ?-subunit of the cardiac sodium channel (SCN5A), sinus node dysfunction, atrial flutter recurrences, and drug induced long-QT syndrome. In this setting, we chose at first to perform linear ablation of cavotricuspid isthmus resulting in a bidirectional isthmus block. As a second step, we decided to implant a miniaturized loop recorder that, with a minimally invasive procedure, permits us to follow the development of the disease in order to define the future strategy. After 8 months follow-up, automatic daily loop-recorder transmissions disclose the complete absence of any arrhythmia along with asymptomatic ventricular pauses due to sinus node dysfunction. Echocardiography shows normal findings, in particular no left ventricular dysfunction. PMID:25346400

Filippo, Paolo DE; Ferrari, Paola; Iascone, Maria; Racheli, Marco; Senni, Michele

2014-10-26

234

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

PubMed

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

Spina, R; Gunalingam, B

2014-03-01

235

Multiple myxomata of soft tissue associated with polyostotic fibrous dysplasia. A case report.  

PubMed

Polyostotic fibrous dysplasia with associated myxomata of soft tissue has been reported rarely. In most cases, the patient appears first with fibrous dysplasia and many years later presents with soft-tissue tumors. This is a report of a 57-year-old woman--an unusual case of soft-tissue myxomas with fibrous dysplasia. This case suggests that a patient developing myxomatous tumors of the soft tissues might be evaluated for the possibility of associated fibrous dysplasia. PMID:3708977

Blasier, R D; Ryan, J R; Schaldenbrand, M F

1986-05-01

236

Characterization of a myxoma virus-encoded serpin-like protein with activity against interleukin-1 beta-converting enzyme.  

PubMed Central

A genomic library of myxoma virus (MV) DNA, a leporipoxvirus that causes myxomatosis, was constructed and screened by in vitro transcription-translation. A clone was selected on the basis of its strong reactivity with MV antiserum. Analysis of the corresponding DNA sequence and the deduced amino acid sequence revealed an open reading frame coding for a 34-kDa protein with strong homologies to members of the serpin superfamily. The gene encoding this new protein, called serp2, was localized on the MV genome. Interestingly, this gene is deleted in an attenuated strain. We constructed a baculovirus vector to produce recombinant Serp2 protein and raised specific antisera that allowed the characterization of Serp2 expression during the MV cycle. The biological relevance of this new serpin from MV was monitored, and it was shown that Serp2 could inhibit human interleukin-1 beta-converting enzyme activity. PMID:8709205

Petit, F; Bertagnoli, S; Gelfi, J; Fassy, F; Boucraut-Baralon, C; Milon, A

1996-01-01

237

The efficacy of two vaccination schemes against experimental infection with a virulent amyxomatous or a virulent nodular myxoma virus strain.  

PubMed

Two types of myxomatosis vaccine are available commercially, namely, vaccine prepared from the Shope fibroma virus (SFV) and that prepared from an attenuated myxoma virus (MV) strain, e.gSG33. An experiment was designed to compare two vaccination schemes for their ability to protect rabbits against challenge with either a virulent amyxomatous MV strain or a virulent nodular MV strain. Apart from a difference in the cutaneous expression of the disease, the two challenge strains resembled each other in respect of mortality rate, naso-conjunctival shedding of virus, and tissue infection. Vaccination with SFV alone failed to prevent clinical signs, naso-conjunctival shedding or tissue infection. Vaccination with SFV followed by a booster inoculation with SG33 protected rabbits against the development of clinical signs and significantly reduced both viral shedding in naso-conjunctival exudates and viral infection of eyelids, lungs and testes; virus was, however, isolated from testes of some surviving animals. PMID:10684680

Marlier, D; Mainil, J; Boucraut-Baralon, C; Linden, A; Vindevogel, H

2000-01-01

238

Induction of Atrial Fibrillation and Flutter in Dogs Using Methacholine  

Microsoft Academic Search

Systemic infusion of methacholine has been used to facilitate induction of atrial fibrillation. However, the dose-response relationship, reproducibility and effect of anesthetic agents on induction are not well understood. The use of methacholine to facilitate electrical induction of sustained (>10 minutes duration) atrial fibrillation or flutter was examined. In 25 dogs induction of atrial arrhythmias was attempted using a series

Stuart P. Thomas; David L. Ross

1999-01-01

239

Results of radiofrequency catheter ablation for atrial flutter  

Microsoft Academic Search

RF catheter ablation for symptomatic typical atrial flutter is associated with a high procedural success rate, but a second RF procedure may be required in up to one third of subjects, particularly those with right atrial enlargement. In those subjects with both established AF and flutter, RF ablation for atrial flutter may decrease the recurrence rate of AF. However, patients

Leslie A. Saxon; Jonathan M. Kalman; Jeffrey E. Olgin; Melvin M. Scheinman; Randall J. Lee; Michael D. Lesh

1996-01-01

240

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

241

Intra-Atrial Pressure Increases Rate and Organization of Waves Emanating From the Superior Pulmonary Veins During Atrial Fibrillation  

Microsoft Academic Search

Background—Atrial fibrillation (AF) commonly associates with atrial dilatation by poorly understood mechanisms. We hypothesized that elevation of intra-atrial pressure elicits high-frequency and spatio-temporally organized left atrial (LA) sources emanating from the superior pulmonary veins. Methods and Results—We used a stretch-related AF model in the sheep heart to induce stable episodes of AF (40 minutes) in 9 animals. Video movies of

Jérôme Kalifa; José Jalife; Alexey V. Zaitsev; Suveer Bagwe; Mark Warren; Javier Moreno; Omer Berenfeld

242

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

243

Lone atrial fibrillation - an overview.  

PubMed

Atrial fibrillation (AF) sometimes develops in younger individuals without any evident cardiac or other disease. To refer to these patients who were considered to have a very favourable prognosis compared with other AF patients, the term 'lone' AF was introduced in 1953. However, there are numerous uncertainties associated with 'lone' AF, including inconsistent entity definitions, considerable variations in the reported prevalence and outcomes, etc. Indeed, increasing evidence suggests a number of often subtle cardiac alterations associated with apparently 'lone' AF, which may have relevant prognostic implications. Hence, 'lone' AF patients comprise a rather heterogeneous cohort, and may have largely variable risk profiles based on the presence (or absence) of overlooked subclinical cardiovascular risk factors or genetically determined subtle alterations at the cellular or molecular level. Whether the implementation of various cardiac imaging techniques, biomarkers and genetic information could improve the prediction of risk for incident AF and risk assessment of 'lone' AF patients, and influence the treatment decisions needs further research. In this review, we summarise the current knowledge on 'lone' AF, highlight the existing inconsistencies in the field and discuss the prognostic and treatment implications of recent insights in 'lone' AF pathophysiology. PMID:24372787

Potpara, T S; Lip, G Y H

2014-04-01

244

Global epidemiology of atrial fibrillation.  

PubMed

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

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

2014-11-01

245

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

246

Myxoma Virus MT5 Protects Infected Cells from the Stress of Cell Cycle Arrest through Its Interaction with Host Cell Cullin-1  

Microsoft Academic Search

The myxoma virus (MV) M-T5 gene encodes an ankyrin repeat protein that is important for virus replication in cells from several species. Insight was gained into the molecular mechanisms underlying the role of M-T5 as a host range determinant when the cell cycle regulatory protein cullin-1 (cul-1) was identified as a cellular binding partner of M-T5 and found to colocalize

J. B. Johnston; G. Wang; J. W. Barrett; S. H. Nazarian; K. Colwill; M. Moran; G. McFadden

2005-01-01

247

Atrial fibrillation organization: quantification of propofol effects.  

PubMed

The effect of conventional i.v. anaesthetic agents on atrial fibrillation (AF) dynamics has not been fully addressed. We aim to evaluate whether the most frequently used intravenous anaesthetic agent, propofol, modifies AF organization parameters. Multiple and simultaneous intraatrial bipolar recordings from 27 patients in AF were analyzed before and after infusing a propofol bolus. Signal organization parameters were determined using time and frequency domain analysis. Non-linear analysis was also performed to determine signal entropy. Linear analysis showed that AF becomes more organized in right atrial recordings after infusing propofol, increasing interelectrode correlation (difference of 0.017 +/- 0.005), with the contrary effect on the left atrial dipoles (difference of -0.015 +/- 0.009, p = 0.008). Entropy analysis showed similar findings, achieving a statistical significance of p = 0.001 with Shannon Entropy. PMID:19018581

Cervigón, Raquel; Moreno, Javier; Sánchez, César; Reilly, Richard B; Villacastín, Julián; Millet, José; Castells, Francisco

2009-03-01

248

Radiofrequency catheter ablation of atrial tachyarrhythmias after an atrial switch operation in a patient with univentricular heart combined with transposition of the great arteries.  

PubMed

A 31-year-old patient previously underwent a Mustard operation presented with palpitations. Atrial tachycardia and paroxysmal atrial fibrillation were documented on the surface electrocardiogram. Under the guidance of a three-dimensional electroanatomic mapping system, ablation of the isolated left-sided pulmonary vein and a cavo-tricuspid isthmus-dependent intra-atrial macro re-entry circuit eliminated atrial tachycardia and paroxysmal atrial fibrillation without the recurrence of atrial tachyarrhythmia. PMID:25275370

Ban, Ji-Eun; Park, Sang-Weon; Kim, Young-Hoon

2014-10-01

249

[Atrial fibrillation : new anticoagulants and antiarrhythmic drugs].  

PubMed

Atrial fibrillation is the most common form of arrhythmia and one of the most frequent causes of ischemic stroke. Several new anticoagulants have recently been introduced as alternatives to vitamin-K antagonists for prophylaxis of ischemic stroke and tested in phase-3 studies for efficacy and safety. Identifying patients who will profit in particular from the new anticoagulant therapy is crucial to the clinical application of these drugs. Vernakalant and dronedarone are new antiarrhythmic drugs for rhythm control of atrial fibrillation. However, therapeutic efficacy of the new agents still has to be proven. PMID:22382136

Kaya, E; Frommeyer, G; Mönnig, G; Eckardt, L

2012-03-01

250

Atrial fibrillation: new drugs, devices, and procedures.  

PubMed

The way atrial fibrillation is managed has changed in recent years. Although new anticoagulants are available and more are coming, they offer only marginal benefit over warfarin (Coumadin) and have the disadvantages that their levels cannot be monitored and that their effect cannot be reversed rapidly if bleeding develops. Attempts should be made To Whom It May Concern: control symptomatic atrial fibrillation, first with antiarrhythmic drugs, then with radiofrequency ablation or with a combination. Ablation can be repeated for fibrillation that persists after the first few months. PMID:22854434

Lindsay, Bruce D

2012-08-01

251

[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

252

PALLAS: limiting indications for dronedarone treatment of atrial fibrillation?  

PubMed

Atrial fibrillation increases the risk of stroke. Dronedarone has been shown to reduce the composite of hospitalizations due to cardiovascular events or death, in subjects with intermittent atrial fibrillation or flutter. Recently, dronedarone has been tested in subjects with permanent atrial fibrillation in the PALLAS (permanent atrial fibrillation outcome study using dronedarone on top of standard therapy) trial, and this clinical trial is evaluated in this paper. PALLAS was stopped early as there was an increased incidence of cardiovascular events in the dronedarone group. Dronedarone also increased the rate of hospitalizations in PALLAS. As a result of PALLAS, dronedarone has been contraindicated in permanent atrial fibrillation. The outcomes of PALLAS highlight a discontinuity between dronedarone actions in permanent and intermittent atrial fibrillation. The mechanism(s) underlying the detrimental effects of dronedarone in permanent atrial fibrillation are unknown at present and need to be investigated. PMID:22424264

Doggrell, Sheila A; Hancox, Jules C

2012-04-01

253

Left to Right Atrial Electrophysiological Differences: Substrate for a Dominant Reentrant Source during Atrial Fibrillation  

Microsoft Academic Search

Experimentally observed differences in the action potential (AP) properties – primarily, refractoriness – between the left\\u000a (LA) and right (RA) atria are believed to be important in maintaining atrial fibrillation. We incorporate AP models for single\\u000a LA and RA cells into 2D atrial tissue models and study the role of tissue heterogeneity in global interaction between reentrant\\u000a spiral waves in

Oleg V. Aslanidi; Mark R. Boyett; Henggui Zhang

2009-01-01

254

Clinical factors that influence response to treatment strategies in recent atrial fibrillation  

Microsoft Academic Search

The atrial hypocontractility caused by short episodes of atrial fibrillation has much faster onset and offset kinetics than the atrial contractile dysfunction caused after long periods of atrial fibrillation. This is a prospective study aimed at detecting the most common predisposing factors for atrial fibrillation and how the clinical factors influence the response to cardioversion. The study included 62 consecutive

Neama El-Meligy; Hamza Kabil; Heba Mansour; Mohammad Abdel Moneim

255

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

256

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

2014-07-21

257

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

PubMed

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

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

2014-01-01

258

What to do with an atrial thrombus?  

Microsoft Academic Search

echocardiography; Pacemaker leads thrombosis An 84-year-old woman presented with progressive dyspnoea and weakness over the last ten days. She had a history of hypertension, essential thrombocytosis treated with hydrea, atrial fibrillation, and a transitory ischaemic acci- dent the previous month. The patient had a pacemaker implanted due to auriculoventricular block, which had been replaced 7 months before. Despite her previous

Rocio Card; Carlos Almeria; Vera Lennie; Viviana Serra; JoseLuis Zamorano

259

Lone atrial fibrillation: what do we know?  

Microsoft Academic Search

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

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

2009-01-01

260

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

261

Carbamazepine induced atrial tachycardia with complete AV block  

PubMed Central

Background/Aim: Carbamazepine, a widely used antiepileptic drug that has been used for the treatment of both partial and generalized seizures, for trigeminal neuralgia, as a mood stabilizer and for treatment of neuropathic pain syndromes, may have negative chronotropic and dromotropic effects on the cardiac conduction system. Description of case: We report a case of cardiac syncope due to atrial tachycardia combined with complete atrioventricular block as a consequence of carbamazepine administration for trigeminal neuralgia. Conclusion: Although sinus tachycardia is the most frequently observed cardiac side effect of carbamazepine, sinus and nodal bradycardia, atrioventricular block, premature ventricular contractions, ventricular tachycardia and junctional escape rhythms have been reported in patients due to carbamazepine toxicity. PMID:25336888

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

2014-01-01

262

Simulation of biatrial conduction via different pathways during sinus rhythm with a detailed human atrial model*  

PubMed Central

In order to better understand biatrial conduction, investigate various conduction pathways, and compare the differences between isotropic and anisotropic conductions in human atria, we present a simulation study of biatrial conduction with known/assumed conduction pathways using a recently developed human atrial model. In addition to known pathways: (1) Bachmann’s bundle (BB), (2) limbus of fossa ovalis (LFO), and (3) coronary sinus (CS), we also hypothesize that there exist two fast conduction bundles that connect the crista terminalis (CT), LFO, and CS. Our simulation demonstrates that use of these fast conduction bundles results in a conduction pattern consistent with experimental data. The comparison of isotropic and anisotropoic conductions in the BB case showed that the atrial working muscles had small effect on conduction time and conduction speed, although the conductivities assigned in anisotropic conduction were two to four times higher than the isotropic conduction. In conclusion, we suggest that the hypothesized intercaval bundles play a significant role in the biatrial conduction and that myofiber orientation has larger effects on the conduction system than the atrial working muscles. This study presents readers with new insights into human atrial conduction. PMID:22949359

Deng, Dong-dong; Gong, Ying-lan; Shou, Guo-fa; Jiao, Pei-feng; Zhang, Heng-gui; Ye, Xue-song; Xia, Ling

2012-01-01

263

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

264

The effects of the Cox maze procedure on atrial function  

PubMed Central

Objective The effects of the Cox maze procedure on atrial function remain poorly defined. The purpose of this study was to investigate the effects of a modified Cox maze procedure on left and right atrial function in a porcine model. Methods After cardiac magnetic resonance imaging, 6 pigs underwent pericardiotomy (sham group), and 6 pigs underwent a modified Cox maze procedure (maze group) with bipolar radiofrequency ablation. The maze group had preablation and immediate postablation left and right atrial pressure–volume relations measured with conductance catheters. All pigs survived for 30 days. Magnetic resonance imaging was then repeated for both groups, and conductance catheter measurements were repeated for the right atrium in the maze group. Results Both groups had significantly higher left atrial volumes postoperatively. Magnetic resonance imaging–derived reservoir and booster pump functional parameters were reduced postoperatively for both groups, but there was no difference in these parameters between the groups. The maze group had significantly higher reduction in the medial and lateral left atrial wall contraction postoperatively. There was no change in immediate left atrial elastance or in the early and 30-day right atrial elastance after the Cox maze procedure. Although the initial left atrial stiffness increased after ablation, right atrial diastolic stiffness did not change initially or at 30 days. Conclusions Performing a pericardiotomy alone had a significant effect on atrial function that can be quantified by means of magnetic resonance imaging. The effects of the Cox maze procedure on left atrial function could only be detected by analyzing segmental wall motion. Understanding the precise physiologic effects of the Cox maze procedure on atrial function will help in developing less-damaging lesion sets for the surgical treatment of atrial fibrillation. PMID:19026812

Voeller, Rochus K.; Zierer, Andreas; Lall, Shelly C.; Sakamoto, Shun–ichiro; Chang, Nai–Lun; Schuessler, Richard B.; Moon, Marc R.; Damiano, Ralph J.

2010-01-01

265

Randomized crossover comparison of right atrial appendage pacing versus interatrial septum pacing for prevention of paroxysmal atrial fibrillation in patients with sinus bradycardia  

Microsoft Academic Search

Background New atrial pacing techniques and overdrive pacing algorithms have been introduced to prevent atrial fibrillation. This study was designed to test the hypotheses that (1) interatrial septum pacing (IASP) at the triangle of Koch would be more effective than right atrial appendage pacing (RAAP) in preventing paroxysmal atrial fibrillation (PAF) in patients with sinus bradycardia and (2) an algorithm

Luigi Padeletti; Paolo Pieragnoli; Cristina Ciapetti; Andrea Colella; Nicola Musilli; Maria Cristina Porciani; Renato Ricci; Carlo Pignalberi; Massimo Santini; Andrea Puglisi; Paolo Azzolini; Andrea Spampinato; Moira Martelli; Alessandro Capucci; Giuseppe Boriani; GianLuca Botto; Alessandro Proclemer

2001-01-01

266

Right atrial spontaneous contrast: echocardiographic and clinical features.  

PubMed

We describe the clinical and echocardiographic findings in eight patients with right atrial spontaneous echo contrast who were identified from 648 consecutive patients undergoing transesophageal echocardiography. Common findings in these patients were right atrial enlargement (8 patients), tricuspid regurgitation (7 patients), atrial fibrillation or flutter (6 patients), elevated right ventricular pressure (5 patients), moderate or severe mitral valve disease (5 patients), and right to left interatrial shunts (3 patients). Right heart catheterization in three patients showed markedly elevated right atrial, right ventricular, and pulmonary artery pressures. Two patients had thromboembolic events-one patient had recurrent pulmonary emboli, and another patient with an atrial septal aneurysm had recurrent transient ischemic attacks. Right atrial echo contrast is an uncommon finding at echocardiography that is associated with severe right heart dysfunction. It may also be associated with paradoxical or pulmonary embolism. PMID:7876662

DeGeorgia, M A; Chimowitz, M I; Hepner, A; Armstrong, W F

1994-09-01

267

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

268

Myotonic dystrophy initially presenting as tachycardiomyopathy successful catheter ablation of atrial flutter.  

PubMed

Myotonic dystrophy is a genetic muscular disease that is frequently associated with cardiac arrhythmias. Bradyarrhythmias, such as sinus bradycardia and atrioventricular block, are more common than tachyarrhythmias. Rarely, previously undiagnosed patients with myotonic dystrophy initially present with a tachyarrhythmia. We describe the case of a 14-year-old boy, who was admitted to the hospital with clinical signs and symptoms of decompensated heart failure and severely reduced left ventricular function. Electrocardiography showed common-type atrial flutter with 2?:?1 conduction resulting in a heart rate of 160?bpm. Initiation of medical therapy for heart failure as well as electrical cardioversion led to a marked clinical improvement. Catheter ablation of atrial flutter was performed to prevent future cardiac decompensations and to prevent development of tachymyopathy. Left ventricular function normalized during followup. Genetic analysis confirmed the clinical suspicion of myotonic dystrophy as known in other family members in this case. PMID:20871860

Asbach, S; Gutleben, K J; Dahlem, P; Brachmann, J; Nölker, G

2010-01-01

269

Spectral Profiles of Complex Fractionated Atrial Electrograms Are Different in Longstanding and Acute Onset Atrial Fibrillation Atrial Electrogram Spectra  

PubMed Central

Background Spectral analysis of complex fractionated atrial electrograms (CFAE)may be useful for gaining insight into mechanisms underlying paroxysmal and longstanding atrial fibrillation (AF). The commonly used dominant frequency (DF) measurement has limitations. Method CFAE recordings were acquired from outside the 4 pulmonary vein ostia and at 2 left atrial free wall sites in 10 paroxysmal and 10 persistent AF patients. Two consecutive 8s-series were analyzed from recordings >16s in duration. Power spectra were computed for each 8s-series in the range 3–12 Hz and normalized. The mean and standard deviation of normalized power spectra (MPS and SPS, respectively) were compared for paroxysmal versus persistent CFAE. Also, the DF and its peak amplitude (ADF) were compared for pulmonary vein sites only. Power spectra were computed using ensemble average and Fourier methods. Results No significant changes occurred in any parameter from the first to second recording sequence. For both sequences, MPS and SPS were significantly greater, and DF and ADF were significantly less, in paroxysmals versus persistents. The MPS and ADF measurements from ensemble spectra produced the most significant differences in paroxysmals versus persistents (P < 0.0001). DF differences were less significant, which can be attributed to the relatively high variability of DF in paroxysmals. The MPS was correlated to the duration of uninterrupted persistent AF prior to electrophysiologic study (P = 0.01), and to left atrial volume for all AF (P < 0.05). Conclusions The MPS and ADF measurements introduced in this study are probably superior to DF for discerning power spectral differences in paroxysmal versus longstanding CFAE. PMID:22578068

Ciaccio, Edward J.; Biviano, Angelo B.; Whang, William; Gambhir, Alok; Garan, Hasan

2015-01-01

270

Hypoplastic left heart syndrome with intact atrial septum  

Microsoft Academic Search

Summary  In patients with hypoplastic left heart syndrome (HLHS) and intact atrial septum, the blood entering the left atrium cannot\\u000a egress. Emergency treatment interventionally or surgically is mandatory immediately after birth. We describe a patient with\\u000a HLHS and intact atrial septum who underwent successful transvenous atrial septostomy immediately after birth. When the interatrial\\u000a communication became restrictive, stent implantation into the arterial

Michael Weidenbach; Paul Caffier; Taja Harnisch; Ingo Daehnert

2006-01-01

271

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

272

Echocardiographic evaluation of patent foramen ovale and atrial septal defect.  

PubMed

Patent foramen ovale (PFO) is a common variant present in up to 25% of the population. Atrial septal defect (ASD) is a direct communication between the 2 atrial chambers, of which the ostium secundum variety is the most common. This manuscript is an in depth review of the complex atrial septation, the diagnosis of PFO and ASD and its clinical and therapeutic implications. PMID:24888883

Hari, Pawan; Pai, Ramdas G; Varadarajan, Padmini

2015-01-01

273

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

PubMed Central

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

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

1968-01-01

274

Pulmonary vein edema in a patient undergoing coronary artery bypass graft surgery and concomitant radiofrequency ablation for chronic atrial fibrillation.  

PubMed

The syndrome of pulmonary vein stenosis characterized by pulmonary hypertension, dyspnea on exertion, and right heart failure, is a well-described complication of percutaneous ablation approaches, but has not been described with surgical approaches. We describe the case of a patient who developed localized edema at the pulmonary vein-left atrial junction after undergoing intraoperative radiofrequency ablation for chronic atrial fibrillation as part of CABG for severe triple vessel disease. The pulmonary vein edema resolved within 10 months suggesting that it may be a clinically silent and self-resolving phenomenon. PMID:16970719

Shah, Amit D; Wokhlu, Nina; Anderson, Mark; Shindler, Daniel

2006-09-01

275

Atrial and venous thrombosis secondary to septic arthritis of the sacroiliac joint in a child with hereditary protein C deficiency.  

PubMed

Septic arthritis and osteomyelitis in children is seldom accompanied by calf vein thrombosis and rarely by atrial thrombosis. We report the case of an 11-year, 5-month-old boy with septic arthritis and osteomyelitis of the sacroiliac region who developed deep venous thrombosis, in addition to life-threatening right atrial thrombosis. After an intensive hematologic investigation, a hereditary protein C deficiency was revealed. The association of venous thrombosis with septic arthritis or osteomyelitis should raise the possibility of the presence of protein C deficiency. PMID:10088680

Letts, M; Lalonde, F; Davidson, D; Hosking, M; Halton, J

1999-01-01

276

Epidemiology of atrial fibrillation: European perspective  

PubMed Central

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

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

2014-01-01

277

Entropy measurements in paroxysmal and persistent atrial fibrillation.  

PubMed

Recent studies on atrial fibrillation (AF) have identified different activation patterns in paroxysmal and persistent AF. In this study, bipolar intra-atrial registers from 28 patients (14 paroxysmal AF and 14 persistent AF) were analyzed in order to find out regional differences in the organization in both types of arrhythmias. The organization of atrial electrical activity was assessed in terms of nonlinear parameters, such as entropy measurements. Results showed differences between the atrial chambers with a higher disorganization in the left atrium in paroxysmal AF patients and a more homogenous behavior along the atria in persistent AF patients. PMID:20577034

Cervigón, R; Moreno, J; Reilly, R B; Millet, J; Pérez-Villacastín, J; Castells, F

2010-07-01

278

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

279

Coherex WAVECREST I Left Atrial Appendage Occlusion Study  

ClinicalTrials.gov

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

2015-01-13

280

The use of warfarin in veterans with atrial fibrillation  

PubMed Central

Background Warfarin therapy is effective for the prevention of stroke in patients with atrial fibrillation. However, warfarin therapy is underutilized even among ideal anticoagulation candidates. The purpose of this study was to examine the use of warfarin in both inpatients and outpatients with atrial fibrillation within a Veterans Affairs (VA) hospital system. Methods This retrospective medical record review included outpatients and inpatients with atrial fibrillation. The outpatient cohort included all patients seen in the outpatient clinics of the VA Connecticut Healthcare System during June 2000 with a diagnosis of atrial fibrillation. The inpatient cohort included all patients discharged from the VA Connecticut Healthcare System West Haven Medical Center with a diagnosis of atrial fibrillation during October 1999 – March 2000. The outcome measure was the rate of warfarin prescription in patients with atrial fibrillation. Results A total of 538 outpatients had a diagnosis of atrial fibrillation and 73 of these had a documented contraindication to anticoagulation. Among the 465 eligible outpatients, 455 (98%) were prescribed warfarin. For the inpatients, a total of 212 individual patients were discharged with a diagnosis of atrial fibrillation and 97 were not eligible for warfarin therapy. Among the 115 eligible inpatients, 106 (92%) were discharged on warfarin. Conclusions Ideal anticoagulation candidates with atrial fibrillation are being prescribed warfarin at very high rates within one VA system, in both the inpatient and outpatient settings; we found warfarin use within our VA was much higher than that observed for Medicare beneficiaries in our state. PMID:15498102

Bravata, Dawn M; Rosenbeck, Karen; Kancir, Sue; Brass, Lawrence M

2004-01-01

281

[Incessant atrial tachycardia and peripartum cardiomyopathy--a therapeutic challenge].  

PubMed

Peripartum cardiomyopathy is an uncommon cause of heart failure but with serious prognosis. We report the case of a patient with peripartum cardiomyopathy presenting acute heart failure (severe biventricular systolic failure) and incessant atrial tachycardia, a rare arrhythmia difficult to control, that was responsible for cardiogenic shock, fetus death and multiple organ failure: renal failure (hemodialysis during 17 days), respiratory and hepatic failure and ischemic acute cholecystitis (treated surgically). After emergency cesarean section, heart rate control was obtained only after administering verapamil. Progressive clinical improvement with total recovery of hepatic and renal functions followed under treatment with vigorous multiple organ support. Six months after referral, the patients is doing well with normal daily life controlled with conventional therapy for heart failure, in stable sinus rhythm. Echocardiography shows a dilated left ventricle with partial resolution of systolic dysfunction rhythm. Echocardiography shows a dilated left ventricle with partial resolution of systolic dysfunction. The use of verapamil in severe biventricular systolic failure is discussed. PMID:9138464

Brito, D; de Lacerda, A P; Freitas, P; Costa e Silva, Z; Bento, H; de Sousa, J; Fiuza, M; Lopes, M G; Barbosa, M; França, C

1997-02-01

282

A survey of atrial fibrillation in general practice: the West Birmingham Atrial Fibrillation Project.  

PubMed Central

BACKGROUND: The management of atrial fibrillation (AF) has changed substantially in recent years, especially with a greater appreciation of the prophylactic role of antithrombotic therapy against stroke. There is therefore a need for further information on the prevalence of AF in Britain, the prevalence of (and contraindications to) anticoagulant treatment, and the factors that influence doctors' decisions in treating AF, including the investigation of patients with this arrhythmia. AIM: To investigate the prevalence, clinical features and management of patients with AF in a general practice setting. METHOD: Cross-sectional survey of patients using treatment prescriptions and clinical records in two general practices from the west of Birmingham (serving a patient population of 16,519) where 4522 subjects (27.4%) were aged > or = 50 years. RESULTS: One hundred and eleven (2.4%) patients who were aged > or = 50 years were found to be in AF (42 males; mean age 76.6, SD 9.1); 77.5% were Caucasian, 2.7% Afro-Caribbean, 0.9% Asian, and 0.9% mixed race; in 20 cases there was no information on ethnicity. Of the AF patients, 5.4% were aged 50-60 years, 16.2% aged 61-70 years, 20.7% aged 71-75 years, 20.7% aged 76-80 years, 24.3% aged 81-85 years, and 12.6% aged > 85 years old, with female patients being significantly older than males. Eighty-one patients (73%) had chronic AF, while 30 patients (27%) had paroxysmal AF. The most common associated factors were hypertension (36.9%) and ischaemic heart disease (28.8%), with no obvious cause for AF in six patients. Cardiac failure was associated with AF in 34 patients (30.6%), and stroke had occurred in 29 patients (18%). Only 20 patients (18%) had had an echocardiogram, 26 (23.4%) a chest X-ray, and 58 (52.3%) thyroid function test. Only 30.6% had ever presented to hospital practice. Warfarin was prescribed to 40 patients (36%), with anticoagulation intensity monitoring by the general practitioner (GP) in three cases (7.5%), by a hospital clinic in 30 (75%), and by both GP and hospital in seven cases (17.5%). Of those not anticoagulated (n = 71), only 12 patients (16.9%) had contraindications to warfarin therapy. Patients treated with warfarin were younger than those who were not prescribed warfarin (71.3 versus 79.6 years, P < 0.001). Aspirin was being prescribed for 21 patients (18.9%), primarily for previous myocardial infarction. Only five patients (4.5%) had ever had attempted cardioversion. CONCLUSION: Atrial fibrillation is a common arrhythmia in general practice, and is commonly associated with hypertension, ischaemic heart disease and heart failure. There is a suboptimal application of standard investigations and use of antithrombotic therapy or attempted cardioversion; and few patients have presented to hospital practice. Guidelines on the management of this common arrhythmia in general practice are required. PMID:9219403

Lip, G Y; Golding, D J; Nazir, M; Beevers, D G; Child, D L; Fletcher, R I

1997-01-01

283

Total anomalous pulmonary venous return with intact atrial septum and associated mitral stenosis  

PubMed Central

Total anomalous pulmonary venous return with an intact atrial septum is an uncommon lesion. With associated mitral stenosis each lung has a different pulmonary flow, individual vascular resistance, and function. This represents the first reported case of this anomaly treated by total correction and mitral valve replacement. Pulmonary flow reverted to normal distribution and heart size decreased, with a reversion of vascular changes on the chest radiograph one year after operation. Images PMID:4250293

Wolfe, Walter G.; Ebert, Paul A.

1970-01-01

284

The hypoplastic mitral valve. When should a left atrial-left ventricular extracardiac valved conduit be used?  

PubMed

Limited experimental and clinical experience with extracardiac bypass of the mitral valve has been reported. We describe the case history of a 3-year-old child in whom a left atrial-left ventricular valved conduit was successfully used to bypass a severely hypoplastic parachute mitral valve. The potential applications of this unconventional surgical option are reviewed. PMID:3713238

Corno, A; Giannico, S; Leibovich, S; Mazzera, E; Marcelletti, C

1986-06-01

285

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

286

Noninvasive evaluation of right atrial pressure.  

PubMed

In current practice, right atrial pressure (RAP) is an essential component in the hemodynamic assessment of patients and a requisite for the noninvasive estimation of the pulmonary artery pressures. RAP provides an estimation of intravascular volume, which is a critical component for optimal patient care and management. Increased RAP is associated with adverse outcomes and is independently related to all-cause mortality in patients with cardiovascular disease. Although the gold standard for RAP evaluation is invasive monitoring, various techniques are available for the noninvasive evaluation of RAP. Various echocardiographic methods have been suggested for the evaluation of RAP, consisting of indices obtained from the inferior vena cava, systemic and hepatic veins, tissue Doppler parameters, and right atrial dimensions. Because the noninvasive evaluation of RAP involves indirect measurements, multiple factors must be taken into account to provide the most accurate estimate of RAP. The authors review the data supporting current guidelines, identifying areas of agreement, conflict, limitation, and uncertainty. PMID:23860098

Beigel, Roy; Cercek, Bojan; Luo, Huai; Siegel, Robert J

2013-09-01

287

Antithrombotic therapy after left atrial appendage closure.  

PubMed

It is important to prevent on-device thrombus formation without increasing the risk for bleeding complications after successful interventional left atrial appendage closure. Therefore, choosing the optimal antithrombotic therapy poses a challenging task. While major clinical studies investigated patients eligible for oral anticoagulation using vitamin K antagonists, the vast majority of implants in 'real life' are performed in patients with contraindications to oral anticoagulation after serious bleeding events. In this patient population, strategies using dual antiplatelet therapy were found to be a sound alternative; however, the optimal duration of antithrombotic therapy remains unclear. Future studies will have to investigate the role of direct anticoagulants for post-implant thrombus formation and address the question of whether left atrial appendage closure obviates the need for long-term aspirin therapy. PMID:25434598

Schmidt, Boris; Chun, Kyoung Ryul Julian

2015-01-01

288

Left atrial receptors and the antidiuretic hormone  

PubMed Central

1. Stimulation of left atrial receptors by distending balloons located at the junction between the pulmonary veins and the left atrium and in the body of the left atrium resulted in a diuresis in anaesthetized dogs. 2. In the same dogs the diuresis was not consistently associated with a reduction in the antidiuretic activity of plasma as compared with that during the initial control period. The antidiuretic activity of dog plasma was assayed in water-loaded rats anaesthetized with ethanol. 3. Intravenous injections of vasopressin suppressed a water diuresis in water-loaded dogs anaesthetized with chloralose. The changes in antidiuretic activity of dog plasma which resulted from these injections were reliably detected by the bio-assay in the rat. 4. It is concluded that the diuretic response to the stimulation of left atrial receptors is not accompanied by a reduction in the plasma antidiuretic hormone level. PMID:4825477

Kappagoda, C. T.; Linden, R. J.; Snow, H. M.; Whitaker, Elaine M.

1974-01-01

289

Fibrolipomatous hamartoma in a patient with tuberous sclerosis: report of a case.  

PubMed

Tuberous sclerosis is a rare congenital disorder with an incidence of 1 in 6000 births. The classic triad is seizure, mental deficiency, and angiofibromas. Orofacial manifestations include fibrous hyperplasia, hemangioma, bifid uvula, cleft lip and palate, macroglossia, high arched palate, and enamel defects. Benign tumors of the jaws including desmoplastic fibroma, calcifying odontogenic tumor, and odontogenic myxoma have been recently reported in tuberous sclerosis. This case report adds fibrolipomatous hamartoma of the mandible to this list. PMID:15660093

Celenk, Peruze; Alkan, Alper; Canger, E Murat; Günhan, Omer

2005-02-01

290

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

291

[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

292

Lone atrial fibrillation: Pathologic or not?  

PubMed

Atrial fibrillation risk has been strongly associated with increasing age and visceral obesity. These characteristics are strongly associated with diabetes, decreased heart rate variability, and chronic inflammation. Lone atrial fibrillation (LAF) on the other hand exhibits a predilection for the physically fit and the middle aged, especially males. Given these opposing features it is postulated that pathologic AF is due to cardiac fibrosis and other age related changes while LAF is due to physiologic neurohormonal changes related to autonomic tone, insulin sensitivity, and electrolyte imbalance and that pathologic AF and LAF can be reliably differentiated via an anthropometric approach using weight, height, hip, and waist measurements. An anthropometric study is undertaken from an LAF database to test this hypothesis. Such individuals in addition to being younger and predominantly male appear to be taller with less central adiposity vs. those with pathologic AF. The ramifications of these findings with respect to insulin resistance, sympathetic tone, inflammation and hypertension, often associated with pathologic atrial fibrillation, are discussed. Speculation is drawn about possible etiologic link with mitral valve prolapse, which is commonly encountered in the tall and thin and which shares multiple clinical features with LAF. PMID:17005327

Chambers, Patrick William

2007-01-01

293

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

294

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

NASA Technical Reports Server (NTRS)

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

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

2000-01-01

295

Atrial Fibrillation Surgery - Maze Procedure  

MedlinePLUS

... in the atrium that disrupt the re-entrant circuits. Once the incisions are made, they are sewn ... some cases, cardiologists are able to disrupt the circuits with catheters. Some patients, however, are so troubled ...

296

The Connexin40A96S mutation from a patient with atrial fibrillation causes decreased atrial conduction velocities and sustained episodes of induced atrial fibrillation in mice.  

PubMed

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia and a major cause of stroke. In the mammalian heart the gap junction proteins connexin40 (Cx40) and connexin43 (Cx43) are strongly expressed in the atrial myocardium mediating effective propagation of electrical impulses. Different heterozygous mutations in the coding region for Cx40 were identified in patients with AF. We have generated transgenic Cx40A96S mice harboring one of these mutations, the loss-of-function Cx40A96S mutation, as a model for atrial fibrillation. Cx40A96S mice were characterized by immunochemical and electrophysiological analyses. Significantly reduced atrial conduction velocities and strongly prolonged episodes of atrial fibrillation were found after induction in Cx40A96S mice. Analyses of the gating properties of Cx40A96S channels in cultured HeLa cells also revealed significantly lower junctional conductance and enhanced sensitivity voltage gating of Cx40A96S in comparison to Cx40 wild-type gap junctions. This is caused by reduced open probabilities of Cx40A96S gap junction channels, while single channel conductance remained the same. Similar to the corresponding patient, heterozygous Cx40A96S mice revealed normal expression levels and localization of the Cx40 protein. We conclude that heterozygous Cx40A96S mice exhibit prolonged episodes of induced atrial fibrillation and severely reduced atrial conduction velocities similar to the corresponding human patient. PMID:24060583

Lübkemeier, Indra; Andrié, René; Lickfett, Lars; Bosen, Felicitas; Stöckigt, Florian; Dobrowolski, Radoslaw; Draffehn, Astrid M; Fregeac, Julien; Schultze, Joachim L; Bukauskas, Feliksas F; Schrickel, Jan Wilko; Willecke, Klaus

2013-12-01

297

New ideas about atrial fibrillation 50 years on  

Microsoft Academic Search

Atrial fibrillation is a condition in which control of heart rhythm is taken away from the normal sinus node pacemaker by rapid activity in different areas within the upper chambers (atria) of the heart. This results in rapid and irregular atrial activity and, instead of contracting, the atria only quiver. It is the most common cardiac rhythm disturbance and contributes

2002-01-01

298

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

299

Comparison of Left Atrial Dimensions by Transesophageal and Transthoracic Echocardiography  

Microsoft Academic Search

Left atrial (LA) size, as determined by transthoracic echocardiography (TTE), predicts the risk of atrial fibrillation and stroke and the success of cardio- version. Transesophageal echocardiography (TEE) is increasingly used in these clinical situations. How- ever, unlike TTE, measurement of LA size by TEE has not been standardized. To validate TEE measurement, we determined LA dimensions in 4 standard views

Matthew Block; Lisa Hourigan; Wayne H. Bellows; John Reeves; Joseph L. Romson; Michael Tran; Darwin Pastor; Nelson B. Schiller; Jacqueline M. Leung

300

Comparison of left atrial dimensions by transesophageal and transthoracic echocardiography  

Microsoft Academic Search

Left atrial (LA) size, as determined by transthoracic echocardiography (TTE), predicts the risk of atrial fibrillation and stroke and the success of cardioversion. Transesophageal echocardiography (TEE) is increasingly used in these clinical situations. However, unlike TTE, measurement of LA size by TEE has not been standardized. To validate TEE measurement, we determined LA dimensions in 4 standard views by TTE

Matthew Block; Lisa Hourigan; Wayne H. Bellows; John Reeves; Joseph L. Romson; Michael Tran; Darwin Pastor; Nelson B. Schiller; Jacqueline M. Leung

2002-01-01

301

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

302

Effects of atrial natriuretic peptide in clinical acute renal failure  

Microsoft Academic Search

Effects of atrial natriuretic peptide in clinical acute renal failure. Fifty-three consenting patients meeting clinical and urine composition criteria for established intrinsic ARF were assigned to two treatment groups. Group I patients were treated with human atrial natriuretic peptide (ANP) with or without diuretics. Groups II patients were treated with or without diuretics and with no ANP. Age, sex, etiology

S Noor Rahman; Grace E Kim; Alan S Mathew; Carol A Goldberg; Robin Allgren; Robert W Schrier; John D Conger

1994-01-01

303

A morphologically realistic shell model of atrial propagation and ablation  

Microsoft Academic Search

A three dimensional morphologically realistic model of atrial propagation is developed, based on the male Visible Human dataset and the Fitzhugh-Nagumo equations for cardiac excitation. The atrial shell geometry incorporates eleven different anatomical structures, including the pulmonary veins, and the septum, Bachmann's bundle and coronary sinus as interatrial conduction pathways. Although the model utilizes a simplified cellular model of cardiac

A. Al Abed; S. Dokos; N. H. Lovell

2009-01-01

304

Left atrial thrombus as an early consequence of blunt chest trauma  

PubMed Central

Thromboembolism is rarely considered in discussions of the complications of blunt chest trauma. The few cases of thromboembolism that have been reported in this setting have occurred in association with significant myocardial damage. A previously fit 23 year old woman was admitted to the intensive care unit following a road traffic accident. A day later, left atrial thrombus was demonstrated by transoesophageal echocardiography in the absence of any other evidence of important myocardial injury. Anticoagulation with heparin was cautiously introduced in spite of her extensive injuries, and there were no consequent bleeding complications. At hospital discharge on day 18 she was entirely well. Full anticoagulation with warfarin was continued for a further eight weeks at which time follow up transoesophageal echocardiography showed complete resolution of the thrombus.?? Keywords: blunt chest trauma;  thromboembolism;  left atrial thrombus;  transoesophageal echocardiography PMID:9538317

Mahy, I; Al-Mohammad, A; Cargill, R

1998-01-01

305

Ventricular rhythm in atrial fibrillation under anaesthetic infusion with propofol.  

PubMed

Changes in patients' autonomic tone and specific pharmacologic interventions may modify the ventricular response (actual heart rate) during atrial fibrillation (AF). Hypnotic agents such as propofol may modify autonomic balance as they promote a sedative state. It has been shown that propofol slightly slows atrial fibrillatory activity, but the net global effect on the ventricular response remains unknown. We aimed to evaluate in patients in AF the effect of a propofol bolus on the ventricular rate and regularity at ECG. We analysed the possible relation with local atrial fibrillatory activities, as ratios between atrial and ventricular rates (AVRs), analysing atrial activity from intracardiac electrograms at the free wall of the right and left atria and at the interatrial septum. We compared data at the baseline and after complete hypnosis. Propofol was associated with a more homogeneous ventricular response and lower AVR values at the interatrial septum. PMID:19590112

Cervigón, R; Moreno, J; Reilly, R B; Pérez-Villacastín, J; Castells, F

2009-08-01

306

Atrial Fibrillation Recurrence Predictors after Conversion to Sinus Rhythm  

PubMed Central

Purpose: We aimed to identify predictors of atrial fibrillation recurrence after conversion to sinus rhythm. Material/Methods: We included 100 patients with a history of documented atrial fibrillation in the last 12 months that were assessed by transthoracic echocardiography, 12-lead electrocardiogram and signal averaged electrocardiogram of the P wave. Follow-up was 7.3 ± 2.2 months. Results: Atrial fibrillation recurrence was documented in 27 patients. It was more frequent in patients with longer duration of previous atrial fibrillation episode, with increased left atrium size and left ventricular mass, and it was correlated with the filtered P wave duration and Integral of the P wave. Conclusions: Signal averaged ECG of the P wave, left atrium size and left ventricular mass determined by echocardiography could be helpful in predicting the risk of atrial fibrillation recurrence after conversion.

MILITARU, C.; DONOIU, I.

2014-01-01

307

Orthogonal Basis Expansion based Atrial Activity Reconstruction for Atrial Fibrillation Electrocardiogram Analysis  

E-print Network

the ECG. First type of methods, known as average beat subtraction (ABS) methods, work by estimating a novel algorithm for extracting atrial activity from single lead electrocardiogram (ECG) signal sustained subtraction (ABS) method using synthetic AF sustained ECG data. The orthogonal basis expansion method has

Abhayapala, Thushara D.

308

Effect of carvedilol on atrial remodeling in canine model of atrial fibrillation  

PubMed Central

Aims We evaluated the effect of carvedilol, a beta-blocker with anti-oxidative action, against the atrial fibrillation (AF) inducibility, the development of atrial remodeling and the oxidative stress markers in a canine AF model. Methods and results AF model was produced by performing 6-week rapid atrial stimulation in 15 dogs. The animals were divided into the following three groups: (I) pacing + carvedilol group (n=5); (II) pacing control group (n=5); and (III) non-pacing group (n=5). AF inducibility was gradually increased along the time course in the pacing control group. In the pacing + carvedilol group, the AF inducibility was suppressed especially in the latter phase of protocol in comparison with the pacing control group. Although carvedilol has beta-blocking effect, pacing control and pacing + carvedilol groups did not exhibit difference in the heart rate (177±13 vs. 155±13 bpm, P=0.08). On 8-hydroxy-2'-deoxyguanosine (8-OHdG), dihydroethidium and dichlorodihydrofluorescein diacetate staining, enhanced oxidative stress was observed in the atrial tissue in the pacing control, but not in the pacing + carvedilol group. Conclusions Carvedilol suppressed AF inducibility and oxidative stress in the canine AF model. PMID:24649422

Kishihara, Jun; Niwano, Hiroe; Aoyama, Yuya; Satoh, Akira; Oikawa, Jun; Kiryu, Michiro; Fukaya, Hidehira; Masaki, Yoshihiko; Tamaki, Hideaki; Izumi, Tohru; Ako, Junya

2014-01-01

309

Simulating the effects of atrial fibrillation induced electrical remodeling: A comprehensive simulation study  

Microsoft Academic Search

Mechanisms underlying atrial fibrillation (AF) are poorly understood. In this study, we computationally evaluated the functional roles of AF induced electrical remodeling (AFER) on atrial electrical excitations. Experimental data of AFER on human atrial myocytes were incorporated into a biophysically detailed model of human atrial cells to simulate the effects of AFER at cellular and tissue levels. Our results show

Sanjay Kharche; Henggui Zhang

2008-01-01

310

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

311

Atrial Reentry around an Anatomic Barrier with a Partially Refractory Excitable Gap A Canine Model of Atrial Flutter  

Microsoft Academic Search

SUMMARY. We have characterized, in dogs, a model of inducible regular atrial tachycardia that resembles atrial flutter. The model involves creating a Y-shaped lesion comprised of an intercaval incision and a connected incision across the right atrium. It is suitable for serial studies of the effects of pacing or antiarrhythmic drugs in chronically instrumented animals studied in the awake state

Lawrence H. Frame; Richard L. Page; Brian F. Hoffman

312

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

Microsoft Academic Search

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

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

1998-01-01

313

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

PubMed Central

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

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

2014-01-01

314

Disrupted calcium release as a mechanism for atrial alternans associated with human atrial fibrillation.  

PubMed

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

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

2014-12-01

315

Genetic Loci Associated With Atrial Fibrillation: Relation to Left Atrial Structure in the Framingham Heart Study  

PubMed Central

Background Atrial fibrillation (AF) results in significant morbidity and mortality. Genome?wide association studies (GWAS) have identified genetic variants associated with AF. Whether genetic variants associated with AF are also associated with atrial structure, an intermediate phenotype for AF, has had limited investigation. We sought to investigate associations between single nucleotide polymorphisms (SNPs) and atrial structure obtained by cardiovascular imaging in the Framingham Heart Study. Methods and Results We selected 11 SNPs that have been associated with AF in GWAS. We examined the SNPs' relations to cross?sectional left atrial (LA) dimensions (determined by transthoracic echocardiography) and LA volume (determined by cardiovascular magnetic resonance [CMR]) employing linear regression. The total sample included 1555 participants with CMR LA volume (age 60±9 years, 53% women) and 6861 participants with echocardiographic LA diameter (age 48±13 years, 52% women) measured. We employed a significance threshold of P<0.0023 to account for multiple testing of the 11 SNPs and 2 LA measures. In a primary analysis, no SNPs were significantly related to the LA measures. Likewise, in secondary analyses excluding individuals with prevalent AF (n=77, CMR sample; n=105, echocardiography sample) no SNPs were related to LA volume or diameter. Conclusion In a community?based cohort, we did not identify a statistically significant association between selected SNPs associated with AF and measures of LA anatomy. Further investigations with larger longitudinally assessed samples and a broader array of SNPs may be necessary to determine the relation between genetic loci associated with AF and atrial structure. PMID:24695651

Magnani, Jared W.; Yin, Xiaoyan; McManus, David D.; Chuang, Michael L.; Cheng, Susan; Lubitz, Steven A.; Arora, Garima; Manning, Warren J.; Ellinor, Patrick T.; Benjamin, Emelia J.

2014-01-01

316

Minimally invasive surgery for atrial fibrillation  

PubMed Central

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

Suwalski, Piotr

2013-01-01

317

Role of Pectinate Muscle Bundles in the Generation and Maintenance of Intra-atrial Reentry Potential Implications for the Mechanism of Conversion Between Atrial Fibrillation and Atrial Flutter  

Microsoft Academic Search

To determine the role of pectinate muscle (PM) bundles in the formation of intra-atrial reentry, 10 isolated canine right atrial tissues were perfused with Tyrode's solution containing 1 to 2.5 mmol\\/L acetylcholine (ACh). The endocardium was mapped using 477 bipolar electrodes with 1.6-mm resolution. Reentry was induced by a premature stimulus (S2). Computer simulation studies were used to investigate the

Tsu-Juey Wu; Masaaki Yashima; Fagen Xie; Charles A. Athill; Young-Hoon Kim; Michael C. Fishbein; Zhilin Qu; Alan Garfinkel; James N. Weiss; Hrayr S. Karagueuzian; Peng-Sheng Chen

318

[Update on current care guidelines: atrial fibrillation].  

PubMed

According to the update of the Finnish guidelines for management of patients with atrial fibrillation (AF) dronedarone should be used only in patients with non-permanent AF as a second line medication. It is recommended to monitor the patients regularly and stop dronedarone if permanent AF, heart failure or other adverse events are detected. Dabigatran and rivaroxaban can be used as an alternative to warfarin in patients requiring oral anticoagulation therapy. The selection between warfarin and the new anticoagulants should be based on careful evaluation of the benefits and disadvantages of the drugs in a given patient. PMID:22448550

2012-01-01

319

Atrial macroreentry in congenital heart disease.  

PubMed

Macroreentrant atrial tachycardia is a common complication following surgery for congenital heart disease (CHD), and is often highly symptomatic with potentially significant hamodynamic consequences. Medical management is often unsuccessful, requiring the use of invasive procedures. Cavotricuspid isthmus dependent flutter is the most common circuit but atypical circuits also exist, involving sites of surgical intervention or areas of scar related to abnormal hemodynamics. Ablation can be technically challenging, due to complex anatomy, and difficulty with catheter stability. A thorough assessment of the patients status and pre-catheter ablation planning is critical to successfully managing these patients. PMID:25308809

Twomey, Darragh J; Sanders, Prashanthan; Roberts-Thomson, Kurt C

2015-01-01

320

Antiarrhythmic drug therapy for atrial fibrillation.  

PubMed

Atrial fibrillation (AF) is the most frequently encountered arrhythmia. Prevalence increases with advancing age and so as its associated comorbidities, like heart failure. Choice of pharmacologic therapy depends on whether the goal of treatment is maintaining sinus rhythm or tolerating AF with adequate control of ventricular rates. Antiarrhythmic therapy and conversion of AF into sinus rhythm comes with the side effect profile, and we should select best antiarrhythmic therapy, individualized to the patient. New antiarrhythmic drugs are being tested in clinical trials. Drugs that target remodeling and inflammation are being tested for their use as prevention of AF or as upstream therapy. PMID:25443235

Sardar, Muhammad Rizwan; Saeed, Wajeeha; Kowey, Peter R

2014-11-01

321

Rate versus rhythm control for atrial fibrillation.  

PubMed

Treatment of patients with symptomatic atrial fibrillation (AF) with antiarrhythmic drug therapy in general improves their symptom scores and exercise tolerance; however, large randomized trials have failed to show a mortality benefit with a rhythm-control compared with a rate-control strategy. Catheter ablation in patients who have failed or not tolerated medical therapy has been shown to alleviate symptoms and improve quality of life. However, catheter ablation cannot undo the structural remodeling that contributed to the arrhythmia in the first place. Patients should be alerted to modifiable factors that may decrease the likelihood of unchecked structural remodeling and AF recurrence. PMID:25443234

Halsey, Colby; Chugh, Aman

2014-11-01

322

Efficacy of atrial antitachycardia pacing using the Medtronic AT500 pacemaker in patients with congenital heart disease  

Microsoft Academic Search

Patients with congenital heart disease are vulnerable to atrial tachyarrhythmias, especially after atrial surgeries. We evaluated the efficacy of atrial arrhythmia detection and antitachycardia pacing (ATP) using the Medtronic AT500 pacemaker in 28 patients with congenital heart disease (age 30 ± 18 years). Of 15 patients with atrial arrhythmias, 14 had atrial tachycardia events that were appropriately detected. ATP was

Elizabeth A. Stephenson; David Casavant; Joann Tuzi; Mark E. Alexander; Ian Law; Gerald Serwer; Margaret Strieper; Edward P. Walsh; Charles I. Berul

2003-01-01

323

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

324

Superiority of ibutilide (a new class III agent) over DL-sotalol in converting atrial flutter and atrial fibrillation  

PubMed Central

Objective—To compare the efficacy and safety of a single dose of ibutilide, a new class III antiarrhythmic drug, with that of DL-sotalol in terminating chronic atrial fibrillation or flutter in haemodynamically stable patients.?Design—Double blind, randomised study.?Setting—43 European hospitals.?Patients—308 patients (mean age 60 years, 70% men, 48% with heart disease) with sustained atrial fibrillation (n = 251) or atrial flutter (n = 57) (duration three hours to 45 days) were randomised to three groups to receive a 10 minute infusion of 1 mg ibutilide (n = 99), 2 mg ibutilide (n = 106), or 1.5 mg/kg DL-sotalol (n = 103). Infusion was discontinued at termination of the arrhythmia.?Main outcome measure—Successful conversion of atrial fibrillation or flutter, defined as termination of arrhythmia within one hour of treatment.?Results—Both drugs were more effective against atrial flutter than against atrial fibrillation. Ibutilide was superior to DL-sotalol for treating atrial flutter (70% and 56% v 19%), while the high dose of ibutilide was more effective for treating atrial fibrillation than DL-sotalol (44% v 11%) and the lower dose of ibutilide (44% v 20%, p < 0.01). The mean (SD) time to arrhythmia termination was 13 (7) minutes with 2 mg ibutilide, 19 (15) minutes with 1 mg ibutilide, and 25 (17) minutes with DL-sotalol. In all patients, the duration of arrhythmia before treatment was a predictor of arrhythmia termination, although this was less obvious in the group that received 2 mg ibutilide. This dose converted almost 48% of atrial fibrillation that was present for more than 30 days. Concomitant use of digitalis or nifedipine and prolongation of the QTc interval were not predictive of arrhythmia termination. Bradycardia (6.5%) and hypotension (3.7%) were more common side effects with DL-sotalol. Of 211 patients given ibutilide, two (0.9%) who received the higher dose developed polymorphic ventricular tachycardia, one of whom required direct current cardioversion.?Conclusion—Ibutilide (given in 1 or 2 mg doses over 10 minutes) is highly effective for rapidly terminating persistent atrial fibrillation or atrial flutter. This new class III drug, under monitored conditions, is a potential alternative to currently available cardioversion options.?? Keywords: atrial fibrillation;  atrial flutter;  antiarrhythmic agents;  ibutilide;  sotalol PMID:10078083

Vos, M; Golitsyn, S; Stangl, K; Ruda, M; Van Wijk, L; Harry, J; Perry, K; Touboul, P; Steinbeck, G; Wellens, H

1998-01-01

325

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

326

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

327

Long-term outcome of patients with drug-refractory atrial flutter and fibrillation after single- and dual-site right atrial pacing for arrhythmia prevention  

Microsoft Academic Search

Objectives. An initial crossover study comparing dual- and single-site right atrial pacing was performed followed by a long-term efficacy and safety evaluation of dual-site right atrial pacing in patients with drug-refractory atrial fibrillation (AF). Also examined was the efficacy of two single-site right atrial pacing modes (high right atrium and coronary sinus ostium) and the long-term need for cardioversion, antithrombotic

Philippe Delfaut; Sanjeev Saksena; Atul Prakash; Ryszard B. Krol

1998-01-01

328

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

PubMed

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

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

2014-09-01

329

Orthogonal basis expansion based atrial activity reconstruction for atrial fibrillation electrocardiogram analysis.  

PubMed

We propose a novel algorithm for extracting atrial activity from single lead electrocardiogram (ECG) signal sustained with atrial fibrillation (AF), based on a short-time expansion of an orthogonal basis function set. The method preserves the time variation of spectral content of the underlying AF signal, thus time-frequency analysis of the AF signal can be successfully performed. The new method is compared to the standard average beat subtraction (ABS) method using synthetic AF sustained ECG data. The orthogonal basis expansion method has a higher correlation with the original AF signal compared to the ABS method for a range of signal to noise ratio (SNR) levels, and correlation is improved by 16% at an SNR of 0dB. Time-frequency analysis of the reconstructed AF signal based on Bessel distribution also shows the superiority of the orthogonal basis expansion method over ABS. PMID:19963515

Kodituwakku, Sandun; Abhayapala, Thushara D; Kennedy, Rodney A

2009-01-01

330

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...

331

VARIATION IN HOST SUSCEPTIBILITY AND INFECTIOUSNESS GENERATED BY CO-INFECTION: THE MYXOMA-TRICHOSTRONGYLUS  

E-print Network

- TRICHOSTRONGYLUS RETORTAEFORMIS CASE IN WILD RABBITS Isabella M. Cattadori1,2* , Réka Albert2,3 and Brian Boag4 1 Division of Animal Production and Public Health, Faculty of Veterinary Medicine, The University of Glasgow: Isabella M. Cattadori Div. Animal Production and Public Health Faculty of Veterinary Medicine Glasgow

Albert, Réka

332

Prevalence of Chronic Atrial Fibrillation in Dialysis Patients  

E-print Network

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

Wetmore, James B.

2011-05-31

333

Resolution of left atrial appendage thrombus with apixaban.  

PubMed

Left atrial appendage (LAA) thrombosis is an important cause of cardiogenic cerebral thromboembolism. Apixaban is a member of the class of novel oral anticoagulants (NOAC) and is superior to warfarin in preventing stroke or systemic embolism, causes less bleeding, and results in lower mortality in patients with atrial fibrillation. There are few reports of resolution of LAA thrombus with other NOAC. We present a 72-year-old male patient with persistent atrial fibrillation associated with left atrial thrombus. Sixteen days of apixaban treatment showed complete thrombus resolution. In this study, soluble fibrin and D-dimer levels decreased without prolongation of international normalized ratio (INR) and activated partial thromboplastin time (APTT). PMID:24359320

Kawakami, Tohru; Kobayakawa, Hiroko; Ohno, Hiroyoshi; Tanaka, Nobukiyo; Ishihara, Hiroki

2013-01-01

334

Atrial autonomic innervation: a target for interventional antiarrhythmic therapy?  

PubMed

Atrial fibrillation is the most common arrhythmia and is associated with significant morbidity and mortality. The autonomic nervous system contributes to the creation of atrial fibrillation substrates. Atrial electrophysiology is influenced differently by sympathetic and parasympathetic activation. Several strategies are available to modulate the complex interaction between the autonomic nervous system and the heart. However, different approaches target the problem differently making the prediction of arrhythmogenic and/or antiarrhythmic effects difficult. We discuss the role of the autonomic nervous system on the development of a substrate for atrial fibrillation and explore the potential antiarrhythmic and/or arrhythmogenic effect of modulation of the autonomic nervous system by renal sympathetic denervation, ganglionated plexi ablation, ganglion stellatum ablation, high thoracic epidural anesthesia, low-level vagal nerve stimulation, and baroreflex stimulation. PMID:24140663

Linz, Dominik; Ukena, Christian; Mahfoud, Felix; Neuberger, Hans-Ruprecht; Böhm, Michael

2014-01-28

335

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

PubMed Central

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

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

2014-01-01

336

Mapping strategies in focal atrial tachycardias demonstrating early septal activation: distinguishing left from right.  

PubMed

Determining the chamber of origin of focal atrial tachycardias (FATs) arising at or close to the septum might require biatrial mapping. This review focuses on the available tools and methods used to distinguish right atrial from left atrial origin before left atrial access is obtained. These include analysis of P wave morphology, assessing the timing of right atrial septal activation, the sequence of right atrial and/or biatrial activation and analysis of earliest electrogram morphology. The electroanatomical properties of the interatrial septum and coronary sinus that provide the basis for the above mentioned tools have also been briefly described. PMID:25308813

Traykov, Vassil B

2015-01-01

337

[Anticoagulation in atrial fibrillation: new therapeutic alternatives].  

PubMed

The fundamental treatment of atrial fibrillation is based on maintenance of sinus rhythm or control of ventricular rate and preventing arterial thromboembolism. Warfarin has been the anti-thrombotic agent of choice for the last 50 years. However multiple interactions with other drugs and certain types of food and vegetables with high Vitamin K content complicate its use. It also requires multiple blood tests to adjust the dose in order to reach adequate and stable anticoagulation. Three new, di-fferent anti thrombotic agents are described. They are as or more effective than Warfarin with decreased incidence of hemorrhagic events. Dabigratan is a direct antithrombotic inhibitor, Rivaroxaban and Apixaban inhibits factor Xa. Their use will probably depend on their cost effectiveness in the population at risk for thromboembolic events. PMID:23763229

Aranda, Juan M

2012-01-01

338

Hybrid therapy in the management of atrial fibrillation.  

PubMed

Atrial fibrillation is the most common sustained arrhythmia. Because of the sub-optimal outcomes and associated risks of medical therapy as well as the recent advances in non-pharmacologic strategies, a multitude of combined (hybrid) algorithms have been introduced that improve efficacy of standalone therapies while maintaining a high safety profile. Antiarrhythmic administration enhances success rate of electrical cardioversion. Catheter ablation of antiarrhythmic drug-induced typical atrial flutter may prevent recurrent atrial fibrillation. Through simple ablation in the right atrium, suppression of atrial fibrillation may be achieved in patients with previously ineffective antiarrhythmic therapy. Efficacy of complex catheter ablation in the left atrium is improved with antiarrhythmic drugs. Catheter ablation followed by permanent pacemaker implantation is an effective and safe treatment option for selected patients. Additional strategies include pacing therapies such as atrial pacing with permanent pacemakers, preventive pacing algorithms, and/or implantable dual-chamber defibrillators are available. Modern hybrid strategies combining both epicardial and endocardial approaches in order to create a complex set of radiofrequency lesions in the left atrium have demonstrated a high rate of success and warrant further research. Hybrid therapy for atrial fibrillation reviews history of development of non-pharmacological treatment strategies and outlines avenues of ongoing research in this field. PMID:25028165

Starek, Zdenek; Lehar, Frantisek; Jez, Jiri; Wolf, Jiri; Novak, Miroslav

2015-01-01

339

Reflex effects on the heart of stimulating left atrial receptors  

PubMed Central

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

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

1971-01-01

340

Analysis of atrial fibrillatory rate during spontaneous episodes of atrial fibrillation in humans using implantable loop recorder electrocardiogram.  

PubMed

Atrial fibrillatory rate (AFR) can predict outcome of interventions for atrial fibrillation (AF); however, AFR behavior at AF onset in humans is poorly described. We studied AFR during spontaneous AF episodes in patients with lone paroxysmal AF who received implantable loop recorders and had AF episodes of 1 hour or more recorded (n = 4). Mean AFR per minute was assessed from continuous implantable loop recorder electrocardiogram using spatiotemporal QRST cancellation and time-frequency analysis. Atrial fibrillatory rate increased from 290 ± 20 to 326 ± 39 fibrillations per minute during the first 3 hours (P<.05) and reached plateau then. Atrial fibrillatory rate beyond the initial 3 hours can, therefore, be considered stable and may be evaluated for prediction of intervention effect. PMID:22698889

Platonov, Pyotr G; Stridh, Martin; de Melis, Mirko; Urban, Lubos; Carlson, Jonas; Corbucci, Giorgio; Holmqvist, Fredrik

2012-01-01

341

Balloon atrial septostomy through internal jugular vein in a 45-day-old child with transposition of great arteries  

PubMed Central

Balloon atrial septostomy is a common palliative procedure in D-transposition of great arteries. It is technically easy before 2-3 weeks of age when the septum primum is thin. Femoral vein or umbilical vein, when available, is the common access used for this procedure. In situations when these accesses are not available or in case of inferior vena cava interruption, trans-hepatic access is used. Internal jugular vein (IJV) access is not used as it is difficult to enter the left atrium through this route. We describe a case of successful Balloon atrial septostomy done through IJV in a 45-day-old child with emphasis on the technique, hardware and precautions necessary during the procedure. PMID:20814481

Padhi, Sumanta S; Bakshi, Kinjal D; Londhe, Avinash P

2010-01-01

342

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

343

Transcatheter closure of secundum atrial septal defects with the atrial septal defect occlusion system (ASDOS): initial experience in children  

Microsoft Academic Search

OBJECTIVE--To report initial experiences with transcatheter occlusion of atrial septal defects using a new occlusion device. SUBJECTS--10 children aged 1.1 to 14.9 years. INCLUSION CRITERIA--Patients with a body weight above 10 kg, normal pulmonary resistance and an indication for surgical closure of a secundum atrial septal defect, a residual tissue rim of interatrial septum surrounding the defect of more than

G. Hausdorf; M. Schneider; B. Franzbach; C. Kampmann; K. Kargus; B. Goeldner

1996-01-01

344

Efficacy of intravenous ibutilide for rapid termination of atrial fibrillation and atrial flutter: A dose-response study  

Microsoft Academic Search

Objectives. Currently available antiarrhythmic drugs have limited efficacy for short-term, rapid termination of atrial fibrillation and atrial flutter.Background. Ibutilide fumarate is an investigational class III antiarrhythmic agent that prolongs repolarization by increasing the slow inward sodium current and by blocking the delayed rectifier current. It can be administered intravenously and has a rapid onset of electrophysiologic effects.Methods. The efficacy and

Kenneth A. Ellenbogen; Bruce S. Stambler; Mark A. Wood; Philip T. Sager; Robert C. Wesley; Marc D. Meissner; Robert G. Zoble; Linda K. Wakefield; Kimberly T. Perry; James T. Vanderlugtt

1996-01-01

345

[Radiofrequency ablation of type I atrial flutter. Personal experience].  

PubMed

The cause of Afl-I is macroentry in the right atrium. The critical site of reentry is the narrow anatomical space in the isthmic region between the posterior part of the annulus of the tricuspid valve and the vena cava inferior (isthmus TA-IVC). Radiofrequency ablation (RF) of the isthmus TA-IVC is successful on average in 90% of patients. The best criterium for evaluation of short-term and long-term effect of RF ablation is a two-way block of conduction in the TA-IVC insthmus, created by RF ablation. In case of a relapse it is possible to repeat ablation. Although a proarrhythmic effect of ablation is not assumed, the cause of the higher frequency of atrial fibrillation is not known. The authors present their own experience with the treatment of Afl-I by RF ablation of the TA-IVC isthmus in a group of 18 patients. RF ablation was successful in 83.3% patients of the group, no complications were recorded. Late relapses of Afl-1 in three patients were resolved by repeated RF ablation which was successful. The results are comparable with results in other departments. Based on their own experience the authors consider ablation treatment of Afl-1 a safe and effective therapeutic method in a selected group of patients. PMID:10422524

Szentiványi, M; Kaliská, G

1999-01-01

346

Attempted closure of a post-pneumonectomy oesophagopleural fistula with an Amplatzer atrial septal occluder  

PubMed Central

Oesophagopleural fistula is a recognized complication of pneumonectomy. Surgical repair with direct closure and reinforcement with omentum, muscle or pleural flap is the mainstay of definitive treatment. However, this option might not be suitable for all patients. The authors report on the case of a 63-year old female refusing surgical repair of an oesophagopleural fistula after left pneumonectomy. A novel approach (using an Amplatzer atrial septal occluder device) for fistula closure was attempted. Despite a promising initial result, the procedure failed. This is the first report on the use of a septal occluder to try and close an oesophagopleural fistula. PMID:23264469

Kadlec, Jakub; Turner, Kenrick; Van Leuven, Marc

2013-01-01

347

The TGFB1 Functional Polymorphism rs1800469 and Susceptibility to Atrial Fibrillation in Two Chinese Han Populations  

PubMed Central

Transforming growth factor-?1 (TGF-?1) is related to the degree of atrial fibrosis and plays critical roles in the induction and perpetuation of atrial fibrillation (AF). To investigate the association of the common promoter polymorphism rs1800469 in the TGF-?1 gene (TGFB1) with the risk of AF in Chinese Han population, we carried out a case-control study of two hospital-based independent populations: Southeast Chinese population (581 patients with AF and 723 controls), and Northeast Chinese population (308 AF patients and 292 controls). Two hundred and seventy-eight cases of AF were lone AF and 334 cases of AF were diagnosed as paroxysmal AF. In both populations, AF patients had larger left atrial diameters than the controls did. The rs1800469 genotypes in the TGFB1 gene were determined by polymerase chain reaction-restriction fragment length polymorphism. The genotype and allele frequencies of rs1800469 were not different between AF patients and controls of the Southeast Chinese population, Northeast Chinese population, and total Study Population. After adjustment for age, sex, hypertension and LAD, there was no association between the rs1800469 polymorphism and the risk of AF under the dominant, recessive and additive genetic models. Similar results were obtained from subanalysis of the lone and paroxymal AF subgroups. Our results do not support the role of the TGFB1 rs1800469 functional gene variant in the development of AF in the Chinese Han population. PMID:24349426

Luo, Zhurong; Chen, Fengping; Yang, Yuhui; Liu, Donglin; Gai, Xiaobo; Hou, Jianping; Huang, Mingfang

2013-01-01

348

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

349

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

350

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

351

Left atrial distension and intrarenal blood flow distribution in conscious dogs  

Microsoft Academic Search

Measurements were made with radioactive microspheres of the distribution of renal blood flow in conscious dogs during left atrial distension. Urine volume, sodium excretion, mean arterial blood pressure and heart rate increased during the 60 min period of left atrial distension (increase in left atrial pressure by about 1.0 kPa). Total renal blood flow and cardiac output (electromagnetic flowmeters) did

G. Kaczmarczyk; V. Unger; R. Mohnhaupt; H. W. Reinhardt

1981-01-01

352

Pathophysiological findings in a model of persistent atrial fibrillation and severe congestive heart failure  

Microsoft Academic Search

Objective: Develop and evaluate a model of persistent atrial fibrillation (AF) and severe congestive heart failure (CHF). Methods: A single-chamber atrial pacemaker was implanted in pigs (20-30 kg). Burst atrial pacing at 42 Hz led to development of persistent AF. Immediately and 20 days after activation of the burst pacing protocol, animals underwent echocardiography. Heart rate, rhythm and general condition

Alexander Bauer; Amy D. McDonald; J. Kevin Donahue

353

Atrial and ventricular fetal heart rate patterns in isolated congenital complete heart block detected by magnetocardiography  

Microsoft Academic Search

Atrial and ventricular fetal heart rate tracings from a patient with isolated congenital complete heart block treated with dexamethasone showed a remarkable degree of correlation and greater reactivity for the ventricular than the atrial fetal heart rate. Ventriculophasic sinus arrhythmia was present continually in the atrial fetal heart rate tracings. (Am J Obstet Gynecol 1998;179:258-60.)

Ronald T. Wakai; Arthur C. Leuthold; Chester B. Martin

1998-01-01

354

Color and pulsed Doppler studies of atrial flow dynamics in normals and adult patients with uncomplicated atrial septal defects.  

PubMed

Left and right atrial flow dynamics were compared by means of color and pulsed Doppler in order to study whether color Doppler could reliably provide differentiation between normals [15] and patients without atrial shunt at catheterization [12], vs patients with confirmed atrial septal defect [12]. The procedure consisted of sequential analysis of colored images throughout the cardiac cycle using an apical approach. In addition pulsed Doppler indices were calculated from both annular traces, relating diastolic early (E) and late (A) filling waves at each annulus (E/A); E and A waves were also summed (E + A), and the sum was related between both annuli (Tricuspid/Mitral ratio). Sequential analysis had a 100% sensitivity and specificity for the diagnosis of atrial septal defect, showing an asymmetrical pattern with predominant images in the right atrium, from the 2nd half of systole till End-diastole, vs the symmetrical 'Horseshoe' pattern found over both atria for control subjects. It avoided diagnostic errors due to overriding septal images in systole in 44% of controls. There also was a significant increase of the Tricuspid/Mitral ratios, (for duration and velocity time integral of waves) in patients with atrial septal defect. The correlation coefficient between ratios and values of the Pulmonary/Systemic flow ratio invasively calculated for 10 patients was respectively 0.6 and 0.7 (p less than 0.01). Sequential analysis of colored images appears highly reliable for the diagnosis of atrial septal defect; anomalies of ratios, although of moderate value for predicting shunt magnitude, substantiate the inequality of atrial fillings. PMID:2286768

Veyrat, C; Legeais, S; Sainte-Beuve, D; Kalmanson, D

355

Incomplete recovery of mechanical and endocrine left atrial functions one month after electrical cardioversion for persistent atrial fibrillation: a pilot study  

PubMed Central

Background Restoration of the mechanical and endocrine functions of the left atrium remains controversial after electrical cardioversion treatment for persistent atrial fibrillation. The objective of the prospective study was to describe the recovery of the endocrine and mechanical functions of the left atrium. Methods Evaluation of left atrium recovery after electrical cardioversion by the new speckle-tracking echocardiography technique and proANP measurement. Results Twenty patients suffering from persistent atrial fibrillation with no alteration of left ventricular ejection fraction were prospectively evaluated at baseline and then one month later by echocardiography, measuring left atrial volume and left atrial deformation (MPALS), as well as the proANP and BNP concentrations. One month after cardioversion 10 patients remained in sinus rhythm and 10 showed recurrent atrial fibrillation. No significant differences between the two groups in terms of clinical, echocardiographic and endocrine parameters were observed at baseline evaluation. We observed a significant reduction of left atrial volume only in the sinus group, whereas restoration of the left atrial deformation was only partial (18%) in that group. By contrast, we registered no significant changes in ANP concentration at one month in either the sinus or the atrial fibrillation groups. Conclusion These results suggest that restoration of left atrium mechanical function is only partial one month after treatment of persistent atrial fibrillation by electrical cardioversion, whereas a significant reduction of left atrial volume was noted, explaining the remaining high level of ANP in the sinus group. PMID:24559296

2014-01-01

356

Postoperative atrial fibrillation in liver transplantation.  

PubMed

Postoperative atrial fibrillation (POAF) is common after major surgeries and is associated with increased morbidity and mortality. POAF after liver transplantation (LT) has not been reported. This study was undertaken to investigate the incidence, impact, and risk factors of POAF in LT patients. After IRB approval, LT between January 2006 and August 2013 at our center were retrospectively reviewed. POAF that occurred within 30 days after LT was included. Patients with and without POAF were compared and independent risk factors were identified by logistic regression. Of 1387 adults LT patients, 102 (7.4%) developed POAF during the study period. POAF was associated with significantly increased mortality, graft failure, acute kidney injury and prolonged hospital stay. Independent risk factors included age, body weight, MELD score, presence of previous history of AF, the vasopressors use prior to LT and pulmonary artery diastolic pressure at the end of LT surgery (odds ratios 2.0-7.2, all p?

Xia, V W; Worapot, A; Huang, S; Dhillon, A; Gudzenko, V; Backon, A; Agopian, V G; Aksoy, O; Vorobiof, G; Busuttil, R W; Steadman, R H

2015-03-01

357

New Oral Anticoagulants for Atrial Fibrillation  

PubMed Central

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

Shafeeq, Hira; Tran, Tran H.

2014-01-01

358

Atrial natriuretic factor increases vascular permeability  

NASA Technical Reports Server (NTRS)

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

Lockette, Warren; Brennaman, Bruce

1990-01-01

359

Atrial natriuretic factor increases vascular permeability  

SciTech Connect

An increase in central blood volume in microgravity may result in increased plasma levels of atrial natriuretic factor (ANF). Since elevations in plasma ANF are found in clinical syndromes associated with edema, and since space motion sickness induced by microgravity is associated with an increase in central blood volume and facial edema, we determined whether ANF increases capillary permeability to plasma protein. Conscious, bilaterally nephrectomized male rats were infused with either saline, ANF + saline, or hexamethonium + saline over 2 h following bolus injections of 125I-albumin and 14C-dextran of similar molecular size. Blood pressure was monitored and serial determinations of hematocrits were made. Animals infused with 1.0 micrograms.kg-1.min-1 ANF had significantly higher hematocrits than animals infused with saline vehicle. Infusion of ANF increased the extravasation of 125I-albumin, but not 14C-dextran from the intravascular compartment. ANF also induced a depressor response in rats, but the change in blood pressure did not account for changes in capillary permeability to albumin; similar depressor responses induced by hexamethonium were not accompanied by increased extravasation of albumin from the intravascular compartment. ANF may decrease plasma volume by increasing permeability to albumin, and this effect of ANF may account for some of the signs and symptoms of space motion sickness.

Lockette, W.; Brennaman, B. (Wayne State Univ. School of Medicine, Detroit, MI (USA))

1990-12-01

360

Biomarkers in atrial fibrillation: a clinical review.  

PubMed

Assessment of atrial fibrillation (AF)-associated stroke risk is at present mainly based on clinical risk scores such as CHADS2 and CHA2DS2-VASc, although these scores provide only modest discrimination of risk for individual patients. Biomarkers derived from the blood may help refine risk assessment in AF for stroke outcomes and for mortality. Recent studies of biomarkers in AF have shown that they can substantially improve risk stratification. Cardiac biomarkers, such as troponin and natriuretic peptides, significantly improve risk stratification in addition to current clinical risk stratification models. Similar findings have recently been described for markers of renal function, coagulation, and inflammation in AF populations based on large randomized prospective clinical trials or large community-based cohorts. These new findings may enable development of novel tools to improve clinical risk assessment in AF. Biomarkers in AF may also improve the understanding of the pathophysiology of AF further as well as potentially elucidate novel treatment targets. This review will highlight novel associations of biomarkers and outcomes in AF as well as recent progress in the use of biomarkers for risk stratification. PMID:23386711

Hijazi, Ziad; Oldgren, Jonas; Siegbahn, Agneta; Granger, Christopher B; Wallentin, Lars

2013-05-01

361

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

PubMed Central

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

De Backer, O; Arnous, S; Ihlemann, N; Vejlstrup, N; Jørgensen, E; Pehrson, S; Krieger, T D W; Meier, P; Søndergaard, L; Franzen, O W

2014-01-01

362

Endocardial and epicardial radiofrequency ablation in the treatment of atrial fibrillation with a new intra-operative device  

Microsoft Academic Search

Objective: Atrial fibrillation has been a difficult problem to solve in many surgical patients, especially in those with mitral valve pathology. This study evaluates the results of endocardial and epicardial radiofrequency ablation with a new intra-operative device in the treatment of atrial fibrillation. Methods: We operated on 65 patients with atrial fibrillation, 58 of which had concomitant mitral surgery. Atrial

João Melo; Pedro Adragão; José Neves; Manuel Ferreira; Ana Timóteo; Teresa Santiago; Regina Ribeiras

2000-01-01

363

Characteristics and prognosis of lone atrial fibrillation. 30-year follow-up in the Framingham Study.  

PubMed

In 30 years of follow-up of 5,209 participants in the Framingham Study, 193 men and 183 women developed atrial fibrillation (AF). Among this group, "lone" AF occurred in 32 men and 11 women free of coronary heart disease, congestive heart failure, rheumatic heart disease, and hypertensive cardiovascular disease. To determine the characteristics and prognosis of lone AF, each case was matched to controls in the remaining Framingham sample. Comparisons indicated that levels of several risk factors associated with coronary heart disease were similar between the two groups. Atrial fibrillation cases, however, had significantly higher rates of preexisting nonspecific T- or ST-wave abnormalities and intraventricular block as determined by electrocardiograms. Follow-up for new cardiovascular events indicated similar rates of coronary heart disease and congestive heart failure, but the rate of strokes was significantly greater in the lone AF group. Findings suggest that subjects with lone AF, despite similar cardiovascular risk profiles to normal controls, have a distinct preponderance of preexisting electrocardiographic abnormalities. Furthermore, contrary to general belief, lone AF is not a benign condition; it has a serious prognosis, indicating a greater need for detection and treatment. PMID:4068186

Brand, F N; Abbott, R D; Kannel, W B; Wolf, P A

1985-12-27

364

Time and frequency recurrence analysis of persistent atrial fibrillation after electrical cardioversion.  

PubMed

Electrical cardioversion (ECV) has become a mainstay of therapy for the treatment of persistent atrial fibrillation (AF), which is an arrhythmia that affects up to 1% of the general population. The procedure is initially effective, but it is also characterized by a high rate of AF recurrence. As a consequence, it would be clinically useful to predict normal sinus rhythm (NSR) maintenance after ECV before it is attempted. In this respect, several clinical, echocardiographic and demographic parameters have been analyzed by other authors. However, these indices are weak predictors of ECV outcome. In this work, surface electrocardiographic (ECG) recordings were used to extract the atrial activity (AA) signal and parametrize the fibrillatory (f) waves, both in time and frequency, to obtain AF recurrence predictors. Parameters as f waves amplitude (fWA), AA mean power, dominant atrial frequency (DAF), its first harmonic, etc were studied. Obtained results showed that fWA was the most significant predictor of AF recurrence 1 month later. Concretely, 72.73% of the patients resulting in NSR, 83.87% relapsing to AF and 80.0% with unsuccessful ECV, were correctly identified. Therefore, fWA classified satisfactorily 79.37% of the analyzed patients. In addition, a forward stepwise discriminant analysis, with a leave-one-out cross validation approach, proved that fWA and DAF combination provided an improved diagnostic ability of 85.71%. In this case 86.36%, 83.87% and 90% of the patients who resulted in NSR, relapsed to AF and with unsuccessful ECV, were correctly discerned, respectively. In conclusion, fWA could be considered as a promising predictor of ECV outcome during the first month following the procedure. Additionally, time and frequency indices could yield complementary information useful to predict the cardioversion outcome. Finally, further studies are needed to validate the robustness of these parameters and the repeatability of the obtained results on wider databases. PMID:19369714

Alcaraz, Raúl; Rieta, José Joaquín

2009-05-01

365

[Atrial fibrillation-pharmacological therapy for rate and rhythm control].  

PubMed

The therapeutic management of patients with atrial fibrillation is based on the three pillars (1) prevention of thromboembolism, (2) rate control, and (3) rhythm control. Patients with one or more risk factors should be treated with an oral anticoagulants in order to prevent stroke and to reduce mortality. The goals of rate control, prevention of heart failure and alleviation of atrial fibrillation related symptoms, normally can be achieved by pharmacological agents slowing the conduction in the AV node (e. g. ?-blockers, calcium channel blockers, digoxin). For patients remaining symptomatic despite sufficient rate control adding a rhythm control strategy may be considered. The currently available antiarrhythmic drugs (e. g. flecainide, propafenone, sotalol, dronedarone, amiodarone) are characterized by a rather low efficacy in maintaining sinus rhythm and various possibly life threatening side effects. Therefore, invasive therapies as catheter ablation are frequently needed to achieve rhythm control in symptomatic patients with atrial fibrillation. PMID:24463376

Müller-Burri, Stephan Andreas

2014-02-01

366

Preprocedural Imaging for Patients with Atrial Fibrillation and Heart Failure  

PubMed Central

Various electrophysiological procedures and device implantation has been shown to improve morbidity and mortality in patients with atrial fibrillation (AF) and patients with heart failure (HF). Non-invasive cardiac imaging is used extensively in the pre-procedural patient selection and for procedural guidance. In this review, we will discuss the application of pre-procedural cardiac imaging in patients with AF prior to pulmonary vein and left atrial ablation as well as insertion of left atrial occluder device. We also discuss the role of non-invasive cardiac imaging in the selection of appropriate HF patients for device therapy as well as their use in guiding implantation of biventricular pacemaker for cardiac resynchronization therapy by assessing left ventricular ejection fraction, coronary venous anatomy, mechanical dyssynchrony and myocardial scar. We describe new research associated with pre-procedural imaging in these patient cohorts. PMID:22828754

Thai, Wai-ee; Wai, Bryan; Truong, Quynh A.

2012-01-01

367

Class 1 antiarrhythmic agents for therapy of atrial fibrillation.  

PubMed

Atrial fibrillation is most the common sustained arrhythmia seen by the cardiologist. Therapy to prevent this arrhythmia is often prescribed so as to eliminate associated symptoms which include palpitations, fatigue, dizziness and presyncope, shortness of breath, congestive heart failure and emboli, especially those that result in a cerebrovascular accident. Pharmacologic therapy is the only effective therapy for preventing atrial fibrillation and the class 1 antiarrhythmic drugs remain the most frequently used agents. Although each of these agents has been reported to be effective for preventing atrial fibrillation, they are associated with frequent side effects, some of which are potentially serious, especially aggravation of arrhythmia. Prior to treatment the benefit vs risk of these drugs for each patient must be established. PMID:8454255

Podrid, P J

1993-02-01

368

Surgical Techniques Used for the Treatment of Atrial Fibrillation  

PubMed Central

The use of surgical lesion sets for the treatment of atrial fibrillation has been increasing, particularly in patients with complicated anatomical substrates and those undergoing concomitant surgery. Preferences in terms of lesion set, surgical approach and ablation technology vary by center. This review discusses both the surgical techniques and the outcomes for the most commonly performed procedures in the context of recent consensus guidelines. The Cox-Maze IV, pulmonary vein isolation, extended left atrial lesion sets, the hybrid approach and ganglionated plexus ablation are each reviewed in an attempt to provide insight into current clinical practice and patient selection PMID:23823731

Robertson, Jason O.; Lawrance, Christopher P.; Maniar, Hersh S.; Damiano, Ralph J.

2015-01-01

369

Anesthesia with propofol slows atrial fibrillation dominant frequencies.  

PubMed

The mechanisms responsible for the maintenance of atrial fibrillation (AF) are not completely understood yet. It has been demonstrated that AF can be modulated by several cardiac diseases, the autonomic nervous system and even drugs with purportedly no antiarrhythmic properties. We evaluated the effects of a widely used anaesthetic agent (propofol) in the fibrillation patterns. Spectral analysis was performed over atrial electrograms at baseline and immediately after a propofol bolus. Only after performing principal component analysis (PCA), we were able to significantly detect that propofol slows AF. PMID:18555984

Cervigón, R; Moreno, J; Castells, F; Mateo, J; Sánchez, C; Pérez-Villacastín, J; Millet, J

2008-07-01

370

Dronedarone in atrial fibrillation: the aftermath of the PALLAS trial.  

PubMed

Dronedarone is a new antiarrhythmic currently approved for use among patients with nonpermanent atrial fibrillation (AF) based on the positive results of the ATHENA trial. Dronedarone was recently investigated in the PALLAS (Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of Standard Therapy) trial, a landmark trial that evaluated treatment with dronedarone compared with placebo among older patients with permanent AF. The trial was terminated early due to a significant increase in adverse cardiovascular events among dronedarone-treated patients. In this article, the trial is presented and the significance and practical implications of the results in the management of older patients with AF briefly discussed. PMID:23244355

Salam, Amar M

2012-11-01

371

Postoperative atrial fibrillation: incidence, mechanisms, and clinical correlates.  

PubMed

Atrial fibrillation is the most commonly encountered arrhythmia after cardiac surgery. Although usually self-limiting, it represents an important predictor of increased patient morbidity, mortality, and health care costs. Numerous studies have attempted to determine the underlying mechanisms of postoperative atrial fibrillation (POAF) with varied success. A multifactorial pathophysiology is hypothesized, with inflammation and postoperative ?-adrenergic activation recognized as important contributing factors. The management of POAF is complicated by a paucity of data relating to the outcomes of different therapeutic interventions in this population. This article reviews the literature on epidemiology, mechanisms, and risk factors of POAF, with a subsequent focus on the therapeutic interventions and guidelines regarding management. PMID:25443241

Yadava, Mrinal; Hughey, Andrew B; Crawford, Thomas Christopher

2014-11-01

372

Ventricular rate control of atrial fibrillation in heart failure.  

PubMed

In the last few years, there has been a major shift in the treatment of atrial fibrillation (AF) in the setting of hear failure (HF), from rhythm to ventricular rate control in most patients with both conditions. In this article, the authors focus on ventricular rate control and discuss the indications; the optimal ventricular rate-control target, including detailed results of the Rate Control Efficacy in Permanent Atrial Fibrillation: a Comparison Between Lenient versus Strict Rate Control II (RACE II) study; and the pharmacologic and nonpharmacologic options to control the ventricular rate during AF in the setting of HF. PMID:24054473

Rienstra, Michiel; Van Gelder, Isabelle C

2013-10-01

373

False detection of atrial fibrillation in children by a blood pressure monitor with atrial fibrillation detection function.  

PubMed

A sphygmomanometer that can detect atrial fibrillation may help to identify asymptomatic patients who might benefit from anticoagulation. Its performance in young people has not been reported. In a school project measuring blood pressure in 60 normal healthy male teenagers (age range 13-18?years; mean±SD 15.0±1.5?years), a Microlife BPA200 blood pressure monitor indicated atrial fibrillation in 11 participants (18%). These participants did not have any personal or family history of heart disease. They had sinus arrhythmia and had significantly lower systolic and diastolic blood pressure, body mass index and waist circumference (all p values <0.05). In young people, atrial fibrillation is very uncommon and false positives are likely. To avoid unnecessary alarm and referrals, this function is best turned off in young patients. PMID:25612757

Cheung, Adrian Justin; Cheung, Bernard Man Yung

2015-01-01

374

Interrupting Anticoagulation in Patients With Nonvalvular Atrial Fibrillation  

PubMed Central

Three target-specific oral anticoagulants (TSOACs)—dabigatran, rivaroxaban, and apixaban—have been approved by the FDA to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation; however, no agents are currently approved to reverse the anticoagulant effects of these TSOACs in cases of active bleeding. This review discusses the benefits and risks of these TSOACs from a clinician’s perspective, with a focus on the interruption of treatment for either elective or emergent surgery, monitoring, and reversal of anticoagulation. Available coagulation assays are not ideal for monitoring the effects of TSOACs and do not provide reliable quantitative measurement of their anticoagulant effects. When necessary, activated partial thromboplastin time (aPTT) may provide qualitative information on dabigatran, and prothrombin time (PT) may provide qualitative assessment of the presence of the factor Xa inhibitors, rivaroxaban and apixaban. Current recommendations for reversal of TSOACs are based largely on limited and sometimes conflicting data from in vitro or in vivo animal models, and clinical experience with these recommendations is also limited. Methods that have been investigated for effectiveness for reversal of the pharmacodynamic effects of the TSOACs include dialysis, activated charcoal, prothrombin complex concentrate (PCC), and recombinant activated factor VII. It is important to note that even within a class of anticoagulant drugs, compounds respond differently to reversal agents; therefore, recommendations for one agent should not be extrapolated to another, even if they are from the same therapeutic class. New antidotes are being explored, including a mouse monoclonal antibody to dabigatran; andexanet alfa, a potential universal factor Xa inhibitor reversal agent; and a synthetic small molecule (PER977) that may be effective for the reversal of factor Xa inhibitors and direct thrombin inhibitors. Given the short half-lives of TSOACs, watchful waiting, rather than reversal, may be the best approach in some circumstances. PMID:25516695

Yates, Scott W.

2014-01-01

375

Interrupting anticoagulation in patients with nonvalvular atrial fibrillation.  

PubMed

Three target-specific oral anticoagulants (TSOACs)-dabigatran, rivaroxaban, and apixaban-have been approved by the FDA to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation; however, no agents are currently approved to reverse the anticoagulant effects of these TSOACs in cases of active bleeding. This review discusses the benefits and risks of these TSOACs from a clinician's perspective, with a focus on the interruption of treatment for either elective or emergent surgery, monitoring, and reversal of anticoagulation. Available coagulation assays are not ideal for monitoring the effects of TSOACs and do not provide reliable quantitative measurement of their anticoagulant effects. When necessary, activated partial thromboplastin time (aPTT) may provide qualitative information on dabigatran, and prothrombin time (PT) may provide qualitative assessment of the presence of the factor Xa inhibitors, rivaroxaban and apixaban. Current recommendations for reversal of TSOACs are based largely on limited and sometimes conflicting data from in vitro or in vivo animal models, and clinical experience with these recommendations is also limited. Methods that have been investigated for effectiveness for reversal of the pharmacodynamic effects of the TSOACs include dialysis, activated charcoal, prothrombin complex concentrate (PCC), and recombinant activated factor VII. It is important to note that even within a class of anticoagulant drugs, compounds respond differently to reversal agents; therefore, recommendations for one agent should not be extrapolated to another, even if they are from the same therapeutic class. New antidotes are being explored, including a mouse monoclonal antibody to dabigatran; andexanet alfa, a potential universal factor Xa inhibitor reversal agent; and a synthetic small molecule (PER977) that may be effective for the reversal of factor Xa inhibitors and direct thrombin inhibitors. Given the short half-lives of TSOACs, watchful waiting, rather than reversal, may be the best approach in some circumstances. PMID:25516695

Yates, Scott W

2014-12-01

376

Stroke and Bleeding Risk in Atrial Fibrillation  

PubMed Central

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

Senoo, Keitaro; Lane, Deirdre

2014-01-01

377

Best practice for atrial fibrillation patient education.  

PubMed

Patients' beliefs about their health (and illness), medications and healthcare they receive are important determinants of whether or not they accept recommended treatments; influence their coping responses in relation to their illness; make them adhere to recommended therapy and ultimately affect health outcomes. Incorporation of patients' preferences for therapy should now be considered an integral part of the decision-making process. This gradual shift in health-care practice from paternalistic to shared-decision making, whereby there is a two-way exchange of information between the patient and healthcare provider and both are involved in the treatment decision, requires a reasonable level of understanding and knowledge of the condition and its treatment by the patient. However, patients with atrial fibrillation (AF) often have poor knowledge about their condition and the benefits and risks of AF and AF treatments. Physicians and other healthcare providers may have doubts over a patient's ability to adhere to certain treatment regimens, particularly oral anticoagulation, due in part to the lack of patient knowledge, and this may be an important determinant of whether such treatments are even considered as therapeutic options. Further, patients often hold misconceptions about AF and treatment options, which may act as barriers to their acceptance of the condition and adherence to therapy. This review will summarise the literature on the knowledge of patients about AF and its management, how patients' values and preferences can impact on their treatment choices, the ideal components of patient education, the impact of educational interventions on patients' knowledge and perceptions of AF, and where appropriate highlight specific issues facing lone AF patients. PMID:25175094

Lane, Deirdre A; Barker, Rachel V; Lip, Gregory Y H

2014-01-01

378

Characteristics and Outcomes of Atrial Tachycardia Originating from the Sinus Venosus during Catheter Ablation of Atrial Fibrillation  

PubMed Central

Background and Objectives The sinus venosus (SV) is not a well known source of atrial tachycardia (AT), but it can harbor AT during catheter ablation of atrial fibrillation (AF). Subjects and Methods A total of 1223 patients who underwent catheter ablation for AF were reviewed. Electrophysiological and electrocardiographic characteristics and outcomes after catheter ablation of AT originating from the SV were investigated. Results Ten patients (0.82%) demonstrated AT from the SV (7 males, 53.9±16.0 years, 6 persistent) during ablation of AF. The mean cycle length was 281±73 ms. After pulmonary vein isolation and left atrial ablation, AF converted to AT from the SV during right atrial ablation in 2 patients, by rapid atrial pacing after AF termination in 7 patients, and during isoproterenol infusion in 1 patient. Positive P-waves in inferior leads were shown in most patients (90%). The activation sequence of AT was from proximal to distal in the superior vena cava and high to low in the right atrium, which was similar to that of AT from crista terminalis. Fragmented double potentials were recorded during sinus, and a second discrete potential preceded the onset of P wave by 80±37 ms during AT. Using 4.4±2.7 radiofrequency focal applications, ATs were terminated and became no longer inducible in all. After ablation procedure, two patients showed transient right phrenic nerve palsy. After 19.9±14.8 months, all but 1 patient were free of atrial tachyarrhythmia without complications. Conclusion The AT which develops during AF ablation is rarely originated from SV, and its electrophysiologic characteristics may be helpful in guiding effective focal ablation. PMID:23407327

Park, Yae Min; Kook, Hyungdon; Kim, Woohyeon; Lee, Son Ki; Choi, Jong-Il; Lim, Hong Euy; Park, Sang Weon

2013-01-01

379

Rotor Termination Is Critically Dependent on Kinetic Properties of IKur Inhibitors in an In Silico Model of Chronic Atrial Fibrillation  

PubMed Central

Inhibition of the atrial ultra-rapid delayed rectifier potassium current (IKur) represents a promising therapeutic strategy in the therapy of atrial fibrillation. However, experimental and clinical data on the antiarrhythmic efficacy remain controversial. We tested the hypothesis that antiarrhythmic effects of IKur inhibitors are dependent on kinetic properties of channel blockade. A mathematical description of IKur blockade was introduced into Courtemanche-Ramirez-Nattel models of normal and remodeled atrial electrophysiology. Effects of five model compounds with different kinetic properties were analyzed. Although a reduction of dominant frequencies could be observed in two dimensional tissue simulations for all compounds, a reduction of spiral wave activity could be only be detected in two cases. We found that an increase of the percent area of refractory tissue due to a prolongation of the wavelength seems to be particularly important. By automatic tracking of spiral tip movement we find that increased refractoriness resulted in rotor extinction caused by an increased spiral-tip meandering. We show that antiarrhythmic effects of IKur inhibitors are dependent on kinetic properties of blockade. We find that an increase of the percent area of refractory tissue is the underlying mechanism for an increased spiral-tip meandering, resulting in the extinction of re-entrant circuits. PMID:24376659

Scholz, Eberhard P.; Carrillo-Bustamante, Paola; Fischer, Fathima; Wilhelms, Mathias; Zitron, Edgar; Dössel, Olaf; Katus, Hugo A.; Seemann, Gunnar

2013-01-01

380

A novel autosomal dominant condition consisting of congenital heart defects and low atrial rhythm maps to chromosome 9q  

PubMed Central

Congenital heart defects (CHDs) occur mostly sporadic, but familial CHD cases have been reported. Mutations in several genes, including NKX2.5, GATA4 and NOTCH1, were identified in families and patients with CHD, but the mechanisms underlying CHD are largely unknown. We performed genome-wide linkage analysis in a large four-generation family with autosomal dominant CHD (including atrial septal defect type I and II, tetralogy of Fallot and persistent left superior vena cava) and low atrial rhythm, a unique phenotype that has not been described before. We obtained phenotypic information including electrocardiography, echocardiography and DNA of 23 family members. Genome-wide linkage analysis on 12 affected, 5 unaffected individuals and 1 obligate carrier demonstrated significant linkage only to chromosome 9q21–33 with a multipoint maximum LOD score of 4.1 at marker D9S1690, between markers D9S167 and D9S1682. This 48-c critical interval corresponds to 39?Mb and contains 402 genes. Sequence analysis of nine candidate genes in this region (INVS, TMOD1, TGFBR1, KLF4, IPPK, BARX1, PTCH1, MEGF9 and S1PR3) revealed no mutations, nor were genomic imbalances detected using array comparative genomic hybridization. In conclusion, we describe a large family with CHD and low atrial rhythm with a significant LOD score to chromosome 9q. The phenotype is representative of a mild form of left atrial isomerism or a developmental defect of the sinus node and surrounding tissue. Because the mechanisms underlying CHD are largely unknown, this study represents an important step towards the discovery of genes implied in cardiogenesis. PMID:21386876

van de Meerakker, Judith B A; van Engelen, Klaartje; Mathijssen, Inge B; Lekanne dit Deprez, Ronald H; Lam, Jan; Wilde, Arthur A M; Baars, Marieke J H; Mannens, Marcel M A M; Mulder, Barbara J M; Moorman, Antoon F M; Postma, Alex V

2011-01-01

381

Body surface potential mapping for mapping and treatment of persistent atrial fibrillation.  

PubMed

Techniques facilitating individual mapping and ablation of arrhythmogenic substrates are desired to enhance our understanding of persistent atrial fibrillation (persAF) mechanisms as a prerequisite to increasing the success rates of single procedure persAF catheter ablation. The technique of body surface potential mapping (BSM) involves the use of multiple electrodes to collect the potentials over a large body surface area and, with the use of a computed tomography scan, it facilitates their correlation to a 3D model of the atrial structures. During AF,the visualization and localization of AF driver activity, both reentrant and focal wavefronts, is possible with this technique. The ECVUE system from CardioInsight was examined for this indication in clinical studies and showed a termination rate of persAF of 63?% in a large multicenter trial (AFACART) with a promising low recurrence rate during follow-up. From our initial experience, the system appears to be effective in persAF patients who have continuous AF for less than ?1 year. However, the utility of the system for highly challenging cases like long-standing persistent AF and patients with very short AF cycle length remains to be explored. Further studies are needed to confirm these data and answer the multitude of open questions in this field. PMID:25200166

Konrad, Torsten; Theis, Cathrin; Mollnau, Hanke; Sonnenschein, Sebastian; Rostock, Thomas

2014-12-01

382

Improved time--frequency analysis of atrial fibrillation signals using spectral modeling.  

PubMed

In patients with atrial fibrillation (AF), the fibrillatory frequency trend and the time-dependent spectral characteristics can be investigated using a spectral profile technique. The spectral profile is updated by fitting each short-time spectrum. The aim of this study is to develop model-based means for stricter control on the update of the spectral profile. A spectral model defined by a superposition of Gaussian functions is suggested for describing the fundamental and harmonics of the atrial waves during AF, thereby accounting for basic characteristics of the typical AF spectrum. The model parameters are obtained from weighted least squares fitting of the model to the observed spectrum. The method was tested on simulated signals as well as on 48 ECG recordings from 15 patients with persistent AF. Using simulated signals, we assessed the accuracy in terms of magnitude and width of the spectral peaks. For SNR=0 dB, the maximum normalized error was less than 0.2 when estimating magnitude of both the fundamental and the harmonics, whereas it was less than 0.15 for the fundamental and 0.7 for the harmonics with respect to the estimation of the width. We observed a marked improvement while tracking the main fibrillatory frequency as the error was reduced by more than 50% in comparison with the original method. Analyzing ECGs, reliable spectral profiles were obtained in all recordings, even in those cases (5/48) that were not well characterized by the original method. PMID:19126451

Corino, Valentina D A; Mainardi, Luca T; Stridh, Martin; Sörnmo, Leif

2008-12-01

383

Saudi Atrial Fibrillation Survey: National, Observational, Cross-sectional Survey Evaluating Atrial Fibrillation Management and the Cardiovascular Risk Profile of Patients With Atrial Fibrillation.  

PubMed

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The Saudi Atrial Fibrillation Survey registry was designed to provide epidemiological and clinical data on patients with AF. The registry included 400 consecutive patients who met the eligibility criteria. Control of AF at the time of the initial visit was achieved by 211 (52.75%) patients. Cardiovascular risk profile of the patients with AF was smoking 92 (23.5%), hypertension 253 (63.25%), diabetes 192 (48%), and dyslipidemia 173 (44%). Rate control was the most frequent management strategy (in 265 patients, 66.2%) whereas rhythm control was chosen in 48 (12%) patients. Both strategies were attempted in 5 (1.2%) patients. This is the first nationwide registry of patients with AF in Saudi Arabia. Compared to developed countries, our patients with AF are relatively young and have higher rates of diabetes and rheumatic heart disease. Rate control is the main strategy currently used for managing AF. PMID:24687415

Hersi, Ahmad; Abdul-Moneim, Mohammad; Almous'ad, Abdulmohsen; Al-Samadi, Faisal; AlFagih, Ahmed; Sweidan, Raid

2015-03-01

384

Clinical Characteristics, Management, and Control of Permanent vs. Nonpermanent Atrial Fibrillation: Insights from the RealiseAF Survey  

PubMed Central

Background Atrial fibrillation can be categorized into nonpermanent and permanent atrial fibrillation. There is less information on permanent than on nonpermanent atrial fibrillation patients. This analysis aimed to describe the characteristics and current management, including the proportion of patients with successful atrial fibrillation control, of these atrial fibrillation subsets in a large, geographically diverse contemporary sample. Methods and Results Data from RealiseAF, an international, observational, cross-sectional survey of 10,491 patients with atrial fibrillation, were used to characterize permanent atrial fibrillation (N?=?4869) and nonpermanent atrial fibrillation (N?=?5622) patients. Permanent atrial fibrillation patients were older, had a longer time since atrial fibrillation diagnosis, a higher symptom burden, and were more likely to be physically inactive. They also had a higher mean (SD) CHADS2 score (2.2 [1.3] vs. 1.7 [1.3], p<0.001), and a higher frequency of CHADS2 score ?2 (67.3% vs. 53.0%, p<0.001) and comorbidities, most notably heart failure. Physicians indicated using a rate-control strategy in 84.2% of permanent atrial fibrillation patients (vs. 27.5% in nonpermanent atrial fibrillation). Only 50.2% (N?=?2262/4508) of permanent atrial fibrillation patients were controlled. These patients had a longer time since atrial fibrillation diagnosis, a lower symptom burden, less obesity and physical inactivity, less severe heart failure, and fewer hospitalizations for acute heart failure than uncontrolled permanent atrial fibrillation patients, but with more arrhythmic events. The most frequent causes of hospitalization in the last 12 months were acute heart failure and stroke. Conclusion Permanent atrial fibrillation is a high-risk subset of atrial fibrillation, representing half of all atrial fibrillation patients, yet rate control is only achieved in around half. Since control is associated with lower symptom burden and heart failure, adequate rate control is an important target for improving the management of permanent atrial fibrillation patients. PMID:24497948

Murin, Jan; Naditch-Brûlé, Lisa; Brette, Sandrine; Chiang, Chern-En; O’Neill, James; Steg, P. Gabriel

2014-01-01

385

Monitoring of ANP secretion from single atrial myocytes using densitometry.  

PubMed

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

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

2002-07-01

386

MRI screening for chronic anticoagulation in atrial fibrillation.  

PubMed

Anticoagulation is highly effective in preventing stroke due to atrial fibrillation, but numerous studies have demonstrated low utilization of anticoagulation for these patients. Assessment of clinicians' attitudes on this topic indicate that fear of intracerebral hemorrhage (ICH), rather than appreciation of anticoagulation benefits, largely drives clinical decision-making for treatment with anticoagulation in atrial fibrillation. Risk stratification strategies have been used for anticoagulation benefits and hemorrhage risk, but ICH is not specifically addressed in the commonly used hemorrhage risk stratification systems. Cerebral microbleeds are cerebral microscopic hemorrhages demonstrable by brain MRI, indicative of prior microhemorrhages, and predictive of future risk of ICH. Prevalence of cerebral microbleeds increases with age; and cross-sectional and limited prospective studies generally indicate that microbleeds confer substantial risk of ICH in patients treated with chronic anticoagulation. MRI thus is a readily available and appealing modality that can directly assess risk of future ICH in patients receiving anticoagulants for atrial fibrillation. Incorporation of MRI into routine practice is, however, fraught with difficulties, including the uncertain relationship between number and location of microbleeds and ICH risk, as well as cost-effectiveness of MRI. A proposed algorithm is provided, and relevant advantages and disadvantages are discussed. At present, MRI screening appears most appropriate for a subset of atrial fibrillation patients, such as those with intermediate stroke risk, and may provide reassurance for clinicians whose concerns for ICH tend to outweigh benefits of anticoagulation. PMID:24109470

Fisher, Mark

2013-01-01

387

[New developments in the antiarrhythmic therapy of atrial fibrillation].  

PubMed

Atrial fibrillation often affects elderly people with cardiovascular disease and takes a progressive course with increasing resistance to treatment. For the latter, electrical and structural changes (remodelling) seem to be responsible that are directly related to the high excitatory rate in the atria. Therapeutic strategies for atrial fibrillation consist of (i) treating the underlying cardiovascular disease, (ii) re-establishing sinus rhythm and (iii) reducing ventricular rate. Rapid pharmacological or electrical cardioversion is expected to prevent remodelling. Classical antiarrhythmic drugs are notoriously ineffective and burdened with serious cardiac and extracardiac side effects so that there is an urgent need for effective and safe novel compounds. In this review the three recently introduced drugs dronedarone, vernakalant and ranolazine are discussed with respect to the use in atrial fibrillation. Other new antiarrhythmic agents are still in the developmental phase and aim at atria-selective mechanisms thereby excluding ventricular proarrhythmic effects. The mechanisms of action will be discussed in the context of the present understanding of the pathophysiology of onset and maintenance of atrial fibrillation. PMID:24496483

Ravens, Ursula

2014-03-01

388

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

PubMed

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

Trigo, Paula; Fischer, Gregory W

2012-01-01

389

Managing atrial fibrillation in the elderly: critical appraisal of dronedarone  

PubMed Central

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

Trigo, Paula; Fischer, Gregory W

2012-01-01

390

Spontaneous onset of type I atrial flutter in patients  

Microsoft Academic Search

Objectives. This study sought to characterize the spontaneous onset of atrial flutter in patients.Background. Temporary epicardial electrodes are routinely placed on the atria of patients at the time of open heart surgery and brought out through the anterior chest wall for potential diagnostic and therapeutic use in the postoperative period. We utilized these electrodes to study the spontaneous onset of

Albert L. Waldo; Terry B. Cooper

1996-01-01

391

T wave alternans during exercise and atrial pacing in humans  

NASA Technical Reports Server (NTRS)

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

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

1997-01-01

392

Spatiotemporal Periodicity During Atrial Fibrillation in the Isolated Sheep Heart  

Microsoft Academic Search

Background—The activation patterns that underlie the irregular electrical activity during atrial fibrillation (AF) have traditionally been described as disorganized or random. Recent studies, based predominantly on statistical methods, have provided evidence that AF is spatially organized. The objective of this study was to demonstrate the presence of spatial and temporal periodicity during AF. Methods and Results—We used a combination of

Allan C. Skanes; Ravi Mandapati; Omer Berenfeld; Jorge M. Davidenko

393

Paroxysmal atrial fibrillation associated with an attack of multiple sclerosis.  

PubMed Central

A young woman presented with an acute right pontine lesion and paroxysmal atrial fibrillation. The lesion was later proven by magnetic resonance imaging to be due to multiple sclerosis. To our knowledge, cardiac arrhythmias have not been previously described in this condition. Published support for this possible association is reviewed. Images Figure 1 Figure 2 PMID:3763547

Chagnac, Y.; Martinovits, G.; Tadmor, R.; Goldhammer, Y.

1986-01-01

394

Emodin accentuates atrial natriuretic peptide secretion in cardiac atria.  

PubMed

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

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

2014-07-15

395

Effects of sympathomimetic drugs on reptilian atrial muscles.  

PubMed

The effects of some sympathomimetic drugs on isolated atria of rainbow lizards (Agama agama Linn.) and land tortoises (Kinixys spp. Linn.) have been examined. Noradrenaline, adrenaline, isoprenaline, phenylephrine or dopamine (10(-9)-10(-5) M) induced concentration-dependent positive chronotropic and inotropic responses in spontaneously-beating right- and electrically-driven left atria of rainbow lizards or tortoises. These catecholamines produced similar responses in guinea-pig isolated atria. Phentolamine or propranolol (10(-10)-10(-6) M) competitively antagonised the positive chronotropic and/or positive inotropic responses induced by these sympathomimetic agonists in these reptilian (and mammalian) atrial muscles; probably suggesting the presence of alpha- and/or beta-adrenoceptors in reptilian atrial muscles (as in the mammalian myocardium). It is suggested that in reptilian atrial muscles, only one adrenoceptor subtype which is capable of converting its properties to either alpha- or beta-, or even alpha- and beta-adrenoceptor subtypes (as in the frog heart) depending on the environmental temperature, may exist. The use of rainbow lizard and tortoise atrial muscle preparations as laboratory models for routine pharmacological evaluation of adrenergic drugs, particularly in developing tropical African countries where these cheap, harmless reptiles abound, is strongly recommended. PMID:6471969

Ojewole, J A; Akinwande, K I

1984-05-01

396

Noninvasive assessment of right atrial pressure using Doppler tissue imaging  

Microsoft Academic Search

Right atrial pressure (RAP) reflects volume and pressure hemodynamics of right cardiac chambers. Previous attempts for noninvasive assessment of RAP include 2-dimensional and Doppler correlates of RAP, which require the presence of optimal subcostal views that may not be always feasible. In this study we utilized Doppler tissue imaging of the tricuspid annulus in the apical 4-chamber view, for noninvasive

Amr Abbas; Steven Lester; F. Carlos Moreno; Komandoor Srivathsan; David Fortuin; Christopher Appleton

2004-01-01

397

Aged atria: electrical remodeling conducive to atrial fibrillation  

PubMed Central

The incidence of atrial fibrillation (AF) increases with age. Alterations in structure and function of atrial ion channels associated with aging provide the substrate for AF. In this review we provide an overview of current knowledge regarding these age-related changes in atria, focusing on intrinsic ion channel function, impulse initiation and conduction. Studies on the action potentials (APs) of atria have shown that the AP contour is altered with age and the dispersion of AP parameters is increased with age. However, studies using human tissues are not completely consistent with experimental animal studies, since specimens from humans have been obtained from hearts with concomitant cardiovascular diseases and/or that are under the influence of pharmacologic agents. Ionic current studies show that while there are no age-related changes in sodium currents in atrial tissue, the calcium current is reduced and the transient outward and sustained potassium currents are increased in aged cells. While sinoatrial node firing is reduced with age, enhanced impulse initiation may occur in aged atrial cells, for example in the pulmonary veins and coronary sinus. Fibrous tissue is increased in aged atria, which is associated with an increased likelihood of abnormal electrical conduction. Thus, age-related AF involves alterations in the substrate as well as in the passive properties of aged atria. PMID:19280327

Dun, Wen; Boyden, Penelope A.

2010-01-01

398

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

PubMed Central

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

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

2013-01-01

399

Association of Left Atrial Fibrosis Detected by Delayed-Enhancement  

E-print Network

resonance imaging (DE-MRI), and the CHADS2 score (point system based on individual clinical risk factors in and the Risk of Stroke in Patients With Atrial Fibrillation Marcos Daccarett, MD, MSC,* Troy J. Badger, MD- cluding congestive heart failure, hypertension, age, diabetes, and prior stroke) variables, specifically

Utah, University of

400

Pulmonary veins: Preferred site for catheter ablation of atrial fibrillation  

Microsoft Academic Search

Atrial fibrillation (AF) is one of the most challenging arrhythmias to treat. Many patients have to accept this disorder and the medications required. Nonpharmacologic therapies have emerged as alternative methods of treatment. However, technical difficulty, low success rate, high recurrence, and complications still are obstacles. Pulmonary veins as the most common trigger foci of paroxysmal AF are now the most

Aree Kantachuvessiri

2002-01-01

401

Detection of reentry currents in atrial flutter by magnetocardiography  

Microsoft Academic Search

The magnetic signal produced by atrial flutter induced in isolated rabbit hearts has been detected. A simple model describing a circus reentry path is discussed and fitted to the experimental data. Agreement between the simulated magnetic field obtained using the model and animal experimental results suggests that, at least in the preparation used, the presence of a reentry current can

P. Costa Riberiro; Antonio C. Bruno; P. L. Saboia e Silva; Carlos R. Hall Barbosa; Eduardo Parente Ribeiro; Elisabeth Costa Monteiro; Ayres Fonseca Costa

1992-01-01

402

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

PubMed Central

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

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

2014-01-01

403

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

PubMed Central

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

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

2014-01-01

404

Prediction of Stroke Risk in Atrial Fibrillation, Prevention of Stroke in Atrial Fibrillation, and the Impact of Long-Term Monitoring for Detecting Atrial Fibrillation  

Microsoft Academic Search

Atrial fibrillation (AF) is a large public health problem that affects about 1% of the population in the United States. It\\u000a confers an increased risk for stroke and thromboembolism, but the stroke risk is not equal in all patients. Further refinement\\u000a in stratifying stroke risk in patients with AF will help in properly directing therapy for AF patients while minimizing

George Thomas; Bruce B. Lerman

2011-01-01

405

Angiotensin II Activates Signal Transducers and Activators of Transcription 3 via Rac1 in the Atrial Tissue in Permanent Atrial Fibrillation Patients with Rheumatic Heart Disease.  

PubMed

Patients with rheumatic heart disease (RHD) often experience persistent atrial fibrillation (AF) associated with adverse atrial structural remodeling (ASR) manifested by atrial fibrosis and left atrial enlargement. The aim of this study was to explore the potential molecular signaling mechanisms for atrial fibrosis and ASR. Twenty RHD patients with persistent AF and 10 RHD patients with sinus rhythm (Group A) were recruited in our study, which all underwent transthoracic echocardiography. Right atrial appendage (RAA) tissue samples were obtained from these patients during mitral/aortic valve replacement operation. The AF patients were further divided into two groups according to left atrial diameter (LAD): Group B with LAD ranging 50-65 mm and Group C with LAD >65 mm. Histological examinations were performed with hematoxylin-eosin staining and Masson's trichrome staining. Atrial angiotensin II (AngII) content was measured by ELISA. Rac1 and STAT3 protein levels were determined by Western blot analysis. Hematoxylin-eosin staining demonstrated highly organized arrangement of atrial muscles in control Group A and significant derangement in both Group B and C AF patients with reduced cell density and increased cell size. Moreover, Masson's trichrome staining showed that atrial myocytes were surrounded by large trunks of collagen fibers in both Group B and C, but not in Group A. There was a positive correlation between atrial tissue fibrosis and LAD. AngII content was markedly higher in Group C than in Group B than in Group A, which was positively correlated with LAD. Similarly, Rac1 and STAT3 protein levels were found considerably higher in Group C and B than in Group A with excellent correlation to LAD. Our study unraveled for the first time the AngII/Rac1/STAT3 signaling as a mechanism for ASR thereby AF in a particular clinical setting-RHD patients with persistent AF and indicated inhibition of this pathway may help ameliorating adverse ASR. PMID:25151145

Xue, Xiao-Dong; Huang, Jian-Hua; Wang, Hui-Shan

2015-01-01

406

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

PubMed Central

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

2014-01-01

407

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

PubMed

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

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

2014-12-01

408

Predictors of anticoagulant treatment in patients with nonvalvular atrial fibrillation: results from atrial fibrillation in Turkey: epidemiologic registry.  

PubMed

The aim of the study was to assess the factors associated with the anticoagulation treatment in patients with atrial fibrillation (AF). A total of 2242 consecutive patients who had been admitted with AF on their electrocardiogram were included in the study. After excluding valvular AF, 1745 patients with nonvalvular AF were analyzed. Mean CHA2DS2-VASc score [cardiac failure, hypertension, age ? 75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 -74 and sex category (female)], frequency of persistent/permanent AF, hypertension, diabetes mellitus (DM), stroke history, body mass index, and left atrial diameter were significantly higher in patients receiving anticoagulant therapy. Stroke history, persistent/permanent AF, hypertension, DM, age, heart failure, and left atrial diameter were independent predictors of warfarin prescription. Labile international normalized ratio was the only independent negative predictor of effective treatment with warfarin. In this study, we demonstrated that stroke history, persistent/permanent AF, hypertension, DM, and left atrial diameter were positive predictors, whereas advanced age and heart failure were negative predictors of oral anticoagulant use in patients with nonvalvular AF. PMID:23742948

Kaya, Hasan; Erta?, Faruk; Köro?lu, Bayram; Vatan, Bülent; Ça?l?yan, Ça?lar Emre; Gedik, Selçuk; Yeter, Ekrem; Aydin, Mesut; Akil, Mehmet Ata; Soydinç, Mehmet Serdar; Ozhan, Hakan; Ülgen, Mehmet S?dd?k

2015-03-01

409

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

PubMed Central

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

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

2014-01-01

410

Biometal muscle to restore atrial transport function in a permanent atrial fibrillation animal model: a potential tool in the treatment of end-stage heart failure  

Microsoft Academic Search

Background: Half of the patients with end-stage heart failure suffer from persistent atrial fibrillation (AF). Atrial kick (AK) accounts for 10–15% of the ejection fraction. A device restoring AK should significantly improve cardiac output (CO) and possibly delay ventricular assist device (VAD) implantation. This study has been designed to assess the mechanical effects of a motorless pump on the right

Piergiorgio Tozzi; Daniel Hayoz; Steven Taub; Mirza Muradbegovic; Elena Rizzo; Ludwig K. von Segesser

2010-01-01

411

Catheter ablation in combination with left atrial appendage closure for atrial fibrillation.  

PubMed

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

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

2013-01-01

412

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

PubMed Central

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

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

2013-01-01

413

Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew/Paisley study  

PubMed Central

OBJECTIVES—Though atrial fibrillation (AF) is an important cause of cardiovascular morbidity, there are few large epidemiological studies of its prevalence, incidence, and risk factors. The epidemiological features of AF are described in one of the largest population cohorts ever studied.?METHODS—The prevalence and incidence of AF were studied in the Renfrew/Paisley population cohort of 15 406 men and women aged 45-64 years living in the west of Scotland. This cohort was initially screened between 1972 and 1976 and again between 1977 and 1979. Incident hospitalisations with AF in the 20 year period following initial screening were also studied.?RESULTS—The population prevalence of AF in this cohort was 6.5 cases/1000 examinations. Prevalence was higher in men and older subjects. In those who were rescreened, the four year incidence of AF was 0.54 cases/1000 person years. Radiological cardiomegaly was the most powerful predictor of new AF (adjusted odds ratio 14.0). During 20 year follow up, 3.5% of this cohort was discharged from hospital with a diagnosis of AF; the rate of incident hospitalisation for AF was 1.9 cases/1000 person years. Radiological cardiomegaly (adjusted odds ratio 1.46) and systolic blood pressure (adjusted odds ratio 2.1 for ? 169 mm Hg) were independent predictors of this outcome.?CONCLUSIONS—Data from one of the largest epidemiological studies ever undertaken confirm that AF has a large population prevalence and incidence, even in middle aged people. More important, it was shown that the long term incidence of hospitalisation related to AF is high and that two simple clinical measurements are highly predictive of incident AF. These findings have important implications for the prevention of AF.???Keywords: atrial fibrillation; epidemiology; systolic blood pressure; cardiac volume PMID:11602543

Stewart, S; Hart, C; Hole, D; McMurray, J

2001-01-01

414

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

PubMed Central

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

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

2014-01-01

415

Circular shunt in a pulmonary artery to right atrial tunnel, an anomaly unreported so far  

PubMed Central

While aortico-right atrial tunnels with left to right shunt from aorta to right atrium are reported widely, pulmonary artery to right atrial tunnels have not been described so far. Such a tunnel will lead to a circular shunt with a recirculation of blood in the right sided cardiac chambers repeatedly bypassing the pulmonary capillary bed. This newly described pulmonary artery to right atrial tunnel was closed nonsurgically with a duct occluder after angiographic delineation. PMID:24987267

Singhi, Anil Kumar; Sivakumar, Kothandam

2014-01-01

416

Histone-deacetylase Inhibition Reverses Atrial Arrhythmia Inducibility and Fibrosis in Cardiac Hypertrophy Independent of Angiotensin  

PubMed Central

Atrial fibrosis influences the development of atrial fibrillation (AF), particularly in the setting of structural heart disease where angiotensin-inhibition is partially effective for reducing atrial fibrosis and AF. Histone-deacetylase inhibition reduces cardiac hypertrophy and fibrosis, so we sought to determine if the HDAC inhibitor trichostatin A (TSA) could reduce atrial fibrosis and arrhythmias. Mice over-expressing homeodomain-only protein (HopXTg), which recruits HDAC activity to induce cardiac hypertrophy were investigated in 4 groups (aged 14-18 weeks): wild-type (WT), HopXTg, HopXTg mice treated with TSA for 2 weeks (HopX-TSA) and wild-type mice treated with TSA for 2 weeks (WT-TSA). These groups were characterized using invasive electrophysiology, atrial fibrosis measurements, atrial connexin immunocytochemistry and myocardial angiotensin II measurements. Invasive electrophysiologic stimulation, using the same attempts in each group, induced more atrial arrhythmias in HopXTg mice (48 episodes in 13 of 15 HopXTg mice versus 5 episodes in 2 of 15 HopX-TSA mice, P<0.001; versus 9 episodes in 2 of 15 WT mice, P<0.001; versus no episodes in any WT-TSA mice, P<0.001). TSA reduced atrial arrhythmia duration in HopXTg mice (1307±289 milliseconds versus 148±110 milliseconds, P<0.01) and atrial fibrosis (8.1±1.5% versus 3.9±0.4%, P<0.001). Atrial connexin40 was lower in HopXTg compared to WT mice, and TSA normalized the expression and size distribution of connexin40 gap junctions. Myocardial angiotensin II levels were similar between WT and HopXTg mice (76.3±26.0 versus 69.7±16.6 pg/mg protein, P=NS). Therefore, it appears HDAC inhibition reverses atrial fibrosis, connexin40 remodeling and atrial arrhythmia vulnerability independent of angiotensin II in cardiac hypertrophy. PMID:18926829

Liu, Fang; Levin, Mark D.; Petrenko, Nataliya B.; Lu, Min Min; Wang, Tao; Yuan, Li Jun; Stout, Andrea L.; Epstein, Jonathan A.; Patel, Vickas V.

2008-01-01

417

An anatomically realistic 3d model of atrial propagation based on experimentally recorded action potentials  

Microsoft Academic Search

A three-dimensional anatomically and electro-physiologically realistic model of atrial propagation is developed utilizing generic cardiac ionic models fitted to experimentally recorded action potentials (APs). The atrial geometry incorporated realistic wall thickness and twelve anatomical structures, including the sino-atrial node (SAN), pulmonary veins, interatrial septum, Bachmann's bundle and coronary sinus as interatrial conduction pathways. The SAN was further subdivided into central

A. Al Abed; Tianruo Guo; N. H. Lovell; S. Dokos

2010-01-01

418

Left atrial and left atrial appendage systolic function in patients with post-myocardial distal blocks  

PubMed Central

Introduction The study aimed to evaluate function of the left atrium (LA) and of the left atrial appendage (LAA) after myocardial infarction (MI) complicated by intracardiac conduction disturbances. Material and methods The study comprised 59 patients with persistent post-myocardial distal blocks, who were allocated to one of the three following subgroups: study group I – 20 patients with left bundle branch block (LBBB); study group II – 20 patients with right bundle branch block (RBBB), and study group III –19 pts with left anterior hemiblock (LAHB). The control groups included patients with MI in their history and no BBBs (19 pts – group IV) and clinically healthy people (16 patients – group V). The parameters of LA and LAA systolic function were determined by means of transthoracic (TTE) and transoesophageal echocardiography (TOE). Results We showed that patients who experienced myocardial infarction not complicated with conduction disturbances expressed compensatory LA systolic function enhancement. In patients with post-myocardial RBBB and LAHB significant enhancement of LA systolic function was observed as well but it was expressed to a lesser degree. There was also a tendency towards deterioration of LA systolic function in patients with post-myocardial LBBB. LBBB did not affect LAA systolic function negatively. Conclusions Parameters of LAA systolic function showed its enhancement in all patients after myocardial infarction irrespective of whether it was complicated by conduction disturbances. PMID:22427763

Piotrowski, Grzegorz; Szyma?ski, Piotr; Banach, Maciej; Piotrowska, Aneta; Gawor, Rafa?; Rysz, Jacek; Gawor, Zenon

2010-01-01

419

Regional atrial blood flow in dogs. Effect of hypertrophy on coronary flow reserve.  

PubMed Central

Little is known regarding regional atrial blood flow responses during varying hemodynamic states in both the normal and hypertrophied atria. This study was undertaken to develop a canine model of chronic atrial hypertrophy and to define in both this group and in normal dogs the regional blood flow response to acute atrial fibrillation and to measure coronary flow reserve. In the 12 dogs with atrial but not ventricular hypertrophy the mean left and right atrial weights were 75 and 47% respectively greater than in the normal group. Blood flow in the normal dogs was less in the appendage than in the non-appendage region for both atria and increased significantly during atrial fibrillation. Similar findings were noted in the hypertrophy group except that during control conditions the left atrial appendage flow was similar to the nonappendage flow. Minimal vascular resistance for the hypertrophy group, 39 +/- 3 was significantly (P less than 0.05) greater when compared to the normal group 28 +/- 2 mmHg/cm3 per min per g. Thus, significant regional blood flow differences occur in both the normal and hypertrophied atria. In addition, atrial hypertrophy does not alter the autoregulatory capacity to the hemodynamic stress of atrial fibrillation but does reduce coronary flow reserve. Images PMID:2523414

Bauman, R P; Rembert, J C; Greenfield, J C

1989-01-01

420

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

E-print Network

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

Rodrigo, Ramón

2010-01-01

421

Atrial fibrillation in chronic dialysis patients in the United states: risk factors for hospitalization and mortality  

PubMed Central

Background The incidence and risk factors for hospitalized atrial fibrillation have not been previously assessed in a national population of dialysis patients. Methods We analyzed the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study (DMMS) Wave II in a historical cohort study of hospitalized atrial fibrillation. Data from 3374 patients who started dialysis in 1996 with valid follow-up times were available for analysis, censored at the time of renal transplantation and followed until November 2000. Cox Regression analysis was used to model factors associated with time to first hospitalization for atrial fibrillation (ICD9 code 427.31x) adjusted for comorbidities, demographic factors, baseline laboratory values, blood pressures, dialysis modality, and cardioprotective medications. Results The incidence density of atrial fibrillation was 12.5/1000 person years. Factors associated with atrial fibrillation were older age (> = 71 years vs. <48 years), extremes (both high and low) of pre-dialysis systolic blood pressure, dialysis modality (hemodialysis vs. peritoneal dialysis), and digoxin use. Baseline use of coumadin was associated with reduced mortality in patients later hospitalized for atrial fibrillation. Conclusions Dialysis patients had a high incidence of atrial fibrillation. This risk was largely segregated among those with established risk factors for atrial fibrillation, and hemodialysis patients. Use of coumadin was associated with improved survival among patients later hospitalized for atrial fibrillation. PMID:12546711

Abbott, Kevin C; Trespalacios, Fernando C; Taylor, Allen J; Agodoa, Lawrence Y

2003-01-01

422

Fourier analysis of a gated blood-pool study during atrial flutter  

SciTech Connect

First-harmonic Fourier analysis of a gated blood-pool study is based on the assumption that the cardiac chambers contract once per cardiac cycle. In atrial arrhythmias this condition may not exist for the atria. We recently studied a patient with atrial flutter and 2:1 artioventricular conduction. There were predictable alterations in the first-harmonic Fourier phase and amplitude images. The observed changes from first-harmonic Fourier analysis were: (a) very low atrial amplitude values, and (b) absence of identifiable atrial regions on the phase image.

Makler, P.T. Jr.; McCarthy, D.M.; London, J.W.; Sandler, M.S.; Alavi, A.

1983-08-01

423

Atrial fibrillation induced by commotio cordis secondary to a blunt chest trauma in a teenage boy.  

PubMed

Low-energy blunt chest trauma can cause commotio cordis and ventricular fibrillation (VF) in otherwise healthy young individuals. If the chest wall impact occurs during a narrow vulnerable window of ventricular repolarization, the generated premature ventricular impulse can lead to VF and sudden death. Atrial fibrillation (AF) in association with a blunt chest trauma has not yet been reported in a child or adolescent. Our case describes a healthy 16-year-old boy who suffered blunt chest trauma during football practice. He was found to have AF, which resolved in 3 days without any therapy. He did not have any identifiable structural or electrical cardiac abnormality and had no previous history of arrhythmia. We hypothesize that AF, similar to commotio cordis-induced VF, may occur as a result of a blunt chest trauma in healthy young individuals. Animal studies evaluating arrhythmias related to chest wall impact may elucidate the timing and mechanism of AF induced by commotio cordis. PMID:25489014

Ota, Kyle; Bratincsak, Andras

2015-01-01

424

Different characteristics of complex fractionated atrial electrograms in acute paroxysmal versus long-standing persistent atrial fibrillation  

PubMed Central

BACKGROUND Complex fractionated atrial electrograms (CFAEs) may represent a phenomenon associated with sources of atrial fibrillation (AF) and are being used increasingly as targets of catheter ablation. However, current methods have limited efficacy for characterizing CFAEs important to substrate arrhythmogenicity and do not measure electrogram morphology. OBJECTIVE The purpose of this study was to develop a methodology for quantifying the degree of morphologic heterogeneity in CFAE deflections, and to determine whether there are differences in this measurement between paroxysmal and persistent AF patients. METHODS Two successive bipolar CFAEs of length 8.4 seconds each were acquired during AF from two sites each at the ostia of the four pulmonary veins (PVs) and from the anterior and posterior left atrial free wall in patients with paroxysmal AF (N =10) and long-standing persistent AF (N = 10). Extrinsic and intrinsic features of electrogram shape were used to characterize fractionation in CFAE sequences. The extrinsic parameters were the amplitude, upslope, downslope, and width of each deflection. The intrinsic parameter was the voltage profile as characterized by the sum of absolute values. These measurements were compared to the mean interval between CFAE deflections, a standard fractionation indicator. RESULTS The variability of intrinsic/extrinsic morphologic parameters was higher in paroxysmal than persistent AF at the left superior PV (P ?.003), the posterior left atrial free wall, anterior left atrial free wall, left inferior PV, and right superior PV (P <.05 for most parameters), and the right inferior PV (not significant). Mean CFAE deflection intervals were longer at all locations in paroxysmal AF but were significant only at the left superior PV and posterior left atrial free wall (P <.05). Quantitative morphologic parameters were not well correlated with dominant frequency (r2 <0.32); thus, our new measures are robust to changes in activation rate. CONCLUSION A novel method for quantifying CFAEs, independent of activation rate, has been developed. The method demonstrates greater significance in the difference between CFAE morphology in paroxysmal and long-standing AF compared with mean interval between CFAE deflections. The differences identified suggest that CFAE morphology may evolve as AF persists. PMID:20558323

Ciaccio, Edward J.; Biviano, Angelo B.; Whang, William; Gambhir, Alok; Garan, Hasan

2015-01-01

425

Granulocytic sarcoma presenting as a right atrial mass.  

PubMed

We describe a 48-year-old male who developed acute myelogenous leukaemia (AML) associated with a right atrial mass. The patient was admitted with fatigue, positional dyspnoea and headache. Transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE) revealed that the right atrium was filled with a mass. Peripheral blood smear revealed 85% blasts, and bone marrow examination showed 74% myeloid blasts and 27% monocytoid cells (monoblast and promonocytes). Immunophenotypic analysis of the bone marrow aspirates showed CD13, CD14 and CD33 positivity, consistent with acute myeloid leukaemia of M4 Fab subtype. The patient achieved remission (but not cure) accompanied by near resolution of the right atrial mass following intensive chemotherapy. PMID:12715908

Erdöl, Cevdet; Ovali, Ercüment; Baykan, Merih

2003-04-01

426

Frequency Analysis of Atrial Fibrillation From the Surface Electrocardiogram  

PubMed Central

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Neither the natural history of AF nor its response to therapy are sufficiently predictable by clinical and echocardiographic parameters. Atrial fibrillatory frequency (or rate) can reliably be assessed from the surface electrocardiogram (ECG) using digital signal processing (filtering, subtraction of averaged QRST complexes, and power spectral analysis) and shows large inter-individual variability. This measurement correlates well with intraatrial cycle length, a parameter which appears to have primary importance in AF domestication and response to therapy. AF with a low fibrillatory rate is more likely to terminate spontaneously, and responds better to antiarrhythmic drugs or cardioversion while high rate AF is more often persistent and refractory to therapy. In conclusion, frequency analysis of AF seems to be useful for non-invasive assessment of electrical remodeling in AF and may subsequently be helpful for guiding AF therapy. PMID:16943980

Husser, Daniela; Stridh, Martin; Sornmo, Leif; Olsson, S. Bertil; Bollmann, Andreas

2004-01-01

427

The paradox of atrial fibrillation in African Americans.  

PubMed

The reported lower prevalence and incidence of atrial fibrillation (AF) despite the higher prevalence of AF risk factors in African Americans compared to Caucasian whites has been referred to as the paradox of AF in African Americans. In this report we highlight this paradox and address potential explanations using data from several US populations studies. These possible explanations include limited methodology to detect AF patterns that are harder to detect (e.g. paroxysmal/intermittent AF or atrial flutter) coupled with the possibility of African Americans having more of these patterns, differential access to health care with African Americans having less access and subsequently less detected AF, survival bias with Caucasian whites living longer and subsequently having more AF, and finally differential impact of AF risk factors with Caucasian whites being more affected or African Americans less affected by AF risk factors whether this is genetically determined or via other unknown predispositions. PMID:25112176

Soliman, Elsayed Z; Prineas, Ronald J

2014-01-01

428

Idiopathic aneurysmal giant right atrial enlargement with thrombus formation.  

PubMed

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

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

2014-01-01

429

Left Atrial Enlargement and Reduced Physical Function During Aging  

PubMed Central

Diastolic dysfunction, often seen with increasing age, is associated with reduced exercise capacity and increased mortality. Mortality rates in older individuals are linked to the development of disability, which may be preceded by functional limitations. The goal of this study was to identify which echocardiographic measures of diastolic function correlate with physical function in older subjects. A total of 36 men and women from the Lou isiana Healthy Aging Study, age 62–101 yr, received a complete echocardiographic exam and performed the 10-item continuous-scale physical-functional performance test (CS-PFP-10). After adjustment for age and gender, left atrial volume index (? = ?0.59; p = .0005) correlated with the total CS-PFP-10 score. Increased left atrial volume index may be a marker of impaired performance of activities of daily living in older individuals. PMID:23238083

Pellett, Andrew A.; Myers, Leann; Welsch, Michael; Jazwinski, S. Michal; Welsh, David A.

2014-01-01

430

[Detection of atrial septal defects using esophageal echocardiography].  

PubMed

By means of transoesophageal (oesophageal) echocardiography (TEE) the authors examined a group of 20 subjects. In 10 there was clinical suspicion (physical finding, ECG, X-ray) of an atrial septal defect. Common precordial echocardiographic examination (TTE) and dilution of indocyan green by means of an acustic sensing unit were negative or only marginally positive and did not provide a final decision. By means of TEE the defect was confirmed in 8 subjects by the finding of anatomical discontinuity of the septum and the presence of coloured Doppler shunt flow. In two subjects the finding was negative, in 10 controls no pathological findings were detected. The authors confirmed that TEE is a reliable method which proves even slight shunts in the area of the atrial septum. It is probably the most sensitive existing method. PMID:2219759

Novotný, J; Hlavácek, K; Sístek, M; Van?cek, T; Fiserová, J

1990-06-01

431

Statistical properties of heartbeat intervals during atrial fibrillation  

NASA Astrophysics Data System (ADS)

Atrial fibrillation is a common cardiac arrhythmia in which there is an irregular heartbeat. This paper develops a theoretical model for the intervals between successive heartbeats during atrial fibrillation based on the following ideas. There is an irregular pattern of activation of the upper chambers (atria) of the heart. Excitation travels from the atria through the specialized conducting tissue called the atrioventricular node to the lower chamber of the heart (ventricles). We model this situation by a stochastic map. If the map is linear, then it is possible to compute analytically the probability density for the timings between ventricular activations. Numerical simulations of nonlinear maps show correspondences with clinical data. Thus this work casts a clinical medical problem in the context of stochastic maps.

Zeng, Wanzhen; Glass, Leon

1996-08-01

432

Right atrial thrombus due to internal jugular vein catheter.  

PubMed

Right atrial thrombus is rare complication of hemodialysis central venous catheter. Literature survey revealed 49 documentations of right atrial thrombus due to a central venous catheter. We report a 58-year-old type 2 diabetic, hypertensive, end-stage renal disease patient, who 2 months after initiation of hemodialysis through a right internal jugular vein catheter, developed clinical features suggestive of pulmonary thromboembolism. An echocardiography revealed presence of a serpentine thrombus in right atrium. The internal jugular vein catheter was removed and unfractionated heparin was initiated. At the end of 6 weeks he was symptom free. We compared conservative treatment with surgery for RAT. Conservative management with central venous catheter removal and anticoagulation therapy is not inferior to the surgery. PMID:19614782

Ram, Rapur; Swarnalatha, Gudithi; Rakesh, Yarlagadda; Jyostna, Maddury; Prasad, Neela; Dakshinamurty, Kaligotla Venkata

2009-07-01

433

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

PubMed Central

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

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

2014-01-01

434

Differences in Repeating Patterns of Complex Fractionated Left Atrial Electrograms in Longstanding Persistent Atrial Fibrillation as Compared With Paroxysmal Atrial Fibrillation  

PubMed Central

Background Complex fractionated atrial electrograms (CFAE) are morphologically more uniform in persistent longstanding as compared with paroxysmal atrial fibrillation (AF). It was hypothesized that this may result from a greater degree of repetitiveness in CFAE patterns at disparate left atrial (LA) sites in longstanding AF. Methods and Results CFAEs were obtained from recording sites outside the 4 pulmonary vein (PV) ostia and at a posterior and an anterior LA site during paroxysmal and longstanding persistent AF (10 patients each, 120 sequences total). To quantify repetitiveness in CFAE, the dominant frequency was measured from ensemble spectra using 8.4-second sequences, and repetitiveness was calculated by 2 novel techniques: linear prediction and Fourier reconstruction methods. Lower prediction and reconstruction errors were considered indicative of increasing repetitiveness and decreasing randomness. In patients with paroxysmal AF, CFAE pattern repetitiveness was significantly lower (randomness higher) at antral sites outside PV ostia as compared with LA free wall sites (P<0.001). In longstanding AF, repetitiveness increased outside the PV ostia, especially outside the left superior PV ostium, and diminished at the LA free wall sites. The result was that in persistent AF, there were no significant site-specific differences in CFAE repetitiveness at the selected LA locations used in this study. Average dominant frequency magnitude was 5.32±0.29 Hz in paroxysmal AF and higher in longstanding AF, at 6.27±0.13 Hz (P<0.001), with the frequency of local activation approaching a common upper bound for all sites. Conclusions In paroxysmal AF, CFAE repetitiveness is low and randomness high outside the PVs, particularly the left superior PV. As evolution to persistent longstanding AF occurs, CFAE repetitiveness becomes more uniformly distributed at disparate sites, possibly signifying an increasing number of drivers from remote PVs. PMID:21536597

Ciaccio, Edward J.; Biviano, Angelo B.; Whang, William; Vest, John A.; Gambhir, Alok; Einstein, Andrew J.; Garan, Hasan

2014-01-01

435

Atrial Fibrillation Ablation in Systolic Dysfunction: Clinical and Echocardiographic Outcomes.  

PubMed

Background: Heart failure and atrial fibrillation (AF) often coexist in a deleterious cycle. Objective: To evaluate the clinical and echocardiographic outcomes of patients with ventricular systolic dysfunction and AF treated with radiofrequency (RF) ablation. Methods: Patients with ventricular systolic dysfunction [ejection fraction (EF) <50%] and AF refractory to drug therapy underwent stepwise RF ablation in the same session with pulmonary vein isolation, ablation of AF nests and of residual atrial tachycardia, named "background tachycardia". Clinical (NYHA functional class) and echocardiographic (EF, left atrial diameter) data were compared (McNemar test and t test) before and after ablation. Results: 31 patients (6 women, 25 men), aged 37 to 77 years (mean, 59.8±10.6), underwent RF ablation. The etiology was mainly idiopathic (19 p, 61%). During a mean follow-up of 20.3±17 months, 24 patients (77%) were in sinus rhythm, 11 (35%) being on amiodarone. Eight patients (26%) underwent more than one procedure (6 underwent 2 procedures, and 2 underwent 3 procedures). Significant NYHA functional class improvement was observed (pre-ablation: 2.23±0.56; postablation: 1.13±0.35; p<0.0001). The echocardiographic outcome also showed significant ventricular function improvement (EF pre: 44.68%±6.02%, post: 59%±13.2%, p=0.0005) and a significant left atrial diameter reduction (pre: 46.61±7.3 mm; post: 43.59±6.6 mm; p=0.026). No major complications occurred. Conclusion: Our findings suggest that AF ablation in patients with ventricular systolic dysfunction is a safe and highly effective procedure. Arrhythmia control has a great impact on ventricular function recovery and functional class improvement. PMID:25387404

Lobo, Tasso Julio; Pachon, Carlos Thiene; Pachon, Jose Carlos; Pachon, Enrique Indalecio; Pachon, Maria Zelia; Pachon, Juan Carlos; Santillana, Tomas Guillermo; Zerpa, Juan Carlos; Albornoz, Remy Nelson; Jatene, Adib Domingos

2014-11-11

436