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1

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

PubMed

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

2014-07-01

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).

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

2014-01-01

3

Atrial Myxoma: Trends in Management  

PubMed Central

Myxomas are the most common type of cardiac tumours in all age groups accounting for one-third to one-half of cases at postmortum and for about three quarter of tumours treated surgically. Most atrial myxomas, whether left or right, arise from the atrial septum. About 10% have other sites of origin, particularly posterior wall, anterior wall and the appendages (in order of frequency). Myxomas are frequently located in left atrium and produce symptoms when they fragment and cause systemic emboli or when they interfere with cardiac valvular function and cause pulmonary congestion. Careful surgical management of these lesions should be curative with minimal early and late morbidity and mortality. Recurrence of atrial myxomas can occur most likely in about 3% of patients. However, extensive resection of the myxoma attached to atrial septum or atrial wall can reduce the likelihood of recurrence to a greater extent. Long term clinical and echocardiographic follow-up is mandatory.

Lone, Reyaz A.; Ahanger, A G; Singh, Shyam; Mehmood, Wani; Shah, Shabir; Lone, GN; Dar, AM; Bhat, MA; Sharma, ML; Lateef, Wani

2008-01-01

4

A Typical Bilateral Atrial Myxoma: A Case Report  

PubMed Central

Myxoma is a rare type of tumor which have an incidence of 0.0017% among the general population. Cardiac myxomas which arise from two different heart chambers is even extremely rare; we herein report a unique case of male patient with bilateral myxoma.

Xiao, Zhenghua; Meng, Wei; Zhu, Da; Zhang, Eryong

2012-01-01

5

A colossal atrial myxoma  

PubMed Central

Atrial myxomas are the most common benign primary tumor of the heart. These cardiac growths can masquerade as mitral stenosis and infective endocarditis. A 35-year-old man presented with complaints of nonspecific symptoms. Echocardiogram revealed a large atrial myxoma occupying the left atrium. Excision revealed a 14 × 8 × 6 cm3 tumor attached to a 4 × 3 × 2 cm3 stalk of septal tissue. We describe a giant left atrial myxoma. We were not able to find another myxoma as big as this one in the literature, so we are reporting it.

Rohani, Atoosheh; Akbari, Vahid

2010-01-01

6

[Secondary pulmonary embolism to right atrial myxoma].  

PubMed

A case of pulmonary thromboembolism secondary to atrial myxoma right. The myxoma is a primary cardiac tumor, namely, has his origin in the cardiac tissue. Primary cardiac tumors are rare, including myxomas, the most common type. Have a predilection for females and the most useful tool for diagnosis is echocardiography. About 75% of myxomas occur in the left atrium of the heart and rest are in the right atrium. Right atrial myxomas in some sometimes associated with tricuspid stenosis and atrial fibrillation. The most common clinical manifestations include symptoms of this neoplasm constitutional, and embolic phenomena resulting from the obstruction to the flow intracavitary. The treatment of this condition is surgical. PMID:24095171

Vico Besó, L; Zúñiga Cedó, E

2013-10-01

7

[Multiple atrial ball thrombi with stalk mimicking myxoma without valve disease: a case report].  

PubMed

A 77-year-old man with atrial tumors was admitted to our hospital. He had no history of dyspnea, palpitation, or chest pain. He had a history of hypertension and atrial fibrillation without valve disease. Transthoracic and transesophageal echocardiography showed floating ball tumors with stalks from the right atrium (28 X 31 mm), the interatrial septum (16 X 11 mm), and the left atrial appendage (14 X 8 mm). The tumors were surgically removed and histologic examination of these tumors confirmed organization thrombus. This case of multiple atrial ball thrombi illustrates the problems with differentiation of myxoma and thrombus. PMID:17552295

Sonoda, Masahiro; Higashi, Kensaku; Shimokawahara, Hiroto; Tanaka, Hideki; Kashima, Katsuro; Nakamura, Kazuhiko

2007-05-01

8

Endocarditis caused by Lactococcus lactis subsp. lactis in a patient with atrial myxoma: a case report.  

PubMed

We report a case of subacute endocarditis in a 55-year-old patient affected by left atrial myxoma and with a severe mitral regurgitation. Lactococcus lactis subsp. lactis was isolated from blood cultures and infection was eliminated by treatment with amoxicillin-clavulanic acid. PMID:16757143

Zechini, Barbara; Cipriani, Paola; Papadopoulou, Styliani; Di Nucci, Giandomenico; Petrucca, Andrea; Teggi, Antonella

2006-11-01

9

Atrial myxoma presenting with orthostatic hypotension in an 84-year-old Hispanic man: a case report  

PubMed Central

Introduction Left atrial myxomas remain the most common benign primary cardiac tumors, and these cardiac growths can masquerade as mitral stenosis, infective endocarditis and collagen vascular disease. Atrial myxomas are found in approximately 14-20% of the population and can lead to embolization, intercardiac obstructions, conduction disturbances and lethal valve obstructions. Case presentation An 84-year-old Hispanic man presented with complaints of dizziness upon standing, and with no prior history of heart murmurs, syncope, shortness of breath, or chest pain. Physical examination revealed evidence of orthostatic hypotension and a soft grade 1/6 systolic murmur at the left sternal border. A transthoracic echocardiogram revealed a large atrial myxoma occupying the majority of the left atrium, with the posterior border of the large atrial mass defined by eccentric mitral regurgitation identified during cardiac catheterization. Left atrial myxoma excision was performed, revealing a 7 × 6.5 × 4.5 cm atrial tumor attached to a 4 × 3 × 2 cm stalk of atrial septal tissue. Conclusion This patient didn't present with the common symptoms associated with an atrial myxoma, which may include chest pain, dyspnea, orthopnea, peripheral embolism or syncope. Two-dimensional echocardiography provides substantial advantages in detecting intracardiac tumors. We recommend a two-dimensional echocardiogram in the workup of orthostatic hypotension of unknown etiology after the common causes such as autonomic disorders, dehydration, and vasodilative dysfunctions have been ruled out. By illustrating this correlation between orthostasis and an atrial myxoma, we hope to facilitate earlier identification of these intracardiac growths.

2009-01-01

10

Severe left ventricular dysfunction in left atrial myxoma--report of 2 cases.  

PubMed

We report 2 patients with left atrial (LA) myxoma with associated severe left ventricular (LV) dysfunction. Both presented with progressive effort intolerance without a history suggestive of acute coronary event. LA myxoma was diagnosed by transthoracic echocardiography, which also detected severe systolic dysfunction and LV dilatation. Regional wall motion abnormality and thinning were absent. Coronary angiograms also showed no occlusive disease, but distal ectasia was seen in 1 patient. Metabolic and endocrine causes of reversible LV dysfunction were excluded. Cardiac function improved following surgery for myxoma in 1 patient. LV dysfunction, thus far, has not been directly attributed to myxoma. Coronary embolization leading to myocardial infarction and coexisting coronary atherosclerosis are the recognized methods by which LV dysfunction manifests in myxoma. Our report suggests the possibility of reversible severe global LV dysfunction due to cardiodepressant effect of myxoma through as yet unclear mechanisms. PMID:16444467

Chockalingam, Anand; Jaganathan, V; Gnanavelu, G; Dorairajan, Smrita; Chockalingam, V

2006-01-01

11

Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases.  

PubMed

We analyzed a series of 112 consecutive cases of left atrial myxoma diagnosed in a single French hospital (72 women and 40 men; age range, 5-84 yr) over 40 years, from 1959 to 1998. Symptoms of mitral valve obstruction, the first arm of the classic triad of myxoma presentation, were present in 75 patients (67%), with mostly cardiac failure or malaise. Symptoms of embolism, the second frequent presentation in the classic triad, were observed in 33 cases (29%) with 1 or several locations, essentially cerebral emboli with stroke. Males are statistically at greater risk than females of developing embolic complications. The third arm of the classic triad consists of constitutional symptoms (34%) with fever, weight loss, or symptoms resembling connective tissue disease, due to cytokine (interleukin-6) secretion. Younger and male patients have more neurologic symptoms, and female patients have more systemic symptoms. Seventy-two patients (64%) had cardiac auscultation abnormalities, essentially pseudo-mitral valve disease (53.5%) and more rarely the suggestive tumor plop (15%). The most frequent electrocardiographic sign was left atrial hypertrophy (35%), whereas arrhythmias were uncommon. The greater number of myxoma patients (98) diagnosed preoperatively after 1977 reflects the introduction of echocardiography as a noninvasive diagnostic procedure. However, there was no significant reduction in the average time from onset of symptoms to operation between patients seen in the periods before and after 1977. The tumor diameter ranged from 1 to 15 cm with a weight of between 15 and 180 g (mean, 37 g). The myxoma surface was friable or villous in 35% of the cases, and smooth in the other 65% cases. Myxomas in patients presenting with embolism have a friable surface; those in patients with cardiac symptoms, pseudo-mitral auscultation signs, tumor plop, and electrocardiogram or radiologic signs of left atrium hypertrophy and dilatation are significantly the larger tumors. The long-term prognosis is excellent, and only 4 deaths occurred among our 112 cases over a median follow-up of 3 years. The recurrence rate is low (5%), but long-term follow-up and serial echocardiography are advisable especially for young patients. PMID:11388092

Pinede, L; Duhaut, P; Loire, R

2001-05-01

12

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

PubMed

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

Buksa, M; Haraci?, A

1999-01-01

13

A probable right atrial myxoma prolapsing through the tricuspid valve into the right ventricle: a case report  

PubMed Central

Introduction Myxoma is the most common primary cardiac tumour. This case report illustrates the case of a probable right atrial myxoma prolapsing through the tricuspid valve into the right ventricle, and the fatal outcome if such a mass is not promptly detected and excised. Case presentation A 51-year old man presented with a 1-year history of recurrent pedal and abdominal swelling, and 6-month history of progressive dyspnoea on exertion. Transthoracic echocardiography showed a large right atrial mass prolapsing through the tricuspid valve into the right ventricle. Patient discharged himself against medical advice and died about one hour after getting home while trying to stand up from the sitting position. Conclusion Cardiac myxomas should always be considered when the cause of heart failure is not obvious. Transthoracic echocardiography remains an invaluable tool in the diagnosis, and prompt treatment is necessary to avoid fatal outcomes.

Ojji, Dike B; Ajiduku, Stella S; Omonua, Omonuyi O; Abdulkareem, Lukman L; Parsonage, Will

2008-01-01

14

Multiple intracranial aneurysms followed left atrial myxoma: case report and literature review  

PubMed Central

Cerebral aneurysms follows atrial myxoma is a rare neurological complication. We report a patient with multiple cerebral aneurysms three years after resection of left atrial myxoma and further review the literature. The characteristics of these aneurysms are indefinite and variable. They can occur prior or post the resection of cardiac myxoma. “Metastasize and Infiltrate” theory may be the key mechanism in the formation of these aneurysms. Magnetic resonance imaging (MRI), computed tomography (CT) and angiography are useful in the diagnosis while digital subtraction angiography (DSA) is the best choice. There are no definite guidelines for therapy of these aneurysms. Resection of the cardiac myxomas, chemotherapy, radiotherapy, coil embolization and surgical treatment could be helpful.

Zhang, Xiaobing; Wu, Pan; Wang, Ming; Zhou, Yongqing; Feng, Yiping

2013-01-01

15

Rapid Growth of Left Atrial Myxoma after Radiofrequency Ablation  

PubMed Central

Atrial myxoma is the most common benign tumor of the heart, but its appearance after radiofrequency ablation is very rare. We report a case in which an asymptomatic, rapidly growing cardiac myxoma arose in the left atrium after radiofrequency ablation. Two months after the procedure, cardiovascular magnetic resonance, performed to evaluate the right ventricular anatomy, revealed a 10 × 10-mm mass (assumed to be a thrombus) attached to the patient's left atrial septum. Three months later, transthoracic echocardiography revealed a larger mass, and the patient was diagnosed with myxoma. Two days later, a 20 × 20-mm myxoma weighing 37 g was excised. To our knowledge, the appearance of an atrial myxoma after radiofrequency ablation has been reported only once before. Whether tumor development is related to such ablation or is merely a coincidence is uncertain, but myxomas have developed after other instances of cardiac trauma.

Alvarez, Jose Rubio; de Alegria, Anxo Martinez; Quiroga, Juan Sierra; Nazar, Belen Adrio; Taboada, Carola Rubio; Comendador, Jose Manuel Martinez

2013-01-01

16

Acute Pulmonary Edema Caused by a Giant Atrial Myxoma  

PubMed Central

Atrial myxoma is the most common primary cardiac tumor. Its clinical presentation spreads from asymptomatic incidental mass to serious life-threatening cardiovascular complications. We report the case of a 44-year-old man with evening fever and worsening dyspnea in the last weeks, admitted to our hospital for acute pulmonary edema. The cardiac auscultation was very suspicious for mitral valve stenosis, but the echocardiography revealed a huge atrial mass with a diastolic prolapse into mitral valve orifice causing an extremely high transmitral gradient pressure. Awareness of this uncommon acute presentation of atrial myxoma is necessary for timely diagnosis and prompt surgical intervention.

Agricola, Eustachio; Marini, Claudia; Margonato, Alberto

2013-01-01

17

Two Cases of Eosinophilic Variant Chromophobe Renal Cell Carcinoma, with a Rare Association of Right Atrial Myxoma in One of them  

PubMed Central

Chromophobe renal cell carcinoma is a relatively uncommon variant of renal cell carcinoma. Eosinophilic variant of chromophobe renal cell carcinoma (EVCRCC) is still less frequent and is composed predominantly of small to medium-sized cells with abundant granular eosinophilic cytoplasm. We report two cases of EVCRCC, with one having a rare association of right atrial myxoma. We present these cases, due to the rarity of EVCRCC and an unusual association of right atrial myxoma in one of them. Both patients recovered well after surgery, with no recurrence or metastasis after 2 years of follow-up.

Yeshvanth, Sunil Kumar; Permi, Harish S; Laxminarayana, Kishan Prasad Hosapatna; Shrinivas, Teerthanath; Shetty, Jayaprakash K

2011-01-01

18

Doppler echocardiographic profiles in obstructive right and left atrial myxomas.  

PubMed

Previous reports have suggested that atrioventricular (AV) flow disturbances accompanying atrial myxomas mimic mitral stenosis. Two patients complaining of orthostatic syncope and positional intolerance had a large right and left atrial myxoma, respectively. Doppler flow records showed abrupt early diastolic flow cessation and normal velocity half-times, unlike AV valve stenosis. Large, obstructing atrial myxomas may behave as ball valves. PMID:3819213

Goli, V D; Thadani, U; Thomas, S R; Voyles, W F; Teague, S M

1987-03-01

19

Atrial myxoma: a rare cause of ischemic stroke.  

PubMed

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

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

2013-04-01

20

Detection of left atrial myxoma by Fourier phase image.  

PubMed

A case of left atrial myxoma shown on an equilibrium radionuclide ventriculography is presented. A peculiar abnormality of the Fourier phase image appears more reliable than the other findings previously revealed by first-pass or equilibrium studies. The findings were perfectly consistent with the gross anatomy of the tumour. PMID:7160403

Tarolo, G L; Picozzi, R; Zatta, G; Baroffio, R; Bossi, M C

1982-01-01

21

Right atrial mass in the context of recurrent non-Hodgkin's lymphoma: atrial myxoma presenting with atrial flutter  

PubMed Central

A case is described of a 57-year-old man with a background of low-grade bronchus-associated lymphoid tissue (BALT) non-Hodgkin’s lymphoma presenting with dyspnoea and palpitations. Diagnostic work-up revealed paroxysmal atrial flutter and the presence of a mass in the right lower lobe at bronchoscopy, with histology confirming recurrent BALTOMA. Transthoracic echocardiography (TTE) revealed a mass in the right atrium. Transoesophageal echocardiography (TOE) confirmed the presence of a fleshy, mobile pedunculated right atrial mass adherent to the interatrial septum, with features more in keeping with an atrial myxoma rather than intracardiac lymphoma. He proceeded to cardiotomy and excision of the mass with histology confirming an atrial myxoma. The clinical and echocardiographic features of atrial myxomas and intracardiac lymphomas are briefly discussed.

Yavari, Arash; El-Mahy, Hossam; McWilliams, Eric T

2009-01-01

22

Surgical Treatment of Right Atrial Myxoma  

PubMed Central

A 51-year-old man with a large right atrial myxoma underwent emergency surgical resection in our institute. The diagnosis of such tumors can be difficult, and their resection presents difficulties for the placement of the venous cannulae. We used a single cannula in the superior vena cava until fibrillation, and then we inserted a cannula into the inferior vena cava. We present this technique as a method of avoiding embolization.

Guhathakurta, Soma; Riordan, John P.

2000-01-01

23

Left atrial myxoma detected after an initial diagnosis of polymyalgia rheumatica.  

PubMed

We herein report the case of a 69-year-old woman with left atrial myxoma detected following treatment with glucocorticoids for an initial diagnosis of polymyalgia rheumatica (PMR). The glucocorticoids markedly improved the patient's symptoms, and the tumor was excised after rapidly tapering the glucocorticoid dose. The PMR-like symptoms did not recur and the inflammatory marker levels returned to normal after surgery. The patient's clinical course indicated that the initial PMR-like symptoms were entirely caused by the left atrial myxoma. This case demonstrates that glucocorticoid treatment for suspected PMR can mask the symptoms of myxoma, leading to a delay in diagnosis. PMID:24583432

Mano, Yoshinori; Yoshizawa, Akihiro; Itabashi, Yuji; Ohki, Takahiro; Takahashi, Tatsuo; Mori, Mitsuharu; Shin, Hankei; Tanaka, Youichi

2014-01-01

24

Migraine with aura triggered by cardiac myxoma: Case report and literature review  

Microsoft Academic Search

We present a new case of cardiac myxoma triggering migraine auras. A 52-year-old woman was suffering from migraine attacks with aura. Magnetic resonance imaging (MRI) showed no abnormalities. Subsequently, she had a minor stroke with multiple ischaemic lesions bilaterally on repeat MRI. An echocardiogram showed a myxoma of the left atrial wall. After removal of the myxoma she was free

Laura de Ceuster; Ton van Diepen; Peter J Koehler

2010-01-01

25

Correlation of phono- and apexcardiographic findings with tumor motion in left atrial myxoma.  

PubMed

We have analyzed the genesis of physical signs in a case of prolapsing left atrial myxoma by simultaneous phono-, apex- and M-mode echocardiography. Our findings confirm a direct relationship of tumor movements with notching in the upstroke of the apexcardiogram and with the protodiastolic "tumor plop." PMID:738104

Cosio, F G; Marin, E; Tascon, J; Sanchez, A; Aguado, J M

1978-11-01

26

Left atrial myxoma: phonocardiographic, echocardiographic, and micromanometric hemodynamic correlations.  

PubMed

We used simultaneous echocardiography, phonocardiography, and high-fidelity micromanometry to investigate the impact of the movement of a large pedunculated left atrial myxoma on hemodynamics. The case we have described shows that (1) the early diastolic sound (tumor plop) coincided with maximal excursion of the tumor in the left ventricular inflow tract, (2) tumor movements during mid to late diastole corresponded to low-frequency oscillations in left ventricular pressure, (3) tumor expulsion from the left ventricle into the left atrium was initiated during "isovolumic" contraction but continued into the early ejection phase, (4) mitral valve closure was abnormally delayed until after the onset of aortic ejection, and (5) systolic ejection was initiated before coaptation of the mitral valve leaflets. These findings support the theory that tumor motion contributes to both systolic and diastolic vibrations of the entire cardiohemic system. PMID:6701593

Cox, W R; Damore, S; Rubal, B J; Murgo, J P

1984-02-01

27

The role of computed tomography in detecting splenic arteriovenous fistula and concomitant atrial myxoma  

PubMed Central

Patient: Female, 45 Final Diagnosis: Arterio-venous fistula of the splean Symptoms: Lef-side abdominal pain Medication: — Clinical Procedure: — Specialty: Surgery Objective: Rare disease Background: Splenic arterial-venous fistula and atrial myxoma are not rare cases but the co-existence of both lesions in the same patient is unpublished so far. Case Report: A 45- year-old woman presented with vague left flank pain. She was initially scanned by B-dimensional echography, which revealed multiple enlarged hypo-echoic lesions in the splenic hilum. To further characterize the lesion, we performed computed tomography angiography (CTA). CTA showed dilatation of the splenic artery, and aneurismal dilatation of the splenic vein, associated with early opacification of the portal system. CTA showed also an intrasplenic venous aneurism, which was presumed to be the site of fistulous communication. Celiac arteriography confirmed the CTA findings. A left atrial mass was detected by cardiac echography, which was evaluated better by CTA, and was consistent with atrial myxoma. The patient underwent open surgery in different stage with resection of the atrial mass and spleen. The postoperative period was uneventful. Conclusions: This is a unique case in the literature, showing the coexistence of a dual-pathology splenic arterial venous fistula and atrial myxoma.

Rroji, Arben; Bilaj, Fatmir; Qirinxhi, Denis; Vucini, Ortencia; Hasimi, Endri; Goda, Artan

2014-01-01

28

Left atrial myxoma, ruptured chordae tendinae causing mitral regurgitation and coronary artery disease.  

PubMed

Mitral regurgitation is uncommon with left atrial myxoma. The echocardiographic assessment of presence of mitral regurgitation and its severity are impaired by the presence of left atrial myxoma. We describe an uncommon association of left atrial myxoma with coronary artery disease and mitral regurgitation. MR was reported as mild on pre-operative transthoracic echocardiography but found to be severe due to ruptured chordae tendinae during intra-operative transesophageal echocardiography, which lead to change in the surgical plan to mitral valve replacement in addition to excision of myxoma. PMID:24732613

Kumar, Bhupesh; Raj, Ravi; Jayant, Aveek; Kuthe, Sachin

2014-01-01

29

Atrial myxoma: 8 years JIPMER experience  

Microsoft Academic Search

Background  Myxoma is the most common benign primary tumour of heart. Left atrium is the most common site (75%). With the advent of Trans\\u000a Esophageal Echocardiography (TEE) the diagnosis has became easier. This study has been under taken to know the clinical profile,\\u000a surgical techniques and post operative outcome of the patients, operated at JIPMER.\\u000a \\u000a \\u000a \\u000a Methods  Between December 1992 to December 2000,

K. Padhy; K. Krishnagopal; N. Sabanayagam; L. P. Pereira; M. Nachiappan; KSVK Subba Rao

2001-01-01

30

Conjunctival Myxoma-A Case Report  

PubMed Central

Ocular myxomas are rare neoplasms. We report a case of conjunctival myxoma in a 33-year-old male. Clinically, it was diagnosed as a conjunctival cyst. Histopathological findings revealed spindle, and fusiform cells in loose myxoid stroma with cystic change. There were no systemic abnormalities detected.

Kini Rao, Anuradha Calicut; Nayal, Bhavna

2013-01-01

31

Recurrent right ventricular cardiac myxoma in a patient with Carney complex: a case report  

PubMed Central

Introduction Carney complex is a multiple neoplasia syndrome involving cardiac, endocrine, neural and cutaneous tumors with a variety of pigmented skin lesions. It has an autosomal dominant mode of inheritance. Approximately 7% of cardiac myxomas are related to the Carney complex. Myxomas that occur as part of the Carney complex affect both sexes with equal frequency. Cardiac myxomas with Carney complex are reported mostly in the left side of the heart and are less common on the right side. As per our review, this is the first reported case of Carney complex with right ventricle cardiac myxoma. Case presentation We present a rare case of recurrent cardiac myxoma in a patient later diagnosed to have Carney complex. A 46-year-old Caucasian man with a history of thyroid hyperplasia came to out-patient cardiology department with new onset atrial fibrillation. A transthoracic echocardiogram revealed a right ventricular mass attached to his interventricular septum, which was later seen on a transesophageal echocardiogram and cardiac magnetic resonance imaging. He underwent resection of the ventricular mass which on pathology revealed myxoma. He later developed skin lesions, pituitary adenoma and Sertoli cell tumor suggesting Carney complex. Two years later he developed a new mass within his right atrium which was later resected. Conclusions Carney complex is a rare autosomal dominant disease with variable penetrance. Since it involves multiple organs, patients diagnosed with Carney complex should undergo serial endocrine workup, neural assessments, echocardiograms and testicular ultrasounds. Of the total number of cases of Carney complex, 65% are linked to PRKAR1A gene mutation. It is important for clinicians to be cognizant of a link between cardiac myxoma and Carney complex. The use of multi-imaging modalities allows better delineation of the mass before planned resection. Carney complex-related cardiac myxoma comprises 7% of all cardiac myxomas. Right ventricular cardiac myxomas are rare. This case report is the first to describe right ventricular myxoma with Carney complex.

2014-01-01

32

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

PubMed

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

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

2014-09-01

33

Left Atrial Myxoma: A Rare Nonatherosclerotic Cause of Acute Myocardial Infarction  

PubMed Central

Myocardial infarction from coronary artery embolism is a very rare but potentially lethal sequel of left atrial myxoma. Most atrial myxomas causing myocardial infarction are diagnosed retrospectively after a 2D echocardiogram is performed for assessment of myocardial function after a myocardial infarction. We present a relatively healthy 53-year-old male with anterolateral wall myocardial infarction and 100% occlusion at the proximal part of the obtuse marginal branch of the circumflex coronary artery that was subsequently reperfused. A 2D echocardiogram performed two days later revealed a left atrial mass, which was successfully resected and proven to be a myxoma. No recurrence of the tumor was seen on follow-up after four months. An automatic implantable cardioverter defibrillator was placed for residual ischemic cardiomyopathy with clinical improvement.

Arcenas, Rey Francisco; Ali, Mir Ishtiaque

2013-01-01

34

Intracoronary Catheter Aspiration Can Be an Adequate Option in Patients with Acute Myocardial Infarction Caused by Left Atrial Myxoma  

PubMed Central

Cardiac myxomas are the most common benign cardiac tumors and can be associated with systemic embolization including acute myocardial infarction (AMI). The probability of an arterial embolization is closely related to a tumor's villous morphology. In cases of AMI caused by cardiac myxoma, open heart surgery including excision of the coronary artery has been the one of the treatment options for removing the myxoma and embolus from the coronary artery to maintain distal coronary flow. However, preparing for emergent open heart surgery takes a considerable amount of time. Moreover, this time delay can deteriorate the coronary perfusion to the infarcted area and is associated with poor clinical prognosis. So intracoronary catheter aspiration can be an additional option to maintain the distal coronary flow. In this report we present a case with acute anterior ST elevation myocardial infarction caused by a left atrial myxoma. The embolus in the left anterior descending coronary artery was successfully removed with intracoronary catheter aspiration, and distal coronary flow was restored after the procedure.

Park, Hyung Seo; Park, Jae-Hyeong

2009-01-01

35

Transient loss of peripheral vision as the presentation of left atrial myxoma.  

PubMed Central

A 42-year-old man developed transient loss of vision in both eyes. On echocardiography to investigate a systolic murmur and determine the potential source of emboli, a large left atrial myxoma was diagnosed. This was removed successfully leaving no visual or neurological deficit. Images

Bolo-deoku, J; Orchard, R T; Fison, P N

1992-01-01

36

Laryngeal myxoma: a case report and review of the literature.  

PubMed

Myxomas are a rare benign neoplasm of uncertain mesenchymal cell origin, typically involving the heart. Laryngeal myxomas are uncommon, and are usually misdiagnosed as laryngeal polyp. To the best of our knowledge, there are only nine reported cases in the English literature. We report a case of a laryngeal myxoma presenting clinically as a left vocal cord polyp in a 77 year old male, and review the literature related to this rare entity. PMID:23975415

Ritchie, Angela; Youngerman, Jay; Fantasia, John E; Kahn, Leonard B; Cocker, Rubina S

2014-06-01

37

[Juxta articular myxoma of the wrist: a case report].  

PubMed

Juxta articular myxomas are rare tumors. The treatment is surgical with a high recurrence rate. A location proximal to the wrist joint is exceptional. We report a case of juxta articular myxoma of the wrist in a 30-year-old patient, with no recurrence four months after surgical excision. PMID:20724197

Abkari, I; El Hassib, J; Latifi, M; Hazmiri, F-E; Belaabidia, B

2010-09-01

38

Right atrium myxoma coexisting with antiphospholipid syndrome: a case report.  

PubMed

In this case report we describe a rare case of right atrium myxoma that coexisted with antiphospholipid syndrome in a young woman. We describe the unusual findings and diagnostic challenges combined with a review of the literature. PMID:19818150

Pliakos, Christos; Alexiadou, Eleni; Metallidis, Symeon; Papavramidis, Theodossis S; Kapoulas, Stergios; Sapalidis, Konstantinos; Nikolaidis, Pavlos

2009-01-01

39

Stroke due to a cardiac myxoma  

PubMed Central

Cardioembolic stroke is an important cause of stroke in young people. Cardioembolism classically causes infarcts in multiple vascular territories. In the case described here a young woman developed cardioembolic stroke secondary to atrial myxoma. The presentation was atypical in that the woman had no systemic manifestations of her myxoma.

Salman, Rustam Al-Shahi; Northridge, David; Graham, Alastair N J; Grant, Robin

2009-01-01

40

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

41

Giant myxoma in the left atrium: case report.  

PubMed

In this study is reported the case of a 63-year-old-woman with history of dyspnea, palpitations, and precordial pain who underwent cardiologic evaluation. The physical examination did not reveal abnormalities. The echocardiogram showed great mass in the left atrium, suggesting myxoma which was confirmed by tomography and catheterization. The patient underwent surgical treatment with a good postoperative evolution. The diagnosis of myxoma was confirmed by histopathologic study. In this study is included a bibliographic review and a comment emphasizing the diagnostic difficulty based on signs and symptoms, as well as the details about the development of bilateral pleural effusion possibly related to the myxoma. PMID:18820794

Vale, Marcos de Paula; Freire Sobrinho, Adalberto; Sales, Marcos Vinícius; Teixeira, Marianna Meirelles; Cabral, Karine Chaves

2008-01-01

42

A case of comorbid myxoma and chronic lymphocytic leukemia: not just a coincidence?  

PubMed

Background. It is unclear why cardiac myxomas develop. We describe a case of comorbid myxoma and chronic lymphocytic leukemia (CLL) to offer insights into the tumor's pathophysiology. Case. A 56-year-old female with recurrent venous thromboembolism developed embolic stroke. Transesophageal echocardiogram showed a 1.7 × 1?cm sessile left atrial mass at the interatrial septum. Histopathology revealed myxoma with a B cell lymphocytic infiltrate suggestive of a low grade lymphoproliferative disorder. Bone marrow biopsy and flow cytometry of blood and the cardiac infiltrate supported the diagnosis of atypical CLL. She was followed clinically in the absence of symptoms, organ infiltration, or cytopenia. After eighteen months, she developed cervical and axillary lymphadenopathy. Biopsy confirmed B cell CLL/small lymphocytic lymphoma. She elected to undergo chemotherapy with fludarabine, cyclophosphamide, and rituximab, with clinical remission. Conclusions. The coexistence of two neoplastic processes may be coincidental, but the cumulative likelihood is estimated at 0.002 per billion people per year. A shared pathogenic mechanism is more likely. Possibilities include chronic inflammation, vascular endothelial growth factor A, shared genetic mutations, changes in posttranslational regulation, or alterations in other cellular signaling pathways. Additional studies could expand our current understanding of the molecular biology of both myxomas and CLL. PMID:24868472

Laird-Fick, Heather; Tiwari, Ashish; Narayanan, Santhosshi; Qin, Ying; Vodnala, Deepthi; Bhutani, Manisha

2014-01-01

43

A Case of Comorbid Myxoma and Chronic Lymphocytic Leukemia: Not Just a Coincidence?  

PubMed Central

Background. It is unclear why cardiac myxomas develop. We describe a case of comorbid myxoma and chronic lymphocytic leukemia (CLL) to offer insights into the tumor's pathophysiology. Case. A 56-year-old female with recurrent venous thromboembolism developed embolic stroke. Transesophageal echocardiogram showed a 1.7 × 1?cm sessile left atrial mass at the interatrial septum. Histopathology revealed myxoma with a B cell lymphocytic infiltrate suggestive of a low grade lymphoproliferative disorder. Bone marrow biopsy and flow cytometry of blood and the cardiac infiltrate supported the diagnosis of atypical CLL. She was followed clinically in the absence of symptoms, organ infiltration, or cytopenia. After eighteen months, she developed cervical and axillary lymphadenopathy. Biopsy confirmed B cell CLL/small lymphocytic lymphoma. She elected to undergo chemotherapy with fludarabine, cyclophosphamide, and rituximab, with clinical remission. Conclusions. The coexistence of two neoplastic processes may be coincidental, but the cumulative likelihood is estimated at 0.002 per billion people per year. A shared pathogenic mechanism is more likely. Possibilities include chronic inflammation, vascular endothelial growth factor A, shared genetic mutations, changes in posttranslational regulation, or alterations in other cellular signaling pathways. Additional studies could expand our current understanding of the molecular biology of both myxomas and CLL.

Laird-Fick, Heather; Tiwari, Ashish; Narayanan, Santhosshi; Qin, Ying; Vodnala, Deepthi; Bhutani, Manisha

2014-01-01

44

The etiology of tumor plop in a patient with huge right atrial myxoma.  

PubMed

In a patient with a large atrial myxoma, the phonocardiographic timing of the tumor plop has been correlated with the two-dimensional echocardiographic motion pattern of the cardiac mass. The tumor plop occurred at the time when the mass stopped its diastolic forward motion into the ventricle and made a strong impact on the interventricular septum and right ventricular posterior wall. Occurrence of tumor plop may require a large mass or long enough tumor stalk to allow the impact of the mass on the ventricular wall. PMID:2640541

Keren, A; Chenzbruna, A; Schuger, L; Milgarter, E; Tzivoni, D

1989-05-01

45

Recurrent pulmonary embolism originating from right atrial myxoma  

Microsoft Academic Search

The use of transesophageal echocardiography is a useful adjunct to transthoracic echocardiography in the diagnosis and management of right atrial tumors in patients who are thought to have idiopathic recurrent pulmonary embolism, especially with suboptimal transthoracic echocardiography studies. We describe a 30-year-old woman with a history of recurrent pulmonary embolism who was admitted for investigation of pleuritic chest pain in

Shadwan Alsafwah; Zaki Lababidi

2001-01-01

46

Recurrent pulmonary embolism originating from right atrial myxoma.  

PubMed

The use of transesophageal echocardiography is a useful adjunct to transthoracic echocardiography in the diagnosis and management of right atrial tumors in patients who are thought to have idiopathic recurrent pulmonary embolism, especially with suboptimal transthoracic echocardiography studies. We describe a 30-year-old woman with a history of recurrent pulmonary embolism who was admitted for investigation of pleuritic chest pain in whom transesophageal echocardiography played a critical role in the diagnosis and management. PMID:11287895

Alsafwah, S; Lababidi, Z

2001-04-01

47

Carney’s syndrome: complex myxomas. Report of four cases and review of the literature  

Microsoft Academic Search

Cardiac myxomas are rare tumors. They usually appear as a sporadic isolated condition in the left atrium of middle-aged women with no other coincidental pathology. Carney and others have described in young people a special complex group of cardiac myxomas associated to a distinctive complex pathology, giving identity to the “Syndrome Myxoma” or “Carney’s Syndrome”. Four additional cases of this

A. Edwards; C. Bermudez; G. Piwonka; M. L. Berr; J. Zamorano; E. Larrain; R. Franck; M. Gonzalez; E. Alvarez; E. Maiers

2002-01-01

48

Right atrial myxoma with glandular differentiation: A rare entity in pediatric age group  

PubMed Central

Cardiac myxomas (CMs) account for nearly half of the primary cardiac tumors in the elderly. They arise from sub-endocardial “reserve” or lepidic” cells, which may show divergent differentiation. We describe a CM with glandular differentiation in the right atrium of a 10-year-old child who presented with respiratory distress on exertion, of 2 months duration. On echocardiography, two large interconnected masses measuring 34×30 mm and 20×17 mm were seen to arise from the free wall of the right atrium. Cut surface of the excised mass was myxoid with areas of calcification. On microscopy, there were typical features of a myxoma with prominent glandular differentiation and characteristic immunophenotype. The case is being reported due to its rarity in pediatric age group as well as its glandular differentiation, which must be recognized as a spectrum of histomorphologic diversity and must not be mistaken for a metastatic adenocarcinoma.

Mallick, Saumya R; Das, Prasenjit; Shukla, Bhaskar; Kothari, SS; Devagourou, V; Ray, Ruma

2010-01-01

49

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.

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

2008-01-01

50

Childhood maxillary myxoma: case report and review of management.  

PubMed

Myxomas are benign neoplasms of uncertain origin and etiology. First described by Virchow in 1863, they are derived from primitive mesenchymal structures and feature components of the umbilical cord. More recently, in 1995, Takahashi et al., through extensive research confirmed the fibroblastic and histiocytic origin of the tumor. We present a case in a female infant whose outcome and follow-up are discussed as well as a literature review in order to discuss many features of this rare pathology. PMID:17764985

Tincani, Alfio Jose; Araújo, Priscila P C; DelNegro, André; Altemani, Albina; Martins, Antonio Santos

2007-11-01

51

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

52

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

53

Right ventricular myxoma. Case report and review of phonocardiographic and auscultatory manifestations.  

PubMed

Tumors in the right ventricle are extremely rare. This report concerns the pathogenesis of physical signs resulting from a right ventricular myxoma. In systole a loud midsystolic murmur representing outflow obstruction was present. In diastole a prominent vibration was heard and recorded. By echophonocardiography this noise could be ascribed to sudden halting of the retrograde excursion of the mass into the right ventricle--a mechanism analogus to the tumor "plop" associated with the halting of antegrade movement of a left atrial myxoma in the left ventricle in early diastole. PMID:7446391

Hada, Y; Wolfe, C; Murray, G F; Craige, E

1980-12-01

54

Corneal Myxoma  

Microsoft Academic Search

Background: Myxomas are rare benign tumors that can be found most frequently in the heart. We report the clinical and histological findings in a very rare case of corneal myxoma, which is only the sixth case in the literature.Case: A whitish elevated tumor of the anterior cornea developed in the left eye cornea of a 46-year-old man 2 years after

Gregor Wollensak; William Richard Green; Theo Seiler

2002-01-01

55

Fever of unknown origin: a case of cardiac myxoma infected with Staphylococcus lugdunensis.  

PubMed

Infected cardiac myxoma is a rare entity. It poses a diagnostic challenge as clinical presentation may reflect an underlying infectious, immune, or a neoplastic disease process. To the best of our knowledge, the first case of a cardiac myxoma infected with Staphylococcus lugdunensis is reported in a 54-year-old man with fever of unknown origin for 4 months. Successful excision of the tumor was performed and was followed by an uneventful recovery. Clinical presentation, diagnosis, and management of infected cardiac myxomas are discussed. PMID:20531054

Bhanot, Nitin; Sahud, Andrew G; Bhat, Sunil; Lane, Stacy; Manyam, Harish; Chan-Tompkins, Noreen H

2010-07-01

56

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.

2014-01-01

57

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

PubMed Central

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

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

2013-01-01

58

Management of cardiac myxoma during pregnancy: a case series and review of the literature.  

PubMed

Cardiac myxomas are the most common primary benign tumors of the heart. The reported incidence during pregnancy is extremely low with only 17 reported cases in the medical literature. Standard therapy involves surgical resection given the potential for embolization. In the pregnant patient, however, the risks of embolization must be balanced against the risk of cardiopulmonary bypass to the mother and the fetus. We present two cases of cardiac myxoma diagnosed during pregnancy and review the presentation and management strategies of previously reported cases. In conclusion, successful surgical resection of the myxomas during pregnancy was performed in both of our cases. Given the rarity of cases, individual multidisciplinary assessment and management strategies are essential. PMID:21715030

John, Anitha S; Connolly, Heidi M; Schaff, Hartzell V; Klarich, Kyle

2012-03-01

59

Odontogenic myxoma  

PubMed Central

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.

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

2013-01-01

60

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

61

Carney Complex: case report and review  

PubMed Central

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

2011-01-01

62

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.

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

2014-01-01

63

Giant paravertebral myxoma  

Microsoft Academic Search

The study design includes case report and clinical discussion. The objective was to describe a rare case of a giant intramuscular\\u000a myxoma (IMM) presenting as a mass in the paravertebral muscles. Myxoma is a rare benign soft tissue tumour of mesenchymal\\u000a origin. Although intramuscular presentation is common, they are rare in the paravertebral muscles and are characteristically\\u000a <5 cm in length.

A. Rashid; H. B. Abdul-Jabar; S. Karmani; K. Rezajooi; A. T. H. Casey

2011-01-01

64

Right atrial mass following transcatheter radiofrequency ablation for recurrent atrial fibrillation: thrombus, endocarditis or mixoma?  

PubMed

We report a case of an asymptomatic patient in whom a right atrial mass was fortuitously documented by echocardiography few months after a transcatheter radiofrequency catheter ablation for recurrent AF. No masses were seen in the cardiac chambers before the ablative procedure, raising important diagnostic and decision-making issues. The patient was referred to the surgeon and a diagnosis of right atrial myxoma was made. PMID:19645213

Ancona, Roberta; Comenale Pinto, Salvatore; Caso, Pio; Di Palma, Vito; Pisacane, Francesca; Martiniello, Alfonso Roberto; Quarto, Cesare; De Rosa, Nicla; Pisacane, Carlo; Calabrò, Raffaele

2009-03-01

65

Peripheral odontogenic myxoma of maxillary gingiva: A rare clinical entity  

PubMed Central

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

Jain, Vijay Kumar; Reddy, Soundarya Narayana

2013-01-01

66

Odontogenic Myxoma of the Mandible  

PubMed Central

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.

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

2012-01-01

67

Nerve sheath myxoma (neurothekeoma) arising in the oral cavity: histological and immunohistochemical features of 3 cases.  

PubMed

This report describes the histological and immunohistochemical characteristics of 3 cases of nerve sheath myxoma (NSM)/neurothekeoma arising in the oral cavity. Histopathologically, 3 distinct variants were observed based on the amount of myxoid matrix: classic/hypocellular, cellular, and mixed types. Immunohistochemically, all types expressed strong immunoreactivity to S-100 protein (3/3), NSE (neuron-specific enolase) (3/3), and NGFR (nerve growth factor receptor) (3/3), whereas all cases were negative for SMA (smooth muscle actin) and FVIII. The number of Ki-67 positive cells was less than 5% in all lesions confirming the slow growing characteristics of NSM. The results suggest that NSMs of the oral cavity are true peripheral nerve sheath tumors and show close relationship to schwannoma. PMID:19272803

Nishioka, Mai; Aguirre, Rodelio L; Ishikawa, Ayataka; Nagumo, Kiyoko; Wang, Li-Hong; Okada, Norihiko

2009-05-01

68

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

PubMed Central

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

2014-01-01

69

NASA's First Atrial Fibrillation Case - Deke Slayton  

NASA Technical Reports Server (NTRS)

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

Tarver, William J.

2010-01-01

70

Sotalol Treatment in a Case with Fetal Atrial Flutter  

Microsoft Academic Search

Objective: Fetal tachycardia leads to nonimmune hydrops fetalis and increases fetal morbidity and mortality. Supraventricular tachy- cardia and atrial flutter are the most diagnosed by ultrasonography. We present a case with fetal atrial flutter in the second trimester, firstly digoxin then, digoxin plus sotalol therapy were given successfully. Case: A thirty years old patient was sent to our clinic for

Ebru Dikensoy; Özcan Balat

71

Intramuscular myxoma of the hyoglossus muscle: A case report and literature review  

PubMed Central

Intramuscular myxoma (IM) is a benign intramuscular neoplasm composed of fibroblasts and abundant myxoid stroma. IMs most commonly affect larger skeletal muscles, while those affecting the oral and maxillofacial regions are rare, with a small number of documented cases in the available literature. The aim of the present study was to describe a highly rare case of an IM within the hyoglossus muscle of the tongue in a 74-year-old male. The patient presented with a painless mass in the submental space that had been growing slowly for more than five years. A computed tomography scan revealed a hypodense lesion located in the root of the tongue. The mass was easily excised with thin margins, including only a small amount of the adjacent muscle tissue. The pathological diagnosis of the mass was an IM. The patient made an excellent recovery following the surgery and the follow-up three years later revealed no local recurrence. IMs of the hyoglossus muscle are highly rare, however must be considered in the differential diagnosis of swellings in the root of the tongue region.

LI, GUIQI; JIANG, WEN; LI, WEI; LI, JUNCHUAN

2014-01-01

72

Cardiac Hemangioma: A Case Report  

PubMed Central

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

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

2014-01-01

73

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

PubMed Central

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

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

2011-01-01

74

Emergency excision of cardiac myxoma and endovascular coiling of intracranial aneurysm after cerebral infarction.  

PubMed

Cardiac myxoma is the most common primary tumor of the heart, located mainly in the left atrium. Cerebral embolization or intracranial aneurysm formation as a consequence of left atrial myxomas has been well documented, whereas myxoma embolization causing the combination of cerebral infarction and intracranial myxomatous aneurysm is rare. We report herein, a 67-year-old female with a cardiac myxoma who experienced a left hemispheric embolic ischemic stroke and in addition was found to have right internal carotid artery aneurysm. The patient underwent emergency surgical excision of left atrial myxoma 2 hours after the stroke onset and endovascular coiling of the aneurysm a week later. Although the timing of cardiac surgery is controversial in patients who have had recent ischemic stroke, we recommend immediate resection of cardiac myxoma, if feasible, and early endovascular treatment of associated intracranial myxomatous aneurysms. PMID:24109531

Al-Said, Youssef; Al-Rached, Heyam; Baeesa, Saleh; Kurdi, Khalil; Zabani, Ibrahim; Hassan, Ahmed

2013-01-01

75

Thirteen years follow-up of heart myxoma operated patients: what is the appropriate surgical technique?  

PubMed Central

Background Cardiac myxoma is a benign neoplasm that represents the most prevalent primary tumor of the heart. If not treated with the right surgical technique recurrence occurs. Aim of our study is to present our surgical approach and the histology of the tumors resected. Methods All patients, except for one, underwent extracorporeal circulation and mild hypothermia, right atrial or both atrial incision and excision of the fossa ovalis, followed by prosthetic patch suturing. All specimens were submitted for microscopic evaluation (haematoxylin-eosin). We contacted personally each patient and asked them to complete a standardized questionnaire, concerning their peri-operative characteristics. Results Six cases were “active” myxomas, 3 were “mildly active” and 3 were “inactive”. “Normal differentiation” was seen in 6, “medium” in 1 and “poor” in 5 cases. In our series there were no recurrences recorded during the follow-up period. Conclusions The ideal approach, according to our experience is right atrial or both atrial incision as described by Shumacker and King, with excision of the fossa ovalis and the surrounding tissues and closure with a pericardial patch. Such a technique provides an excellent long-term survival in these patients.

Siminelakis, Stavros; Kakourou, Alexandra; Batistatou, Alexandra; Sismanidis, Stelios; Ntoulia, Alexandra; Tsakiridis, Kosmas; Syminelaki, Theodora; Apostolakis, Eleftherios; Tsiouda, Theodora; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Dryllis, Georgios; Machairiotis, Nikolaos; Mpakas, Andreas; Beleveslis, Thomas; Zarogoulidis, Konstantinos

2014-01-01

76

A prominent crista terminalis associated with atrial septal aneurysm that mimics right atrial mass leading to atrial arrhythmias: a case report  

PubMed Central

Introduction The crista terminalis is a variant of normal anatomical structures within the right atrium that mimics an atrial mass on a transthoracic echocardiogram. Atrial septal aneurysm is a rare but well-recognized cardiac abnormality of uncertain clinical significance. The association between crista terminalis and atrial septal aneurysm is unusual but not completely casual. Both anatomical heart structures can lead to atrial arrhythmias. Case presentation This case report describes the accidental discovery during an echocardiographic examination of a 64-year-old Caucasian woman who had a left bundle branch block and palpitations. Conclusion The clinical relevance of this anatomical evidence in unknown. This was an occasional finding of transthoracic echocardiography, but in this case it is possible to assume its relationship with the occurrence of atrial arrhythmias, and also that computed tomography scan and cardiovascular magnetic resonance is mandatory to define the structure and function of these incidental findings.

2012-01-01

77

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.

2013-01-01

78

[Family myxoma of the heart with metachronic multiple growth].  

PubMed

A case of familial heart myxoma in 4 members of one family combined with myxomic (hamartomatous) syndrome is reported. The tumor in a proband was characterized with a multiple growth in various heart chambers. Five operations were made in the proband for 16 years and seven myxomas of different locations were removed. Myxomas originating from the endocardium of the interatrial septum oval hole were removed in 3 members of his family. The case confirms the conception of heart myxoma origin from endothelial hamartia of the endocardium. PMID:15449689

Rogov, K A; Sheremet'eva, G F; Nechaenko, M A

2004-01-01

79

Left atrial spindle cell sarcoma - Case report  

PubMed Central

Primary spindle cell sarcoma of the left atrium is an extremely rare tumour. Surgical excision is the mainstay of treatment since it responds poorly to chemotherapy or radiotherapy. In spite of all the treatment, the prognosis remains poor due to inadvertent delay in diagnosis, few therapeutic options and propensity to metastasize. We present a 47-year-old male who underwent a surgical excision of a left atrial mass in February 2010. It was proved to be a high-grade spindle cell sarcoma on histopathology. He presented again in October 2010 with recurrence of the tumour for which he was re-operated. However, the tumour recurred again within one month, to which the patient succumbed.

Mehta, Nihar; Desai, Ajit; Shivdasani, Bharat; Suryawanshi, Satyajeet; Mehta, A.B.; Behranwala, A.; Dhabhar, Boman

2012-01-01

80

Electrophysiological Features of Atrial Flutter in Cardiac Sarcoidosis: A Report of Two Cases  

PubMed Central

We report two cases of systemic sarcoidosis with atrial flutter as the clinical manifestation. In one patient, who had symptoms of shorter duration, the arrhythmia was no longer inducible after a course of glucocorticoid therapy. Electroanatomical mapping in the other case revealed patchy fibrosis of the left atrial myocardium and multiple macro-reentrant circuits. Sinus rhythm could be restored with ablation of these reentrant circuits. To our knowledge, this is the first report on the demonstration of atrial scarring in a patient with sarcoidosis using 3-D electroanatomical mapping. These two cases illustrate that the inflammation of atrial myocardium is the primary mechanism of atrial arrhythmias in patients with cardiac sarcoidosis.

Namboodiri, Narayanan; Stiles, Martin K; Young, Glenn D; Sanders, Prashanthan

2012-01-01

81

Intramuscular myxoma of the cervical paraspinal muscle.  

PubMed

Myxoma is a neoplasm of mesenchymal origin composed of undifferentiated stellate cells in a myxoid stroma. This tumor can develop in a variety of locations. Myxomas that arise from skeletal muscles are called intramuscular myxomas. They usually occur in large skeletal muscles. Only ten cases of these benign tumors involving the neck muscles were reported in literature. Of them, only three were located at the paraspinal muscles. A 64-year-old woman presented with occipital and neck pain over 5 years noted an expansive painful lesion located at posterior cervical region with progressive volume increase in the last 12 months. Image exams revealed a large mass located in the left posterior region of the neck in contact with the C2, C3 and C4 laminae with no invasion of the vertebrae. Tumor total removal was performed through normal muscle margins and the vertebral periosteum was scraped. The tumor was encapsulated, lobulated with a gray-white appearance. The histological examination yielded the diagnosis of intramuscular myxoma. Follow-up at 1 year showed complete resolution of preoperative symptoms and no evidence of local recurrence. In conclusion, although rare, intramuscular myxoma should be included in differential diagnosis of cervical paraspinal tumors. We reported the fourth case of intramuscular myxoma in the paraspinal musculature of the neck. Despite its benign characteristics, local recurrence was reported after subtotal resection. Tumor total removal should be the goal of surgery. PMID:19301043

Falavigna, Asdrubal; Righesso, Orlando; Volquind, Daniel; Teles, Alisson Roberto

2009-07-01

82

Pulmonary myxoma in a sheep.  

PubMed

Pulmonary myxomas are rare in domestic animals and only two cases have been reported previously in sheep. An 8 x 6 x 4 cm mass was detected in the diaphragmatic lobe of the right lung of a 4-year-old Persian Karakul ewe. The mass was well demarcated, multilobulated, soft in consistency and white in colour. The cut surface exuded a mucoid substance and a distinct capsule was evident. Microscopically, the tumour comprised a hypocellular myxomatous matrix, rich in acid mucopolysaccharides, with scattered spindle-shaped or stellate cells. These cells had uniform, oval-shaped nuclei without visible nucleoli and expressed vimentin and S100 on immunohistochemical examination. These gross, microscopical and immunohistochemical features are characteristics of myxoma. PMID:19406435

Oryan, A; Ahmadi, N; Ghane, M; Daneshbod, Y

2009-01-01

83

[Heart myxoma histogenesis in the light of its histological and ultrastructural features].  

PubMed

In 168 cases of heart myxoma histological and electron-microscopic examination have revealed signs of embryonal endothelium capable of vasoformation and glycoprotein and glycosaminoglycanes synthesis in myxoma cells. Neither differentiation of myxomas cells up to mature endotheliocytes no signs of malignant transformation was found. According to the authors, heart myxoma is a true benign dysontogenetic tumor originating from embryonal endothelium. The term myxoma does not reflect morphological entity of the tumor and the authors suggest to call it embryonal endocardial endothelioma. PMID:12879606

Rogov, K A; Sheremet'eva, G F; Nechaenko, M A

2003-01-01

84

A case report of a right ventricular mass in a patient with Beh?et's disease: Myxoma or thrombus?  

PubMed Central

Introduction Behçet’s disease (BD) is a multi-system, chronic and relapsing disorder classified as “vasculitic syndrome”. It typically affects young adult females between 20 and 40 years of age. There are some typical clinical manifestations associated with this disease, however, at times; rare sign and symptoms pose a challenge to the treating physician and making a definitive diagnosis. Presentations with cardiac symptoms are one of the extremely rare manifestations of the Behçet’s disease. Methods The authors present clinical, laboratory and imaging findings of a patient who presented with a cardiac mass which was the first presenting feature or manifestation of Behçet’s disease. Results A 19-year-old boy was admitted to our hospital for the investigation of “fever of unknown origin”, weight loss, shortness of breath and a scrotal ulcer of recent on-set. X-ray chest and electrocardiograms were inconclusive. Transthoracic echocardiography revealed a right ventricular (RV) mass attached to the interventricular septum measuring 1.5 × 1.5 cms (Panel A). Cardiac MRI identified it as a RV Myxoma. In addition, on CT scan of the chest pulmonary embolism was noted. The patient underwent excision biopsy of the tumor under cardiopulmonary bypass via right atriotomy (Panel B). Histopathology of the mass described it as “an organizing thrombus with a few groups of interrupted myocardial fibers and some infiltration of lymphocytes and plasma cells”. Moreover his HLA typing was found positive for HLA-B51 (5). In view of the above findings and associated lesions, the patient was diagnosed as a case of Behçet’s disease. The medical management included immunosuppressant and anticoagulation. Conclusion Behçet’s disease, even in the absence of the typical clinical features, should be considered in the differential diagnosis of right ventricular mass, especially when dealing with young adults from the Mediterranean basin and the Middle-East.

Ghori, M.A.; Al Sousi, Awatif; Al Mahmeed, Wael; Ellahham, Samer; Ayman, Moataz; Augustin, Norbert

2013-01-01

85

Effect of left atrial compliance on pulmonary artery pressure: a case report  

PubMed Central

Background Left ventricular diastolic dysfunction, with secondary atrial pressure elevation, is a well-known concept. On the contrary, effect of left atrial compliance on pulmonary pressure is rarely considered. Case presentation We report the echocardiographic case of a 9-year-old child who presented severe rheumatic mitral valve regurgitation with a giant left atrium, in contrast to a normal artery pulmonary pressure, testifying of the high left atrial compliance. Conclusion Left atrial compliance is an important determinant of symptoms and pulmonary artery pressure in mitral valve disease.

Marijon, Eloi; Jani, Dinesh; Voicu, Sebastian; Ou, Phalla

2006-01-01

86

Infected cardiac myxoma.  

PubMed

A 66-year-old male presenting with low-grade fever and general fatigue was diagnosed as having infected myxoma of the left atrium. Blood cultures grew Streptococcus mitis. He underwent urgent resection and histological examination revealed tumor cells in a mucopolysaccharide matrix and bacterial colonies along with active inflammation. Infected cardiac myxoma is extremely rare; however, it contains a potential risk of arterial embolization and so early diagnosis and urgent surgery should be considered. PMID:23931763

Nagata, Tomoki; Totsugawa, Toshinori; Katayama, Keijiro; Kuinose, Masahiko; Yoshitaka, Hidenori; Uesugi, Tadahisa

2013-11-01

87

Pediatric giant right atrial aneurysm: a case series and review of the literature.  

PubMed

Giant right atrial aneurysm is a rare form of congenital heart disease with a wide spectrum of clinical presentation varying from asymptomatic patients to those with refractory atrial arrhythmias or severe airway obstruction. Diagnosis is often confused with other causes of right atrial dilation such as Ebstein disease. Because of its rare occurrence and variable clinical presentation, inconsistencies in medical and surgical management strategies exist between centers. We present five cases of giant right atrial aneurysm managed at our institution and discuss the clinical presentation, diagnostic challenges, and medical and surgical management. PMID:23663418

Harder, Erika E; Ohye, Richard G; Knepp, Marc D; Owens, Sonal T

2014-05-01

88

Robotic assisted excision of a left ventricular myxoma.  

PubMed

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

Hassan, Mohammed; Smith, J Michael

2012-01-01

89

Asymptomatic right atrial cavernous hemangioma: a case report and review of the literature  

Microsoft Academic Search

A case of asymptomatic right atrial cavernous hemangioma in a 50-year-old man is reported. With right atriotomy under total cardiopulmonary bypass, the right atrial mass was identified as arising from the noncoronary Sinus of Valsalva. The mass was successfully resected with the Sinus of Valsalva closed primarily. The patient is alive and well 9 months following the operation. The incidental

John E. Thomas; Alec T. Eror; Minh Kenney; Joseph Caravalho

2004-01-01

90

[Atrial tumors in cardiac MRI].  

PubMed

Cardiac magnetic resonance imaging (MRI) is an important tool for the diagnosis of cardiac masses. Various cardiac tumors are predisposed to occurring in atrial structures. The aim of this review article is the description of atrial tumors and their morphological features in MRI. In general, cardiac tumors are rare: approximately 0.001 - 0.03 % in autopsy studies. About 75 % of them are benign. The most common cardiac tumor is the myxoma. They are predisposed to occur in the atria and show a characteristically strong hyperintense signal on T 2-wieghted images in MRI. In other sequences a heterogeneous pattern reflects its variable histological appearance. Lipomas exhibit a signal behavior identical to fatty tissue with a typical passive movement in cine imaging. Fibroelastomas are the most common tumors of the cardiac valves. Consisting of avascular fibrous tissue, they often present with hypointense signal intensities. Thrombi attached to their surface can cause severe emboli even in small tumors. Amongst primary cardiac malignancies, sarcomas are most common and favor the atria. Secondary malignancies of the heart are far more common than primary ones (20 - 40 times). In case of known malignancies, approximately 10 % of patients develop cardiac metastasis at the end of their disease. Lymphogenic metastases favor the pericardium, while hematogenic spread prefers the myocardium. Since they are not real atrial tumors, thrombi and anatomical structures of the atria have to be differentiated from other pathologies. PMID:19830642

Kraemer, N; Balzer, J C; Schoth, F; Neizel, M; Kuehl, H; Günther, R W; Krombach, G

2009-11-01

91

Atrial flutter in fetuses and early childhood: a report of eight cases.  

PubMed

Atrial flutter is an uncommon arrhythmia in children. The presenting features and treatment responses of two fetuses and six children with atrial flutter were presented. Two patients were diagnosed prenatally at 31 and 35 weeks' gestation. One patient was successfully controlled in utero by maternal administration of digoxin and the other by direct current cardioversion after delivery. Two fetuses and 2 of 6 children had normal cardiac structure by echocardiogram. Three patients had right atrial enlargement due to atrial primun septal defect, secundum atrial septal defect with primary pulmonary hypertension, and endomyocardial fibrosis. One patient developed atrial flutter with sinus node dysfunction after surgical correction of total anomalous pulmonary venous connection. Four cases presented as atrial flutter with regular atrioventricular conduction (2:1 or 3:1 conduction) while the remainder presented with irregular atrioventricular conduction. Heart failure was presented in two patients and improved after the arrhythmias were controlled. Successful termination of atrial flutter was accomplished by using DC cardioversion in 4 patients and one patient converted to normal sinus rhythm following combination of digoxin and amiodarone administration. Digoxin was administered for one year as the prophylactic medication in six patients. None had recurrence of atrial flutter during the follow-up period of one to four years. Two patients required chronic digoxin and amiodarone therapy. We concluded that atrial flutter in fetuses and early childhood carries a good prognosis. Acute treatment with direct current cardioversion is sufficient in most patients, combination of digoxin and amiodarone may be an alternative therapy to convert atrial flutter. PMID:11529363

Chotivittayatarakorn, P; Uerpairojkit, B; Khonphatthanayothin, A; Lertsupchareon, P; Muangminsuk, S

2001-06-01

92

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.

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

2014-01-01

93

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

PubMed

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

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

2014-01-16

94

Case report - Congenital Remarkable giant right atrial diverticulum in asymptomatic patient  

Microsoft Academic Search

We describe the case of a 31-year-old man who had a giant right atrial diverticulum. Although he was asymptomatic, preoperative echocardiography and three-dimensional computed tomography scan found a large mass on the right atrium. He was diagnosed with a right atrial diverticulum and underwent surgical resection of the diverticulum because of the risk of thromboembolism, arrhythmia and rupture of the

Kota Agematsu; Toru Okamura; Kazuaki Ishihara; Hiromi Kurosawa

95

Silence is golden: an uncommon case of vocalization-triggered atrial tachycardia.  

PubMed

Vocalization-related atrial tachyarrhythmias are extremely rare. We describe the case of a young woman in whom speaking was proven to be the trigger of a nearly incessant right atrial tachycardia, poorly controlled with medical therapy and successfully treated with catheter ablation. The identification of the trigger was pivotal for mapping and ablation, providing a reliable means to assess the success of the procedure. PMID:24290860

Zucchelli, Giulio; Coluccia, Giovanni; Di Cori, Andrea; Soldati, Ezio; Bongiorni, Maria Grazia

2014-02-01

96

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.

Onyekwelu, O; DeZoysa, O; Watts, S

2012-01-01

97

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

EPA Science Inventory

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

98

Cardiac myxoma originating from areas of ventricular akinesia.  

PubMed

We present a case of large pedunculated myxoma (61×39 mm) in the left ventricular cavity with anterior-septal and anterior free wall akinesia. Angiographic study showed normal coronary arteries, but the clinical signs strongly suggested a previous myocardial infarction. We cannot exclude the possibility that the ventricular akinesia results from embolization of tumor fragments. For a time, cardiac myxomas were believed to arise from mural thrombi. In this case the presence of blood stasis or low-velocity blood flow related to wall motion abnormalities may have played a role in improving tumor growth. PMID:25001667

De Viti, D; Stragapede, A; Riccioni, G; Bucciarelli, V; Memmola, C D

2014-01-01

99

Cryoballoon pulmonary vein isolation prior to percutaneous atrial septal defect closure: a case report.  

PubMed

We report the case of a 61-year-old female who was admitted to our department with progressive dyspnea and palpitation. Transthoracic echocardiography and transesophageal echocardiography showed a small atrial septal defect (ASD, 8x7 mm). Paroxysmal atrial fibrillation (AF) was detected in Holter monitoring. As repair of ASD does not significantly reduce the risk of arrhythmias, cryoablation of AF was performed prior to ASD closure. On cardiac examination at one year, this combined intervention improved right ventricular function and prevented AF episodes. PMID:24351948

Aytemir, Kudret; Sunman, Hamza; Canpolat, U?ur; Oto, Ali

2013-12-01

100

Detection of a left atrial thrombus under fondaparinux treatment: a case report.  

PubMed

Interruption of oral anticoagulation is discussed often, particularly in the outpatient setting. We present a 66- year-old woman who developed a thrombus in the left atrial appendage under bridging therapy with fondaparinux. With this case report we would like to emphasize that off-label use of fondaparinux should not be administered to patients at high risk for systemic embolism. PMID:22122396

Reind, Iris Katharina; Vogt, Alexander; Raaz, Uwe; Buerke, Michael; Werdan, Karl; Schlitt, Axel

2011-07-01

101

High-resolution esophageal long-term ECG allows detailed atrial wave morphology analysis in case of atrial ectopic beats.  

PubMed

Detection of arrhythmic atrial beats in surface ECGs can be challenging when they are masked by the R or T wave, or do not affect the RR-interval. Here, we present a solution using a high-resolution esophageal long-term ECG that offers a detailed view on the atrial electrical activity. The recorded ECG shows atrial ectopic beats with long coupling intervals, which can only be successfully classified using additional morphology criteria. Esophageal high-resolution ECGs provide this information, whereas surface long-term ECGs show poor atrial signal quality. This new method is a promising tool for the long-term rhythm monitoring with software-based automatic classification of atrial beats. PMID:22610727

Niederhauser, Thomas; Marisa, Thanks; Haeberlin, Andreas; Goette, Josef; Jacoment, Marcel; Vogel, Rolf

2012-07-01

102

An Incidentally Discovered Left Atrial Appendage Membrane: Case Report and Literature Review  

PubMed Central

The left atrial appendage (LAA) is an extension of the left wall of the atrium and its close anatomic relationship to the free wall of the left ventricle gives it anatomic characteristics distinct from the left atrium. To date, only seven cases involving a LAA membrane have been described. A patient with an incidentally discovered, partially obstructive membrane at the orifice of the LAA, causing functional stenosis is presented, and our case is compared to those in the existing literature. The clinical significance of LAA membranes remains unknown. These rare membranes are usually an incidental finding on transesophageal echocardiogram during evaluation of an atrial dysrhythmia. It is not clear if these membranes could be promoting atrial fibrillation or if the association is merely a result of sampling bias. These membranes may also affect cardioembolic risk. Finally, the increasing use of percutaneous catheter-based therapies such as radiofrequency ablation and occlusion of the left atrial appendage, will likely result in the increasingly frequent identification of these membranes, and when present may increase the technical difficulty associated with these catheter-based therapies.

Hunt, Marc; Geimer-Flanders, Jone

2012-01-01

103

[Unexpected atrial fibrillation when monitoring in operating room. Case of the trimester].  

PubMed

A real case reported to the SENSAR database of incidents is presented. In a patient scheduled for nose fracture repair surgery an unexpected atrial fibrillation was found when monitored in the operating room. The operation was not delayed. After induction of general anaesthesia heart rate suddenly increased and hemodinamic situation was impaired. Cardioversion was required. Two electric countershocks were given but sinus rhythm was not restored. Heart rate was controlled with amiodarone infusion. Optimal defibrillation characteristics are described in these cases. Increased risk of thromboembolism (1-2%) following cardioversion is present even if atrial thrombi are ruled out. The mainstay therapies of are rhythm and rate control and prevention of thromboembolic complications. We describe recommendations on the management of these critical situations with emphasis in learning through the creation of protocols and training practice in simulation. PMID:24287084

2014-05-01

104

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

PubMed Central

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

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

2014-01-01

105

Synchronous occurrence of odontogenic myxoma with multiple keratocystic odontogenic tumors in nevoid basal cell carcinoma syndrome.  

PubMed

The keratocystic odontogenic tumor (KCOT) is a benign developmental tumor with many distinguishing clinical and histologic features. Usually, multiple KCOTs occur as a component of nevoid basal cell carcinoma syndrome. The odontogenic myxoma is a rare benign tumor that represents about 3% of all odontogenic tumors. This article reports the case of mandible odontogenic myxoma with synchronous occurrence of multiple KCOTs, partial expression of nevoid basal cell carcinoma syndrome. A review of the international literature is also presented. PMID:24163866

Shao, Zhe; Liu, Bing; Zhang, WenFeng; Chen, XinMing

2013-09-01

106

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.

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

2013-01-01

107

Cardiac myxoma: the grand masquerader.  

PubMed

Cardiac myxoma is the most common primary tumor of the heart. A high suspicion of this potentially lethal disease is warranted because it may mimick a large variety of diseases. Two patients with different symptoms and signs are presented, in whom resection of the tumor was successful. Complete resection of the tumor is the only effective method of treatment. PMID:1922885

van Son, J A; Corten, P M; Poels, E F; van de Wal, H J; Lacquet, L K

1991-06-01

108

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

PubMed Central

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

WU, XIAOLIN; ZHU, RUI; JIANG, HONG; LIU, WENWEI

2013-01-01

109

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

NSDL National Science Digital Library

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

Schubert, Eric

2007-12-14

110

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

111

Atrial septal stenting to increase interatrial shunting in cyanotic congenital heart diseases: a report of two cases.  

PubMed

Aiming to increase mixing at the atrial level, atrial septal stenting was performed in two pediatric cases with cyanotic congenital cardiac diseases. The first case was a 3-month-old male infant with transposition of the great arteries. The second case was an 18-month-old male infant with increased central venous pressure due to postoperative right ventricular outflow tract obstruction. Premounted bare stents of 8 mm in diameter were used in both cases. The length of the stent was 20 mm in the first case and 30 mm in the latter. The procedure was accomplished without any complications. In the first case, oxygen saturation increased approximately 20-25% with no significant interatrial gradient. In the latter, central venous pressure decreased from 16 to 8 mmHg immediately after the procedure. The patient was weaned from the ventilator on the second day and discharged from intensive care unit on the fifth day. Follow-up echocardiograms of both patients showed patent stents with good position relative to the atrial septum. Stenting of the atrial septum seems to be a safe and effective method to create a reliable, nonrestrictive interatrial communication. PMID:21743269

Yalç?n, Yal?m; Zeybek, Cenap; Onsel, Ibrahim Ozgür; Bilal, Mehmet Salih

2011-07-01

112

Amplatzer Amulet left atrial appendage occluder entrapment through mitral valve.  

PubMed

We report on a 77-year-old woman in whom percutaneous left atrial appendage (LAA) closure was performed. The patient had a left atrial myxoma resection 3 years previously, and 2 years later, she suffered a transient ischemic attack. Atrial fibrillation was detected and anticoagulation therapy was established. An episode of intracranial bleeding forced interruption of anticoagulation. Thus, percutaneous LAA closure with an Amplatzer Amulet LAA Occluder (St Jude Medical) was proposed. During the procedure, the LAA occluder migrated and became trapped in the mitral valve. Secondary massive mitral regurgitation and hemodynamic instability forced emergent cardiac surgery. Successful removal of the Amplatzer Amulet LAA Occluder was achieved. PMID:24182760

González-Santos, Jose María; Arnáiz-García, María Elena; Arribas-Jiménez, Antonio; López-Rodríguez, Javier; Rodríguez-Collado, Javier; Vargas-Fajardo, María del Carmen; Dalmau-Sorlí, María José; Bueno-Codoñer, María Encarnación; Arévalo-Abascal, R Adolfo

2013-11-01

113

Atrial Septal Defect (For Parents)  

MedlinePLUS

About Atrial Septal Defects An atrial septal defect (ASD) — sometimes referred to as a hole in the ... of the heart (the atria). In most cases ASDs are diagnosed and treated successfully with few or ...

114

Missed case of sinus venosus atrial septal defect post coronary artery bypass grafting.  

PubMed

We report a case of a 41-year-old Indian man who initially underwent an emergency coronary artery bypass grafting surgery (CABG) after presenting with an anterolateral myocardial infarction.Post-operatively he developed progressively worsening symptoms of right heart failure with increasing abdominal distension and lower limb swelling. Clinically, the patient was in NYHA class 4 heart failure.He was admitted multiple times for the treatment of his heart failure, which was recalcitrant to diuretic therapy.He subsequently underwent an MRI scan, which revealed near transmural myocardial infarction involving mainly the left side of the heart. The right atrium and ventricle were grossly dilated, with moderate to severe right ventricular systolic dysfunction. A sinus venosus atrial septal defect with right-sided partial anomalous pulmonary venous drainange (PAPVD) was noted. He subsequently underwent surgery to repair the sinus venosus atrial septal defect (ASD) as well as re-route the PAPVD to the left atrium (LA). He was discharged on post-operative day 19 with oral diuretics.On follow-up at 1 month, the patient's symptoms had resolved and his clinical status corresponded to NYHA class 1-2. PMID:24884712

De, Sudeep Das; Maung Maung Aye, Winn; Shankar, Sriram

2014-01-01

115

Missed case of sinus venosus atrial septal defect post coronary artery bypass grafting  

PubMed Central

We report a case of a 41-year-old Indian man who initially underwent an emergency coronary artery bypass grafting surgery (CABG) after presenting with an anterolateral myocardial infarction. Post-operatively he developed progressively worsening symptoms of right heart failure with increasing abdominal distension and lower limb swelling. Clinically, the patient was in NYHA class 4 heart failure. He was admitted multiple times for the treatment of his heart failure, which was recalcitrant to diuretic therapy. He subsequently underwent an MRI scan, which revealed near transmural myocardial infarction involving mainly the left side of the heart. The right atrium and ventricle were grossly dilated, with moderate to severe right ventricular systolic dysfunction. A sinus venosus atrial septal defect with right-sided partial anomalous pulmonary venous drainange (PAPVD) was noted. He subsequently underwent surgery to repair the sinus venosus atrial septal defect (ASD) as well as re-route the PAPVD to the left atrium (LA). He was discharged on post-operative day 19 with oral diuretics. On follow-up at 1 month, the patient's symptoms had resolved and his clinical status corresponded to NYHA class 1–2.

2014-01-01

116

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

SciTech Connect

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

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

1986-08-01

117

Angioplasty in acute middle cerebral artery stroke due to atrial fibrillation selected by CT perfusion: a case report  

PubMed Central

We report the experience of a case of acute stroke in a patient affected by Rendu Osler syndrome and atrial fibrillation. The combination of dynamic computerized tomography perfusion scans and the use of a high-compliance balloon allowed increasing the treatment window for intra-arterial recanalization over 6 h after stroke onset in a patient with middle cerebral artery occlusion.

2011-01-01

118

Diffuse alveolar haemorrhage secondary to warfarin therapy for atrial fibrillation: a case report and literature review  

PubMed Central

Alveolar haemorrhage is a rare and serious medical emergency with many causes. Diffuse alveolar haemorrhage due to warfarin therapy has been rarely reported in the literature. In this paper, we describe the case of 62-year-old woman with a history of chronic atrial fibrillation treated with warfarin, who was admitted to our institution with haemoptysis and dyspnoea. Alveolar haemorrhage was suspected clinically and subsequently confirmed by bronchoscopy. The patient required aggressive treatment with fresh frozen plasma, vitamin K and mechanical ventilation with a successful outcome. We emphasise the need for early diagnosis and fast therapeutic intervention, especially with over-anticoagulation (INR >9), in patients with this rare and potentially lethal condition.

Waness, Abdelkarim; Aldabbagh, Tarek; Harakati, Mohammed

2009-01-01

119

Spectrum of cardiac tumors excluding myxoma: Experience of a tertiary center with review of the literature.  

PubMed

The aim of this study was to determine the histological spectrum of operated cardiac tumors, excluding myxoma, at a tertiary center in India. Between 1995 and 2010, we encountered 188 cases of operated cardiac tumors that had been subjected to histopathological examination. Morphological characterization was done by light microscopy along with histochemical stains. Immunohistochemistry using a panel of antibodies, i.e., vimentin, desmin, myogenin, smooth muscle actin (SMA), epithelial membrane antigen (EMA), cytokeratins, factor VIII-related antigen, S100-protein, synaptophysin, chromogranin, Bcl2, MIB-1, leukocyte common antigen (LCA), CD 3, CD20, CD34, and CD 99 (MIC-2) was performed wherever applicable. Out of the 188 cases, 184 were primary cardiac tumors, including 170 cases of benign cardiac tumors. Among the benign tumors, myxomas were the most frequent ones (168 cases), followed by fibroma (2 cases). Primary malignancy was diagnosed in 14 cases, including undifferentiated sarcomas, primitive neuroectodermal tumor, rhabdomyosarcoma non-Hodgkin lymphoma, angiosarcoma, synovial sarcoma, and leiomyosarcoma. Metastatic (secondary) tumors were seen in four cases, including one each of adenocarcinoma, choriocarcinoma, renal cell carcinoma, and alveolar soft part sarcoma. Hence, out of the total of 188 cases, 20 were non-myxoma cardiac tumors (NMCTs), including 2 benign tumors, 14 malignant tumors, and 4 metastatic tumors. In our series, the majority of cardiac tumors were primary in nature. The malignant primary tumors outnumbered benign ones, excluding myxomas, and the most common malignant histology was undifferentiated sarcoma, as opposed to the literature. PMID:22078057

Kumar, Narender; Agarwal, Shipra; Ahuja, Arvind; Das, Prasenjit; Airon, Balram; Ray, Ruma

2011-12-15

120

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

121

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

Microsoft Academic Search

Marfan’s syndrome is a common connective tissue disease with different musculoskeletal, ophthalmic and cardiac manifestations.\\u000a Marfan’s patients carry increased risk for cardiac arrhythmias. Only three cases of atrial flutter in Marfan’s patients are\\u000a described in the literature. We report a fourth case of a young Marfan’s patient who presents with typical atrial flutter\\u000a after motor vehicle accident. After electrical cardioversion,

Ahmad Halawa; Vipul Brahmbhatt; Stephen A. Fahrig

2007-01-01

122

Right pulmonary artery to left atrial fistula in a neonate: case report and review of the literature.  

PubMed

A communication between the right pulmonary artery (RPA) and the left atrium is a rare congenital anomaly that presents with cyanosis and heart failure. We describe the surgical repair of an RPA to left atrial fistula using cardiopulmonary bypass in a neonate. Advanced imaging (computed tomography scan) guided the surgical approach. Although previous reports have associated a patent ductus arteriosus with high neonatal mortality, in our case, the ductus arteriosus was actually important for maintaining enough total pulmonary blood flow. PMID:24668980

Mongé, Michael C; Russell, Hyde M; Popescu, Andrada R; Robinson, Joshua D

2014-04-01

123

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

PubMed Central

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

2014-01-01

124

Lift the quilt in case of atrial fibrillation and disc prolapse  

PubMed Central

Background Peripheral embolism to the lower extremities may mimic disc prolapse with severe consequences. Case report A 71-year-old male with a history of chronic alcoholism developed low back pain radiating to both lower extremities in a nonradicular distribution and bilateral dysesthesias of the distal lower legs after lifting a heavy weight. Given that magnetic resonance imaging (MRI) of the lumbar spine showed disc herniation in L3/4 and L4/5, he was scheduled for laminectomy but was unable to undergo surgery due to thrombocytopenia. After transfer to another hospital, persistence of symptoms and signs, absent pulses on the distal lower legs, and rhabdomyolysis with temporary renal insufficiency, peripheral embolism with compartment syndrome was suspected. Magnetic resonance angiography revealed occlusion of the right superficial femoral artery and long high-grade stenosis of the left superficial and profound femoral arteries and distal arteries. He successfully underwent embolectomy and fasciotomy. Conclusions If lumbar pain is not radicular, peripheral pulses are minimally palpable, and distal limbs are cold and show livid decolorization, peripheral embolism is much more likely than disc herniation, particularly if the patient’s history is positive for atrial fibrillation. MRI of the lumbar spine must be interpreted in conjunction with clinical presentation.

Bastovansky, Adam; Ziegler, Kathrin; Stollberger, Claudia; Finsterer, Josef

2012-01-01

125

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

126

Canine atrial fibrillation.  

PubMed

Atrial fibrillation (AF) is the most commonly diagnosed supraventricular tachyarrhythmia in dogs. It typically develops when atrial enlargement occurs secondary to underlying cardiovascular disease. Electrocardiographically, AF is characterized by disorganized atrial electrical activity resulting in an absence of P waves and a rapid, irregular ventricular rate. The hemodynamic consequences of AF include decreased cardiac output and the development of clinical signs of heart failure. Therapeutic management focuses on controlling ventricular rate or restoring and maintaining sinus rhythm using antiarrhythmic medication and, in some cases, biphasic transthoracic electrical cardioversion. The prognosis varies and is especially guarded in the presence of significant underlying cardiac disease, such as dilated cardiomyopathy. PMID:20180218

Saunders, Ashley; Gordon, Sonya; Miller, Matthew

2009-11-01

127

Role of electroanatomic mapping in assessing the extent of atrial standstill: diagnostic and therapeutic implications.  

PubMed

Atrial standstill is characterized by failure of atrial excitation, either spontaneous or induced by atrial electric stimulation. We report the case of a 38-year-old man with severe bradycardia and junctional escape rhythm associated with dilative cardiomyopathy. Electroanatomic mapping showed the absence of atrial viability in almost the entire right atrial endocardial surface and excluded the feasibility of atrial pacing. PMID:19512940

Castro, Antonio; Loricchio, Maria Luisa; Turreni, Federico; Perna, Silvia; Altamura, Giuliano

2009-10-01

128

Atrial Septal Aneurysm Mimicking a Cor Triatriatum Sinister: A Case Report and Review of the Literature  

PubMed Central

An atrial septal aneurysm (ASA) is a rare but well-recognized abnormality of uncertain clinical relevance. It is a localized bulging of the inter-atrial septum into either or both atria during the cardiac cycle. ASA has been reported as an unexpected finding during autopsy but may also be diagnosed in living patients by echocardiographic techniques. We present a 37-year-old woman with a recurrent atypical chest pain of one-year duration. She was found to have a congenital atrial septal aneurysm on evaluation. The echocardiographic images mimicked a left sided cor triatriatum sinister. She had no other symptoms and had no co-morbidities. There was no audible murmur. ASA can mimic cor-triatriatum and echocardiographic examination should be performed from multiple views before any echocardiographic diagnosis is made.

Oyedeji, Adebayo Tolulope; Okunola, Oluyomi; Umar Sani, Mahmoud

2012-01-01

129

Case of single right atrial diverticulum and review of etiology and management.  

PubMed

Single diverticulum of the right atrium is an exceedingly rare congenital malformation. We describe successful surgical resection in a 22-year-old asymptomatic woman with single right atrial diverticulum. An attempt is also made to throw light on the etiology and management of this disease entity. PMID:24570563

Borgohain, Shyamadeep; Malik, Lalitaditya; Prasad, Sarveshwer; Gupta, Anubhav; Grover, Vijay; Gupta, Vijay Kumar

2013-10-01

130

Acute aortoiliac thrombotic occlusion in an infant with protein C deficiency and small atrial sepal defect--a rare case.  

PubMed

Aortoiliac thrombosis is rare in infants and neonates. Protein C deficiency is frequently observed with venous thromboembolism, but off-late report of arterial thrombosis is increasingly common. We report a case of large infrarenal aortoiliac saddle and right popliteal artery thrombosis in a 7-month-old infant, with 3-mm atrial septal defect without clinical and Doppler evidence of deep vein thrombosis, presented with acute bilateral lower limb ischemic attack. Diagnosis was made by computed tomographic (C T) angiography of aorta and bilateral lower limbs. Patient operated on in emergency by transperitoneal route. Aortoiliac and right popliteal artery thromboembolectomy with closure of aortotomy with polytetraflouroethylene patch was performed. PMID:23480928

Yadav, Raj K; Yadav, Vimal Kant; Pokharna, Pradeep; Mathur, Rajendra M

2013-03-01

131

Cardiac myxomas: a long term study  

Microsoft Academic Search

From 1980 to 1992 we followed 12 patients with cardiac myxomas for an average of 4.4 years (8 months–11 years). Presenting symptoms were neurological in four patients (hemiparesis, aphasia, visual field deficits, progressive dementia or vertigo), progressive dyspnoea in six, pulmonary embolism in one, and peripheral arterial or renal emboli in three. The diagnosis was suspected clinically in 11 patients.

H. P. Mattle; D. Maurer; M. Sturzenegger; C. Ozdoba; R. W. Baumgartner; G. Schroth

1995-01-01

132

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.

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

2012-01-01

133

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.

2014-01-01

134

Aggregation of BioGlue(®) presenting as a right atrial mass: a case report.  

PubMed

Use of biological glue during cardiovascular surgery is a common practice, rarely associated with immediate or long-term complications. We present a patient with a right atrial mass as a long-term complication associated with the use of biological glue. Surgical exploration revealed the mass to be an unabsorbed and infected aggregate of biological glue used to stop bleeding from a friable right atrium during previous surgery. PMID:22607106

Ramineni, Rajesh; Mandalapu, Tapasya; Chernobelsky, Alexander

2012-07-01

135

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.

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

2013-01-01

136

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

PubMed

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

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

2013-01-01

137

Atrial Fibrillation  

MedlinePLUS

... speed or rhythm of the heartbeat. Atrial fibrillation (AF) is the most common type of arrhythmia. The ... the heart's electrical system. Often, people who have AF may not even feel symptoms. But you may ...

138

Lack of Association between Stroke and Left Atrial Out-Pouching Structures: Results of a Case-Control Study  

PubMed Central

Background and Purpose Clinical significance of out-pouching structures of the left atrium (LA) as potential embolic sources remains unclear. We sought to evaluate the association between stroke and LA out-pouching structures. Methods A case-control study was conducted to assess the prevalence of LA out-pouching structures in subjects with and without stroke. Case subjects were 270 stroke patients who had undergone cardiac CT. Control subjects were 270 age- and sex-matched patients without a history of stroke and who had undergone cardiac CT. Presence of LA out-pouching structures was determined by ECG-gated cardiac CT. The location of out-pouching structures was categorized as near Bachmann bundle, anterior, inferoseptal, inferior, and lateral. The prevalence, number and location of out-pouching structures and clinical characteristics were compared between the two groups. Results One hundred sixty eight out-pouching structures were identified in 139 stroke patients (51%), while a total of 169 out-pouching structures were found in 155 control patients (57%) (p=0.1949). The prevalence of LA out-pouching structures with different locations was not significantly different between the stroke group and control group. In the stroke group, the prevalence of out-pouching structures was not significantly different by subtypes of ischemic stroke and the prevalence of LA out-pouching structures was not different between patients with atrial fibrillation (AF) and without AF. Conclusion The left atrial out-pouching structures are commonly seen in a population with and without stroke with similar prevalence. Our study suggests that LA out-pouching structures are not significant risk factors of stroke.

Hong, Yoo Jin; Lee, Hye-Jeong; Hur, Jin; Choi, Byoung Wook; Heo, Ji Hoe; Kim, Young Jin

2013-01-01

139

[First episode of atrial fibrillation].  

PubMed

We report the case of a patient seen at the outpatient clinic for a first episode of atrial fibrillation. We discussed the steps of the treatment including anticoagulation, rate and rhythm control. PMID:20499826

Mélon, P; Garweg, C; Piérard, L; Lancellotti, P

2010-04-01

140

[Mitral regurgitation and atrial septum aneurysm complicated with osteogenesis imperfecta;report of a case].  

PubMed

A 43-year-old female with a history of osteogenesis imperfecta was admitted to our hospital for congestive heart failure due to mitral valve regurgitation. The patient had suffered from bone fractures 5 times, dislocation of elbow and fingers 3 times since childhood, and subarachnoid hemorrhage 2 years before. She and her son have blue scleras. She was diagnosed with osteogenesis imperfecta type IA clinically. Echocardiography revealed severe mitral regurgitation and aneurysmal formation in the interatrial septum bulging to the right atrium. Mitral valve replacement and repair of the atrial septum were performed without any blood transfusion, but with rib fractures. Echocardiography showed no peri-valvular regurgitation at 1 year after the valve replacement. Cardiovascular disease is rarely associated with osteogenesis imperfecta, but its surgical mortality rate is high due to coagulation abnormality and fragile tissue. To reduce postoperative complications, precise classification of the disease and careful handling of the tissues during operation will be needed. PMID:24743416

Nagai, Ryo; Hattori, Takashi; Shigeta, Osamu

2014-01-01

141

Mazabraud's syndrome: case report and literature review  

PubMed Central

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

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

2013-01-01

142

[Percutaneous mitral commissurotomy associated to sinus venosus atrial septal defect and partial anomalous pulmonary venous connection: a case report].  

PubMed

Lutembacher's syndrome refers to the rare combination of congenital atrial septal defect and acquired mitral stenosis. It is rarely associated to partial anomalous pulmonary venous connection. This condition is treated surgically by mitral commissurotomy or mitral valve operation with concomitant closure of the atrial septal defect with correction of the abnormal pulmonary venous connection. Percutaneous mitral commissurotomy before surgery can be a therapeutic alternative when mitral valve stenosis is severe and valve anatomy is favourable. The authors bring back the case of a 24 years old man having mitral stenosis in sinus rhythm associated to sinus venosus septal defect and partial anomalous pulmonary venous connection. The diagnosis was made for the age of 17 years old on the occasion of dyspnea. He benefited in February 2003 of rescue percutaneous mitral commissurotomy because of pulmonary oedema. Mitral valve area increased from 0.7 cm(2) to 1.6 cm(2). The patient was clinically approved, so that he refused surgery and was lost sight. Seven years later (August 2010) he was taken back for a second rescue percutaneous mitral commissurotomy because of a very severe mitral stenosis (mitral valve area was 0.8cm(2)), in pulmonary oedema with echocardiographic evaluated pulmonary hypertension at 68mmHg. The trans-septal complicated of a false road from the right atrium, towards the pericardic cavity. The patient was operated as the matter of urgency, and benefited from a mitral valve replacement by mechanical prosthesis, of closure of sinus venosus septal defect by PTFE patch and correction of abnormal pulmonary venous connection. Operating suites were simple, and the postoperative echocardiography concludes to a good prosthesis profile, the absence of residual shunt and a decrease of pulmonary artery blood pressure from 68 to 40mmHg. In conclusion, percutaneous mitral commissurotomy may be a waiting procedure for surgery of this disease or emergency treatment of it's valve anomaly, with regular monitoring while awaiting surgery faster and in better conditions. PMID:22436630

Fradi El Faleh, I; Ezzar, M T; Zaroui, A; Boussaada, R; Mechmèche, R

2014-04-01

143

Macro-reentrant atrial tachycardias.  

PubMed

Macro-reentrant atrial arrhythmias development is conditioned by the presence of fixed (anatomical or acquired) or functional barriers of conduction with areas of slow conduction at critical atrial sites. It may occur with or without underlying heart disease. Recent development of sophisticated 3D mapping systems has greatly contributed to a better understanding of these atrial arrhythmias. However, classical electrophysiological manoeuvres are usually efficient to locate the tachycardia circuit and to find critical isthmuses as well. In the vast majority of the cases, these techniques allow physicians to cure these tachycardias with a high success rate using catheter ablation. PMID:22497047

Anselme, Frédéric; Saoudi, Nadir

2011-01-01

144

Left atrial-esophageal fistula following radiofrequency catheter ablation of atrial fibrillation.  

PubMed

This report describes a fatal case of left atrial-esophageal fistula occurring in a 72-year-old man after a radiofrequency catheter ablation of paroxysmal atrial fibrillation. Catheter ablation was performed around the pulmonary vein using an 8-mm-tip electrode (60 W or 55 degrees C) guided by a 25-mm circular catheter. On day 22 of follow-up, the patient presented with seizures followed by hematemesis due to left atrial-esophageal fistula. His clinical condition deteriorated, and he died of speticemia. Thus, left atrial-esophageal fistula is a sever complication of radiofrequency catheter ablation of the left atrial posterior wall. PMID:15333097

Scanavacca, Mauricio I; D'ávila, André; Parga, José; Sosa, Eduardo

2004-08-01

145

Giant aneurysm of the atrial appendages in infants  

PubMed Central

This case series describe two patients with giant aneurysms of the atrial appendages. This report discusses the clinical symptoms, imaging modalities, indications for surgical intervention, and histology of atrial appendage aneurysms.

Lang, Sean M; Hall, Kevin E; Zaidi, Abbas Haider; Geva, Tal; Sanders, Stephen P; del Nido, Pedro J

2014-01-01

146

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.

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

2012-01-01

147

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

PubMed Central

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.

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

2013-01-01

148

Venous line filtration: a novel technique for cases involving inferior vena caval and right atrial tumor and associated thrombus: a two-case series.  

PubMed

Two patients are presented with right atrial tumors, who were considered to be at risk for tumor thrombus migration down the venous line into the cardiopulmonary bypass (CPB) circuit during surgical excision, which may lead to compromised or interrupted venous drainage. An arterial line filter was placed in the venous line to capture any material that might become dislodged and embolize into the circuit. Vacuum-assisted venous drainage, at approximately -50 mmHg, was used to overcome any resistance caused by the filter in the venous line. In one case, tumor thrombus obstructed the filter, requiring the use of the bypass line around the filter, so venous return could be maintained. In both cases, thrombus was found in the filter. The first case was a 44-year-old female (81 kg, 137 cm, body surface area (BSA) 1.66 m2) who presented with a metastatic pheochromocytoma with associated thrombus arising from the left adrenal gland and extending into the inferior vena cava (IVC) and right atrium. The second case was a 37-year-old male (95 kg, 178 cm, BSA 2.17 m2), who presented with a very large angiosarcoma tumor involving almost the entire right atrium. We have shown that venous line filtration with vacuum-assisted venous drainage can be performed safely, and should be considered in cases where there is tumor thrombus in the vena cava or right atrium, which may threaten venous return. PMID:17312864

Smigla, Gregory R; Lawson, D Scott; Kaemmer, David D; Shearer, Ian R

2006-11-01

149

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

PubMed

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

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

2013-01-01

150

Unusual cause of an ejection murmur: myxoma in the left ventricular outflow tract.  

PubMed

We present the case of a healthy, asymptomatic 50-year-old woman with a systolic ejection murmur who was found to have an obstructive left ventricular outflow tract mass. Transthoracic echocardiography revealed a large mobile mass attached to the basal anterior septum of the left ventricle. Surgical resection was performed and a benign left ventricular outflow tract myxoma was diagnosed. The patient's postoperative course was unremarkable. We describe the clinical presentation and role of 2- and 3-dimensional transthoracic and transesophageal echocardiography in surgical management. PMID:24404613

Rao, Rajeev V; Walsh, Sam; Chan, Vincent; Stadnick, Ellamae; Sohmer, Benjamin; Veinot, John P; Chan, Kwan L

2013-12-01

151

Revelation of changing axis deviation at the end of atrial fibrillation without acute myocardial infarction.  

PubMed

Changing axis deviation has been reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also reported during acute myocardial infarction associated with atrial fibrillation too or at the end of atrial fibrillation during acute myocardial infarction. We present a case of revelation of changing axis deviation at the end of atrial fibrillation without acute myocardial infarction in a 74-year-old Italian man. Also this case focuses attention on changing axis deviation. PMID:19923019

Patanè, Salvatore; Marte, Filippo; Sturiale, Mauro

2012-03-01

152

Echocardiographic detection of left atrial mobile calcium debris of trido valve surgery: a case report  

PubMed Central

Calcification of the cardiac chambers is among the challenges associated with reoperative cardiac surgeries by increasing the risk of systemic embolization. We experienced a case of an unexpected detected mass by intraoperative transesophageal echocardiography during weaning from cardiopulmonary bypass in a patient undergoing trido mitral and tricuspid valve replacement surgery. The surgically removed mass was identified as calcified tissue. This case shows the importance of careful echocardiographic evaluation of the left heart in patients undergoing repeat valve surgery given their greater potential for embolic sources.

Song, Young; Shim, Jae-Kwang; Sun, Jong-Min; Lee, Bora

2014-01-01

153

A large Right atrial mass in a patient with hepatocellular carcinoma: Case report and literature review  

PubMed Central

Background Hepatocellular carcinoma (HCC) is a common malignancy and the most frequent sites of metastasis include lungs, bone, lymphatic, and brain, however, Intra-cardiac involvement rarely develops in patients with HCC and it has poor prognosis. The clinical course may be complicated by many fatal cardiovascular complications. Absence of cardiac symptoms, however, is an unusual condition. Case report We reported a rare case of hepatocellular carcinoma with large invasion into the right atrium and no cardiac symptoms. Conclusion Cardiac metastases occur in 10% of all cancer patients. Heart involvement should be suspected in all patients.

Albackr, Hanan B.

2014-01-01

154

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

Microsoft Academic Search

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

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

2011-01-01

155

Atrial arrhythmias.  

PubMed

Atrial arrhythmias are commonly encountered by the primary care clinician. They are usually asymptomatic or have only minor symptoms, unless the ventricular rate becomes very rapid. The challenges for the clinician are to recognize the benign from the more severe arrhythmias, to identify and treat the precipitating cause, to control the symptoms that concern the patient, and to prevent any complications. There are new medicinal and nonmedicinal treatments available that offer greater likelihood of acute and long-term success in the treatment, and sometimes cure, of the original arrhythmias. PMID:10918675

Applegate, T E

2000-09-01

156

[Contribution of nuclear magnetic resonance in right atrial angiosarcoma. Apropos of a case].  

PubMed

A 25-year old female patient was admitted to hospital for respiratory failure with pulmonary miliary. Subsequently, clinical signs of pericardial tamponade developed. Echocardiography showed a tumour of the right atrium. Malignancy of the tumour was strongly suspected on the basis of magnetic resonance findings. At surgery, the tumour could not be removed and multiple biopsies showed that it was an angiosarcoma with metastases in the lymph nodes and the lungs, the latter presenting as carcinomatous miliary. This case is of interest because of the unusual way the tumour was discovered with a possible alternative diagnosis of cardiac tuberculoma, and because of the usefulness of magnetic resonance imaging to diagnose cardiac tumours and evaluate the extension of those which are malignant. PMID:3147645

Aouate, P; Artigou, J Y; Rovany, X; Orion, L; Salloum, J; Chomette, G; Grosgogeat, Y

1988-12-01

157

Primitive neuroectodermal tumour of the kidney with vena caval and atrial tumour thrombus: a case report  

PubMed Central

Introduction Renal primitive neuroectodermal tumour is an extremely rare malignancy. Case presentation A 21-year-old woman presented with microscopic haematuria, a palpable right loin mass, dyspnoea, dizziness and fatigue. Initial ultrasound scan of the kidneys revealed an 11 cm right renal mass with venous extension into the inferior vena cava. Computed tomography of the thorax and abdomen revealed an extension of the large renal mass into the right renal vein, inferior vena cava and up to the right atrium. A small paracaval lymph node was noted and three small metastatic nodules were identified within the lung parenchyma. The patient underwent a radical nephrectomy and inferior vena caval tumour (level IV) thrombectomy with cardiopulmonary bypass and deep hypothermic circulatory arrest. Immunohistochemical staining of the specimen showed a highly specific cluster of differentiation (CD) 99, thus confirming the diagnosis of a primitive neuroectodermal tumour. Conclusion It is important that a renal primitive neuroectodermal tumour be considered, particularly in young patients with a renal mass and extensive thrombus.

Ong, Poh Ho; Manikandan, Ramaswamy; Philip, Joe; Hope, Kirsten; Williamson, Michael

2008-01-01

158

Surgical management and treatment of a traumatic right atrial rupture  

Microsoft Academic Search

We have treated three patients with blunt traumatic right atrial rupture, all of whom survived after an emergent cardiac repair\\u000a without cardiopulmonary bypass. Cardiac tamponade was seen in two of the three cases on ultrasonographic cardiography (UCG).\\u000a The site of rupture was the right atrial appendage in two cases and the superior vena cava-right atrial (SVC-RA) junction\\u000a in one case.

Takeshi Hakuba; Naoki Minato; Toshinori Minematsu; Keiji Kamohara

2008-01-01

159

Novel Association between Plasma Matrix Metalloproteinase-9 and Risk of Incident Atrial Fibrillation in a Case-Cohort Study: The Atherosclerosis Risk in Communities Study  

PubMed Central

Background Previous cross-sectional studies have suggested that biomarkers of extracellular matrix remodelling are associated with atrial fibrillation (AF), but no prospective data have yet been published. Hence, we examine whether plasma matrix metalloproteinases (MMP) and their inhibitors are related to increased risk of incident AF. Methods We used a case-cohort design in the context of the prospective Atherosclerosis Risk in Communities (ARIC) study. From 13718 eligible men and women free from AF in 1990-92, we selected a stratified random sample of 500 individuals without and 580 with incident AF over a mean follow-up of 11.8 years. Using a weighted proportional hazards regression model, the relationships between MMP-1, MMP-2, MMP-9, tissue inhibitor of matrix metalloproteinase (TIMP)-1, TIMP-2 and C-terminal propeptide of collagen type-I with incident AF were examined after adjusting for confounders. Results In models adjusted for age, sex and race, all biomarkers were associated with AF, but only the relationship between plasma MMP-9 remained significant in the fully-adjusted model: each one standard deviation increase in MMP-9 was associated with 27% (95% Confidence Interval: 7% to 50%) increase in risk of AF with no evidence of an interaction with race or sex. Individuals with above mean levels of MMP-9 were more likely to be male, white and current smokers. Conclusions The findings suggest that elevated levels of MMP-9 are independently associated with increased risk of AF. However, given the lack of specificity of MMP-9 to atrial tissue, it remains to be determined whether the observed relationship reflects the impact of atrial fibrosis or more generalized fibrosis on risk of incident AF.

Huxley, Rachel R.; Lopez, Faye L.; MacLehose, Richard F.; Eckfeldt, John H.; Couper, David; Leiendecker-Foster, Catherine; Hoogeveen, Ron C.; Chen, Lin Yee; Soliman, Elsayed Z.; Agarwal, Sunil K.; Alonso, Alvaro

2013-01-01

160

[Role of internal cardioversion in the treatment of permanent atrial fibrillation. Early results apropos of 28 cases].  

PubMed

Internal cardioversion is a new method of treating atrial fibrillation. It consists in delivering an electric shock between an electrode positioned in the right atrium and a dorsal electrode. A quadripolar electrophysiological catheter is used as the proximal electrode, the two distal poles of which are used to locate the His bundle deflection. Care is taken that the electrode used for cardioversion is not in contact with the atrial wall by using biplane fluoroscopy and unipolar endocavitary recordings. Twenty-eight patients (18 men and 10 women) average age 55 years, underwent this treatment for chronic atrial fibrillation resistant to one or two attempts at external cardioversion. Each patient was given one or two shocks (average 1.68) in the same session. There were 22 immediate reversions to sinus rhythm, giving a primary success rate of 78.57%. Four patients relapsed in the 3 days following the procedure, giving a short term success rate of 64.28%. The minimum effective energy would seem to be 200 joules. The only rhythm complications were sinus bradycardia and/or atrioventricular block lasting a few seconds, both countered by prophylactic ventricular pacing : no traumatic complications due to electric shock were observed. The long term results show sinus rhythm maintained in 66.66% of patients at 6 months and more. In conclusion, internal cardioversion is an effective method of treating cardiac arrhythmias resistant to external cardioversion. The procedure would seem to be reliable and relatively atraumatic. The long term results are promising, particularly the stability of sinus rhythm which seems to be longer than after external cardioversion, by they need further confirmation. PMID:2048924

Chauvin, M; Koenig, A; Theolade, R; Brechenmacher, C

1991-03-01

161

A net clinical benefit analysis of warfarin and aspirin on stroke in patients with atrial fibrillation: a nested case-control study  

PubMed Central

Background As the management of patients treated with anticoagulants and antiplatelet drugs entails balancing coagulation levels, we evaluated the net clinical benefit of warfarin and aspirin on stroke in a large cohort of patients with atrial fibrillation (AF). Methods A population-based cohort study of all patients at least 18?years of age with a first-ever diagnosis of chronic AF during the period 1993–2008 was conducted within the United Kingdom General Practice Research Database. A nested case–control analysis was conducted to estimate the risk of ischemic stroke and intracranial hemorrhage associated with the use of warfarin and aspirin. Cases were matched up to 10 controls on age, sex, and date of cohort entry. The adjusted net clinical benefit of warfarin and aspirin (expressed as the number of strokes prevented per 100 persons per year) was calculated by subtracting the ischemic stroke rate (prevented by therapy) from the intracranial hemorrhage (ICH) rate (increased by therapy). Results The cohort included 70,766 patients newly-diagnosed with chronic AF, of whom 5519 experienced an ischemic stroke and 689 an ICH during follow-up. The adjusted net clinical benefit of warfarin was 0.59 (95% CI: 0.45, 0.73). However, the benefit was not seen for patients below (0.08, 95%: -0.38, 0.54) and above (?0.49, 95% CI: -1.13, 0.15) therapeutic range. The net clinical benefit of warfarin, apparent after 3?months of continuous use, increased as a function of CHADS2 score. The net clinical benefit was not significant with aspirin (?0.07, 95% CI: -0.22, 0.08), though it was seen in certain subgroups. Conclusions Warfarin provides a net clinical benefit in patients with atrial fibrillation, which is maintained with longer duration of use, particularly when used within therapeutic range. A similar net effect is not as clear with aspirin.

2012-01-01

162

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

PubMed

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

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

2014-07-01

163

[Vectorcardiographic findings in atrial enlargement].  

PubMed

Rational interpretation of changes of the P loop, due to atrial enlargements, must be based on the magnitude and spatial orientation of the main resulting vectors of the atrial activation phenomenon. Under normal conditions, these ones give origin to a mean vector oriented to the left, downward and slightly forward. Right atrial enlargement can be recognized by P loops of more than 100 mcv. The main axis of the elongated PF is comprised between + 60 degrees and + 90 degrees; that of the open PH between + 70 degrees and + 80 degrees and that of PS is located around + 135 degrees. Left atrial enlargement can be diagnosed by a characteristic box glove configuration of the PF loop as well as by an eight-shaped PH. In some cases, the PS loop also becomes eight-shaped. Biatrial enlargement gives rise to slurrings and notchings of the distal portion of the PF loop, a diphasic aspect and frequently an eight-shaped configuration of the PH loop and a triangular morphology of PS, whose base lasts 30 msec. or more. PMID:162442

De Micheli, A; Medrano, G

1979-01-01

164

[The Waffle procedure for constrictive epicarditis after direct closure of atrial septal defect; report of a case].  

PubMed

A 20-year-old man was admitted with a diagnosis of constrictive pericarditis 6 months after direct closure of atrial septal defect (ASD). He complained of fatigue and dyspnea. Cardiac echo cardiography, computed tomography (CT), magnetic resonance imaging (MRI) and cardiac catheterization suggested pericardial and epicardial constriction. During the operation, the thickened pericardium was peeled off. Multiple longitudinal and transverse incisions were made in the thickened epicardium as reported by waffle. Postoperative hemodynamic state was improved. The cardiac index increased from 1.91 to 3.17 l/min/m2. The pulmonary capillary wedge pressure (PCWP) decreased from 26 to 14 mmHg, although dip and plateau pattern was maintained. The postoperative course was uneventful. PMID:18078088

Suzuki, K; Tsuboi, H; Murakami, M; Kobayashi, T; Sirasawa, B; Ito, H; Mikamo, A; Hamano, K

2007-12-01

165

Aorto-left atrial tunnel: a rare entity.  

PubMed

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

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

2013-05-01

166

Treatment of an 8-mm Myxoma Using Acellular Corneal Tissue  

PubMed Central

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

Lim, Kyung Sup; Wee, Sung Wook

2014-01-01

167

On the Subviral Agents of Rabbit Myxoma and Shope Fibroma Viruses.  

National Technical Information Service (NTIS)

The results from a study of several characteristics of infective subviral agents which can be separated from the mature particles in the cell lysate from RK cells infected with rabbit myxoma or Shope fibroma viruses are as follows: (1) SVA from myxoma vir...

M. Takehara

1968-01-01

168

Heart rhythm monitoring over 1 year following cardiac surgery in patients with permanent atrial fibrillation: A mono centric prospective case study  

Microsoft Academic Search

Background: Patients with permanent atrial fibrillation have a clearly higher risk for thromboembolic events than people with sinus rhythm. Because also anticoagulant therapy, which is the therapy of choice in chronic atrial fib- rillation, has its risks, intra operative ablation therapy as a concomitant procedure has become more and more im- portant. Nevertheless this option is not available for all

M. Knaut; S. Norkus; S. M. Tugtekin; S. Brose; F. Jung; K. Matschke

169

Atrial isomerism: a surgical experience.  

PubMed

Most publications on atrial isomerism are autopsy or case reports. The authors review 41 consecutive children operated on from 1980 through to 1996 with emphasis on associated cardiac anomalies, surgical procedures and outcome. Left atrial isomerism was present in 23 patients. Interruption of the inferior vena cava (56%), atrio-ventricular septal defect (47%), common atrium (38%) and cor triatriatum sinistrum (30%) were the most common diagnoses. Biventricular repair was achieved in 17 children and total cavo-pulmonary connection in two. Three underwent staged palliation: modified Blalock-Taussig shunt for two and bidirectional Glenn anastomosis for one. The remainder received a cardiac pacemaker. One patient died early after repair. Two underwent reoperation to correct a regurgitant left atrio-ventricular valve: one of these, in another hospital, had peroperative death. Three died later. Actuarial survival rate after repair and total cavo-pulmonary connection that was stabilized after 2 years was 84%. In the 18 children with right atrial isomerism, pulmonary atresia or stenosis predominated (89%) with discordant ventriculo-arterial connection (72%), atrio-ventricular septal defect (72%), 'single' ventricle (55%) and extracardiac total anomalous pulmonary venous drainage (50%). Biventricular repair was achieved in two patients and complete Fontan circulation in eight. The other eight underwent various staged palliative procedures and correction of extracardiac total anomalous pulmonary venous drainage. Five patients died postoperatively: two in our unit after modified Blalock-Taussig shunt and total cavo-pulmonary connection, three in other hospitals after repair (n = 1) and Fontan (n = 2). Five died later. One was lost for review. Survival after repair and Fontan stabilized after 6 months at 49%. In conclusion, the cardiovascular malformations associated with left atrial isomerism can often be successfully corrected. Those accompanying right atrial isomerism usually preclude a biventricular repair, require staged palliation and carry a poor prognosis. PMID:10430527

Sinzobahamvya, N; Arenz, C; Brecher, A M; Urban, A E

1999-06-01

170

Odontogenic myxoma presenting as localized inflammatory gingival enlargement: A diagnostic dilemma.  

PubMed

Odontogenic myxoma (OM) is a rare and locally invasive benign neoplasm found exclusively in the maxillofacial region. The radiographic and clinical features are variable, and the diagnosis is therefore not easy. A case of OM of the maxilla is described in a 19-year-old female, previously diagnosed as inflammatory gingival enlargement. Clinical, histological, radiographic, and computed tomographic (CT) scan assessments were done, which were confirmatory for OM. Surgical excision of the lesion was done. The patient was put on periodic recall, as the recurrence rate of the lesion was high. The biological spectrum of OM was highly variable and diagnosis at an early stage was very difficult. Gingival enlargement presentation might not always be an inflammatory reaction. All possible differential diagnosis should be explored and various diagnostic tools utilized, to screen the enlargement. PMID:23162348

Singhal, Rameshwari; Singh, Aparna; Rastogi, Pavitra; Dixit, Jaya

2012-07-01

171

[Focal atrial tachycardia originating in the right atrial appendage].  

PubMed

We present a case of 14-year-old boy with incessant atrial tachycardia from right atrial appendage, resistant to pharmacotherapy and with early signs of the left ventricle tachyarrhythmic dysfunction. The P-wave was positive in leads I, II, III, aVF, negative in aVR, aVL. Moreover, P waves configuration specific for this localization: negative in V1-V2 that become positive in V3-V6 was present. After first ablation session a recurrence was observed after 3 weeks, due to inadequate power delivery resulting from trabeculation/anatomy that limited conventional ablation catheter cooling. Second ablation session with the use of an active electrode cooling and 3D mapping system was successful. PMID:20054777

Jastrzebski, Marek; Bacior, Bogumi?a; Pitak, Maciej; Za?uska-Pitak, Beata; Rudzi?ski, Andrzej; Czarnecka, Danuta

2009-12-01

172

Ablation of a resistant right atrial appendage tachycardia using a magnetic navigation system.  

PubMed

The right atrial appendage is an uncommon site of origin for ectopic atrial tachycardia. Right atrial appendage tachycardia (RAAT) has been noted to be prevalent in young males and responds well to radiofrequency ablation. We report a case of RAAT resistant to multiple attempts of ablation that responded to ablation using Stereotaxis Niobe™ Magnetic Navigation System (RMN, Stereotaxis, St. Louis, MO, USA). PMID:22486158

Khan, Mohsin K; Elmouchi, Darryl

2013-01-01

173

Mitral chordae myxoma--chordae replacement with a premeasured gore-tex loop using a minimally invasive video-assisted approach  

PubMed Central

Cardiac myxomas are one of the most common types of primary cardiac tumors and are associated with embolization, angina, and sudden death. Most cardiac myxomas arise from the fossa ovalis, while those that arise from the mitral valve are exceedingly rare and those that arise from the chordae are even rarer. We report the case of a 28-year-old Caucasian woman who suffered from a brain infarction. A duplex ultrasound showed no cerebrovascular stenosis or occlusion, but an echocardiogram revealed a left ventricle pedunculated mobile mass (5 mm in diameter) that was attached to the mitral valve chordae tendineae. We elected cardiac surgery to resect the cardiac tumor and to avoid further embolic events. The traditional surgical strategy—mitral valve replacement through full sternotomy—has many disadvantages, particularly for young women. Therefore we desided to use the Premeasured Gore-Tex chordal loop method followed by annuloplasty using a minimally invasive video-assisted approach. Exploration of the mitral valve showed a globular tumor involving the anterior mitral leaflet chordae tendineae, which was removed along with the involved chordae tendineae. Histopathological examination of the tissue revealed a benign polypoid myxoma. The patient had an uneventful recovery and has remained symptom-free. Echocardiography one week after surgery showed satisfactory valve function. We believe our surgical treatment was the most appropriate option for this case and it resulted in an excellent medical outcome and improved the quality of life, including only a small lateral scar without the need for teratogenic anticoagulants.

2013-01-01

174

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

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

1997-01-01

175

Multiple external electrical cardioversions for refractory neonatal atrial flutter.  

PubMed

This report describes a case of atrial flutter in a fetal/neonatal patient who did not respond to adenosine, a propafenone bolus, and three electrical external cardioversions. A fourth direct current cardioversion after propafenone premedication resolved the atrial flutter. The arrhythmia did not recur with propafenone therapy during a 12-month follow-up period. PMID:21965089

Gulletta, Simone; Rovelli, Rosanna; Fiori, Rossana; Bella, Paolo Della

2012-02-01

176

Atrial Arrhythmias and Their Implications for Space Flight - Introduction  

NASA Technical Reports Server (NTRS)

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

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

2010-01-01

177

Transcatheter closure of secundum atrial septal defect with atrial septal defect occlusion system (ASDOS): initial experience and short-term follow-up.  

PubMed

Transcatheter closure of secundum atrial septal defect is a well known alternative to surgery. It was attempted in seven patients (age range 7-34 years, mean 20.1 +/- 6.5 years) with the double umbrella nitinol device (ASDOS, Dr. Ing Osypka, Germany). The interatrial septal anatomy and blood flow were examined by transthoracic and multiplane transoesophageal echocardiography. The size of atrial septal defect varied from 1.25-2.4 cm (mean 1.75 +/- 0.3 cm), minimal septal rim 0.5-1.0 cm (mean 0.75 +/- 0.20 cm), and Qp/Qs 1.6-3.2:1 (mean 2.4 +/- 0.6). One patient had an atrial septal defect following surgery for left atrial myxoma. The procedure which involved the use of monorail system for deployment of device under transoesophageal echocardiography guidance, was successful in six (86%) of the seven patients. The size of the implanted device ranged from 30-45 mm. In two patients, the right atrial umbrella had to be oversized in comparison to the left atrial umbrella for stability and adequate occlusion of the defect. The patient in whom the procedure failed had a defect size of 1.7 cm, with minimal septal rim (anterosuperior) of 5 mm; however, the device could be easily retrieved. Immediately after and at follow-up of one year, transoesophageal echocardiography-guided colour flow mapping revealed complete abolition of left-to-right shunt in five (83%) of the six patients. One patient had a small residual flow at the posterior rim of the defect; none had atrioventricular valve regurgitation. Although the procedure is complex, it is safe with the advantage of excellent control on the monorail system for proper positioning, repositioning and, if required, retrieval of the device. PMID:9835200

Kalra, G S; Verma, P K; Dhall, A; Singh, S; Bhardwaj, S; Arora, R

1998-01-01

178

Subsequent shunt closure after targeted medical therapy can be an effective strategy for secundum atrial septal defect with severe pulmonary arterial hypertension: two case reports : strategy for ASD with severe PAH.  

PubMed

Secundum atrial septal defect (ASD) is the most common form of congenital heart disease in adults. Surgical and transcatheter closures of ASD are widely accepted therapeutic approaches. In patients with severe pulmonary arterial hypertension (PAH), however, the closure of the defect is still controversial. We report two cases of ASD patients with severe PAH successfully repaired subsequent to effective medical therapy. Subsequent shunt closure after targeted medical therapy can be an effective strategy in selected ASD patients with severe PAH. PMID:23595779

Taniguchi, Yu; Emoto, Noriaki; Miyagawa, Kazuya; Nakayama, Kazuhiko; Kinutani, Hiroto; Tanaka, Hidekazu; Shinke, Toshiro; Okada, Kenji; Okita, Yutaka; Hirata, Ken-ich

2014-03-01

179

Atrial Septal Defect  

MedlinePLUS

... Atrial Septal Defect? Atrial septal defect (say: AY-tree-ul SEP-tul DEE-fekt), or ASD for short, is a heart condition that can affect kids. To understand an ASD, it helps to know how the heart works: The heart has four chambers. The lower chambers ...

180

Left Atrial Ablation for Atrial Fibrillation  

PubMed Central

The maze procedure is the gold standard for the ablation of atrial fibrillation, and the “box lesion” around the pulmonary veins is the most important part of this procedure. We have created this lesion with a bipolar radiofrequency ablator, abandoning the usual use of this device (to achieve bilateral epicardial isolation of the pulmonary veins). From March 2004 through the end of May 2010, we performed surgical ablation of atrial fibrillation in 240 patients. Of this number, 205 underwent operation by a hybrid maze technique and the remaining 35 (our study cohort) underwent the creation of a box lesion around the pulmonary veins by means of a bipolar radiofrequency device. Ablation lines were created by connecting the left atriotomy to the amputated left atrial appendage, with 2 ablation lines made with a bipolar radiofrequency device above and below the pulmonary veins. Lesions were made along the transverse and oblique sinuses by epicardial and endocardial application of a bipolar device. The left atrial isthmus was ablated by bipolar radiofrequency and cryoprobe. No complications were associated with the box lesion: 90% and 89% of patients were in sinus rhythm at 3 and 6 months of follow-up, respectively. By creating a box lesion around the pulmonary veins, we expect to improve transmurality by means of epicardial and endocardial ablation of 1 rather than 2 layers of atrial wall, as in epicardial pulmonary vein isolation. Isolation of the entire posterior wall of the left atrium is better electrophysiologically and renders dissection around the pulmonary veins unnecessary.

Sternik, Leonid; Schaff, Hartzel V.; Luria, David; Glikson, Michael; Kogan, Alexander; Malachy, Ateret; First, Maya; Raanani, Ehud

2011-01-01

181

Electrophysiological Mechanisms of Atrial Flutter  

PubMed Central

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

Tai, Ching- Tai; Chen, Shin-Ann

2006-01-01

182

Echocardiographic diagnosis of left ventricular-right atrial communication (Gerbode-type defect) in an adult with chronic renal failure: a case report.  

PubMed

Left ventricular-right atrial communication, known as a Gerbode-type defect, is a rare form of ventricular septal defect. It is usually congenital, but rarely acquired. Clinical presentation is associated with the volume of the shunt. Transthoracic echocardiography is the most useful diagnostic method. We present a 63-year-old man with chronic renal failure and left ventricular-right atrial shunt. PMID:17223611

Eroglu, Serpil; Sade, Elif; Bozbas, Huseyin; Pirat, Bahar; Yildirir, Aylin; Muderrisoglu, Haldun

2008-03-01

183

Spontaneous bone regeneration following mandibular resection for odontogenic myxoma.  

PubMed

Spontaneous bone regeneration is an uncommon condition following traumatic or iatrogenic bone loss. The factors responsible for its occurrence are yet to be fully elucidated. This report presents spontaneous bone regeneration following mandibular resection for a giant odontogenic myxoma in a 16-years-old Nigerian male. New bone formation was observed at the postoperative fourth week and has continued for one year after. Likely factors that favor this occurrence are critically examined. The advantages of spontaneous bone regeneration in resource-poor settings include low biologic and economic costs as compared to bone grafting. PMID:22684138

Adebayo, Ezekiel T; Fomete, Benjamin; Ajike, Sunday O

2012-01-01

184

A Case of Thrombosis of Intra-Atrial Extracardiac Conduit and Left Pulmonary Artery due to Infective Endocarditis After Modified Fontan Operation.  

PubMed

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

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

2014-07-10

185

[Marked PT-INR prolongation associated with appetite loss due to urinary tract infection in a late elderly case with chronic atrial fibrillation].  

PubMed

An 80-year old woman presented with macroscopic hematuria on June 4(th), 2008. She had been suffering from general malaise and appetite loss since about 10 days previously. She had received anticoagulant therapy with warfarin due to chronic atrial fibrillation and PT-INR was well controlled between 1.6-2.2. When she presented, PT-INR was 12.88, and urinary tract infection (UTI) and hypoalbuminemia (2.2 g/dl) were observed. Therefore, warfarin therapy was discontinued, and antibiotics and vitamin K were administered. Normalization of PT-INR resulted in the disappearance of hematuria and UTI improved as a result of antibiotics administration. As the appetite loss improved, for serum albumin level increased. The previous dose of warfarin achieved PT-INR around 1.8. Her drug compliance had been good, and she took no drug nor food which could interact with warfarin. We also found no liver dysfunction, acute renal failure, malignancy, nor hyper- or hypo-thyroidism. Hypoalbuminemia caused by appetite loss due to UTI seems very likely to increase concentration of circulating free warfarin resulting in extreme prolongation of PT-INR. Our findings in the present case may suggest that we should pay more attention on changes of drug pharmacokinetics in elderly patients because of their poor adaptation to their circumstances such as infection or dehydration. PMID:20139651

Saito, Ryuhei; Akao, Hironobu; Kaseno, Kenichi; Nomura, Yuusuke; Kitayama, Michihiko; Tsugawa, Hiroichi; Kajinami, Kouji

2009-01-01

186

Lessons in Détente or know thy host: The immunomodulatory gene products of myxoma virus  

Microsoft Academic Search

The poxvirus, myxoma virus, encodes within its genome at least eleven different proteins that compromise, skew, or disable\\u000a the innate and adaptive responses of its hosts. In the laboratory rabbit,Oryctolagus cuniculus, these effects result in myxomatosis, a fatal condition characterized by skin lesions and systemic immunosuppression. Interestingly,\\u000a while myxoma infection also causes skin lesions in its natural host and in

Martha C. Zúñiga

2003-01-01

187

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

PubMed Central

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

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

2014-01-01

188

Atrial Arrhythmias in Astronauts - Summary of a NASA Summit  

NASA Technical Reports Server (NTRS)

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

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

2010-01-01

189

Left atrial extension of metastatic lung tumor via pulmonary vein: report on the first case of Ewing sarcoma  

PubMed Central

Extension of metastatic lung tumors into the left atrium via pulmonary veins is rare. Here, we report the first case of Ewing sarcoma exhibiting such extension. A 31-year-old man with pulmonary metastasis from Ewing sarcoma presented with a mass in the left lung, extending to the left atrium through the left inferior pulmonary vein. As the patient was considered to be at risk of tumor embolism, the mass was excised surgically.

Funakoshi, Yohei; Mukohara, Toru; Kataoka, Tomoko; Tomioka, Hideo; Chayahara, Naoko; Fujiwara, Yutaka; Kiyota, Naomi; Shirasaka, Tomonori; Oka, Takanori; Okada, Kenji; Okita, Yutaka; Hara, Shigeo; Itoh, Tomoo; Fumita, Soichi; Nakagawa, Kazuhiko; Minami, Hironobu

2010-01-01

190

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

PubMed

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

Barake, Walid; Baranchuk, Adrian; Pinter, Arnold

2014-05-01

191

Atrial selectivity of antiarrhythmic drugs.  

PubMed

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

2013-09-01

192

Anticoagulation in atrial fibrillation.  

PubMed

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

Steinberg, Benjamin A; Piccini, Jonathan P

2014-01-01

193

Distribution of atrial electrogram types during atrial fibrillation: Effect of rapid atrial pacing and intercaval junction ablation  

Microsoft Academic Search

Objectives. This study examined the anatomic distribution types and possible determinant of atrial electrogram types during atrial fibrillation.Background. Different types of atrial electrograms during atrial fibrillation have been observed and classified, but their anatomic distribution patterns, determinants and potential usefulness in guiding future catheter ablation are unknown.Methods. Two animal models of atrial fibrillation were used: the sterile pericarditis model (n

Huagui Li; John Hare; Kashef Mughal; David Krum; Michael Biehl; Sanjay Deshpande; Anwer Dhala; Zalmen Blanck; Jasbir Sra; Mohammad Jazayeri; Masood Akhtar

1996-01-01

194

Cardioversion of atrial fibrillation.  

PubMed Central

Cardioversion to sinus rhythm should be considered for all patients in atrial fibrillation in order to improve cardiac performance and perhaps to reduce the long-term risk of thromboembolic complications. Different methods of cardioversion, whether electrical or pharmacological, exist and there is often uncertainty about performing the procedure. In particular, there is often confusion about the use of anti-arrhythmic drugs and the suitable length of anticoagulant therapy required pre- and post-cardioversion. This review discusses the current understanding of electrical and pharmacological cardioversion of atrial fibrillation, the clinical effects and the role of prophylactic anti-arrhythmic and anticoagulant therapy in this procedure. Images Figure 1

Lip, G. Y.

1995-01-01

195

[Two cases of malignant cardiac tumors attached on the anterior mitral valve].  

PubMed

Two cases were reported in which malignant cardiac tumors attached to the mitral valve were diagnosed during their lifetimes using two-dimensional echocardiography. Case 1 was a 29-year-old man with speech disturbance and left hemiparesis. Histological examination of the specimen excised from the cardiac tumor during the operation revealed mesenchymal chondrosarcoma, which is extremely rare etiologically and has never been reported so far. Case 2 was a 62-year-old woman complaining of paroxysmal nocturnal dyspnea and chest pain. The diagnosis of malignant histiocytosis was made from the pathological examination of biopsy specimen taken from the rib metastasis. Using two-dimensional echocardiography, characteristic findings for the cardiac tumor were obtained. The tumor echo in Case 1 showed, unlike to that reported for myxoma, two different echogenic layers; the outer dense and the inner light in the echo density. On surgery, tumor echo was revealed to reflect the cystic lesion. In Case 2, two-dimensional echocardiography on admission revealed two separate tumor echoes which attached to the mitral valve and left atrial wall region, respectively. Within two months, they grew rapidly and finally fused into one mass resulting in so-called ball valve syndrome. Phonocardiographically, the tumor plop in Case 1 was high-pitched in quality, and was extinguished completely after the tumor was resected. The tumor plop in Case 2 was not audible on admission, but became evident after fusion of the tumor echoes and was associated with a presystolic murmur. PMID:6520424

Tashiro, N; Fujino, M; Fukuda, K; Okudaira, T; Inoue, T; Kawaguchi, H; Kumamoto, M; Hiroki, T; Arakawa, K; Sukehiro, S

1984-06-01

196

Permanent atrial standstill with irregular junctional ectopic rhythm mimicking atrial fibrillation.  

PubMed

We present an interesting case of 'pseudo' atrial fibrillation which was further diagnosed as atrial standstill with irregular junctional ectopic rhythm during electrophysiologic study. A 56-year-old woman presented to a health facility with symptoms of palpitation, lightheadedness, and shortness of breath. Upon detection of irregular rhythm with narrow QRS complexes and no visible P waves on the electrocardiogram, newly developed atrial fibrillation was considered and a direct current cardioversion was performed, during which cardiac asystole developed necessitating cardiopulmonary resuscitation. The patient was then transferred to our institution. Echocardiographic examination showed biatrial dilatation, normal left ventricular systolic function, marked left ventricular hypertrophy, severe aortic stenosis, moderate mitral regurgitation, and severe tricuspid regurgitation. The electrocardiogram showed an irregular rhythm with narrow QRS complexes without any fibrillatory f waves and 24-hour Holter monitoring revealed three episodes of ventricular asystole lasting for more than 3.5 seconds. During the electrophysiologic study, no electrical activity was observed at the high and low levels of the right atrial lateral free wall and septal wall. The final diagnosis was established as atrial standstill and irregular junctional ectopic rhythm. The patient refused aortic valve replacement and died due to progression of the underlying disease one year following permanent pacemaker implantation.. PMID:21358233

Türko?lu, Cengizhan; Aliyev, Farid; Celiker, Cengiz; F?ratl?, Inci

2011-01-01

197

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.

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

198

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

199

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

PubMed

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

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

2014-04-17

200

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

201

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

202

Atrial septal defect (ASD)  

MedlinePLUS

Atrial septal defect (ASD) is a heart defect that is present at birth (congenital). While the baby is in the womb, there is normally an opening between the upper chambers of the heart (atria) to allow blood to flow around the ...

203

Management of atrial fibrillation.  

PubMed

Atrial fibrillation (AF) is one of the most common arrhythmias encountered in the adult population. It can be an isolated event or a chronic lifelong rhythm disturbance. The common causes of AF and the presenting electrocardiogram characteristics are outlined. The risks to the patient in AF, the role of the nurse, and treatment options are also discussed. PMID:15000028

Hubbard, Julia

204

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

PubMed

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

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

2014-01-01

205

Acute vagal modulation of electrophysiology of the atrial and pulmonary veins increases vulnerability to atrial fibrillation.  

PubMed

Vagal activity is thought to influence atrial electrophysiological properties and play a role in the initiation and maintenance of atrial fibrillation (AF). We evaluated the effects of acute vagal stimulation on atrial conduction, refractoriness of atrial and pulmonary veins (PVs) and inducibility of AF. An open-chest epicardial approach was performed in New Zealand White rabbits with preserved autonomic innervation. Atrial electrograms were obtained with four unipolar electrodes placed epicardially along the atria (n = 22) and an electrode adapted to the proximal left PV (n = 10). The cervical vagus nerve was stimulated with bipolar platinum electrodes (20 Hz). Epicardial activation was recorded in sinus rhythm, and effective refractory periods (ERPs), dispersion of refractoriness and conduction times from high-lateral right atrium (RA) to high-lateral left atrium (LA) and PVs assessed at baseline and during vagal stimulation. Burst pacing (50 Hz, 10 s), alone or combined with vagal stimulation, was applied to the right (RAA) and left atrial appendage (LAA) and PVs to induce AF. At baseline, ERPs were lower in PVs than in LA and LAA, but did not differ significantly from RA and RAA, and there was a significant delay in the conduction time from RA to PVs compared with the activation time from RA to LA (P < 0.01). During vagal stimulation, ERP decreased significantly at all sites, without significant differences in the dispersion of refractoriness, and the atrial conduction times changed from 39 ± 19 to 49 ± 9 ms (RA to PVs; n.s.) and from 14 ± 7 to 28 ± 12 ms (RA to LA; P = 0.01). Induction of AF was reproducible in 50% of cases with 50 Hz and in 82% with 50 Hz combined with vagal stimulation (P < 0.05). During vagal stimulation, AF cycle length decreased at all sites, and AF duration changed from 1.0 ± 0.9 to 14.0 ± 10.0 s (P < 0.01), with documentation of PV tachycardia in three cases. In 70% of the animals, AF ceased immediately after interruption of vagal stimulation. We conclude that in the intact rabbit heart, vagal activity prolongs interatrial conduction and shortens atrial and PV ERP, contributing to the vulnerability to the induction and maintenance of AF. This model may be useful in the assessment of the autonomic influence in the mechanisms underlying AF. PMID:20952490

Oliveira, Mário; da Silva, M Nogueira; Geraldes, Vera; Xavier, Rita; Laranjo, Sérgio; Silva, Vitor; Postolache, Gabriela; Ferreira, Rui; Rocha, Isabel

2011-02-01

206

Transcriptional Remodeling of Rapidly Stimulated HL-1 Atrial Myocytes Exhibits Concordance with Human Atrial Fibrillation  

PubMed Central

During atrial fibrillation (AF), rapid stimulation causes atrial remodeling that increases arrhythmia susceptibility. Using an established atrial (HL-1) myocyte model, we investigated the transcriptional profile associated with early atrial myocyte remodeling. Spontaneously contracting HL-1 cells were cultured in the absence and presence of rapid stimulation for 24 hrs and RNA harvested for microarray analysis. We identified 758 genes that were significantly altered with rapid stimulation (626 up- and 132 down-regulated). Results were confirmed using real-time quantitative RT-PCR for selected genes based on physiological relevance in human AF and/or experimental atrial tachycardia (AT), and regulation in the microarray results. In some cases, transcriptional changes were rapid, occurring within 3 hours. For a selected group of genes, results were validated for the expressed protein, with findings that correlated with observed transcriptional changes. Significantly regulated genes were classified using the Gene Ontology Database to permit direct comparison of our findings with previously published myocardial transcriptional profiles. For broad functional categories, there was strong concordance between rapidly stimulated HL-1 myocytes and human AF, but not for other remodeling paradigms (cardiomyopathy and exercise). Many individual gene changes were conserved with AF/AT, with marked up-regulation of genes encoding brain and atrial natriuretic peptide precursors, and heat shock proteins. For the conserved genes, both a cellular stress and survival response was evident. Our results demonstrate similarities with human AF/experimental AT with respect to large-scale patterns of transcriptional remodeling, as well as regulation of specific individual genes. Importantly, we identified novel pathways and molecules that were concordantly regulated in vivo.

Mace, Lisa C.; Yermalitskaya, Liudmila V.; Yi, Yajun; Yang, Zhenjiang; Murray, Katherine T.

2009-01-01

207

[Contemporary treatment of atrial flutter].  

PubMed

Atrial flutter is a relatively common arrhythmia that may be associated with substantial symptoms and morbidity. It can be harmful by impairing the cardiac output and by encouraging atrial thrombus formation that can lead to systemic embolization. In patients with atrial flutter four major issues that must be addressed. These are reversion to normal sinus rhythm, maintenance of sinus rhythm, control of the ventricular rate, and prevention of systemic thrombo-embolism. Nowadays, catheter ablation is the first line treatment of recurrent symptomatic or hemodynamically significant atrial flutter. PMID:24463378

Kobza, Richard

2014-02-01

208

Large free-floating left atrial thrombus with normal mitral valve  

PubMed Central

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

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

2013-01-01

209

Cryoablation of atrial fibrillation  

Microsoft Academic Search

Atrial fibrillation (AF) is a significant burden to the public health. AF is associated with increased morbidity and mortality,\\u000a including an increased risk of heart failure, stroke, cognitive impairment, and diminished quality of life. Catheter ablation\\u000a is an effective therapy for recurrent, symptomatic, drug-refractory AF. To date, radiofrequency ablation has been the most\\u000a common catheter-based method of pulmonary vein isolation;

Jonathan P. Piccini; James P. Daubert

210

The atrial natriuretic factor.  

PubMed Central

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

Genest, J

1986-01-01

211

ABC of atrial fibrillation. Antithrombotic treatment for atrial fibrillation.  

PubMed Central

Antithrombotic prophylaxis with long term warfarin or aspirin reduces thromboembolic risk in atrial fibrillation. Identification, risk assessment, and regular review of all patients with atrial fibrillation should be routine in general and hospital practice. Risk stratification is easily performed on clinical grounds--echocardiography may refine it. Images p45-a p45-b

Lip, G. Y.; Lowe, G. D.

1996-01-01

212

Partial left pericardial defect with herniation of the left atrial appendage  

Microsoft Academic Search

A case is reported of herniation of the left atrial appendage through a partial pericardial defect, probably congenital. The diagnosis was suggested by the history of chest pain and bulging of the middle segment of the left heart border on the plain chest film, without other signs. Angiography revealed a dilated left atrial appendage. An artificial left pneumothorax confirmed the

C. Pernot; J C. Hoeffel; M. Henry; R. Frisch; B. Brauer

1972-01-01

213

Safety and efficacy of intravenous diltiazem in atrial fibrillation or atrial flutter  

Microsoft Academic Search

This study examines the efficacy of various doses of intravenous dilfiazem to control the ventricular response during atrial fibrillation or atrial flutter. Control of the ventricular response of patients with atrial fibrillation and a rapid ventricular response can provide patients with relief of symptoms and improve hemodynamics. Eighty-four consecutive patients with atrial fibrillation or atrial flutter, or both, received an

Kenneth A. Ellenbogen; Virgil C. Dias; Frank P. Cardello; William E. Strauss; Charles A. Simonton; Scott J. Pollak; Mark A. Wood; Bruce S. Stambler

1995-01-01

214

Reversal of atrial electrical remodeling following cardioversion of long-standing atrial fibrillation in man  

Microsoft Academic Search

Background: In animal studies, atrial fibrillation has been shown to shorten the atrial refractory period and impair its rate adaptation. However, little is known about the effects of chronic atrial fibrillation on atrial electrophysiology and its recovery course in humans. Methods and results: Nineteen patients, mean age 64614 years, with chronic atrial fibrillation of more than six months duration were

Wen-Chung Yu; Shih-Huang Lee; Ching-Tai Tai; Chin-Feng Tsai; Ming-Hsiung Hsieh; Chien-Cheng Chen; Yu-An Ding; Mau-Song Chang; Shih-Ann Chen

215

Alterations in atrial electrophysiology associated with chronic atrial fibrillation in man  

Microsoft Academic Search

Methods and Results Atrial monophasic action potential duration at 90% repolarization and the eVective refractory period were measured in 13 patients with chronic persistent atrial fibrillation after low-energy endocardial cardio- version, and compared to eight controls without a history of atrial fibrillation. Measurements were made at the right atrial appendage and midlateral right atrial wall at basic, 600 ms and

K. Kamalvand; K. Tan; G. Lloyd; J. Gill; C. Bucknall; N. Sulke

1999-01-01

216

The hypoplastic left heart syndrome with intact atrial septum: atrial morphology, pulmonary vascular histopathology and outcome  

Microsoft Academic Search

OBJECTIVESThe purpose of this study was to investigate the outcome in infants with hypoplastic left heart syndrome and intact atrial septum and to evaluate the relationship of atrial morphology, left atrial decompression pathway and lung histopathology to outcome.BACKGROUNDIn the hypoplastic left heart syndrome, severe restriction at the atrial level results in marked systemic hypoxemia after birth. Infants with intact atrial

Jack Rychik; Jonathan J Rome; Margaret H Collins; William M DeCampli; Thomas L Spray

1999-01-01

217

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

PubMed Central

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

Liu, Jia; Wennier, Sonia; McFadden, Grant

2010-01-01

218

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

219

Genetics Home Reference: Carney complex  

MedlinePLUS

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

220

Detached tip of a transseptal sheath during left atrial ablation.  

PubMed

Left atrial ablation has become more commonplace with the advent of catheter ablation for atrial fibrillation. A number of transseptal sheaths have been produced to enhance safe and efficient catheter manipulation in the left atrium (LA) for these procedures. Some of the sheaths have been subject to recall due to partial or complete detachment of its radiopaque tip. We report a case of a 46 year-old female diagnosed with idiopathic dilated cardiomyopathy that presented with atypical left atrial flutter. During electrophysiologic study, a Swartz braided SL1 (SL-1) transseptal sheath was used to introduce the ablation catheter to the left atrium. During left atrial mapping, the radiopaque tip of the sheath detached from the rest of the sheath and was seen floating in the LA. After exchanging the SL-1 sheath with a deflectable sheath, the detached segment was retrieved out of the LA and eventually out of the vascular system using an angioplasty balloon advanced over a wire and inflated distal to the lumen of the detached tip. The root cause of this malfunction was found to be lack of a secondary bonding process that these sheaths generally undergo during the manufacturing process. We describe the case of a left atrial ablation procedure where a novel percutaneous method was able to successfully retrieve the detached tip of a transseptal sheath from the vascular system, thereby avoiding a potential catastrophic complication or thoracotomy. This method may be useful in other cases where similar circumstances may present. PMID:22162088

El-Damaty, Ahmed; Love, Michael; Parkash, Ratika

2012-02-15

221

Ablation for Atrial Fibrillation  

PubMed Central

Executive Summary Objective To review the effectiveness, safety, and costing of ablation methods to manage atrial fibrillation (AF). The ablation methods reviewed were catheter ablation and surgical ablation. Clinical Need Atrial fibrillation is characterized by an irregular, usually rapid, heart rate that limits the ability of the atria to pump blood effectively to the ventricles. Atrial fibrillation can be a primary diagnosis or it may be associated with other diseases, such as high blood pressure, abnormal heart muscle function, chronic lung diseases, and coronary heart disease. The most common symptom of AF is palpitations. Symptoms caused by decreased blood flow include dizziness, fatigue, and shortness of breath. Some patients with AF do not experience any symptoms. According to United States data, the incidence of AF increases with age, with a prevalence of 1 per 200 people aged between 50 and 60 years, and 1 per 10 people aged over 80 years. In 2004, the Institute for Clinical Evaluative Sciences (ICES) estimated that the rate of hospitalization for AF in Canada was 582.7 per 100,000 population. They also reported that of the patients discharged alive, 2.7% were readmitted within 1 year for stroke. One United States prevalence study of AF indicated that the overall prevalence of AF was 0.95%. When the results of this study were extrapolated to the population of Ontario, the prevalence of AF in Ontario is 98,758 for residents aged over 20 years. Currently, the first-line therapy for AF is medical therapy with antiarrhythmic drugs (AADs). There are several AADs available, because there is no one AAD that is effective for all patients. The AADs have critical adverse effects that can aggravate existing arrhythmias. The drug selection process frequently involves trial and error until the patient’s symptoms subside. The Technology Ablation has been frequently described as a “cure” for AF, compared with drug therapy, which controls AF but does not cure it. Ablation involves directing an energy source at cardiac tissue. For instance, radiofrequency energy uses heat to burn tissue near the source of the arrhythmia. The purpose is to create a series of scar tissue, so that the aberrant electrical pathways can no longer exist. Because the pulmonary veins are the predominant source of AF initiation, the primary goal of ablation is to isolate the pulmonary veins from the left atria through the creation of a conduction block. There are 2 methods of ablation: catheter ablation and surgical (operative) ablation. Radiofrequency energy is most commonly used for ablation. Catheter ablation involves inserting a catheter through the femoral vein to access the heart and burn abnormal foci of electrical activity by direct contact or by isolating them from the rest of the atrium. The surgical ablation is performed minimally invasively via direct visualization or with the assistance of a special scope for patients with lone AF. Review Strategy In March 2006, the following databases were searched: Cochrane Library International Agency for Health Technology Assessment (first quarter 2006), Cochrane Database of Systematic Reviews (first quarter 2006), Cochrane Central Register of Controlled Trials (first quarter 2006), MEDLINE (1966 to February 2006), MEDLINE In-Process and Other Non-indexed Citations (1966 to March 1, 2006), and EMBASE (1980 to 2006 week 9). The Medical Advisory Secretariat also searched Medscape on the Internet for recent reports on trials that were unpublished but that were presented at international conferences. In addition, the Web site Current Controlled Trials (www.controlled-trials.com) was searched for ongoing trials investigating ablation for atrial fibrillation. Search terms included: radiofrequency ablation, catheter ablation and atrial fibrillation. Summary of Findings Sixteen RCTs were identified that compared ablation methods in patients with AF. Two studies were identified that investigated first-line therapy for AF or atrial flutter. Seven other studies examined patients with drug-refra

2006-01-01

222

Protection against Myxomatosis and Rabbit Viral Hemorrhagic Disease with Recombinant Myxoma Viruses Expressing Rabbit Hemorrhagic Disease Virus Capsid Protein  

Microsoft Academic Search

Twomyxomavirus-rabbithemorrhagicdiseasevirus(RHDV)recombinantviruseswereconstructedwiththe SG33 strain of myxoma virus to protect rabbits against myxomatosis and rabbit viral hemorrhagic disease. These recombinant viruses expressed the RHDV capsid protein (VP60). The recombinant protein, which is 60 kDa in size, was antigenic, as revealed by its reaction in immunoprecipitation with antibodies raised against RHDV. Both recombinant viruses induced high levels of RHDV- and myxoma virus-specific antibodies

STEPHANE BERTAGNOLI; JACQUELINE GELFI; GHISLAINE LE GALL; ERIC BOILLETOT; JEAN-FRANCOIS VAUTHEROT; DENIS RASSCHAERT; SYLVIE LAURENT; FREDERIQUE PETIT; CORINE BOUCRAUT-BARALON; ANDALAIN MILON

1996-01-01

223

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

SciTech Connect

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

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

1990-08-01

224

Dronedarone for atrial fibrillation?  

PubMed

Atrial fibrillation (AF) is the commonest sustained heart arrhythmia and is associated with significant morbidity and mortality, with, for example, one in five of all strokes being attributable to the condition. Dronedarone (pronounced dro-ne-da-roan) (Multaq--sanofi-aventis) is a new anti-arrhythmic drug related to the established anti-arrhythmic amiodarone. It is licensed for use in clinically stable adult patients with a history of, or current, non-permanent AF to prevent recurrence of AF or to lower ventricular rate. Here we review its role in the management of patients with non-permanent AF. PMID:21057032

2010-11-01

225

Management of atrial fibrillation  

PubMed Central

Atrial fibrillation (AF) is associated with increases in the risk of mortality, congestive heart failure, and stroke. Medical treatment is aimed at preventing thrombo-embolic complications and reducing symptoms and consequences related to the arrhythmia. In the first section of this review, we discuss the principles of mainstream oral anticoagulant therapy and the possible advantages of the new oral anticoagulants. In the second section, we review the catheter ablation approaches to paroxysmal and persistent/long-standing AF, their results, and the current application of new catheters.

Della Bella, Paolo

2014-01-01

226

Benchmarking electrophysiological models of human atrial myocytes  

PubMed Central

Mathematical modeling of cardiac electrophysiology is an insightful method to investigate the underlying mechanisms responsible for arrhythmias such as atrial fibrillation (AF). In past years, five models of human atrial electrophysiology with different formulations of ionic currents, and consequently diverging properties, have been published. The aim of this work is to give an overview of strengths and weaknesses of these models depending on the purpose and the general requirements of simulations. Therefore, these models were systematically benchmarked with respect to general mathematical properties and their ability to reproduce certain electrophysiological phenomena, such as action potential (AP) alternans. To assess the models' ability to replicate modified properties of human myocytes and tissue in cardiac disease, electrical remodeling in chronic atrial fibrillation (cAF) was chosen as test case. The healthy and remodeled model variants were compared with experimental results in single-cell, 1D and 2D tissue simulations to investigate AP and restitution properties, as well as the initiation of reentrant circuits.

Wilhelms, Mathias; Hettmann, Hanne; Maleckar, Mary M.; Koivumaki, Jussi T.; Dossel, Olaf; Seemann, Gunnar

2013-01-01

227

Frontier of catheter ablation for atrial fibrillation.  

PubMed

The sudden evolution of catheter ablation (CA) therapy for atrial fibrillation (AF) was brought by the discovery of a new insight into the triggering mechanism of AF by Haïssaguerre et al. in 1998. This discovery opened a new era of evolution of ablation therapy of paroxysmal AF (PAF). At the frontier of AF ablation, technical development of CA for long-standing persistent AF (CAF) has been done enthusiastically, although the detailed electrophysiologic mechanism and anatomical substrate of persistent AF remain unknown. Stepwise ablation composed of multiple procedures, circumferential pulmonary vein isolation (PVI), biatrial defragmentation, and anatomical linear ablation with the endpoint of AF termination has been the most widely accepted method, because the efficacy of this method was reported to be surprisingly high during a relatively short duration of follow-up. Recently, they showed this strategy has a significant limitation in efficacy for CAF with long AF duration (>7 years), enlarged left atrium (>50 mm in left anterior descending artery), short AF cycle length (AFCL) (<130 ms) and impaired cardiac function. For cases associated with these clinical, anatomical, and electrophysiological parameters, AF termination as an endpoint might be abandoned if peak prolongation of AFCL, reduction of intra-/inter-atrial AFCL gradient, and low defibrillation threshold are attained after predetermined lesion set is completed. Prolonged procedure with massive tissue ablation to attain AF termination should be avoided, because it potentially increases adverse events during and immediately after the procedure and causes extensive scar-formation in both atria with atrial mechanical dysfunction. PMID:21831596

Iesaka, Yoshito

2011-09-01

228

Atrial Fibrillation During an Exploration Class Mission  

NASA Technical Reports Server (NTRS)

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

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

2010-01-01

229

Atrial standstill with subnodal conduction defect and diffuse ventricular fibrosis managed with low right atrial pacing.  

PubMed

In patients with congenital heart disease presenting with bradyarrhythmia, many electrophysiological abnormalities are found. This report presents a case of a man with surgically corrected single atrium and pulmonary valve stenosis, atrial standstill, delayed AV node conduction, first-degree intra- and second-degree infra-His block, who was permanently paced from a restricted excitable area of the low right atrium, as the pacing threshold was unacceptable at any ventricular site. PMID:14764182

Apostolopoulos, Theodoros; Gatzoulis, Konstantinos; Gialafos, John

2004-02-01

230

Assessment of Left Atrial Ejection Force in Mildly Asphyxiated Newborns  

PubMed Central

Objective Asphyxia-induced cardiac insult is one of the major causes of mortality and morbidity in the course of perinatal asphyxia. Nowadays, a remarkable trend of interest is sensed introducing a plausible modality for early detection of cardiac insults at the beginning stages of asphyxia. In this study we aimed to evaluate diagnostic utility of transmitral Doppler–derived parameters as well as left atrial ejection force index as a marker of left atrial contractile function in these patients. Methods In a prospective study selected cases of 26 asphyxiated newborns with preserved systolic function underwent conventional transmitral Doppler flow echocardiographic assessment. Left atrial ejection force index was further calculated for all patients. Data was compared with normal ranges of healthy newborns in order to clarify the diagnostic utility of these parameters for determining minor cardiac insults in this age group. Findings We found that mildly asphyxiated newborns showed an increase in the values of left atrial ejection force index (5.44±2.12 kilodyne vs. 6.66±2.17 kilodyne, P= 0.02) and left atrial filling fraction (39%±10% vs. 45%±8%, P= 0.01). Furthermore, the acceleration and deceleration rate of early filling flow peak velocity were decreased in this group of asphyxiated newborns. Conclusion Assessment of left atrial ejection force in mildly asphyxiated newborns reveals that newborns with even mild asphyxia, although could not be categorized in conventional grading system, suffer to some extent from a ventricular filling abnormality. This type of latent ventricular filling abnormality could simply be unmasked by calculation of atrial ejection force index.

Kiani, Abdolrazagh; Shabanian, Reza; Rekabi, Mahsa; Kocharian, Armen; Heidari-Bateni, Giv

2012-01-01

231

Atrial and ventricular function after cardioversion of atrial fibrillation.  

PubMed Central

OBJECTIVE--Previous studies on atrial recovery after cardioversion of atrial fibrillation have not taken into account new knowledge about the pathophysiology of transmitral and transtricuspid flow velocity patterns. It is possible to shed further light on this problem if atrioventricular inflow velocity, venous filling pattern, and atrioventricular annulus motion are recorded and interpreted together. DESIGN--Prospective examinations of mitral and tricuspid transvalvar flow velocities, superior caval and pulmonary venous filling, and mitral and tricuspid annulus motion were recorded using Doppler echocardiography. Examinations were performed before and 24 hours, 1 month, and 20 months after cardioversion. SETTING--Tertiary referral centre for cardiac disease with facilities for invasive and non-invasive investigation. PATIENTS--16 patients undergoing cardioversion of atrial fibrillation in whom sinus rhythm had persisted for 24 hours or more. RESULTS--Before conversion there was no identifiable A wave in transvalvar flow recordings. The total motion of the tricuspid and mitral annulus was subnormal and there was no identifiable atrial component. Venous flow patterns in general showed a low systolic velocity. After conversion, A waves and atrial components were seen in all patients and increased significantly (P < 0.01) with time. There was a similar time course for the amplitude of annulus atrial components, an increased systolic component of venous inflow, an increased A wave velocity, and a decreased E/A ratio of the transvalvar velocity curves. The ventricular component of annulus motion was unchanged. Changes in general occurred earlier on the right side than the left. CONCLUSIONS--This study indicates that, in addition to the previously known electromechanical dissociation of atrial recovery that exists after cardioversion of atrial fibrillation, there may also be a transient deterioration of ventricular function modulating the transvalvar inflow velocity recordings. Function on the right side generally becomes normal earlier than on the left. Integration of information from transvalvar inflow curves, annulus motion, and venous filling patterns gives additional insight into cardiac function.

Xiong, C.; Sonnhag, C.; Nylander, E.; Wranne, B.

1995-01-01

232

Transcatheter closure of fossa ovalis atrial septal defect: a single institutional experience.  

PubMed

Transcatheter closure of the fossa ovalis atrial septal defect with adequate rims has become the procedure of choice in recent times. We report our experience with 439 patients who were selected for percutaneous device closure and 430 of whom underwent transcatheter closure of fossa ovalis atrial septal defects from May 1997 to May 2006. Device closure was not attempted in the remaining nine patients after initial evaluation due to high right atrial pressure following balloon occlusion (n=1 not parallel, high pulmonary vascular resistance (n=1), significant coronary artery disease (n=1), or the fact that the atrial septal defect was unsuitable for device closure (n=6). The anatomical size of the atrial septal defects ranged from 7-40 mm. Six patients underwent a combined procedure at the time of the atrial septal defect device closure (balloon pulmonary valvotomy in 4 cases, balloon pulmonary valvotomy and patent ductus arteriosus device closure in 1, and pulmonary ductus arteriosus coil closure in 1). The patients were in the age group of 2-77 years, the mean age being 20 years. Major complications occurred in seven cases. In 4 patients, there was device embolization immediately after deployment; there was left atrial appendage perforation, in one patient leading to cardiac tamponade during deployment of the device, and development of pulmonary edema in two patients. The cases in which device embolization took place underwent conventional surgery for atrial septal defect patch closure, while the patient with left atrial appendage perforation underwent emergency surgery (suturing of the left atrial appendage). Both patients with pulmonary edema were managed conservatively. The immediate success rate of device closure was 96.9%. All but one patient with multiple defects had no residual shunt at follow-up. On three months' to nine years' follow-up, the device remained stable, with no significant residual shunt and no history of thrombus formation on transthoracic echocardiography. PMID:19039149

Tomar, Munesh; Radhakrishnan, Sitaraman; Shrivastava, Savitri

2006-01-01

233

Atrial-selective drugs for treatment of atrial fibrillation.  

PubMed

Atrial fibrillation (AF) is accompanied by a high risk of thromboembolic complications necessitating anticoagulation therapy. Arrhythmias have a high tendency to become persistent. Catheter ablation techniques are highly effective in the treatment of AF; however, these procedures are far too costly and time-consuming for the routine treatment of large numbers of AF patients. Moreover, many patients prefer drug treatment although conventional antiarrhythmic drugs are moderately effective and are burdened with severe cardiac and noncardiac side effects. New antifibrillatory drugs developed for the treatment of AF include multichannel blockers with a high degree of atrial selectivity. The rationale of this approach is to induce antiarrhythmic actions only in the atria without conferring proarrhythmic effects in the ventricles.Atrial selective drug action is expected with ion channel blockers targeting ion channels that are expressed predominantly in the atria, i.e., Kv1.5 (I(Kur)), or Kir 3.1 and Kir 3.4 (I(K,ACh)). Na(+) channel blockers that dissociate rapidly may exert atrial selectivity because of subtle differences in atrial and ventricular action potentials. Finally, atrial-selective targets may evolve due to disease-specific processes (e.g., rate-dependent Na(+) channel blockers, selective drugs against constitutively active I(K,ACh) channels). PMID:21082185

Ravens, U; Christ, T

2010-12-01

234

[Pharmaceutical treatment of atrial fibrillation].  

PubMed

Atrial fibrillation is one of the most common long-lasting arrhythmias of the heart. It leads to an increase in morbidity and a substantial reduction in quality of life in most patients. Therefore, an early and adequate therapy strategy and prevention of comorbidities of atrial fibrillation are demanding. There is no controversy about the pharmaceutical treatment as the first choice and gold standard in atrial fibrillation patients. As there is no evidence that frequency control is superior to rhythm control or vice versa, therapy strategies should depend on the clinical status and comorbidities of the individual patient. However, adequate anticoagulation for prevention of thromboembolism should be performed in every patient, even after conversion of atrial fibrillation into sinus rhythm. PMID:18629452

Sinha, Anil-Martin; Brachmann, Johannes; Schmidt, Martin

2008-06-01

235

If I Had - Atrial Fibrillation  

MedlinePLUS Videos and Cool Tools

... In Depth In the Spotlight If I Had... Universities and Hospitals By Disease or Symptom View QuickTime ... Disease (Interview with Dr. Mary McDermott, MD, Northwestern University) If I Had - Atrial Fibrillation - Dr. John L. ...

236

Stroke Prevention in Atrial Fibrillation  

MedlinePLUS

... Institution: NIH Library User Name Password Sign In Cardiology Patient Page Stroke Prevention in Atrial Fibrillation Christian ... Section Footnotes The information contained in this Circulation Cardiology Patient Page is not a substitute for medical ...

237

Prenatal diagnosis of atrial isomerism in the Korean population  

PubMed Central

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

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

2014-01-01

238

Postoperative Atrial Fibrillation  

PubMed Central

Postoperative atrial fibrillation (POAF) is common among surgical patients and associated with a worse outcome. Pathophysiology of POAF is not fully disclosed, and several perioperative factors could be involved. Direct cardiac stimulation from perioperative use of catecholamines or increased sympathetic outflow from volume loss/anaemia/pain may play a role. Metabolic alterations, such as hypo-/hyperglycaemia and electrolyte disturbances, may also contribute to POAF. Moreover, inflammation, both systemic and local, may play a role in its pathogenesis. Strategies to prevent POAF aim at reducing its incidence and ameliorate global outcome of surgical patients. Nonpharmacological prophylaxis includes an adequate control of postoperative pain, the use of thoracic epidural analgesia, optimization of perioperative oxygen delivery, and, possibly, modulation of surgery-associated inflammatory response with immunonutrition and antioxidants. Perioperative potassium and magnesium depletion should be corrected. The impact of those interventions on patients outcome needs to be further investigated.

Chelazzi, C.; Villa, G.; De Gaudio, A. R.

2011-01-01

239

Mass in the left atrial appendage: a therapeutic dilemma.  

PubMed

This is a case of a persistent mobile mass in the left atrial appendage in which 3-dimensional transesophageal echocardiography provided excellent definition of the contour of the mass and helped in comparison during follow-up. The mass was incidentally found before atrial fibrillation ablation and initially thought to be a thrombus. As it persisted almost unchanged despite adequate anticoagulation, a tumour such as a fibroelastoma became the leading possibility, presenting us with a management dilemma. Ablation was cancelled, and, because the mass was stable with no embolic sequelae, a conservative approach was adopted. The patient was discharged on long-term anticoagulation. PMID:22906804

Natarajan, Arun; Tan, Stuart; Patel, Hetal N; Chukwu, Chukwuma; Harkness, Allan; Harris, Stuart

2013-10-01

240

Atrial fibrillation and pneumothorax after transthoracic needle lung biopsy  

PubMed Central

An obese 65-year-old male smoker with chronic obstructive pulmonary disease developed an iatrogenic pneumothorax with pulmonary haemorrhage during an elective transthoracic needle biopsy of a pulmonary lesion. Successful re-inflation was achieved with a chest drain which was then removed before transfer to the medical ward. He later developed persistent atrial fibrillation with breathlessness and haemoptysis. He was treated empirically for a pulmonary embolus, which was subsequently ruled out with CT pulmonary angiogram. Serial chest radiographs demonstrated recurrence of his pneumothorax and a chest drain was re-inserted. His atrial fibrillation was erroneously managed as supraventricular tachycardia, which was resistant to vagal manoeuvres and adenosine but later responded to intravenous amiodarone before a further relapse. Upon successful management of the pneumothorax, his atrial fibrillation terminated. This case highlighted the persistent and serious nature of complications posttransthoracic needle biopsy.

Liu, Alexander; Southern, Iain; Nicol, Edward

2012-01-01

241

[Massive intravascular haemolysis after percutaneous atrial septal defect closure].  

PubMed

We present a case of a 55 year-old female, who survived a complication of percutaneous closure of atrial septal defect never described before. Within the first day after treatment the device has dislodged and got stuck in the mitral valve apparatus. This has caused mitral insufficiency and massive haemolysis which resolved after interventional removal of the device. PMID:22267428

Sabiniewicz, Robert; Cie?wierz, Dariusz; Meyer-Szary, Jaros?aw; Ereci?ski, Jan

2012-01-01

242

Reconstruction of atrial signals derived from the 12-lead ECG using atrial signal extraction techniques  

Microsoft Academic Search

Several techniques are available for the extraction of the atrial signal from the ECG. Two of these techniques, independent component analysis (ICA) and principal component analysis (PCA), derive global atrial signals which cannot be directly compared with the atrial signals in specific leads. An algorithm for projecting into lead V1 the global atrial signals of these techniques was developed, allowing

P. Langley; J. J. Rieta; M. Stridh; J. Millet-Roig; L. Sornmo; A. Murray

2003-01-01

243

Predictors of atrial rhythm after atrioventricular node ablation for the treatment of paroxysmal atrial arrhythmias  

PubMed Central

Objective—To assess the natural history of the atrial rhythm of patients with paroxysmal atrial arrhythmias undergoing atrioventricular node ablation and permanent pacemaker implantation.?Design and setting—A retrospective cohort study of consecutive patients identified from the pacemaker database and electrophysiology records of a tertiary referral hospital.?Patients—62 consecutive patients with paroxysmal atrial arrhythmias undergoing atrioventricular node ablation and permanent pacemaker implantation between 1988 and July 1996.?Main outcome measures—(1) Atrial rhythm on final follow up ECG, classified as either ordered (sinus rhythm or atrial pacing) or disordered (atrial fibrillation, atrial flutter or atrial tachycardia). (2) Chronic atrial fibrillation, defined as a disordered rhythm on two consecutive ECGs (or throughout a 24 hour Holter recording) with no ordered rhythm subsequently documented.?Results—Survival analysis showed that 75% of patients progressed to chronic atrial fibrillation by 2584 days (86 months). On multiple logistic regression analysis a history of electrical cardioversion, increasing patient age, and VVI pacing were associated with the development of chronic atrial fibrillation. A history of electrical cardioversion and increasing patient age were associated with a disordered atrial rhythm on the final follow up ECG.?Conclusions—Patients with paroxysmal atrial arrhythmias are at high risk of developing chronic atrial fibrillation. A history of direct current cardioversion, increasing patient age at the time of ablation, and VVI pacing are predictive of the development of chronic atrial fibrillation in this patient group.?? Keywords: atrioventricular node ablation;  pacemaker mode;  cardioversion;  atrial fibrillation

Gribbin, G; Bourke, J; McComb, J

1998-01-01

244

Simple Left Atrial Procedure for Chronic Atrial Fibrillation Associated With Mitral Valve Disease  

Microsoft Academic Search

Background. A computerized 48-channel mapping system was used to investigate the characteristics of an atrial epicardial electrogram during chronic atrial fibrillation (AF) in patients with solitary mitral valve disease. We have devised a simple left atrial procedure to eliminate the chronic AF during a mitral valve operation.Methods. Using this mapping system, we performed intraoperative atrial mapping in 11 patients with

Taijiro Sueda; Hideyuki Nagata; Hiroo Shikata; Kazumasa Orihashi; Satoru Morita; Masafumi Sueshiro; Kenji Okada; Yuichiro Matsuura

1996-01-01

245

Right atrial tunnel to the left atrial appendage: a danger during balloon septostomy.  

PubMed

Right atrial tunnel to the left atrial appendage is a very rare anomaly not previously described. Per se, it has no physiological significance but is a source of potential disaster during balloon atrial septostomy. The precise anatomy is demonstrated and ways are proposed to avoid tearing the atrial wall during therapeutic cardiac catheterization. PMID:11526414

Waldman, J D; McFeeley, P; Bornikova, L

2001-01-01

246

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.

2012-01-01

247

Assessment of the dynamics of atrial signals and local atrial period series during atrial fibrillation: effects of isoproterenol administration  

Microsoft Academic Search

BACKGROUND: The autonomic nervous system (ANS) plays an important role in the genesis and maintenance of atrial fibrillation (AF), but quantification of its electrophysiologic effects is extremely complex and difficult. Aim of the study was to evaluate the capability of linear and non-linear indexes to capture the fine changing dynamics of atrial signals and local atrial period (LAP) series during

Luca T Mainardi; Valentina DA Corino; Leonida Lombardi; Claudio Tondo; Massimo Mantica; Federico Lombardi; Sergio Cerutti

2004-01-01

248

Persistent atrial standstill in a cat.  

PubMed

A domestic shorthaired cat was presented with a 1-month history of cardiomegaly and recurrent chylothorax. The heart rate was 130 beats/min and no P waves were present on a surface electrocardiogram. Thoracic radiographs and an echocardiogram demonstrated severe biatrial dilatation, pleural effusion and restrictive pleural disease. Permanent atrial standstill was suspected. Pleurocentesis was performed and therapy was started with enalapril, frusemide and aspirin. Intracardiac electrograms revealed no atrial activity, and atrial pacing failed to elicit atrial or ventricular depolarisations. The patient was euthanased. Necropsy showed severe atrial wall thinning with marked cardiocyte loss. Persistent atrial standstill is a rare disease in the cat. Clinical signs may have been due to loss of atrial function, ventricular diastolic dysfunction, bradycardia, neurohormonal activation and reduced atrial natriuretic peptide plasma concentrations. PMID:10561791

Gavaghan, B J; Kittleson, M D; McAloose, D

1999-09-01

249

Who Is at Risk for Atrial Fibrillation?  

MedlinePLUS

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

250

Atrial fibrillation in endurance athletes.  

PubMed

There is a growing population of veteran endurance athletes, regularly participating in training and competition. Although the graded benefit of exercise on cardiovascular health and mortality is well established, recent studies have raised concern that prolonged and strenuous endurance exercise may predispose to atrial and ventricular arrhythmias. Atrial fibrillation (AF) and atrial flutter are facilitated by atrial remodelling, atrial ectopy, and an imbalance of the autonomic nervous system. Endurance sports practice has an impact on all of these factors and may therefore act as a promoter of these arrhythmias. In an animal model, long-term intensive exercise training induced fibrosis in both atria and increased susceptibility to AF. While the prevalence of AF is low in young competitive athletes, it increases substantially in the aging athlete, which is possibly associated with an accumulation of lifetime training hours and participation in competitions. A recent meta-analysis revealed a 5-fold increased risk of AF in middle-aged endurance athletes with a striking male predominance. Beside physical activity, height and absolute left atrial size are independent risk factors for lone AF and the stature of men per se may explain part of their higher risk of AF. Furthermore, for a comparable amount of training volume and performance, male non-elite athletes exhibit a higher blood pressure at rest and peak exercise, a more concentric type of left ventricular remodelling, and an altered diastolic function, possibly contributing to a more pronounced atrial remodelling. The sports cardiologist should be aware of the distinctive features of AF in athletes. Therapeutic recommendations should be given in close cooperation with an electrophysiologist. Reduction of training volume is often not desired and drug therapy not well tolerated. An early ablation strategy may be appropriate for some athletes with an impaired physical performance, especially when continuation of competitive activity is intended. This review focuses on the prevalence, risk factors, and mechanisms of AF in endurance athletes, and possible therapeutic options. PMID:23610454

Wilhelm, Matthias

2013-01-30

251

Staple closure of the left atrial appendage.  

PubMed

Closure of the fibrillating left atrial appendage has been recommended during mitral valve repair or replacement to prevent systemic emboli postoperatively. Closure of the left atrial appendage has been accomplished in the past by direct intra-atrial suture or by external ligation. The authors have used the TA-55 automatic stapler in 40 patients to close the left atrial appendage during mitral valve surgery. In all patients the closure was effected successfully at the first attempt without complication. PMID:6704817

Landymore, R; Kinley, C E

1984-03-01

252

Comparison of atrial rhythm extraction techniques for the estimation of the main atrial frequency from the 12-lead electrocardiogram in atrial fibrillation  

Microsoft Academic Search

One of the greatest challenges in analysis of the atrial rhythm from the ECG is to distinguish the atrial component from the large ventricular components. Our aim was to compare three techniques of atrial rhythm extraction from three groups working on this problem. 12-lead ECG data from 7 patients in atrial fibrillation were analysed. For extraction of the atrial rhythm,

P. Langley; M. Stridh; J. J. Rieta; L. Sornmo; J. Millet-Roig; A. Murray

2002-01-01

253

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

PubMed Central

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

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

2008-01-01

254

[Transesophageal electroconversion of atrial reentrant tachycardias early or late following surgery for congenital heart disease].  

PubMed

Atrial reentrant tachycardias (ART) are a potentially life-threatening complication in survivors of congenital heart disease surgery. From July 1993 to December 1997, temporary transesophageal pacing was used to convert 29 tachycardia episodes in 19 patients. At the time of the first tachycardia episode, patients' ages were 1 month to 26 years (mean 9.8 yrs). Time from operation to onset of first tachycardia episode ranged from 1 day to 19 years. Onset was within the first 2 weeks postoperatively in 6 patients and occurred later in 13 patients (1 to 19 years after operation). Postoperative pacemaker implantation had been performed in 2 pts; 17 of 19 pts were receiving antiarrhythmic medication. After placing a quadripolar transesophageal catheter, atrial and ventricular signals were recorded and atrial stimulation performed. Atrial cycle length of tachycardia ranged from 160-380 ms with 1:1 to 4:1 AV conduction. Temporary transesophageal pacing was performed following an algorithm starting with 4 extrastimuli (20 ms below atrial cycle length of tachycardia). Tachycardia terminated in 27 of 29 cases (93%) without complications. In 3 cases, conversion was achieved by pacing after amiodarone 5 mg/kg i.v. After tachycardia conversion, sinus- or pacemaker rhythm was present in 20 cases. In 9 cases atrial fibrillation was recorded; spontaneous conversion to sinus rhythm occurred after a maximum of 3 min (7 cases) or persisted and required direct current cardioversion (2 cases). In conclusion, transesophageal atrial pacing is an effective, relatively noninvasive method for conversion of atrial reentrant tachycardias after operation for congenital heart disease. PMID:10209830

Hessling, G; Brockmeier, K; Rüdiger, H J; Ulmer, H E

1999-02-01

255

Transcatheter left atrial appendage occlusion.  

PubMed

Occlusion of the left atrial appendage (LAA) may reduce the risk of stroke in patients with atrial fibrillation (AF). Trials comparing LAA occlusion to warfarin anticoagulation in patients with nonvalvular AF showed a reduction in hemorrhagic stroke, although an increase in safety events due to procedural complications. Long-term follow-up suggests possible superiority of LAA occlusion due to fewer strokes and bleeding events. The superior dosing and safety profiles of the novel oral anticoagulants raise the accepted threshold for safety and efficacy of LAA occlusion procedures, and underscore the need for randomized studies comparing LAA occlusion with these newer anticoagulants. PMID:23931100

Don, Creighton W; Fuller, Cindy J; Reisman, Mark

2013-08-01

256

A review of atrial fibrillation.  

PubMed Central

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

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

2002-01-01

257

Atrial Fibrillation and Delayed Gastric Emptying  

PubMed Central

Background Atrial fibrillation and delayed gastric emptying (DGE) are common after pancreaticoduodenectomy. Our aim was to investigate a potential relationship between atrial fibrillation and DGE, which we defined as failure to tolerate a regular diet by the 7th postoperative day. Methods We performed a retrospective chart review of 249 patients who underwent pancreaticoduodenectomy at our institution between 2000 and 2009. Data was analyzed with Fisher exact test for categorical variables and Mann-Whitney U or unpaired T-test for continuous variables. Results Approximately 5% of the 249 patients included in the analysis experienced at least one episode of postoperative atrial fibrillation. Median age of patients with atrial fibrillation was 74 years, compared with 66 years in patients without atrial fibrillation (p?=?0.0005). Patients with atrial fibrillation were more likely to have a history of atrial fibrillation (p?=?0.03). 92% of the patients with atrial fibrillation suffered from DGE, compared to 46% of patients without atrial fibrillation (p?=?0.0007). This association held true when controlling for age. Conclusion Patients with postoperative atrial fibrillation are more likely to experience delayed gastric emptying. Interventions to manage delayed gastric function might be prudent in patients at high risk for postoperative atrial fibrillation.

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

2011-01-01

258

Apixaban and atrial fibrillation: no clear advantage.  

PubMed

For the prevention of thromboembolic events in patients with atrial fibrillation and a high thrombotic risk, the standard treatment is warfarin, an anticoagulant. Dabigatran, a thrombin inhibitor, is the alternative when warfarin fails to maintain the INR within the therapeutic range. Patients with a moderate thrombotic risk may receive either warfarin or low-dose aspirin. Apixaban, a factor Xa inhibitor anticoagulant, has been authorised in the European Union for use in patients with non-valvular atrial fibrillation and a moderate or high risk of thrombosis. In a double-blind, randomised non-inferiority trial versus warfarin in 18 201 patients, the incidence of stroke or systemic embolism was lower in the apixaban group (average 1.3 versus 1.6 events per 100 patient-years; p = 0.01). This difference was mainly due to a lower incidence of haemorrhagic stroke and did not result in a clear decline in mortality. In addition, these results are undermined by multiple methodological flaws. Clinical evaluation included no trials comparing apixaban with dabigatran; any indirect comparison would be risky given the poor quality of the clinical assessment of both drugs in atrial fibrillation. A double-blind, randomised trial including 5598 patients compared apixaban with aspirin but provided little information on these options in patients with a moderate risk of thrombosis, as most patients were at high risk. In clinical trials, major bleeding events were less frequent with apixaban than with warfarin (average 2.1 versus 3.1 events per 100 patient-years), but they were more frequent with apixaban than with aspirin (1.4 versus 0.9 events per 100 patient-years). In 2013, there is no way of monitoring the anticoagulant activity of apixaban in routine clinical practice, and there is no antidote in case of overdose; the same is true for dabigatran. Apixaban is a substrate for various cytochrome P450 isoenzymes and for P-glycoprotein, creating a risk of multiple drug-drug interactions. In addition, the anticoagulant action of apixaban is increased by renal failure, meaning that renal function must be regularly monitored. In practice, the antithrombotic treatment of choice for patients with atrial fibrillation is warfarin when the risk of thrombosis is high, and warfarin or aspirin when the thrombotic risk is moderate. When the INR cannot be maintained within the desired therapeutic range, it is best to stick with dabigatran. PMID:24669381

2014-02-01

259

[Epidemiology of atrial fibrillation].  

PubMed

Atrial fibrillation (AF) is the most frequent maintained arrhythmia and constitutes a major morbidity cause, especially because of its associated risk of ischemic stoke. Additionally, it represents an independent risk factor for global mortality. The incidence of AF varies, according to different studies, between a minimum of 0.25 per 1000 person/year (women) and 0.9 per 1000 person/year (men) and a maximum of 8.9 per 1000 person/year (women) and 11.5 per 1000 person/year (men). Several cross sectional and prospective studies indicate that the prevalence of AF is inferior to 1% in individuals who are less than 55 years old. It is estimated that this arrhythmia's suffers a significant increase throughout the entire life span, and that its highest raise occurs between the ages of 65 and 80. A Portuguese study performe d between June and November 2003, in the scope of Rede Médicos-Sentinela, showed an AF prevalence of 0.53% in a population of 32,185 Health Centres patients. The mean age of patients suffering from this disease is situated within the interval of 70 to 80 years old. It is inferior for those who suffer from a concomitant cardiovascular disease, being significantly higher for women versus men. The risk factors and comorbidities which are most commonly associated to AF are age, several cardiovascular conditions, alcoholism, family history of AF and hyperthyroidism. Considering the high rate of stroke mortality in Portugal and assuming that AF is present in 15% ischemic stroke triggering and that it increases its risk 2 to 7 times, it can be concluded that knowledge regarding AF's incidence and prevalence in the different age groups will be important in order to improve its level of control, which is essential for preventing stroke and better management of this condition's treatment in the cardiovascular diseases' general context. PMID:21072908

Bonhorst, Daniel; Mendes, Miguel; de Sousa, Joao; Primo, João; Adrag?o, Pedro; Andrade, Sofia; De Macedo, Ana Moita

2010-01-01

260

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

PubMed Central

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

2014-01-01

261

Interatrial blocks. A separate entity from left atrial enlargement: a consensus report.  

PubMed

Impaired interatrial conduction or interatrial block is well documented but is not described as an individual electrocardiographic (ECG) pattern in most of ECG books, although the term atrial abnormalities to encompass both concepts, left atrial enlargement (LAE) and interatrial block, has been coined. In fact, LAE and interatrial block are often associated, similarly to what happens with ventricular enlargement and ventricular block. The interatrial blocks, that is, the presence of delay of conduction between the right and left atria, are the most frequent atrial blocks. These may be of first degree (P-wave duration >120 milliseconds), third degree (longer P wave with biphasic [±] morphology in inferior leads), and second degree when these patterns appear transiently in the same ECG recording (atrial aberrancy). There are evidences that these electrocardiographic P-wave patterns are due to a block because they may (a) appear transiently, (b) be without associated atrial enlargement, and (c) may be reproduced experimentally. The presence of interatrial blocks may be seen in the absence of atrial enlargement but often are present in case of LAE. The most important clinical implications of interatrial block are the following: (a) the first degree interatrial blocks are very common, and their relation with atrial fibrillation and an increased risk for global and cardiovascular mortality has been demonstrated; (b) the third degree interatrial blocks are less frequent but are strong markers of LAE and paroxysmal supraventricular tachyarrhythmias. Their presence has been considered a true arrhythmological syndrome. PMID:22920783

Bayés de Luna, Antonio; Platonov, Pyotr; Cosio, Francisco G; Cygankiewicz, Iwona; Pastore, Carlos; Baranowski, Rafa; Bayés-Genis, Antoni; Guindo, Josep; Viñolas, Xavier; Garcia-Niebla, Javier; Barbosa, Raimundo; Stern, Shlomo; Spodick, David

2012-09-01

262

Enhancement of myocardial vulnerability by atrial fibrillation.  

PubMed

Certain groups are known to have an increased risk for sudden cardiac death. Epidemiologic studies have suggested that patients with atrial fibrillation may be at higher risk. The authors hypothesize that atrial fibrillation may increase myocardial vulnerability. To test this hypothesis, 37 dogs were studied using programmed electrical stimulation techniques to determine myocardial vulnerability as assessed by the ability to provoke ventricular tachycardia. Prior to atrial fibrillation, programmed electrical stimulation did not induce ventricular tachycardia. Aconitine was then topically applied to the right atrial appendage with care taken not to make contact with the ventricle. Application of aconitine caused atrial fibrillation with an increase in ventricular rate, but did not affect arterial blood pressure. Ventricular tachycardia was induced by programmed electrical stimulation studies in 25 of 26 dogs in atrial fibrillation. The enhanced vulnerability was noted following atrial fibrillation, not after aconitine application to the great veins, which did not cause atrial fibrillation. To further exclude the possibility that aconitine application may cause changes in ventricular threshold, atrial fibrillation was induced by pacing techniques in five dogs. Prior to atrial fibrillation induction, programmed electrical stimulation did not induce ventricular tachycardia. Following atrial fibrillation, ventricular tachycardia could be repeatedly induced. Mean heart rate following atrial fibrillation increased, while pacing animals at this increment in rate did not change the noninducibility of dogs in sinus rhythm. Six patients with a history of atrial fibrillation and ventricular tachycardia were studied to determine if AF lowered myocardial threshold to VT induction. Ventricular tachycardia could only be induced by PES techniques in four of five patients when the patients' rhythm was AF (P < 0.05). This study suggests that atrial fibrillation lowers myocardial threshold for ventricular tachycardia induction and thus enhances myocardial vulnerability. The association of AF with a higher incidence of sudden death may be due to an enhanced electrical instability. PMID:14704594

Somberg, John C; Torres, Vilma; Keren, Gad; Butler, Brenda; Tepper, David; Kleinbaum, Herman; Molnar, Janos

2004-01-01

263

Left atrial metastases of poorly differentiated thyroid carcinoma diagnosed by echocardiography and magnetic resonance imaging--case report and review of literature.  

PubMed

Intracardiac metastases of thyroid carcinoma are a rare event. Their incidence is low in large autopsy series, and antemortem diagnosis is even less common. We present the case of a woman with advanced poorly differentiated thyroid carcinoma who had extensive intracardiac metastases. This case highlights the usefulness of echocardiography and magnetic resonance imaging in the diagnosis and differential diagnosis of cardiac metastases. PMID:22044639

Bertoldi, Eduardo Gehling; Severo, Mateus Dornelles; Scheffel, Rafael Selbach; Foppa, Murilo; de Azevedo, Mirela Jobim; Maia, Ana Luiza

2012-02-01

264

Lack of prevention of heart failure by serial electrical cardioversion in patients with persistent atrial fibrillation  

Microsoft Academic Search

OBJECTIVETo investigate the occurrence of heart failure complications, and to identify variables that predict heart failure in patients with (recurrent) persistent atrial fibrillation, treated aggressively with serial electrical cardioversion and antiarrhythmic drugs to maintain sinus rhythm.DESIGNNon-randomised controlled trial; cohort; case series; mean (SD) follow up duration 3.4 (1.6) years.SETTINGTertiary care centre.SUBJECTSConsecutive sampling of 342 patients with persistent atrial fibrillation (defined

A E Tuinenburg; I C Van Gelder; M P Van Den Berg; J Brügemann; P J De Kam; H J G M Crijns

1999-01-01

265

Surgical treatment of atrial septal aneurysm.  

PubMed

The atrial septal aneurysm (ASA) is a morphologic abnormality known to cause peripheral and pulmonary embolism. 28-52% patients with ASA have embolic events. However ASA -- with no other concomittant cardiac patology has rarely been reported as the indication for open heart surgery. In this work, five cases of patients operated for ASA are presented. Embolic complications with cerebral symptoms were presented in three cases. The diagnosis of ASA was established with the use of transesophageal echocardiography. The surgical correction of the defect was performed in extracorporeal circulation. The aneurysmal part of interatrial septum was excised and replaced with a pericardial patch. The postoperative course was uneventful. The patients have no new embolic events during the follow up period of one year. PMID:10064366

Wos, S; Bachowski, R; Domaradzki, W; Jasinski, M; Matuszewski, M; Ceglarek, W; Deja, M

1996-12-01

266

Surgical Therapy of Atrial Fibrillation  

PubMed Central

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

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

2012-01-01

267

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

PubMed

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

2013-09-01

268

Estimation of atrial fibrillatory wave from single-lead atrial fibrillation electrocardiograms using principal component analysis concepts.  

PubMed

A new method for the assessment of the atrial fibrillatory wave (AFW) from the ECG is presented. This methodology is suitable for signals registered from Holter systems, where the reduced number of leads is insufficient to exploit the spatial information of the ECG. The temporal dependence of the bio-electrical activity were exploited using principal component analysis. The main features of ventricular and atrial activity were extracted, and several basis signals for each subspace were determined. Hence, the estimated (AFW) are reconstructed exclusively from the basis signals that formed the atrial subspace. Its main advantage with respect to adaptive template subtraction techniques was its robustness to variations in the QRST morphology, which thus minimised QRST residua. The proposed approach was first validated using a database of simulated recordings with known atrial activity content. The estimated AFW was compared with the original AFW, obtaining correlation indices of 0.774 +/- 0.106. The suitability of this methodology for real recordings was also proven, though its application to a set of paroxysmal AF ECGs. In all cases, it was possible to detect the main frequency peak, which was between 4.6 Hz and 6.9 Hz for the patients under study. PMID:16411627

Castells, F; Mora, C; Rieta, J J; Moratal-Pérez, D; Millet, J

2005-09-01

269

Recurrent pulmonary embolism due to hydatid disease of heart. Study of 3 cases, one with intermittent tricuspid valve obstruction (atrial pseudomyxoma).  

PubMed Central

Three cases of pulmonary hypertension caused by hydatid emboli from the right side of the heart are described; cardiac catheterisation was performed in 2. One case was confirmed at operation and 2 at necropsy. The pulmonary emboli were caused by hydatid vesicles in all 3 cases and in none was there pulmonary thrombosis; free scolices were found in the pulmonary alveoli in 2. In 1 patient with repeated syncopal attacks there was a pedunculated cyst in the right atrium which was though to have intermittently obstructed the tricuspid valve. Gamma radiography, angiocardiography, and necropsy suggested a mechanical cause for the pulmonary hypertenion with no vasoconstrictive element. The surgical patient was alive and well 18 months later. Images

Gilsanz, V; Campo, C; Cue, R; Estella, J; Estrada, R V; Perez-oteiza, C; Rabago, G; Rebollar, J L; Zarco, P

1977-01-01

270

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

Microsoft Academic Search

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

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

2004-01-01

271

Recovery of cardiac function after ablation of atrial tachycardia arising from the tricuspid annulus.  

PubMed

Tachycardia-induced cardiomyopathy is a reversible form of heart failure. An early diagnosis and an effective cure of the underlying tachycardia are crucial for a favorable outcome. Different kinds of atrial and ventricular arrhythmias may induce tachycardiomyopathy. Focal atrial tachycardia may be easily suppressed by means of transcatheter ablation. Relationships between focal atrial tachycardia and tachycardiomyopathy have not been deeply analyzed. In the present paper we report a case of a 76-year-old man with tachycardia-induced cardiomyopathy caused by recurrences of focal atrial tachycardia arising from the tricuspid annulus. The arrhythmia was successfully treated with transcatheter ablation. In the follow-up no recurrences of the arrhythmia occurred and a significant improvement in myocardial function was observed. PMID:16161499

Calò, Leonardo; Sciarra, Luigi; Scioli, Roberto; Lamberti, Filippo; Loricchio, Maria Luisa; Pandozi, Claudio; Santini, Massimo

2005-08-01

272

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

PubMed Central

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

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

2014-01-01

273

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

PubMed

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

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

2014-06-01

274

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

Microsoft Academic Search

Myxoma virus (MV), a member of the family Poxviridae, is the causative agent of myxomatosis, a fatal disease of the European rabbit. The MV genome is a linear, double-stranded DNA molecule that encodes several factors important for evasion of the host immune system. Sequencing the right-end region of the MV genome identified an 801 bp open reading frame (ORF) encoding

Jean-Luc Guerin; Jacqueline Gelfi; Christelle Camus; Maxence Delverdier; James C. Whisstock; Marie-France Amardeihl; Robert Py

2001-01-01

275

Intermittent Right Ventricular Outflow Tract Capture due to Chronic Right Atrial Lead Dislodgement  

PubMed Central

A 58 year old male, known case of type 2 diabetes and hypertension, had undergone implantation of a dual chamber pacemaker(DDDR) in 2007 for complaints of recurrent syncope and trifascicular block with a normal ejection fraction andnormal coronaries. His post implantation parameters were normal at that time.He now presented to our pacemaker clinic where his ECG done showed two types o fpaced complexes. The first few complexes were consistent with atrial sensed right ventricular apical pacing with left superior axis. Later complexes showed loss of atrial sensing with pacing from right ventricular outflow tract(inferior axis) with subtle oscillation in it's axis. On application of magnet, two pacemaker spikes were visible withinterspike interval of 120 ms and paced complexes with inferior axis starting from the first spike suggesting that the atrial lead was responsible for RVOT depolarization. On interrogation of the pacemaker, atrial EGM showed sensed activity from atrium followed by large sensed ventricular complex. Fluoroscopy confirmed that the atrial lead was dislodged and was intermittently prolapsing into the RVOT. Since the patient was asymptomatic, he refused any intervention and subsequentlyhis atrial lead was switched off by telemetry. The above case signifies that asymptomatic lead dislodgement is no talways manifested as loss of capture and even subtle variation of the axis o fthe paced complexes can provide us with a clue that can be confirmed by telemetry of the pacemaker and fluoroscopy.

Choudhury, Partha Prateem; Chaturvedi, Vivek; Mukhopadhyay, Saibal; Yusuf, Jamal

2014-01-01

276

Intermittent Right Ventricular Outflow Tract Capture due to Chronic Right Atrial Lead Dislodgement.  

PubMed

A 58 year old male, known case of type 2 diabetes and hypertension, had undergone implantation of a dual chamber pacemaker(DDDR) in 2007 for complaints of recurrent syncope and trifascicular block with a normal ejection fraction andnormal coronaries. His post implantation parameters were normal at that time.He now presented to our pacemaker clinic where his ECG done showed two types o fpaced complexes. The first few complexes were consistent with atrial sensed right ventricular apical pacing with left superior axis. Later complexes showed loss of atrial sensing with pacing from right ventricular outflow tract(inferior axis) with subtle oscillation in it's axis. On application of magnet, two pacemaker spikes were visible withinterspike interval of 120 ms and paced complexes with inferior axis starting from the first spike suggesting that the atrial lead was responsible for RVOT depolarization. On interrogation of the pacemaker, atrial EGM showed sensed activity from atrium followed by large sensed ventricular complex. Fluoroscopy confirmed that the atrial lead was dislodged and was intermittently prolapsing into the RVOT. Since the patient was asymptomatic, he refused any intervention and subsequentlyhis atrial lead was switched off by telemetry. The above case signifies that asymptomatic lead dislodgement is no talways manifested as loss of capture and even subtle variation of the axis o fthe paced complexes can provide us with a clue that can be confirmed by telemetry of the pacemaker and fluoroscopy. PMID:25057224

Choudhury, Partha Prateem; Chaturvedi, Vivek; Mukhopadhyay, Saibal; Yusuf, Jamal

2014-07-01

277

Repair of atrial septal defects on the perfused beating heart.  

PubMed

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

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

2009-01-01

278

Centrifugal Gradients of Rate and Organization in Human Atrial Fibrillation  

PubMed Central

Introduction Animal studies show that atrial fibrillation (AF) may emanate from sites of high rate and regularity, with fibrillatory conduction to adjacent areas. We used simultaneous mapping to find evidence for potential drivers in human AF defined as sites with higher rate and regularity than surrounding tissue. Materials and Methods In 24 patients (age 61±10 years; 12 persistent) we recorded AF simultaneously from 32 left atrial bipolar basket electrodes in addition to pulmonary veins (PV), coronary sinus and right atrial electrodes. We measured AF cycle length by Fourier transform and electrogram regularity at each electrode, referenced to patient-specific atrial anatomy. Results We analyzed 10,298 electrode-periods. Evidence for potential AF drivers was found in 11 patients (5 persistent). In persistent AF, these sites lay at the coronary sinus and left atrial roof but not PVs, while in paroxysmal AF 6 of 9 sites lay at PVs (p<0.05). During ablation, a subset of patients experienced AF CL prolongation or termination with a focal lesion; in each case this lesion mapped to potential driver sites on blinded analysis. Conversely, sequential mapping failed to reveal these sites, possibly due to fluctuations in dominant frequency at driver locations in the context of migratory AF. Conclusions Simultaneous multi-site recordings in human AF reveal evidence for drivers that lie near PVs in paroxysmal but not persistent AF, and were sites where ablation slowed or terminated AF in a subset of patients. Future work should determine if real-time ablation of AF-maintaining regions defined in this fashion eliminates AF.

Krummen, David E.; Peng, Kevin A.; Bullinga, John R.; Narayan, Sanjiv M.

2010-01-01

279

Atrial fibrillation after taser exposure in a previously healthy adolescent.  

PubMed

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

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

2009-12-01

280

Resuming electroconvulsive therapy (ECT) after emergence of asymptomatic atrial fibrillation during a course of right unilateral ECT.  

PubMed

Atrial fibrillation induced by electroconvulsive therapy (ECT) is rare, with only 3 reported cases. None of those cases involved either young healthy patients or right unilateral ECT. We report a 46-year-old healthy male observed to be in atrial fibrillation immediately after electrical induction of the 25th administration of right unilateral ECT. Diltiazem was administered, and he spontaneously cardioverted. After a negative cardiology workup, he safely resumed ECT. Atrial fibrillation was most likely triggered by autonomic imbalance due to the combination of electrical induction, seizure, and medication. PMID:22343588

Loeffler, George; Capobianco, Marc

2012-03-01

281

Overdrive atrial pacing for conversion of atrial flutter: Comparison of postoperative with nonpostoperative patients  

Microsoft Academic Search

Background Previous studies have reported varying success rates in overdrive pace termination of atrial flutter. We hypothesized that these discrepancies might be caused by differences in study populations. Accordingly, we prospectively compared the success rate of pacing in patients with atrial flutter that occurred after heart surgery with that of patients with atrial flutter from other causes. Methods and Results

Robert W. Peters; Steven R. Shorofsky; Michael Pelini; Mary Olsovsky; Michael R. Gold

1999-01-01

282

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

283

Effects of atrial pacing site on atrial and atrioventricular nodal function  

Microsoft Academic Search

The effects of the site used for atrial pacing on atrial and atrioventricular nodal conduction were assesed in 16 patients. In 13 patients, three atrial pacing sites were used: high right atrium, low lateral right atrium, and midcoronary sinus. Two recording sites were used: low septal right atrium, including His electrogram, and high right atrium. Stimulus (S) to high right

y Leon FA; P Denes; D Wu; R J Pietras; K M Rosen

1975-01-01

284

Atrial activity extraction from atrial fibrillation episodes based on maximum likelihood source separation  

Microsoft Academic Search

A novel non-invasive approach for the atrial wave estimation in atrial fibrillation (AF) episodes is presented. The method is based on the maximum likelihood (ML) solution of independent component analysis (ICA). The densities of the bioelectric independent sources corresponding to the ventricular and atrial activities are previously analyzed, and the prior knowledge extracted from them is considered in order to

Francisco Castells; Jorge Igual; José Millet; José Joaquín Rieta

2005-01-01

285

Validation of a left atrial lesion pattern for intraoperative ablation of atrial fibrillation  

Microsoft Academic Search

Background. Evidence that atrial fibrillation may begin in early stages from triggers or reentry circuits primarily in the left atrium suggests that the entire Maze 3 lesion pattern may be unnecessary. In the present study we describe a new left atrial lesion pattern for intraoperative linear ablation of chronic atrial fibrillation.Methods. Endocardial radiofrequency ablation was performed on 12 dogs with

David C Kress; David Krum; Valeri Chekanov; John Hare; Nicole Michaud; Masood Akhtar; Jasbir Sra

2002-01-01

286

Left atrial rhabdomyosarcoma mimicking mitral valve stenosis.  

PubMed

A rare case of left atrial rhabdomyosarcoma is presented in a patient with symptoms of congestive heart failure mimicking a hemodynamically obstructive mitral stenosis and secondary pulmonary hypertension. Although the diagnosis of a cardiac neoplasm is often difficult, it should be suspected in any patient with idiopathic heart failure refractory to conventional therapy, or with systemic or pulmonary emboli without an obvious source. The possibility of a "tumor plop" should always be considered during auscultation of a diastolic click. If clinically suspected, echocardiography will usually establish the diagnosis and allow follow-up for recurrences. If the tumor is benign, cardiac surgery will be curative and, if malignant, chemotherapy or radiotherapy should be considered. PMID:15227049

Villasenor, H R; Fuentes, F; Walker, W E

1985-03-01

287

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

288

Synovial myxoma in the vertebral column of a dog: MRI description and surgical removal.  

PubMed

A 12 yr old castrated male mixed-breed dog presented with a 2 wk history of progressive tetraparesis. Neurologic deficits included a short-strided choppy gait in the thoracic limbs and a long-strided proprioceptive ataxia in the pelvic limbs. Withdrawal reflexes were decreased bilaterally in the thoracic limbs. Signs were consistent with a myelopathy of the caudal cervical/cranial thoracic spinal cord (i.e., the sixth cervical [C] vertebra to the second thoracic [T] vertebra). A mass associated with the C6-C7 articular facet on the left side was identified on MRI of the cervical spinal cord. The lesion was hyperintense to spinal cord parenchyma on T2-weighted images, hypointense on T1-weighted images, and there was strong homogenous contrast enhancement. Significant spinal cord compression was associated with the lesion. The mass was removed through a C6-C7 dorsal laminectomy and facetectomy. Histopathology of the mass was consistent with a synovial myxoma of the articular facet. A postoperative MRI showed complete surgical resection. Albeit rare, synovial myxomas should be included in the list of differential diagnoses for neoplasms affecting the vertebral columns in dogs. PMID:24659730

Neary, Casey P; Bush, William W; Tiches, Deena M; Durham, Amy C; Gavin, Patrick R

2014-01-01

289

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.

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

290

Comparative analysis of the complete genome sequence of the California MSW strain of myxoma virus reveals potential host adaptations.  

PubMed

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; Ghedin, Elodie

2013-11-01

291

Cardiac embolism after implantable cardiac defibrillator shock in non-anticoagulated atrial fibrillation: The role of left atrial appendage occlusion.  

PubMed

Cardioembolic events are one of the most feared complications in patients with non-valvular atrial fibrillation (NVAF) and a formal contraindication to oral anticoagulation (OAC). The present case report describes a case of massive peripheral embolism after an implantable cardiac defibrillator (ICD) shock in a patient with NVAF and a formal contraindication to OAC due to previous intracranial hemorrhage. In order to reduce the risk of future cardioembolic events, the patient underwent percutaneous left atrial appendage (LAA) occlusion. A 25 mm Amplatzer™ Amulet was implanted and the patient was discharged the following day without complications. The potential risk of thrombus dislodgement after an electrical shock in patients with NVAF and no anticoagulation constitutes a particular scenario that might be associated with an additional cardioembolic risk. Although LAA occlusion is a relatively new technique, its usage is rapidly expanding worldwide and constitutes a very valid alternative for patients with NVAF and a formal contraindication to OAC. PMID:24772261

Freixa, Xavier; Andrea, Rut; Martín-Yuste, Victoria; Fernández-Rodríguez, Diego; Brugaletta, Salvatore; Masotti, Mónica; Sabaté, Manel

2014-04-26

292

Cardiac embolism after implantable cardiac defibrillator shock in non-anticoagulated atrial fibrillation: The role of left atrial appendage occlusion  

PubMed Central

Cardioembolic events are one of the most feared complications in patients with non-valvular atrial fibrillation (NVAF) and a formal contraindication to oral anticoagulation (OAC). The present case report describes a case of massive peripheral embolism after an implantable cardiac defibrillator (ICD) shock in a patient with NVAF and a formal contraindication to OAC due to previous intracranial hemorrhage. In order to reduce the risk of future cardioembolic events, the patient underwent percutaneous left atrial appendage (LAA) occlusion. A 25 mm Amplatzer™ Amulet was implanted and the patient was discharged the following day without complications. The potential risk of thrombus dislodgement after an electrical shock in patients with NVAF and no anticoagulation constitutes a particular scenario that might be associated with an additional cardioembolic risk. Although LAA occlusion is a relatively new technique, its usage is rapidly expanding worldwide and constitutes a very valid alternative for patients with NVAF and a formal contraindication to OAC.

Freixa, Xavier; Andrea, Rut; Martin-Yuste, Victoria; Fernandez-Rodriguez, Diego; Brugaletta, Salvatore; Masotti, Monica; Sabate, Manel

2014-01-01

293

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.

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

2014-01-01

294

Electrophysiological mechanisms of atrial flutter.  

PubMed

Atrial flutter (AFL) is a common arrhythmia in clinical practice. Several experimental models, such as tricuspid regurgitation model, tricuspid ring model, sterile pericarditis model and atrial crush injury model, have provided important information about reentrant circuit and can test the effects of antiarrhythmic drugs. Human AFL has typical and atypical forms. Typical AFL rotates around the tricuspid annulus and uses the crista terminalis and sometimes sinus venosa as the boundary. The tricuspid isthmus is a slow conduction zone and the target of radiofrequency ablation. Atypical AFL may arise from the right or left atrium. Right AFL includes upper loop reentry, free wall reentry and figure-of-8 reentry. Left AFL includes mitral annular AFL, pulmonary vein-related AFL and left septal AFL. Radiofrequency ablation of the isthmus between the boundaries can eliminate these arrhythmias. PMID:19251532

Tai, Ching-Tai; Chen, Shih-Ann

2009-02-01

295

P loops during common and uncommon atrial flutter in man.  

PubMed Central

Atrial flutter has never been satisfactorily defined. The 'common' pattern of flutter was originally described by Lewis in 1913. Less frequently observed forms of flutter are termed 'uncommon'. Sixteen cases of the 'common' and 6 of the 'uncommon' type have been studied using isolated P loop vectorcardiography. All patients had some degree of atrioventricular block but none had evidence of digitalis excess. The atrial rates were regular and were in a range between 250 and 330/minute. Vagal manoeuvres increased AV block in each instance. All those with the 'common' type of flutter had P loops with a caudad-cephalad orientation and fifteen of the sixteen had forces which descended over the right atrium and ascended over the left atrium. The 6 cases of the uncommon type of flutter had rates which ranged between 250 and 300/minute and did not fulfil both of the criteria for 'common' flutter; namely continuous baselineu ndulation and prominent negative P deflections in the inferior leads. The cases with the 'uncommon' type of flutter had a variety of loop patterns. The most frequent type was oriented inferior slightly to the right and anterior. One patient satisfied criteria for left atrial flutter. In another the loop was oriented inferior leftward and anterior. The vectorcardiogram provides a rich source of descriptive data but does not identify the underlying mechanism(s) of flutter. Images

Cohen, S I; Koh, D; Lau, S H; Rosen, K M; Damato, A N

1977-01-01

296

Effect of atrial antitachycardia pacing treatments in patients with an atrial defibrillator: randomised study comparing subthreshold and nominal pacing outputs  

PubMed Central

Objective: To assess the true efficacy of antitachycardia pacing on spontaneous persistent atrial fibrillation in patients with an implanted atrial defibrillator, by comparing the effects of nominal pacing treatment with subthreshold pacing treatment. Design: The effects of antitachycardia pacing and burst 50 Hz atrial pacing on spontaneous atrial arrhythmias were evaluated six months after implantation of a Medtronic Jewel AF® atrial defibrillator. Setting: Cardiology department in a district general hospital. Patients: 15 patients with persistent atrial fibrillation. Interventions: Patients were randomised to either “nominal” output pacing treatment or surface ECG and endocardial electrogram proven subthreshold “sham” pacing treatment for three months, and then crossed over to the alternative treatment for a further three months. Results: During the nominal output phase, 31 episodes of atrial fibrillation were treated with 53 bursts of 50 Hz pacing, 98 sequences of ramp atrial pacing, and 61 sequences of burst atrial pacing. Atrial fibrillation was not pace terminated during any episode. Thirty one episodes of atrial tachycardia were treated with 19 bursts of 50 Hz atrial pacing, 103 sequences of ramp atrial pacing, and 38 sequences of burst atrial pacing. Termination of atrial tachycardia was observed in 17 episodes. During the “sham” pacing period, no episodes were terminated by any pacing treatment. Conclusion: Atrial antitachycardia pacing treatments are ineffective at terminating persistent atrial fibrillation but may be useful in terminating episodes of atrial tachycardia or flutter, thus reducing the burden of arrhythmia.

Mitchell, A R J; Spurrell, P A R; Cheatle, L; Sulke, N

2002-01-01

297

Atrial Fibrillation after Noncardic Surgery  

Microsoft Academic Search

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

Dhiraj D. Narula; Jonathan S. Steinberg

298

New drugs for atrial fibrillation  

Microsoft Academic Search

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Epidemiologic studies suggest that the number of\\u000a patients with AF will triple in the next 30 years, and therefore, its impact on medical and economic issues will further increase.\\u000a Due to the limited efficacy and significant side effects of antiarrhythmic drugs, much effort has been made to develop alternative\\u000a pharmacologic treatments

Matthias Hammwöhner; Jan Smid; Uwe Lendeckel; Andreas Goette

2008-01-01

299

The 'Missing' Link in Atrial Fibrillation Heritability  

PubMed Central

Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, represents a major health burden to individuals and health care system within the Western world. The lifetime risk for the development of AF at age 40 years has been estimated to be approximately 1 in 4. AF is associated with substantial morbidity and a two-fold increased risk of mortality. Given its increasing prevalence with age, coupled with the aging population, the number of Americans affected with AF is expected to increase from ~ 2.3 million in the year 2000 to nearly 16 million by 2050. This AF epidemic is further complicated by the lack of highly effective therapies. One reason for the lack of effective therapies for AF stems from incomplete understanding of the complex pathophysiology of the arrhythmia. AF has often been regarded as a condition that occurs in the context of atrial electrical and structural remodeling that can result from cardiac and systemic disorders. However, up to 30% of patients have no obvious cause and are said to have idiopathic or “lone” AF. Up until recently, AF was considered to be a sporadic, non-genetic disorder, but we and others have shown that lone AF has a substantial genetic basis. Mutations in genes encoding cardiac ion channels (KCNQ1, KCNE1-5, KCNJ2, KCNA5 and SCN5A), gap junctions (GJA5), and signaling molecules (atrial natriuretic peptide [ANP], nucleoporins [NUP155]) have been reported in isolated cases and small kindreds. The advent of the human genome and HapMap projects and high-throughput genotyping has fundamentally accelerated our ability to discover the genetic contribution to common variation in human disease. In 2007, a genome-wide association study (GWAS) identified two genetic variants that associated with AF. More recently, two additional AF loci on chromosomes 16q22 and 1q21 have been identified. It is quite likely however, that the effects of alleles in many genes contribute to common complex diseases such as AF. The overall AF risk associated with common variants identified by the GWAS approach is small (odds ratios 1.1–2.5) and explains less than 10% of the heritability in lone AF. This raises the possibility that rare independent variants with large effects strong effects may account for a large fraction of the risk for lone AF.

Parvez, Babar; Darbar, Dawood

2011-01-01

300

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

PubMed

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

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

2014-03-01

301

Radiofrequency perforation and cutting balloon septoplasty of intact atrial septum in a newborn with hypoplastic left heart syndrome using transesophageal ICE probe guidance.  

PubMed

Newborns with hypoplastic left heart syndrome and intact atrial septum present an emergent and unique challenge to a children's heart center. This case report describes new transcatheter techniques (use of radiofrequency energy to perforate the atrial septum followed by cutting balloon and static balloon septoplasty) and novel use of a transesophageal ICE probe. PMID:15678458

Hill, Sharon L; Mizelle, Katherine M; Vellucci, Sean M; Feltes, Timothy F; Cheatham, John P

2005-02-01

302

Atrial fibrillation associated with exogenous subclinical hyperthyroidism, changing axis deviation, troponin-I positive and without acute coronary syndrome.  

PubMed

Changing axis deviation has been rarely reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also rarely reported during acute myocardial infarction associated with atrial fibrillation or at the end of atrial fibrillation during acute myocardial infarction. Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroxine and free triiodothyronine levels with a thyroid-stimulating hormone level suppressed below the normal range and usually undetectable. It has been reported that subclinical hyperthyroidism is not associated with coronary heart disease or mortality from cardiovascular causes but it is sufficient to induce arrhythmias including atrial fibrillation and atrial flutter. It has also been reported that increased factor X activity in patients with subclinical hyperthyroidism represents a potential hypercoagulable state. Serum troponin-I is a sensitive indicator of myocardial damage but abnormal troponin-I levels have been also reported without acute coronary syndrome and without cardiac damage. Abnormal troponin-I levels after supraventricular tachycardia have been also reported. We present a case of changing axis deviation in a 49-year-old Italian man with atrial fibrillation, exogenous subclinical hyperthyroidism and troponin-I positive without acute coronary syndrome. Also this case focuses attention on changing axis deviation, on subclinical hyperthyroidism and on the importance of a correct evaluation of abnormal troponin-I levels. PMID:19342112

Patanè, Salvatore; Marte, Filippo

2011-08-01

303

Atrial defibrillation with a transvenous lead  

Microsoft Academic Search

OBJECTIVESThe purpose of this study was to compare transvenous atrial defibrillation thresholds with lead configurations consisting of an active left pectoral electrode and either single or dual transvenous coils.BACKGROUNDLow atrial defibrillation thresholds are achieved using complex lead systems including coils in the coronary sinus. However, the efficacy of more simple ventricular defibrillation leads with active pectoral pulse generators to defibrillate

Michael Cooklin; Mary R Olsovsky; Randall G Brockman; Stephen R Shorofsky; Michael R Gold

1999-01-01

304

Novel molecular targets for atrial fibrillation therapy  

Microsoft Academic Search

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

Leif Carlsson; Dobromir Dobrev

2012-01-01

305

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

306

Electrophysiologic mechanisms of perpetuation of atrial fibrillation  

Microsoft Academic Search

The presence of an excitable gap during atrial fibrillation (AF), although short and variable, may be of potential importance for the development of alternative techniques for termination of AF by rapid pacing. Also the notion that perpetuation of AF may be partly dependent on macroreentry around the natural atrial orifices, may provide a new therapeutic option for the permanent cure

Maurits A. Allessie; Karen Konings; Charles J. H. J. Kirchhof; Maurits Wijffels

1996-01-01

307

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

308

Refractory atrial fibrillation effectively treated with ranolazine.  

PubMed

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

309

Determinants of recurrent atrial flutter after cardioversion.  

PubMed Central

Eighteen male patients (mean age 59 years) who were electrically cardioverted for pure atrial flutter were retrospectively studied to determine those factors influencing the maintenance of regular sinus rhythm or reversion to atrial flutter. Six months after successful cardioversion, 10 patients (55%) had recurrent atrial flutter and eight patients (45%) were still in sinus rhythm. The two groups were not significantly different with respect to age, symptomatology, abnormalities on the 12 lead electrocardiogram (during sinus rhythm), or the administration of digoxin and a class Ia antiarrhythmic agent (after cardioversion). There was a trend for those patients with recurrent atrial flutter to have a higher incidence of underlying heart disease and previous episodes of atrial flutter than the non-recurrent group. There were statistically significant differences between the recurrent and non-recurrent groups with respect to echocardiographically determined left atrial size and left ventricular ejection fraction. Patients with a left atrial size greater than 45 mm or with an ejection fraction less than 45% were all at high risk for recurrent atrial flutter after successful cardioversion.

Pozen, R G; Pastoriza, J; Rozanski, J J; Kessler, K M; Myerburg, R J

1983-01-01

310

Minimally Invasive Surgical Therapies for Atrial Fibrillation  

PubMed Central

Atrial fibrillation is the most common sustained arrhythmia and is associated with significant risks of thromboembolism, stroke, congestive heart failure, and death. There have been major advances in the management of atrial fibrillation including pharmacologic therapies, antithrombotic therapies, and ablation techniques. Surgery for atrial fibrillation, including both concomitant and stand-alone interventions, is an effective therapy to restore sinus rhythm. Minimally invasive surgical ablation is an emerging field that aims for the superior results of the traditional Cox-Maze procedure through a less invasive operation with lower morbidity, quicker recovery, and improved patient satisfaction. These novel techniques utilize endoscopic or minithoracotomy approaches with various energy sources to achieve electrical isolation of the pulmonary veins in addition to other ablation lines. We review advancements in minimally invasive techniques for atrial fibrillation surgery, including management of the left atrial appendage.

Nakamura, Yoshitsugu; Kiaii, Bob; Chu, Michael W. A.

2012-01-01

311

Catheter closure of secundum atrial septal defects.  

PubMed Central

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

O'Laughlin, M P

1997-01-01

312

Dual chamber pacemaker with adaptive atrial escape interval  

US Patent & Trademark Office Database

A dual chamber pacemaker having an atrial escape interval which is varied on a beat-to-beat basis in response to the measured time from a ventricular event to the next atrial sensed event. Additionally, a portion of the atrial escape interval is bifurcated into a first sensing portion T1 and a second sensing portion T2 wherein atrial sense events occurring during T1 may be ignored by the pacemaker, while atrial sense events falling within T2 are used to compute a new atrial escape interval and are used to resynchronize the pacemaker and are used to inhibit the otherwise scheduled atrial pace event.

1990-05-01

313

Percutaneous management of late leak after lariat transcatheter ligation of the left atrial appendage in patients with atrial fibrillation at high risk for stroke.  

PubMed

Left atrial appendage (LAA) occlusion or ligation is a novel approach to stroke prevention in atrial fibrillation that may obviate the need for long-term anticoagulation. The Lariat device has received Food and Drug Administration 510K clearance for the approximation of soft tissue and has been applied to transcatheter LAA ligation using a combined trans-pericardial and transseptal approach. The occurrence of late leak after transcatheter LAA ligation and its percutaneous management has not been previously reported. Herein, we report three cases of late leak with reconstitution of the LAA after initially successful Lariat closure, and present a simple percutaneous technique for leak closure. PMID:24214652

Mosley, William J; Smith, Michael R; Price, Matthew J

2014-03-01

314

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

315

Factors associated with early atrial fibrillation after ablation of common atrial flutter. A single centre prospective study  

Microsoft Academic Search

Background The occurrence of early atrial fibrillation (6 months) after ablation of common atrial flutter is of clinical significance. Variables predicting this evolution in ablated patients without a previous atrial fibrillation history have not been fully investigated. Objectives The aim of the present study was: (1) to identify predictive factors of early atrial fibrillation (6 months) in the overall population

A. Da Costa; C. Romeyer; S. Mourot; M. Messier; A. Cerisier; E. Faure; K. Isaaz

2002-01-01

316

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.

Krummen, David E.; Narayan, Sanjiv M.

2012-01-01

317

Spontaneous Normal Sinus Rhythm Conversion Using Integrative Medicine in Atrial Fibrillation  

PubMed Central

The relationship between acute life stress and the development of atrial fibrillation (AF) has been noted in the literature. However, the use of integrative medicine (IM) in restoring cardiac rhythm has not been adequately studied. This case report describes how an IM approach was used in a patient with atrial fibrillation and acute pain. Spontaneous cardioversion to normal sinus rhythm occurred during the IM session, in addition to marked decreases in self-reported pain, anxiety, and nausea at the conclusion of IM treatment. These results provide initial support that for some cases of AF, IM therapies can help to reduce costs via avoidance of additional hospitalization, electrocardioversion, and general anesthesia.

Farrar, Wendy S.; Baechler, Courtney J.; Dusek, Jeffery A.

2012-01-01

318

Dronedarone for the treatment of atrial fibrillation and atrial flutter.  

PubMed

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

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

2010-10-01

319

Isolated ruptured inter-atrial septal cystic echinococcosis during pregnancy.  

PubMed

Herein, we present a case of asymptomatic isolated cardiac cystic echinococcosis localized entirely to the inter-atrial septum in a pregnant woman. The patient underwent successful surgery. Cardiac cystic echinococcosis is rarely seen in pregnancy. A high index of suspicion is necessary for the diagnosis of a cardiac cyst hydatid. The treatment of cardiac cyst hydatid is surgical and should not be delayed during pregnancy. Early surgery might prevent septic embolization and cardiac life-threatening complications and save the lives of both mother and baby as in the present case. PMID:23710802

Ercan, Suleyman; Gokaslan, Gokhan; Davutoglu, Vedat; Inanc, Ibrahim Halil; Bosnak, Vuslat; Deniz, Hayati

2013-09-01

320

[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

321

Successful closure of a previously unsuspected atrial septal defect by an implantable Clamshell device and subsequent transvenous pacemaker implantation.  

PubMed Central

Implantation of transvenous leads for a permanent cardiac pacing system usually requires the absence of intracardiac shunts. We report the case of an asymptomatic atrial septal defect in an 11-year-old boy who required permanent pacing. We implanted an atrial septal defect closure (Clamshell) device prior to implantation of transvenous leads. This new device makes transvenous implantation possible and may reduce the risk of stroke in patients with these anomalies. Images

Friedman, R A; O'Laughlin, M P; Moak, J P; Perry, J C; Mullins, C E; Garson, A; Feltes, T F

1994-01-01

322

Atrial fibrillation associated with chocolate intake abuse and chronic salbutamol inhalation abuse.  

PubMed

The use of substances as the substrate for atrial fibrillation is not frequently recognized. Chocolate is derived from the roasted seeds of the plant theobroma cacao and its components are the methylxanthine alkaloids theobromine and caffeine. Caffeine is a methylxanthine whose primary biological effect is the competitive antagonism of the adenosine receptor. Normal consumption of caffeine was not associated with risk of atrial fibrillation or flutter. Sympathomimetic effects, due to circulating catecholamines cause the cardiac manifestations of caffeine overdose toxicity, produce tachyarrhythmias such as supraventricular tachycardia, atrial fibrillation, ventricular tachycardia, and ventricular fibrillation.The commonly used doses of inhaled or nebulized salbutamol induced no acute myocardial ischaemia, arrhythmias or changes in heart rate variability in patients with coronary artery disease and clinically stable asthma or chronic obstructive pulmonary disease. Two-week salbutamol treatment shifts the cardiovascular autonomic regulation to a new level characterized by greater sympathetic responsiveness and slight beta2-receptor tolerance. We present a case of atrial fibrillation associated with chocolate intake abuse in a 19-year-old Italian woman with chronic salbutamol inhalation abuse. This case focuses attention on chocolate intake abuse associated with chronic salbutamol abuse as the substrate for atrial fibrillation. PMID:19171401

Patanè, Salvatore; Marte, Filippo; La Rosa, Felice Carmelo; La Rocca, Roberto

2010-11-19

323

Atrial flutter, ventricular tachycardia and changing axis deviation associated with scleroderma.  

PubMed

Rhythm disturbances have been described in immunological and connective diseases. Scleroderma is a fibrotic condition characterized by immunological abnormalities, vascular injury and increased accumulation of extracellular matrix proteins. The heart is one of the major organs involved in scleroderma, the involvement of which can be manifested by myocardial disease, conduction system abnormalities, arrhythmias, or pericardial disease. Additionally, scleroderma renal crisis and pulmonary hypertension lead to significant cardiac dysfunction secondary to damage in the kidney and lung. Changing axis deviation has been reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also reported during acute myocardial infarction associated with atrial fibrillation too or at the end of atrial fibrillation during acute myocardial infarction. We present a case of atrial flutter, ventricular tachycardia and changing axis deviation in a 61-year-old Italian woman with scleroderma. This case focuses attention on changing axis deviation and on the presentation of arrhythmias in scleroderma. The underlying arrhythmogenic mechanisms are probably multiple and intriguing, even though the myocardial fibrosis and immunological autoantibody-mediated mechanisms seem to play a pivotal role. PMID:19359055

Patanè, Salvatore; Marte, Filippo; Sturiale, Mauro; Dattilo, Giuseppe; Luzza, Francesco

2011-12-01

324

A Virulence Factor of Myxoma Virus Colocalizes with NF B in the Nucleus and Interferes with Inflammation  

Microsoft Academic Search

NF-B is one of the most important elements that coordinate stress-induced, immune, and inflammatory responses. Myxoma virus, a member of the Poxviridae family responsible for rabbit myxomatosis, codes for several factors that help its survival in the host. In this study, we focused on the product of the M150R gene. We show that the protein has nine ankyrin repeats (ANKs),

Christelle Camus-Bouclainville; Laurence Fiette; Sophie Bouchiha; Beatrice Pignolet; Dorian Counor; Cedric Filipe; Jacqueline Gelfi; Frederique Messud-Petit

2004-01-01

325

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

PubMed Central

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

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

2000-01-01

326

Atrial fibrillation: cure or treat?  

PubMed

Controversies exist with regard to the optimal management of atrial fibrillation (AF). Restoration and maintenance of sinus rhythm is a desirable goal in AF patients because the prevention of recurrences may improve cardiac function, relieve symptoms and should reduce the likelihood of adverse events. Pharmacological therapy for AF has been disappointing with unacceptable rates of AF recurrence and other proarrhythmic sequelae. Recent studies suggested that potential benefit of sinus-rhythm maintenance with respect to mortality may have been neutralized by harmful effects of currently available antiarrhythmic therapies. Because of the inefficacy and dangers with nonablative therapies currently available for maintaining sinus rhythm, alternative treatments are certainly desirable. Curative treatment of atrial fibrillation with catheter ablation is now a legitimate option for a large number of patients. In several studies AF ablation has consistently been demonstrated to be superior to antiarrhythmic medications for the maintenance of sinus rhythm. Nevertheless, many aspects of the therapy are still controversial and large-scale prospective studies are needed to confirm the efficacy and safety of this approach. PMID:19443515

Forleo, Giovanni B; Tondo, Claudio

2009-06-01

327

Treatment of nonvalvular atrial fibrillation.  

PubMed Central

Nonvalvular atrial fibrillation is an increasingly common condition. It may cause disabling symptoms and is an important risk factor for stroke. The goals of treatment include the relief and prevention of rate- and rhythm-related symptoms and the prevention of stroke and systemic emboli. Three principal treatments should be considered: pharmacologic rate control, cardioversion and antiarrhythmic therapy to restore and maintain sinus rhythm, and prophylactic anticoagulation or antiplatelet therapy to reduce the risk of stroke. The risks and benefits of each of these therapies have been reviewed. Symptoms, if present, can often be managed safely with rate-directed therapy alone. Until issues regarding safety and long-term efficacy are resolved, cardioversion and antiarrhythmic therapy should be limited to those patients whose symptoms cannot otherwise be controlled. The benefits of warfarin anticoagulation for the primary and secondary prevention of stroke in nonvalvular atrial fibrillation have been demonstrated convincingly by several randomized clinical trials. These benefits must be weighed against the real risk of major hemorrhage. For patients at low risk of stroke, the use of aspirin may be an acceptable alternative to warfarin sodium therapy. Images

Stettin, G D

1995-01-01

328

Antiarrhythmic therapy in atrial fibrillation.  

PubMed

Currently available antiarrhythmic drugs for the management of AF are not sufficiently effective and are burdened with cardiac and extracardiac side effects that may offset their therapeutic benefits. Better knowledge about the mechanisms underlying generation and maintenance of AF may lead to the discovery of new targets for pharmacological interventions. These could include atrial-selective ion channels (e.g. atrial I(Na), I(Kur) and I(K,ACh)), pathology-selective ion channels (constitutively active I(K,ACh), TRP channels), ischemia-uncoupled gap junctions, proteins related to malfunctioning intracellular Ca2+ homeostasis (e.g., "leaky" ryanodine receptors, overactive Na+, Ca2+ exchanger) or risk factors for arrhythmias ("upstream" therapies). The review will briefly summarize the current pathophysiological and therapeutic concepts of AF. A description of recently developed antiarrhythmic drugs and their proposed pharmacological action will follow. The final section will speculate about some putative targets for antiarrhythmic drug action in the context of the remodelled atria. PMID:20624425

Ravens, Ursula

2010-10-01

329

Atrial natriuretic peptide modulates the hyperpolarization-activated current (If) in human atrial myocytes  

Microsoft Academic Search

Abstract Objectives: The relationship between atrial stretching and changes in cell excitability is well documented. Once stretched, human atrial myocytes (HuAM) release atrial natriuretic peptide (hANP). Receptors for hANP (NPR) are coupled to a guanylyl cyclase (GC) activity, and are present on HuAM, but the electrophysiological effects of hANP are largely unknown. We investigated the effect of hANP on If,

Giuseppe Lonardo; Elisabetta Cerbai; Simona Casini; Gabriele Giunti; Massimo Bonacchi; Francesco Battaglia; Brenno Fiorani; Pier Luigi Stefano; Guido Sani; Alessandro Mugelli

330

Electrophysiology of atrial fibrillation: evolving insights.  

PubMed

In the last few years many studies have been performed to better understand the pathophysiological nature of atrial fibrillation (AF). These recent observations provide new insights into the initiation and perpetuation of AF, underlying the importance of the pulmonary veins as major sources of atrial triggers and introducing new concepts such as atrial electrical remodeling and spatial heterogeneity of the electrophysiologic characteristics of this arrhythmia. The purpose of this review was to provide current knowledge about AF electrophysiology in an effort to unite old models and new concepts. PMID:10994932

Calò, L; Pandozi, C; Lamberti, F; Riccardi, R; Loricchio, M L; Castro, A; Gaita, F; Santini, M

2000-08-01

331

Transesophageal programmed atrial pacing as a method of selecting patients with sick sinus syndrome for permanent atrial pacing.  

PubMed

Many recent studies have shown transesophageal programmed atrial pacing (TP) as a very practical, safe and convenient way for assessment of sinus node function and AV conduction. On the other hand, permanent atrial pacing is known to be superior to ventricular pacing due to arrhythmogenic and hemodynamic reasons. This is the reason why we decided to use TP as a method of choosing patients with sick sinus syndrome (SSS) for permanent atrial pacing. Sixty-three patients with symptomatic (58) and asymptomatic (5) SSS in a variety of clinical situations were examined in this way. The following electrophysiological features were examined: sinus cycle length, sinus node recovery time as well as corrected time, secondary pause after overdrive stimulation, sinoatrial conduction time, Wenckebach point, induction of supraventricular arrhythmias by S1, S2, S3 programmed stimulation and burst pacing. Patients with abnormal parameters were examined once more after intravenous atropine 0.2 mg/kg to evaluate parasympathetic component. Standard 12-lead ECG was performed in all, and Holter monitoring in most of patients. Twenty-six patients were candidates for permanent AAI pacing. Failures occurred in eight patients usually due to low P wave amplitude and electrode instability. Eighteen patients received AAI pacing systems: eight with brady-tachycardia syndrome, nine with bradyarrhythmia and one with sinoatrial block. In the follow-up of 5-28 months in one patient occurred high degree AV block (II degree) during digitalis therapy. Reduction of doses made this block disappear. Examination of Wenckebach point and possibility of inducation of supraventricular tachyarrhythmias in cases of atrial overexcitability are particularly useful in selecting patients for AAI pacing. PMID:2463528

Swiatecka, G; Lubi?ski, A; Raczak, G; Stanke, A; Juzwa, A; Kubica, J

1988-11-01

332

Percutaneous closure of the left atrial appendage for thromboembolic prevention in atrial fibrillation.  

PubMed

Atrial fibrillation is a common arrhythmia in clinical practice. It is associated with high morbidity and mortality due to its thromboembolic potential, which makes thromboembolic prevention particularly important. Warfarin has been the first-line therapy for this purpose, but it has various limitations and is often contraindicated or underutilized. The fact that thrombi are frequently located in the left atrial appendage in atrial fibrillation led to the development of percutaneous closure for thromboembolic prevention. This article examines the current evidence on percutaneous closure of the left atrial appendage by reviewing the results of the numerous clinical trials on the technique. PMID:23528437

Faustino, Ana; Paiva, Luís; Providência, Rui; Cação, Romeu; Costa, Marco; Leitão-Marques, António

2013-04-01

333

Prediction of paroxysmal atrial fibrillation by analysis of atrial premature complexes.  

PubMed

Currently, no reliable method exists to predict the onset of paroxysmal atrial fibrillation (PAF). We propose a predictor that includes an analysis of the R-R time series. The predictor uses three criteria: the number of premature atrial complexes (PAC) not followed by a regular R-R interval, runs of atrial bigeminy and trigeminy, and the length of any short run of paroxysmal atrial tachycardia. An increase in activity detected by any of these three criteria is an indication of an imminent episode of PAF. Using the Physionet database of the Computers in Cardiology 2001 Challenge, the predictor achieved a sensitivity of 89% and a specificity of 91%. PMID:15072210

Thong, Tran; McNames, James; Aboy, Mateo; Goldstein, Brahm

2004-04-01

334

Morphological considerations pertaining to recognition of atrial isomerism. Consequences for sequential chamber localisation.  

PubMed Central

The atrial morphology and venous connections were assessed "blind" in 51 necropsy specimens from patients with visceral heterotaxy. This was compared with bronchial morphology as established by dissection. Six specimens were found to have both atria and bronchi in situs solitus or inversus, and were rejected. In the remainder, atrial isomerism was diagnosed, though this required minor revision of the atrial assessment in two patients. Thirty-four patients had isomeric right atria and bronchi, while 11 had isomeric left atria and bronchi. In seven cases, splenic status was unknown, but in seven of the remaining 38 (18.4%) atrial isomerism was not associated with either asplenia or polysplenia. Nevertheless, right isomerism was strongly associated with total anomalous pulmonary venous drainage (as is asplenia) and left isomerism was likewise associated with interruption of the inferior vena cava (as is polysplenia). Bilateral superior venae cavae and hepatic veins, and absence of the coronary sinus, were frequent in both forms of isomerism (as they are in asplenia and polysplenia). These findings suggest that atrial situs can be defined as solitus inversus, right isomerism, and left isomerism. This determination of atrial situs is quite independent of any other abnormalities of visceral situs. The high incidence of anomalies of both venous return and common atrium resulted in presumed complete mixing of blood at atrial level in all but one patient (97.8%), making the haemodynamic connection between atria and ventricles almost always ambiguous. To describe this anatomical connection as ambiguous when there are two ventricles present is therefore no more than recognition of anatomical and haemodynamic reality. Images

Macartney, F J; Zuberbuhler, J R; Anderson, R H

1980-01-01

335

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

PubMed Central

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

2014-01-01

336

Presence of accessory left atrial appendage/diverticula in a population with atrial fibrillation compared with those in sinus rhythm: a retrospective review.  

PubMed

Accessory left atrial appendages and atrial diverticula have an incidence of 10-27%. Their association with atrial fibrillation needs to be confirmed. This study determined the prevalence, number, size, location and morphology of accessory left atrial appendages/atrial diverticula in patients with atrial fibrillation compared with those in sinus rhythm. A retrospective analysis of 47 consecutive patients with atrial fibrillation who underwent 320 multidetector Coronary CT angiography (CCTA) was performed. A random group of 47 CCTA patients with sinus rhythm formed the control group. The presence, number, size, location and morphology of accessory left atrial appendages and atrial diverticula in each group were analysed. Twenty one patients had a total of 25 accessory left atrial appendages and atrial diverticula in the atrial fibrillation group and 22 patients had a total of 24 accessory left atrial appendages and atrial diverticula in the sinus rhythm group. Twenty-one atrial diverticula were identified in 19 patients in the atrial fibrillation group and 19 atrial diverticula in 17 patients in the sinus rhythm group. The mean length and width of accessory left atrial appendage was 6.9 and 4.7 mm, respectively in the atrial fibrillation group and 12 and 4.6 mm, respectively, in the sinus rhythm group, P = ns (not significant). The mean length and width of atrial diverticulum was 4.7 and 3.6 mm, respectively in the atrial fibrillation group and 6.2 and 5 mm, respectively in the sinus rhythm group (P = ns). Eighty-four % and 96% of the accessory left atrial appendages/atrial diverticula in the atrial fibrillation and sinus rhythm groups were located along the right anterosuperior left atrial wall. Accessory left atrial appendages and atrial diverticula are common structures with similar prevalence in patients with atrial fibrillation and sinus rhythm. PMID:21331611

Troupis, John; Crossett, Marcus; Scneider-Kolsky, Michal; Nandurkar, Dee

2012-02-01

337

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

338

Atrial electromechanical coupling intervals in pregnant subjects  

PubMed Central

Summary Objective The aim of this study was to evaluate atrial conduction abnormalities obtained by tissue Doppler imaging (TDI) and electrocardiogram analysis in pregnant subjects. Methods A total of 30 pregnant subjects (28 ± 4 years) and 30 controls (28 ± 3 years) were included. Systolic and diastolic left ventricular (LV) function was measured using conventional echocardiography and TDI. Inter-atrial, intra-atrial and intra-left atrial electromechanical coupling (PA) intervals were measured with TDI. P-wave dispersion (PD) was calculated from a 12-lead electrocardiogram. Results Atrial electromechanical coupling at the septal and left lateral mitral annulus (PA septal, PA lateral) was significantly prolonged in pregnant subjects (62.1 ± 2.7 vs 55.3 ± 3.2 ms, p < 0.001; 45.7 ± 2.5 vs 43.1 ± 2.7 ms, p < 0.001, respectively). Inter-atrial (PA lateral – PA tricuspid), intra-atrial (PA septum – PA tricuspid) and intra-left atrial (PA lateral – PA septum) electromechanical coupling intervals, maximum P-wave (Pmax) duration and PD were significantly longer in the pregnant subjects (26.4 ± 4.0 vs 20.2 ± 3.6 ms, p < 0.001; 10.0 ± 2.0 vs 8.0 ± 2.6 ms, p = 0.002; 16.4 ± 3.3 vs 12.2 ± 3.0 ms, p < 0.001; 103.1 ± 5.4 vs 96.8 ± 7.4 ms, p < 0.001; 50.7 ± 6.8 vs 41.6 ± 5.5 ms, p < 0.001, respectively). We found a significant positive correlation between inter-atrial and intra-left atrial electromechanical coupling intervals and Pmax (r = 0.282, p = 0.029, r = 0.378, p = 0.003, respectively). Conclusion This study showed that atrial electromechanical coupling intervals and PD, which are predictors of AF, were longer in pregnant subjects and this may cause an increased risk of AF in pregnancy.

Altun, Burak; Emine, Gaz; Temi, Ahmet; Barutcu, Ahmet; Colkesen, Yucel; Ozturk, Ufuk; Tasolar, Hakan; Gungor, Aysenur Cakir; Uysal, Ahmet; Acar, Gurkan; Akkoyun, Murat

2014-01-01

339

Atrial conduction delay predicts atrial fibrillation in paroxysmal supraventricular tachycardia patients after radiofrequency catheter ablation.  

PubMed

This study aimed to assess whether intra- and inter-atrial conduction delay could predict atrial fibrillation (AF) for paroxysmal supraventricular tachycardia (PSVT) patients after successful treatment by radiofrequency catheter ablation (RFCA). Echocardiography examination was performed on 524 consecutive PSVT patients (15 patients were excluded). Left atrial dimension, right atrial diameter and intra- and inter-atrial conduction delay were measured before ablation. Patients were divided into group A (n = 32): occurrence of AF after the ablation and group B (n = 477): remained in sinus rhythm during follow-up. Receiver operating characteristic (ROC) curve analysis was performed to estimate the predictive value of intra- and inter-atrial conduction delay. Both intra- and inter-atrial conduction delay were higher in group A than in group B (4.79 ± 0.30 msec vs. 4.56 ± 0.32 msec; 21.98 ± 1.32 msec vs. 20.01 ± 1.33; p < 0.05). Binary logistic regression analysis showed that intra- and inter-atrial conduction were significant influential factors for the occurrence of AF (odds ratio [OR] = 13.577, 95% confidence interval [CI], 3.469-48.914; OR = 2.569, 95% CI, 1.909-3.459, p < 0.05). The ROC cure analysis revealed that intra-atrial conduction delay ? 4.45 msec and inter-atrial conduction delay ? 20.65 were the most optimal cut-off value for predicting AF in PSVT patients after RFCA. In conclusion, this is the first study to show that the intra- and inter-atrial conduction delay could effectively predict AF in post-ablation PSVT patients. PMID:24613637

Xu, Zhen-Xing; Zhong, Jing-Quan; Zhang, Wei; Yue, Xin; Rong, Bing; Zhu, Qing; Zheng, Zhaotong; Zhang, Yun

2014-06-01

340

[Biology of the substrate of atrial fibrillation].  

PubMed

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

Hatem, Stéphane

2012-01-01

341

[Atrial fibrillation in the elderly].  

PubMed

Atrial fibrillation (AF) is prevalent in the elderly (affecting 5% of persons aged >or= 65 years and around 10% of those aged >or= 80 years old) and is associated with stroke, heart failure and poor quality of life. The symptoms of AF are palpitations, fatigue, reduced exercise capacity, dyspnea or dizziness. AF is associated with comorbidity, mainly hypertension in outpatients, and ischaemic heart disease and heart failure in hospitalized patients. Two therapeutic strategies are available to treat arrhythmia: rhythm control or frequency control. In many elderly patients with AF, frequency control is an effective option, particularly when there is heart failure, contraindications to antiarrhythmic agents or when cardioversion is not indicated. Anticoagulation is the main measure to reduce stroke risk. If anticoagulation is not appropriate for a patient, antiaggregants can be used, but the benefit is clearly lower than that provided by anticoagulation. PMID:18682121

Urrutia de Diego, Agustín

2008-01-01

342

Electrocardiographic artefacts mimicking atrial tachycardia resulted in unnecessary diagnostic and therapeutic measures  

PubMed Central

Electrocardiographic (ECG) artefacts may closely simulate both supraventricular and ventricular tachycardias. We describe a case initially diagnosed as rapid atrial fibrillation, based on 12-lead surface ECG (especially the limb leads) and monitor tracing. The arrhythmia was resistant to beta blockers. Because of the at times apparently regular rhythm, an esophageal ECG recording was performed, and adenosine was administered. When the presumed atrial fibrillation terminated after sodium pentothal was administered while preparing for electrical cardioversion, the oesophageal ECG recordings and the ECGs during adenosine administration were reviewed. An ECG artefact diagnosis was suspected, and then confirmed, during relapse of the "arrhythmia," with simple palpation of the radial pulse and cardiac auscultation.

Sylven, Christer

2013-01-01

343

Gastric hypomotility following epicardial vagal denervation ablation to treat atrial fibrillation.  

PubMed

We report a case of a 55-year-old man with vagal paroxysmal atrial fibrillation (AF) who was submitted to selective epicardial and endocardial atrial vagal denervation with the objective of treating AF. Radiofrequency pulses were applied on epicardial and endocardial surface of the left atrium close to right pulmonary veins (PVs) and also on epicardial surface close to left inferior PV. Following the procedure, patient presented with symptoms of gastroparesis, which was documented on CT scan and gastric emptying scintigraphy. Symptoms were transient and the patient recovered completely. PMID:17711431

Pisani, Cristiano F; Hachul, Denise; Sosa, Eduardo; Scanavacca, Mauricio

2008-02-01

344

Conversion of atrial fibrillation after levothyroxine in a dog with hypothyroidism and arterial thromboembolism.  

PubMed

A six-year-old female spayed mixed-breed dog was referred following a 3-week history of lameness and progressive neurological deficits in both hindlimbs, and a 1-week history of a cardiac arrhythmia. The dog was diagnosed with hypothyroidism, atrial fibrillation, myocardial dysfunction and arterial thromboembolism. Cardioversion occurred after 2?weeks of levothyroxine supplementation, with improved systolic function over time. To the authors' knowledge, this is the first case reported in the veterinary or human literature documenting hypothyroidism with persistent atrial fibrillation being converted to sinus rhythm with levothyroxine as sole therapy. PMID:24521196

Chow, B; French, A

2014-05-01

345

Development of rapid preexcited ventricular response to atrial fibrillation in a patient with intermittent preexcitation.  

PubMed

Intermittent preexcitation during sinus rhythm is indicative of an accessory pathway at a very low risk for sudden death. We present the case of a 49-year-old man with intermittent preexcitation who subsequently developed rapid atrial fibrillation with a shortest preexcited R-R interval of 230 milliseconds. Electrophysiology study showed intermittent preexcitation at baseline and 1:1 anterograde accessory pathway conduction to 220 milliseconds in the presence of 1 mcg/min isoproterenol infusion. The pathway was successfully ablated at the lateral mitral annulus. Accessory pathways highly sensitive to catecholamines may show intermittent preexcitation at baseline with potential for rapid conduction during atrial fibrillation and sudden death. PMID:22817823

Gemma, Lee W; Steinberg, Leonard A; Prystowsky, Eric N; Padanilam, Benzy J

2013-03-01

346

Thrombus formation after left atrial appendage exclusion using an Amplatzer cardiac plug device.  

PubMed

The feasibility and safety of left atrial appendage closure with the Amplatzer cardiac plug (AGA Medical Corp., Minneapolis, MN) have been recently published; no thrombus formation on the device surface has been reported previously. We describe a case of a 66-year-old man with permanent atrial fibrillation, previous stroke, and contraindication for long-term oral anticoagulant therapy. A 22-mm ACP device was deployed successfully without complications. The patient was discharged on acetyl salicylic acid 100 mg and clopidogrel 75 mg daily. After 4 weeks, the patient was admitted for a lower gastrointestinal bleeding and clopidogrel was stopped. A 3-month follow-up echocardiogram confirmed the exclusion of the LAA but it demonstrated the presence of a thrombus on the atrial surface of the device. It was decided to keep the patient on acetyl salicylic acid 100 mg with the addition of enoxaparin 60 mg bid. Transesophageal echocardiogram demonstrated total resolution of the thrombus after 2 months. PMID:21523900

Cruz-Gonzalez, Ignacio; Martín Moreiras, Javier; García, Eulogio

2011-11-15

347

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

PubMed Central

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

Fernandez-Rodriguez, Diego; Vannini, Luca; Martin-Yuste, Victoria; Brugaletta, Salvatore; Robles, Rocio; Regueiro, Ander; Masotti, Monica; Sabate, Manel

2013-01-01

348

Atrial Natriuretic Peptide Single Nucleotide Polymorphisms in Patients with Nonfamilial Structural Atrial Fibrillation  

PubMed Central

Background Atrial natriuretic peptide (ANP) has antihypertrophic and antifibrotic properties that are relevant to AF substrates. The –G664C and rs5065 ANP single nucleotide polymorphisms (SNP) have been described in association with clinical phenotypes, including hypertension and left ventricular hypertrophy. A recent study assessed the association of early AF and rs5065 SNPs in low-risk subjects. In a Caucasian population with moderate-to-high cardiovascular risk profile and structural AF, we conducted a case-control study to assess whether the ANP –G664C and rs5065 SNP associate with nonfamilial structural AF. Methods 168 patients with nonfamilial structural AF and 168 age- and sex-matched controls were recruited. The rs5065 and –G664C ANP SNPs were genotyped. Results The study population had a moderate-to-high cardiovascular risk profile with 86% having hypertension, 23% diabetes, 26% previous myocardial infarction, and 23% left ventricular systolic dysfunction. Patients with AF had greater left atrial diameter (44 ± 7 vs. 39 ± 5 mm; P < 0.001) and higher plasma NTproANP levels (6240 ± 5317 vs. 3649 ± 2946 pmol/mL; P < 0.01). Odds ratios (ORs) for rs5065 and –G664C gene variants were 1.1 (95% confidence interval [CI], 0.7–1.8; P = 0.71) and 1.2 (95% CI, 0.3–3.2; P = 0.79), respectively, indicating no association with AF. There were no differences in baseline clinical characteristics among carriers and noncarriers of the –664C and rs5065 minor allele variants. Conclusions We report lack of association between the rs5065 and –G664C ANP gene SNPs and AF in a Caucasian population of patients with structural AF. Further studies will clarify whether these or other ANP gene variants affect the risk of different subphenotypes of AF driven by distinct pathophysiological mechanisms.

Francia, Pietro; Ricotta, Agnese; Frattari, Alessandra; Stanzione, Rosita; Modestino, Anna; Mercanti, Federico; Adduci, Carmen; Sensini, Isabella; Cotugno, Maria; Balla, Cristina; Rubattu, Speranza; Volpe, Massimo

2013-01-01

349

Successful surgical excision of primary right atrial angiosarcoma  

PubMed Central

Primary cardiac angiosarcoma is a rare and aggressive tumor with a high incidence of metastatic spread (up to 89%) at the time of diagnosis, which restricts the indication for surgical resection to a small number of patients. We report the case of a 50-year old Caucasian woman with non-metastatic primary right atrial angiosarcoma, who underwent successful surgical excision of the tumor (with curative intent) and reconstruction of the right atrium with a porcine pericardial patch. However, after a symptom-free survival of five months the patient presented with bone and liver metastases without evidence of local tumor recurrence.

2011-01-01

350

Dysphagia Lusoria with atrial septal defect: Simultaneous repair through midline  

PubMed Central

An aberrant right subclavian artery from the descending aorta is almost always reported as an isolated anomaly. We present the case of a four-year-old child with an anomalous origin of the right subclavian artery from the descending aorta, associated with an ostium secundum atrial septal defect. The patient underwent simultaneous repair of both the anomalies through median sternotomy, with implantation of the subclavian artery into the right common carotid artery. We believe that median sternotomy is the optimal surgical approach for the management of these lesions. Other operative approaches are also discussed.

Rathnakar, Rithin; Agarwal, Saket; Datt, Vishnu; Satsangi, Deepak K

2014-01-01

351

Successful radiofrequency catheter ablation of recurrent atrial fibrillation due to left inferior pulmonary vein tachycardia.  

PubMed

This report illustrates the case of a young lady evaluated for drug-refractory symptomatic paroxysmal atrial fibrillation. Successful isolation of left inferior pulmonary vein was achieved by segmental ostial ablation and circumferential Lasso mapping catheter. Patient is now free of symptoms and is off all anti-arrhythmic drugs. PMID:16350682

Rao, B Hygriv; Sharada, K; Narasimhan, C

2005-01-01

352

Hyperthyroidism with periodic paralysis, acropachy, pre-tibial myxoedema, transient atrial fibrillation and myopathy  

PubMed Central

A case of thyrotoxicosis presenting with periodic paralysis and later complicated by acropachy, pretibial myxoedema and transient atrial fibrillation is described. This association has not been reported previously. Possible aetiological links are discussed. ImagesFig. 1Fig. 2Fig. 3Fig. 4

Guan, R.; Cheah, J. S.

1982-01-01

353

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

PubMed

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

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

2014-07-01

354

Huge left atrial thrombus with mitral stenosis in congenital factor XII deficiency  

Microsoft Academic Search

Factor XII deficiency has been reported to be a risk factor for thromboembolism as a result of inactivation of fibrinolysis. We describe a case of a huge left atrial thrombus with mitral stenosis, which was successfully removed surgically in a Factor XII deficient patient.

Tomomi Hasegawa; Masahisa Uematsu; Takuro Tsukube; Yukihiro Takemura; Yutaka Okita

2002-01-01

355

A patient with sick sinus syndrome, atrial flutter and bidirectional ventricular tachycardia: Coincident or concomitant presentations?  

Microsoft Academic Search

Channelopathies are among the major causes of syncope or sudden cardiac death in patients with structurally normal hearts. In these patients, the atrium, ventricle or both could be affected and reveal different presentations. In this case, we present a patient with an appar- ently structurally normal heart and recurrent syncope, presented as sick sinus syndrome with atrial flutter and bidirectional

Amir Farjam Fazelifar; Mohammad Hosein Nikoo; Majid Haghjoo; Zahra Emkanjoo; Abolfath Alizadeh; Hamid Reza Bonakdar

356

Asymptomatic pulmonary vein stenosis after cryoballoon catheter ablation of paroxysmal atrial fibrillation.  

PubMed

Pulmonary vein (PV) isolation is an effective treatment option for symptomatic atrial fibrillation. PV stenosis is a well-recognized complication of radiofrequency energy application but has not been observed following cryoballoon ablation. Here, we report a case of asymptomatic PV stenosis associated with cryoballoon PV isolation, illustrating a risk that should be considered when applying this technique. PMID:21146833

Thomas, Dierk; Katus, Hugo A; Voss, Frederik

2011-01-01

357

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

Microsoft Academic Search

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

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

2004-01-01

358

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

359

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

360

Intra-atrial endothelial lesion resulting from transseptal puncture for catheter ablation of atrial fibrillation  

PubMed Central

Thromboembolic events are known complications of left atrial ablation therapy. We describe a complication which may also lead to systemic thromboembolism that has not been reported so far: the formation of a moving structure attached to the fossa ovalis after an attempted transseptal puncture in a 66-year old patient with symptomatic paroxysmal atrial fibrillation.

Genz, Conrad; Esperer, Hans D.; Schmeisser, Alexander; Braun-Dullaeus, Ruediger C.; Said, Samir M.

2012-01-01

361

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.

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

2014-01-01

362

Transcatheter occlusion of left atrial appendage for stroke prevention in patients with atrial fibrillation  

Microsoft Academic Search

Cardiac emboli in patients with atrial fibrillation are one of the major causes of ischemic stroke. Because the vast majority of these cardiac emboli descend from the left atrial appendage (LAA), the therapeutic strategy of percu- taneous transcatheter occlusion of the LAA by means of a mechanical implant was a logical consequence. Three different devices have been developed and used

J.-W. Park; B. Leithäuser; F. Jung

363

Odontogenic tumours in Istanbul: 527 cases  

Microsoft Academic Search

We retrieved and analysed the records of 527 odontogenic tumours from a total of 62,565 cases in the department of tumour pathology in the Institute of Oncology, University of Istanbul, from 1971 to 2003. Of these 527 tumours, 521 were benign and 6 were malignant. The most common lesions were ameloblastomas (n=133) followed by odontomas (n=109), odontogenic myxomas (n=83) and

V. Olgac; B. G. Koseoglu; N. Aksakall?

2006-01-01

364

Atrial Ectopy as a Predictor of Incident Atrial Fibrillation  

PubMed Central

Background Atrial fibrillation (AF) prediction models have unclear clinical utility given the absence of AF prevention therapies and the immutability of many risk factors. Premature atrial contractions (PACs) play a critical role in AF pathogenesis and may be modifiable. Objective To investigate whether PAC count improves model performance for AF risk. Design Prospective cohort study. Setting 4 U.S. communities. Patients A random subset of 1260 adults without prevalent AF enrolled in the Cardiovascular Health Study between 1989 and 1990. Measurements The PAC count was quantified by 24-hour electrocardiography. Participants were followed for the diagnosis of incident AF or death. The Framingham AF risk algorithm was used as the comparator prediction model. Results In adjusted analyses, doubling the hourly PAC count was associated with a significant increase in AF risk (hazard ratio, 1.17 [95% CI, 1.13 to 1.22]; P < 0.001) and overall mortality (hazard ratio, 1.06 [CI, 1.03 to 1.09]; P < 0.001). Compared with the Framingham model, PAC count alone resulted in similar AF risk discrimination at 5 and 10 years of follow-up and superior risk discrimination at 15 years. The addition of PAC count to the Framingham model resulted in significant 10-year AF risk discrimination improvement (c-statistic, 0.65 vs. 0.72; P < 0.001), net reclassification improvement (23.2% [CI, 12.8% to 33.6%]; P < 0.001), and integrated discrimination improvement (5.6% [CI, 4.2% to 7.0%]; P < 0.001). The specificity for predicting AF at 15 years exceeded 90% for PAC counts more than 32 beats/h. Limitation This study does not establish a causal link between PACs and AF. Conclusion The addition of PAC count to a validated AF risk algorithm provides superior AF risk discrimination and significantly improves risk reclassification. Further study is needed to determine whether PAC modification can prospectively reduce AF risk. Primary Funding Source American Heart Association, Joseph Drown Foundation, and National Institutes of Health.

Dewland, Thomas A.; Vittinghoff, Eric; Mandyam, Mala C.; Heckbert, Susan R.; Siscovick, David S.; Stein, Phyllis K.; Psaty, Bruce M.; Sotoodehnia, Nona; Gottdiener, John S.; Marcus, Gregory M.

2014-01-01

365

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

366

Pharmacologic Atrial Natriuretic Peptide Reduces Human Leg Capillary Filtration.  

National Technical Information Service (NTIS)

Atrial natriuretic peptide (ANP) is produced and secreted by atrial cells. We measured calf capillary filtration rate with prolonged venous-occlusion plethysmography of supine healthy male subjects during pharmacologic infusion of ANP (48 pmol/kg/min for ...

D. E. Watenpaugh S. F. Vissing L. D. Lane J. C. Buckey B. G. Firth W. Erdman A. R. Hargens C. G. Blomqvist

1995-01-01

367

Left atrial volumes and associated stroke subtypes  

PubMed Central

Background Cardio embolism and cerebrovascular atherosclerosis are two major mechanisms of stroke. Studies investigating associations between advanced echocardiographic parameters and stroke mechanisms are limited. Methods This study is a standardized review of 633 patients admitted to the stroke service of a tertiary care hospital following a standardized stroke investigation and management pathway. Stroke subtypes were characterized using the Causative Classification System, using the hospitals online radiologic archival system with CCS certified stroke investigators. Patients with two mechanisms were excluded. Results Patients with cardioembolic stroke had a higher proportion of atrial fibrillation (p?atrial fibrillation (p?atrial volume indices (LAVi) (p?atrial diameters (LAD) (p?atrial volume indices may be linked to specific stroke phenotype. At mild increases in left atrial dimensions, the risks of atherosclerotic stroke are high, and probably reflect hypertension as the unifying mechanism. Further increases in left atrial dimensions shifts the risk towards cardioembolic stroke.

2013-01-01

368

Association of GGCX gene polymorphism with warfarin dose in atrial fibrillation population in Xinjiang  

PubMed Central

Objective To study the effects of ?-glutamyl carboxylase (GGCX) rs2592551 polymorphism on warfarin dose in atrial fibrillation patients in Xinjiang region. Methods Polymerase chain reaction - restriction fragment length polymorphism and direct sequencing methods were used to detect the rs2592551 genotype in 269 atrial fibrillation patients with warfarin administration. The effects of different genotypes on warfarin dose were statistically analyzed. Results The rs2592551 polymorphism detection results were 136 cases of wild-type homozygous CC genotype (50.56%), 115 cases of heterozygous CT genotype (42.75%), 18 cases of homozygous TT genotype (6.69%). The allele frequency C was 71.93%, T was 28.07%. The stable warfarin dose average was 2.86?±?0.61 mg/d in patients with CC genotype, 3.59?±?0.93 mg/d in patients with CT genotype and 4.06?±?0.88 mg/d in patients with TT genotype. The warfarin dose in different genotypes were compared, there was statistically significant difference between CC and TT, CC and CT (P <0. 05), but the TT and CT showed no significant difference (P?>?0.05). Conclusion In atrial fibrillation population in Xinjiang, patients with CT and TT genotypes in GGCX gene rs259251 loci required for significantly higher warfarin dose than those with CC genotype. Therefore, rs2592551 polymorphism may one of the factors affecting the warfarin dose in patients with atrial fibrillation.

2013-01-01

369

Adverse Outcome of Early Recurrent Ischemic Stroke Secondary to Atrial Fibrillation after Repeated Systemic Thrombolysis  

PubMed Central

Background. Recurrent ischemic stroke is associated with adverse neurological outcome in patients with atrial fibrillation. There is very scarce information regarding the neurological outcome of atrial fibrillation patients undergoing repeated systemic thrombolysis after early recurrent ischemic stroke. Clinical Case and Discussion. We describe a case of a 76-year-old woman with known paroxysmal atrial fibrillation who was admitted because of an acute right middle cerebral artery ischemic stroke and who underwent repeated systemic thrombolysis within 110 hours. The patient underwent systemic thrombolysis after the first ischemic stroke with almost complete neurological recovery. On the fourth day after treatment, an acute left middle cerebral artery ischemic stroke was diagnosed and she was treated with full-dose intravenous recombinant tissue plasminogen activator. A hemorrhagic transformation of the left middle cerebral artery infarction was noted on follow-up cranial computed tomographic scans. The patient did not recover from the second cerebrovascular event and died 25 days after admission. Conclusion. To the best of our knowledge, this is the second case reporting the adverse neurological outcome of a patient with diagnosis of atrial fibrillation undergoing repeated systemic thrombolysis after early recurrent ischemic stroke. Our report represents a contribution to the scarce available evidence suggesting that repeated systemic thrombolysis for recurrent ischemic stroke should be avoided.

Sposato, Luciano A.; Salutto, Valeria; Beratti, Diego E.; Monti, Paula; Riccio, Patricia M.; Mazia, Claudio

2013-01-01

370

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

PubMed

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

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

2013-03-01

371

Dental pulp stem cells express proteins involved in the local invasiveness of odontogenic myxoma.  

PubMed

Little is known about the histogenesis of the odontogenic myxoma (OM). Dental pulp stem cells could be candidate precursors of OM because both OM and the dental pulp share the same embryological origin: the dental papilla. For the purpose of comparing OM and stem cells, this study analyzed the expression of two proteins related to OM invasiveness (MMP-2 and hyaluronic acid) in human immature dental pulp stem cells (hIDPSCs). Three lineages of hIDPSCs from deciduous and permanent teeth were used in this study. Immunofluorescence revealed positive reactions for MMP-2 and hyaluronic acid (HA) in all hIDPSCs. MMP-2 appeared as dots throughout the cytoplasm, whereas HA appeared either as diffuse and irregular dots or as short fibrils throughout the cytoplasm and outside the cell bodies. The gene expression profile of each cell lineage was evaluated using RT-PCR analysis, and HA was expressed more intensively than MMP-2. HA expression was similar among the three hIDPSCs lineages, whereas MMP-2 expression was higher in DL-1 than in the other cell lines. The expression of proteins related to OM invasiveness in hIDPSCs could indicate that OM originates from dental pulp stem cells. PMID:22473349

Miyagi, Sueli Patricia Harumi; Maranduba, Carlos Magno da Costa; Silva, Fernando de Sá; Marques, Márcia Martins

2012-01-01

372

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

PubMed

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

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

2014-08-01

373

[Early diastolic sound in a patient with hepatocarcinoma].  

PubMed

On physical examination an early diastolic sound is usually associated with mitral stenosis, prosthetic mitral valve replacement and chronic constrictive pericarditis. In case of an atrial myxoma, an early diastolic sound can be usually heard due to movement of the tumor towards the tricuspid valve (tumor plop). The following case report shows an example in which an early diastolic sound was heard in a patient presenting with a hepatocellular carcinoma. This sound was due to the presence of a thrombus that originated from the inferior vena cava and invaded the right atrium up to the tricuspid valve. It was thus similar to an atrial myxoma and produced a tumor plop. PMID:11582723

Greco, A; Varriale, A; Curci, S; D'Alessandro, V; Russo, A; de Rito, V; Nemore, F; Camagna, A

2001-08-01

374

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

375

Oesophageal electrical cardioversion of atrial fibrillation.  

PubMed

Atrial fibrillation is the most common cardiac arrhythmia and the most frequent cause of hospitalization and utilization expense among all heart diseases. Taking into account persistent atrial fibrillation we know that, in order to cardiovert persistent atrial fibrillation, external direct current cardioversion is the method most frequently used to restore sinus rhythm. But external cardioversion has also some limitations: it requires high energy direct current shocks so that patients have to be anaesthetised, which means a dedicated apparatus and place to adequately assist the patients. The oesophageal cardioversion is an alternative method to restore sinus rhythm, which could obviate some of these limitations of external cardioversion. Compared to external cardioversion oesophageal one has lower defibrillation impedance and requires lower energies to restore sinus rhythm, increasing for the same energy level, success rate. Using low energy shocks, a mild sedation is sufficient to make the procedure well tolerated by most of patients. Other 2 important advantages coming from low energy shocks are the safety in patients with pacemaker or implantable cardioverter-defibrillator and the availability of a back up atrial pacing. Oesophageal cardioversion is not indeed a new technique. Looking at literature, studies in animals and in humans have been performed since the 60s, assessing feasibility, effectiveness and safety of such a procedure. The oesophageal-precordial cardioversion is usually performed on an outpatient regimen, resulting in a very cost-effective method to cardiovert patients with persistent atrial fibrillation, which may definitely represent a real alternative technique to external cardioversion. PMID:15194990

Santini, L; Forleo, G B; Santini, M; Romeo, F

2004-04-01

376

Mean platelet volume is associated with the presence of left atrial stasis in patients with non-valvular atrial fibrillation  

PubMed Central

Background Mean platelet volume has been associated with stroke in patients with atrial fibrillation. However, its role as a predictor of left atrial stasis, assessed by transesophageal echocardiography, in patients with non-valvular atrial fibrillation has not yet been clarified. Methods Single center cross-sectional study comprising 427 patients admitted to the emergency department due to symptomatic atrial fibrillation and undergoing transesophageal echocardiogram evaluation for exclusion of left atrial appendage thrombus before cardioversion. All patients had a complete blood count performed in the 12 hours prior to transesophageal echocardiogram. Markers of left atrial stasis were sought: left atrial appendage thrombus, dense spontaneous echocardiographic contrast and low flow velocities in the left atrial appendage. The presence of at least one of the former markers of left atrial stasis was designated left atrial abnormality. Binary logistic multivariate analysis was used for obtaining models for the prediction of transesophageal echocardiogram endpoints. Results Left atrial appendage thrombus was found in 12.2%, dense spontaneous echocardiographic contrast in 29.7%, low flow velocities in 15.3% and left atrial abnormality in 34.2%. Mean platelet volume (exp ??=?3.41 p?=?0.048) alongside with previous stroke or transient ischemic attack (exp ??=?5.35 p?=?0.005) and troponin I (exp ??=?5.07 p?=?0.041) were independent predictors of left atrial appendage thrombus. Mean platelet volume was also incorporated in the predictive models of dense spontaneous echocardiographic contrast, low flow velocities and left atrial abnormality, adding predictive value to clinical, echocardiographic and laboratory variables. Conclusions These findings suggest that mean platelet volume may be associated with the presence of markers of left atrial stasis, reinforcing a likely cardioembolic mechanism for its association with stroke in patients with non-valvular atrial fibrillation.

2013-01-01

377

[Results of the treatment of paroxysmal atrial fibrillation with ethacizine].  

PubMed

Ethacizine was given to 28 patients with frequent (at least once a week) paroxysms of cardiac fibrillation (PCF), the larger proportion of the patients was those with coronary heart disease. The long-term use of ethacisine was preceded by an acute drug test in which the drug was administered orally in a starting dose of 100 mg to assess its effects on myocardial conduction and contractility. Its positive effect as evidenced by reduction in PCF frequency by 70% per more was seen in 19 (68%) patients. The antiarrhythmic effect of the drug showed up on day 2 after initiation of the therapy. Analysis of the relationship between the drug's positive effect and the changes in the atrial myocardium showed that the most potent effect (up to 80%) was observed in patients with coronary heart disease complicated with PCF in the presence of "combined" changes in the atrial myocardium as compared to "hemodynamic" changes. The authors studied the most common adverse effects resulted from the therapy, the most dangerous of them included abnormal right bundle branch conduction (1 case) and sinoauricular block (1 case). PMID:2681923

Lozinski?, L G; Zamotaev, I P; Kerimova, R E; Rakova, N A

1989-07-01

378

Esmolol versus diltiazem in the treatment of postoperative atrial fibrillation\\/atrial flutter after open heart surgery  

Microsoft Academic Search

Background Supraventricular tachyarrhythmias are common after open heart surgery. Possible causative factors for these arrhythmias include operative trauma, atrial ischemia, electrolyte imbalances, pericardial irritation, and excess catecholamines. Two agents commonly used to control ventricular rate in atrial fibrillation or atrial flutter (AF\\/AFL) are ?-blockers and calcium channel blockers. Methods and Results This randomized study was designed to compare the safety

Aryan N. Mooss; Richard L. Wurdeman; Syed M. Mohiuddin; Antonio P. Reyes; Jeffrey T. Sugimoto; Walter Scott; Daniel E. Hilleman; Ali Seyedroudbari

2000-01-01

379

Fibrosis of Collagen I and Remodeling of Connexin 43 in Atrial Myocardium of Patients with Atrial Fibrillation  

Microsoft Academic Search

Background: Fibrosis in atrial myocardium is a common phenomenon for patients with atrial fibrillation (AF). Remodeling of connexins was found accompanying with AF. The aim of the study is to investigate whether it is by causing the remodeling of connexin 43 (Cx43) that the fibrosis of atrial muscle plays an important role during the initiation and maintenance of AF. Methods:

Ming Hua Luo; Yu Shu Li; Ke Ping Yang

2007-01-01

380

Pulmonary vein, dorsal atrial wall and atrial septum abnormalities in podoplanin knockout mice with disturbed posterior heart field contribution.  

PubMed

The developing sinus venosus myocardium, derived from the posterior heart field, contributes to the atrial septum, the posterior atrial wall, the sino-atrial node, and myocardium lining the pulmonary and cardinal veins, all expressing podoplanin, a coelomic and myocardial marker. We compared development and differentiation of the myocardium and vascular wall of the pulmonary veins (PV), left atrial dorsal wall, and atrial septum in wild type with podoplanin knockout mouse embryos (E10.5-E18.5) by 3D reconstruction and immunohistochemistry. Expression of Nkx2.5 in the pulmonary venous myocardium changes from mosaic to positive during development pointing out a high proliferative rate compared with Nkx2.5 negative myocardium of the sino-atrial node and cardinal veins. In mutants, myocardium of the PVs, dorsal atrial wall and atrial septum was hypoplastic. The atrial septum and right-sided wall of the PV almost lacked interposed mesenchyme. Extension of smooth muscle cells into the left atrial body was diminished. We conclude that myocardium of the PVs, dorsal atrial wall, and atrial septum, as well as the smooth muscle cells, are derived from the posterior heart field regulated by podoplanin. PMID:18784615

Douglas, Yvonne L; Mahtab, Edris A F; Jongbloed, Monique R M; Uhrin, Pavel; Zaujec, Jan; Binder, Bernd R; Schalij, Martin J; Poelmann, Robert E; Deruiter, Marco C; Gittenberger-de Groot, Adriana C

2009-01-01

381

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

PubMed

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

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

2014-08-01

382

Transgenic Insights Linking Pitx2 and Atrial Arrhythmias  

PubMed Central

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

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

2012-01-01

383

Atrial Tachyarrhythmia in Rgs5-Null Mice  

PubMed Central

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

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

2012-01-01

384

Atrial fibrillation and stroke: prevalence in different types of stroke and influence on early and long term prognosis (Oxfordshire community stroke project)  

PubMed Central

OBJECTIVE--To determine in patients with first ever stroke whether atrial fibrillation influences clinical features, the need to perform computed tomography, and prognosis. DESIGN--Observational cohort study with maximum follow up of 6.5 years. SETTING--Primary care, based on 10 general practices in urban and rural Oxfordshire. SUBJECTS--Consecutive series of 675 patients with first ever stroke registered in the Oxfordshire community stroke project. MAIN OUTCOME MEASURES--Prevalence of atrial fibrillation by type of stroke; effect of atrial fibrillation on case fatality rate and risk of recurrent stroke, vascular death, and death from all causes. RESULTS--Prevalence of atrial fibrillation was 17% (95% confidence interval 14% to 20%) for all stroke types (115/675), 18% (15% to 21%) for cerebral infarction (97/545), 11% (4% to 11%) for primary intercerebral haemorrhage (7/66), and 0% (0 to 11%) for subarachnoid haemorrhage (0/33). For patients with cerebral infarction the 30 day case fatality rate was significantly higher with atrial fibrillation (23%) than with sinus rhythm (8%); the risk of early recurrent stroke (within 30 days) was 1% with atrial fibrillation and 4% with sinus rhythm. In patients who survived at least 30 days the average annual risk of recurrent stroke was 8.2% (5.9% to 10.9%) with sinus rhythm and 11% (6.0% to 17.3%) with atrial fibrillation. CONCLUSIONS--After a first stroke atrial fibrillation was not associated with a definite excess risk of recurrent stroke, either within 30 days or within the first few years. Survivors with and without atrial fibrillation had a clinically important absolute risk of further serious vascular events.

Sandercock, P.; Bamford, J.; Dennis, M.; Burn, J.; Slattery, J.; Jones, L.; Boonyakarnkul, S.; Warlow, C.

1992-01-01

385

Magnesium adjunctive therapy in atrial arrhythmias.  

PubMed

Magnesium (Mg) is an important intracellular ion with cardiac metabolism and electrophysiologic properties. A large percentage of patients with arrhythmias have an intracellular Mg deficiency, which is out of line with serum Mg concentrations, and this may explain the rationale for Mg's benefits as an atrial antiarrhythmic agent. A current limitation of antiarrhythmic therapy is that the potential for cardiac risk offsets some of the benefits of therapy. Mg enhances the balance of benefits to harms by enhancing atrial antiarrhythmic efficacy and reducing antiarrhythmic proarrhythmia potential as well as providing direct antiarrhythmic efficacy when used as monotherapy in patients undergoing cardiothoracic surgery. PMID:23731344

Ganga, Harsha V; Noyes, Adam; White, Charles Michael; Kluger, Jeffrey

2013-10-01

386

Cryoballoon Catheter Ablation in Atrial Fibrillation  

PubMed Central

Pulmonary vein isolation with catheter ablation is an effective treatment in patients with symptomatic atrial fibrillation refractory or intolerant to antiarrhythmic medications. The cryoballoon catheter was recently approved for this procedure. In this paper, the basics of cryothermal energy ablation are reviewed including its ability of creating homogenous lesion formation, minimal destruction to surrounding vasculature, preserved tissue integrity, and lower risk of thrombus formation. Also summarized here are the publications describing the clinical experience with the cryoballoon catheter ablation in both paroxysmal and persistent atrial fibrillation, its safety and efficacy, and discussions on the technical aspect of the cryoballoon ablation procedure.

Ozcan, Cevher; Ruskin, Jeremy; Mansour, Moussa

2011-01-01

387

Atrial fibrillation and the 4P medicine.  

PubMed

Although the paradigm of the 4P medicine - Predictive, Personalized, Preemptive, and Participatory - has been suggested several years ago, its application to atrial fibrillation is still far away. Given the increasing prevalence and incidence of this pathology it is the time to promote preventive strategies, by identifying the risk factors associated to life style and by incentivizing innovative diagnostic technologies. The promotion of the correct life style and of the use of diagnostic devices based on innovative and reliable technologies, represent a first step towards the full realization of the revolution of 4P medicine in atrial fibrillation. PMID:24071602

Censi, Federica; Cianfrocca, Cinzia; Purificato, Ivana

2013-01-01

388

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.

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

2014-01-01

389

The myxoma virus EcoRI-O fragment encodes the DNA binding core protein and the major envelope protein of extracellular poxvirus.  

PubMed

The nucleotide sequences of the myxoma virus gene homologs encoding the DNA binding core protein (MF17) and the major envelope protein of the extracellular poxvirus particle (MF13) have been localized to the myxoma virus 4 kB EcoRI-O fragment. The EcoRI-O fragment is located approximately 22 kb from the left end of the 163 kb DNA genome and encodes homologs of the F12L, F13L, F15L, F16L, F17R and E1L genes of the Copenhagen strain of vaccinia virus. The inferred amino acid sequences of the myxoma virus EcoRI-O encoded products have been compared to the protein databases to identify related proteins. The myxoma virus open reading frames MF12, MF15, MF16, MF17 and ME1 encode homologs of poxvirus specific proteins while the MF13 envelope protein also shares amino acid similarity with other poxvirus and cellular proteins. PMID:9778789

Jackson, R J; Hall, D F

1998-01-01

390

Virulence and pathogenesis of the MSW and MSD strains of Californian myxoma virus in European rabbits with genetic resistance to myxomatosis compared to rabbits with no genetic resistance  

Microsoft Academic Search

The pathogenesis of two Californian strains of myxoma virus (MSW and MSD) was examined in European rabbits (Oryctolagus cuniculus) that were either susceptible to myxomatosis (laboratory rabbits) or had undergone natural selection for genetic resistance to myxomatosis (Australian wild rabbits). MSW was highly lethal for both types of rabbits with average survival times of 7.3 and 9.4 days, respectively, and

L. Silvers; B. Inglis; A. Labudovic; P. A. Janssens; B. H. van Leeuwen; P. J. Kerr

2006-01-01

391

Three origins of focal atrial tachycardia in the lateral mitral isthmus.  

PubMed

Multiple origins of focal atrial tachycardia (AT) located at the left lateral isthmus is a rare case. We present a case of a 31-year-old female with incessant AT. During radiofrequency ablation, 3 origins of AT located in the lateral mitral ishtmus from a lower to a higher position were identified with changes of the ECG morphology and earliest activation on 3D mapping. Ablation of the AT origins can terminate the tachycardia. PMID:21235673

Hartono, Beny; Chang, Shih-Lin; Lin, Yenn-Jiang; Chen, Shih-Ann

2011-08-01

392

Pneumopericardium: an uncommon complication of atrial lead perforation following pacemaker implantation.  

PubMed

Cardiac perforation is an infrequent but potentially life-threatening complication of pacemaker implantation. We report a case of right atrial lead perforation complicated by pneumopericardium shortly after pacemaker lead insertion. Transthoracic echocardiography revealed no evidence of pericardial effusion and pacemaker lead displacement, but a thoracic computed tomography scan illustrated the lead course and confirmed the diagnosis. This case suggests that computed tomography is a sensitive modality to confirm the diagnosis at the early stage of this complication. PMID:24783478

Higny, Julien; Blommaert, Dominique

2014-04-01

393

An improved method for echographic detection of left atrial enlargement  

NASA Technical Reports Server (NTRS)

Echographic dimensions of the aortic root and left atrium were compared in 170 patients in order to assess dilation of the left atrium with reference to the relatively nondistensible fibrous aortic root. In 50 patients without cause for left atrial or aortic enlargement, the ratio of left atrial/aortic root dimensions was 0.87 to 1.11. In 80 patients with known cause for left atrial enlargement, the left atrial/aortic root ratio was greater than or equal to 1.17. In 40 patients with isolated valve disease, dilation of both the aortic root and the left atrium resulted in a left atrial/aortic root dimension ratio less than 1.17 in some patients. Despite this consideration, the comparison of left atrial and aortic root dimension appears to be as specific as, and more sensitive than, previously proposed methods for the evaluation of left atrial enlargement.

Brown, O. R.; Harrison, D. C.; Popp, R. L.

1974-01-01

394

Current concepts and management strategies in atrial flutter.  

PubMed

After atrial fibrillation, atrial flutter (AFL) is the most important and most common atrial tachyarrhythmia. Atrial flutter describes an electrocardiographic model of atrial tachycardia >or=240/min, with a uniform and regular continuous wave-form. There is classically a 2:1 conduction across the atrioventricular (AV) node; as a result, the ventricular rate is usually one-half the flutter rate in the absence of AV node dysfunction. AFL can be harmful by impairing the cardiac output and by encouraging atrial thrombus formation that can lead to systemic embolization. There are four major concerns that must be addressed in the treatment of AFL: reversion to normal sinus rhythm (NSR); maintenance of NSR; control of the ventricular rate; and prevention of systemic embolization. Our review will highlight strategies for reverting patients back to NSR and then maintaining them in NSR, with emphasis on the recent updates, including the role of ablation in the management of atrial flutter. PMID:19668035

Dhar, Sunil; Lidhoo, Pooja; Koul, Deepak; Dhar, Sanjay; Bakhshi, Manvendra; Deger, Florin T

2009-09-01

395

Atrial Ca2+ signaling in atrial fibrillation as an antiarrhythmic drug target.  

PubMed

Atrial fibrillation (AF) is the most frequent arrhythmia and is associated with increased morbidity and mortality. Current drugs for AF treatment have moderate efficacy and increase the risk of life-threatening antiarrhythmias, making novel drug development crucial. Newer antiarrhythmic drugs like dronedarone and possibly vernakalant are efficient and may have less proarrhythmic potential. Emerging evidence suggests that abnormal intracellular Ca(2+) signaling is the key contributor to focal firing, substrate evolution, and atrial remodeling during AF. Accordingly, identification of the underlying atrial Ca(2+)-handling abnormalities is expected to discover novel mechanistically based therapeutic targets. This article reviews the molecular mechanisms of altered Ca(2+) signaling in AF and discusses the potential value of novel approaches targeting atrial Ca(2+)-handling abnormalities. PMID:19784635

Dobrev, Dobromir

2010-03-01

396

Atrial arrhythmias and pacing after orthotopic heart transplantation: bicaval versus standard atrial anastomosis.  

PubMed Central

BACKGROUND--Right and left atrial configuration is more normal when the donor left atrium is anastomosed to a recipient left atrial cuff with direct anastomoses of the donor and recipient vena cavas on the right side. The right atrium and sinus node may be less disturbed by the technique of bicaval anastomosis than by the standard procedure. OBJECTIVE--To compare the incidence of atrial arrhythmias and pacing after bicaval and standard anastomoses. METHODS--75 patients had heart transplants between January 1991 and December 1993. The notes were reviewed. Nine patients who died within the first 30 days were excluded from further analysis (seven patients with standard anastomoses, one with bicaval anastomosis, and one with a hybrid technique). RESULTS--66 patients survived for more than 30 days. Thirty five patients had standard anastomoses and 31 bicaval anastomoses. Atrial tachyarrhythmias (atrial fibrillation, atrial flutter, atrial tachycardia, or supraventricular tachycardia) occurred on four days in three patients in the bicaval group compared with 27 days in 13 patients in the standard group (P = 0.009). The relative risk of atrial tachyarrhythmias with standard anastomosis was 5.52 (P = 0.015) compared with that of bicaval anastomosis. Atrial tachyarrhythmias requiring treatment occurred less often in the bicaval group (four episodes in three patients in the bicaval group and eight episodes in four patients in the standard group), and fewer patients with a bicaval anastomosis required temporary pacing (pacing on 20 days in 10 patients in the bicaval group, but pacing on 49 days in 16 patients in the standard group) and late permanent pacing (no patients in the bicaval group and three patients in the standard group), although these differences were not statistically significant. Patients in the bicaval group were discharged from hospital sooner than those in the standard group (mean 24.1 v 29.1 days, P = 0.024). CONCLUSIONS--The technique of bicaval anastomosis, in addition to theoretical advantages from maintaining a more normal atrial configuration, has a lower incidence of postoperative atrial tachyarrhythmias, may reduce the need for pacing, and allows earlier discharge from hospital.

Grant, S. C.; Khan, M. A.; Faragher, E. B.; Yonan, N.; Brooks, N. H.

1995-01-01

397

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

2011-01-01

398

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

399

[Atrial mechanical and electrical dysfunction in patient with Emery-Dreifuss muscular dystrophy reason of change in electrotherapeutical approach: frequent result of rare disease].  

PubMed

We present a case of a 35 year-old male patient with Emery-Dreifuss muscular dystrophy diagnosed in the age of 12 who was assigned to dual chamber pacing system due to bradycardia primarily recognised as sinus node insufficiency with the atrio-ventricular nodal rhythm. During the procedure permanent electrical atrial stand-still without atrial capture were detected and the mode of stimulation was change to VVIR. PMID:23788349

Steckiewicz, Roman; Stolarz, Przemys?aw; Kosior, Dariusz A; Marchel, Micha?; Pieniak, Marian; ?wi?to?, El?bieta; Piotrowska-Kownacka, Ewa; Grabowski, Marcin

2013-01-01

400

Myxoma Virus Infection Promotes NK Lysis of Malignant Gliomas In Vitro and In Vivo  

PubMed Central

Myxoma virus (MYXV) is a well-established oncolytic agent against different types of tumors. MYXV is also known for its immunomodulatory properties in down-regulating major histocompatibility complex (MHC) I surface expression (via the M153R gene product, a viral E3-ubiquitin ligase) and suppressing T cell killing of infected target cells. MHC I down-regulation, however, favors NK cell activation. Brain tumors including gliomas are characterized by high MHC I expression with impaired NK activity. We thus hypothesized that MYXV infection of glioma cells will promote NK cell-mediated recognition and killing of gliomas. We infected human gliomas with MYXV and evaluated their susceptibility to NK cell-mediated cytotoxicity. MYXV enhanced NK cell-mediated killing of glioma cells (U87 cells, MYXV vs. Mock: 51.73% vs. 28.63%, P?=?.0001, t test; U251 cells, MYXV vs. Mock: 40.4% vs. 20.03%, P .0007, t test). Using MYXV M153R targeted knockout (designated vMyx-M153KO) to infect gliomas, we demonstrate that M153R was responsible for reduced expression of MHC I on gliomas and enhanced NK cell-mediated antiglioma activity (U87 cells, MYXV vs. vMyx-M153KO: 51.73% vs. 25.17%, P?=?.0002, t test; U251 cells, MYXV vs. vMyx-M153KO: 40.4% vs. 19.27, P?=?.0013, t test). Consequently, NK cell-mediated lysis of established human glioma tumors in CB-17 SCID mice was accelerated with improved mouse survival (log-rank P?=?.0072). These results demonstrate the potential for combining MYXV with NK cells to effectively kill malignant gliomas.

Ogbomo, Henry; Zemp, Franz J.; Lun, Xueqing; Zhang, Jiqing; Stack, Danuta; Rahman, Masmudur M.; Mcfadden, Grant; Mody, Christopher H.; Forsyth, Peter A.

2013-01-01

401

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

PubMed

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

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

2012-01-01

402

[Carney complex: a syndrome with cardial, cutaneous and neuronal tumours].  

PubMed

A 12 year-old boy presented with neurological symptoms and was found to have a left atrial myxoma. Characteristic facial skin pigmentation raised a suspicion of Carney complex, a rare autosomal dominant disease, which includes cutaneous changes, atrial myxomas and neuroendocrine tumours. The boy's mother had similar skin pigmentation and on subsequent cardiac echocardiography she was found to have left and right atrial myxomas. Both mother and child underwent successful surgical resection of the myxomas. PMID:22546165

Røpcke, Diana M; Bjerre, Jesper; Heuck, Carsten; van Doorn, Carin

2012-04-30

403

New oral anticoagulants in atrial fibrillation  

Microsoft Academic Search

Atrial fibrillation (AF) is a major risk factor for stroke. Currently, acetylsalicylic acid (a platelet inhibitor) and vitamin K antagonists (VKAs; oral anticoagulants), including warfarin, are the only approved antithrombotic therapies for stroke prevention in patients with AF. Although effective, VKAs have unpredictable pharmacological effects, requiring regular coagulation monitoring and dose adjustment to maintain effects within the therapeutic range. The

Alexander G. G. Turpie

2008-01-01

404

Atrial Ejection Force in Systemic Autoimmune Diseases  

Microsoft Academic Search

Systemic autoimmune disorders may affect several organs, including the heart. We analyzed two-dimensional and pulsed Doppler echocardiograms of patients (n = 37) with systemic lupus erythematosus (SLE, n = 24) or rheumatoid arthritis (RA, n = 13) to determine whether atrial ejection force (AEF) could represent a suitable parameter for detecting left ventricular filling abnormalities in SLE and RA. In

Roland Jahns; Johji Naito; Hans-Peter Tony; Gerhard Inselmann

1999-01-01

405

Sample size estimates for atrial fibrillation endpoints  

Microsoft Academic Search

This article reviews the current sample size requirements for studies evaluating the efficacy of atrial therapies. Sample sizes for several study designs and endpoints are presented. However, emphasis is given to studies conducted in patients with implantable devices in the light of new available data from recent trials involving such patients. Studies utilizing mortality require >5,000 patients followed for at

Eduardo N Warman; Andrea Grammatico; Luigi Padeletti

2004-01-01

406

Atrial fibrillation following methylprednisolone pulse therapy  

Microsoft Academic Search

Two children, one with renal manifestations of systemic lupus erythematosus and the other with idiopathic nephrotic syndrome, were treated with methylprednisolone pulses. Neither had previous evidence of underlying cardiac disease. Within 24 h of pulse therapy, they complained of palpitations and developed atrial fibrillation which reversed spontaneously or after anti-arrhythmic therapy. Subsequent serial electro-and echocardiograms were normal. We propose that

Norishi Ueda; Tetsushi Yoshikawa; Masaru Chihara; Shinji Kawaguchi; Yukihiko Niinomi; Takehiko Yasaki

1988-01-01

407

Antithrombotic Treatment of Atrial Fibrillation in China  

Microsoft Academic Search

Atrial fibrillation (AF) is a common arrhythmia encountered in daily clinical practice in China. It is also one of the most important risk factors to increased morbidity and mortality. The most serious complication associated with AF is ischemic stroke, which may occur in 5-15% of patients with high risk features. (1)Anticoagulant therapy is of proven benefit in stroke reduction and

Dayi Hu; Yihong Sun

408

Atrial tachycardia with 1:1 atrioventricular conduction precipitated by propafenone.  

PubMed

A 58-year-old man presented to the emergency department with sudden onset rapid palpitations and significant presyncope while walking on the flat. The previous day he had undergone DC cardioversion for atrial fibrillation (AF) which had been initially successful. However, 6 h after cardioversion he was aware of intermittently raised but regular heart rates. On arrival at the emergency department (ED) he was well with no haemodynamic compromise. The ECG showed an atrial tachycardia instead of AF. Medications consisted of propafenone 300 mg twice daily, bisoprolol 5 mg at night and warfarin. Bisoprolol was increased to 5 mg twice daily and he was discharged with a plan for outpatient ablation. He collapsed in the hospital car park with rapid palpitations, chest tightness and vagal symptoms. On return to the ED he was hypotensive with a heart rate of 200 bpm. The ECG showed 1:1 atrioventricular conduction (AV) of the atrial tachycardia which promptly improved after administering intravenous atenolol. Class 1c antiarrhythmic agents such as propafenone can precipitate 1:1 AV conduction of atrial tachycardias resulting in dangerous exacerbations of ventricular rate or even malignant tachyarrhythmias. It is therefore essential that concomitant AV blocking agents are used both prophylactically or acutely in suspected cases. PMID:19934146

Khavandi, A; Walker, S K

2009-12-01

409

Myxoma Virus M141R Expresses a Viral CD200 (vOX2) That Is Responsible for Down-Regulation of Macrophage and T-Cell Activation In Vivo  

Microsoft Academic Search

M141R is a myxoma virus gene that encodes a cell surface protein with significant amino acid similarity to the family of cellular CD200 (OX-2) proteins implicated in the regulation of myeloid lineage cell activation. The creation of an M141R deletion mutant myxoma virus strain (vMyx141KO) and its subsequent infection of European rabbits demonstrated that M141R is required for the full

Cheryl M. Cameron; John W. Barrett; Liying Liu; Alexandra R. Lucas; Grant McFadden

2005-01-01

410

Kv1.5 channelopathy due to KCNA5 loss-of-function mutation causes human atrial fibrillation.  

PubMed

Atrial fibrillation is a rhythm disorder characterized by chaotic electrical activity of cardiac atria. Predisposing to stroke and heart failure, this common condition is increasingly recognized as a heritable disorder. To identify genetic defects conferring disease susceptibility, patients with idiopathic atrial fibrillation, lacking traditional risk factors, were evaluated. Genomic DNA scanning revealed a nonsense mutation in KCNA5 that encodes Kv1.5, a voltage-gated potassium channel expressed in human atria. The heterozygous E375X mutation, present in a familial case of atrial fibrillation and absent in 540 unrelated control individuals, introduced a premature stop codon disrupting the Kv1.5 channel protein. The truncation eliminated the S4-S6 voltage sensor, pore region and C-terminus, preserving the N-terminus and S1-S3 transmembrane domains that secure tetrameric subunit assembly. Heterologously expressed recombinant E375X mutant failed to generate the ultrarapid delayed rectifier current I(Kur) vital for atrial repolarization and exerted a dominant-negative effect on wild-type current. Loss of channel function translated into action potential prolongation and early after-depolarization in human atrial myocytes, increasing vulnerability to stress-provoked triggered activity. The pathogenic link between compromised Kv1.5 function and susceptibility to atrial fibrillation was verified, at the organism level, in a murine model. Rescue of the genetic defect was achieved by aminoglycoside-induced translational read-through of the E375X premature stop codon, restoring channel function. This first report of Kv1.5 loss-of-function channelopathy establishes KCNA5 mutation as a novel risk factor for repolarization deficiency and atrial fibrillation. PMID:16772329

Olson, Timothy M; Alekseev, Alexey E; Liu, Xiaoke K; Park, Sungjo; Zingman, Leonid V; Bienengraeber, Martin; Sattiraju, Srinivasan; Ballew, Jeffrey D; Jahangir, Arshad; Terzic, Andre

2006-07-15

411

Systolic time intervals in atrial fibrillation.  

PubMed

Forty patients with atrial fibrillation and 20 patients with congestive heart failure and sinus rhythm were studied. Patients were divided into two groups. Group A consisted of 20 patients with atrial fibrillation in whom systolic time intervals were measured. Twenty to 50 beats were analyzed. Five of the patients had high-fidelity measurements of left ventricular pressure simultaneous with determination of systolic time intervals. Analysis of the systolic time intervals for the entire group showed that the preejection period lengthened at faster heart rates and that the left ventricular ejection time was relatively constant at slower heart rates. This resulted in a progressive increase in the ratio of preejection period over left ventricular ejection time (PEP/LVET) as the heart rate increased. The rate of increase in PEP/LVET was minimal below a heart rate of 75 beats per minute. The increase in preejection period at faster heart rates is due to greater isovolumic developed pressure without a corresponding increase in left ventricular dp/dt. Group B consisted of 40 additional patients (20 with atrial fibrillation and 20 with sinus rhythm). In group B, the total electromechanical systole corrected for heart rate (QS2I) and the levels of digoxin in the blood were compared. The QS2I was significantly shorter in atrial fibrillation (497 +/- 5 msec vs 528 +/- 4 msec; P less than 0.01), while the levels of digoxin in the blood were identical (0.9 +/- 0.1 vs 1.0 +/- 0.1 ng/ml). The results of this study must be considered when systolic time intervals are to be employed in patients with atrial fibrillation. PMID:738120

Boudoulas, H; Lewis, R P; Sherman, J A; Bush, C A; Dalamangas, G; Forester, W F

1978-12-01

412

Predicting initiation and termination of atrial fibrillation from the ECG.  

PubMed

Atrial fibrillation is the most common cardiac arrhythmia, affecting more than two million people in the US. Several therapies for patients with atrial fibrillation are available, but methods to help physicians select the optimal therapy for an individual patient are still required. Knowledge of whether a patient with a normal ECG will exhibit atrial fibrillation in the future, as well as whether atrial fibrillation will terminate spontaneously, would be very useful in clinical routine. The paper presents a software system for predicting the initiation and termination of atrial fibrillation from the ECG. The algorithms have been validated on ECGs from several signal databases. Prediction of the initiation of atrial fibrillation was achieved by detecting premature heart beats and analyzing the morphology of their P waves. Prediction of the termination of atrial fibrillation was based on calculation of the major atrial frequency. This frequency has been shown to decrease significantly prior to the termination of atrial fibrillation. Nevertheless, the effect is much less distinct in the large data set used for this study compared to previous studies. The initiation of atrial fibrillation, however, could be correctly predicted in approximately 75% of the data analyzed. PMID:17313327

Hayn, Dieter; Kollmann, Alexander; Schreier, Günter

2007-02-01

413

Behavior of an Automatic Pacemaker Sensing Algorithm for Single-Pass VDD Atrial Electrograms.  

National Technical Information Service (NTIS)

Single-pass VDD pacemakers have been used as a result of simple implantation procedures and generally reliable atrial tracking. However, there is a controversy over their reliabilities of atrial tracking. As a new sensing method for reliable atrial tracki...

J. Kim S. H. Lee S. Y. Yang B. S. Cho W. Huh

2001-01-01

414

Could successful cryoballoon ablation of paroxysmal atrial fibrillation prevent progressive left atrial remodeling?  

PubMed Central

Background Radiofrequency catheter ablation of atrial fibrillation (AF) has been proved to be effective and to prevent progressive left atrial (LA) remodeling. Cryoballoon catheter ablation (CCA), using a different energy source, was developed to simplify the ablation procedure. Our hypothesis was that successful CCA can also prevent progressive LA remodeling. Methods 36 patients selected for their first CCA because of nonvalvular paroxysmal AF had echocardiography before and 3, 6 and 12 months after CCA. LA diameters, volumes (LAV) and LA volume index (LAVI) were evaluated. LA function was assessed by: early diastolic velocities of the mitral annulus (Aasept, Aalat), LA filling fraction (LAFF), LA emptying fraction (LAEF) and the systolic fraction of pulmonary venous flow (PVSF). Detailed left ventricular diastolic function assessment was also performed. Results Excluding recurrences in the first 3-month blanking period, the clinical success rate was 64%. During one-year of follow-up, recurrent atrial arrhythmia was found in 21 patients (58%). In the recurrent group at 12 months after ablation, minimal LAV (38 ± 19 to 44 ± 20 ml; p < 0.05), maximal LAV (73 ± 23 to 81 ± 24 ml; p < 0.05), LAVI (35 ± 10 to 39 ± 11 ml/m2; p = 0.01) and the maximal LA longitudinal diameter (55 ± 5 to 59 ± 6 mm; p < 0.01) had all increased. PVSF (58 ± 9 to 50 ± 10%; p = 0.01) and LAFF (36 ± 7 to 33 ± 8%; p = 0.03) had decreased. In contrast, after successful cryoballoon ablation LA size had not increased and LA function had not declined. In the recurrent group LAEF was significantly lower at baseline and at follow-up visits. Conclusions In patients whose paroxysmal atrial fibrillation recurred within one year after cryoballoon catheter ablation left atrial size had increased and left atrial function had declined. In contrast, successful cryoballoon catheter ablation prevented progressive left atrial remodeling.

2012-01-01

415

Protein Analysis of Atrial Fibrosis via Label-Free Proteomics in Chronic Atrial Fibrillation Patients with Mitral Valve Disease  

PubMed Central

Background Atrial fibrosis, as a hallmark of atrial structure remodeling, plays an important role in maintenance of chronic atrial fibrillation, but interrelationship of atrial fibrosis and atrial fibrillation is uncertain. Label-free proteomics can implement high throughput screening for finding and analyzing pivotal proteins related to the disease.. Therefore, we used label-free proteomics to explore and analyze differentially proteins in chronic atrial fibrillation patients with mitral valve disease. Methods Left and right atrial appendages obtained from patients with mitral valve disease were both in chronic atrial fibrillation (CAF, AF?6 months, n?=?6) and in sinus rhythm (SR, n?=?6). One part of the sample was used for histological analysis and fibrosis quantification; other part were analyzed by label-free proteomic combining liquid chromatography with mass spectrometry (LC-MS), we utilized bioinformatics analysis to identify differential proteins. Results Degree of atrial fibrosis was higher in CAF patients than that of SR patients. 223 differential proteins were detected between two groups. These proteins mainly had vital functions such as cell proliferation, stress response, focal adhesion apoptosis. We evaluated that serine/threonine protein kinase N2 (PKN2), dermatopontin(DP), S100 calcium binding protein B(S100B), protein tyrosine kinase 2(PTK2) and discoidin domain receptor tyrosine kinase 2(DDR2) played important roles in fibrotic process related to atrial fibrillation. Conclusion The study presented differential proteins responsible for atrial fibrosis in chronic atrial fibrillation patients through label-free proteomic analysis. We assessed some vital proteins including their characters and roles. These findings may open up new realm for mechanism research of atrial fibrillation.

Zhang, Peide; Wang, Wei; Wang, Xin; Wang, Xu; Song, Yunhu; Han, Yong; Zhang, Jing; Zhao, Hui

2013-01-01

416

The Efficacy of Administration of Intravenous Magnesium Sulfate for Improved Ventricular Rate Control or Rhythm Control in Patients with Non-postoperative Atrial Fibrillation and Atrial Flutter  

Microsoft Academic Search

INTRODUCTION: Standard treatment for atrial tachyarrthmias, such as atrial fibrillation or atrial flutter, involves rate and rhythm control. Previous studies have looked at the electrophysiologic effects of magnesium on impulse formation and propagation, and theorized it could be beneficial in treatment for atrial tachycardias. There recently have been studies about magnesium sulfate and its utility in establishing rate and rhythm

Mary Schindeler

2009-01-01

417

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

PubMed Central

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

2014-01-01

418

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

PubMed

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

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

2014-04-01

419

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

PubMed

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

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

2011-10-01

420

Endoscopic management of an esophagopericardial fistula after radiofrequency ablation for atrial fibrillation.  

PubMed

A case is reported of a 76-year-old man with a past history of atrial fibrillation. A radiofrequency ablation procedure was suggested following several failed cardioversion attempts. However, an esophagopericardial fistula complicated the procedure. This life-threatening complication was successfully managed using both the placement of a covered esophageal stent and surgical pericardial and mediastinal drainage. In fact, no persisting fistula could be detected when the esophageal stent was removed seven weeks later. Atrioesophageal and esophagopericardial fistulas are two of the most severe complications associated with cardiological radiofrequency ablation procedures. They are responsible for majority of the deaths associated with this procedure. Despite the extremely high morbimortality associated with cardiothoracic surgery in such conditions, this treatment is the gold-standard for the management of such complications. This case report emphasizes the importance and efficacy of the endoscopic approach as part of a multidisciplinary management approach to this serious adverse event following radiofrequency ablation for atrial fibrillation. PMID:23745039

Quénéhervé, Lucille; Musquer, Nicolas; Léauté, Franck; Coron, Emmanuel

2013-06-01

421

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

422

Cardiorespiratory interactions in patients with atrial flutter.  

PubMed

Respiratory sinus arrhythmia (RSA) is generally known as the autonomically mediated modulation of the sinus node pacemaker frequency in synchrony with respiration. Cardiorespiratory interactions have been largely investigated during sinus rhythm, whereas little is known about interactions during reentrant arrhythmias. In this study, cardiorespiratory interactions at the atrial and ventricular level were investigated during atrial flutter (AFL), a supraventricular arrhythmia based on a reentry, by using cross-spectral analysis and computer modeling. The coherence and phase between respiration and atrial (gamma(AA)(2), phi(AA)) and ventricular (gamma(RR)(2), phi(RR)) interval series were estimated in 20 patients with typical AFL (68.0 +/- 8.8 yr) and some degree of atrioventricular (AV) conduction block. In all patients, atrial intervals displayed oscillations strongly coupled and in phase with respiration (gamma(AA)(2)= 0.97 +/- 0.05, phi(AA) = 0.71 +/- 0.31 rad), corresponding to a paradoxical lengthening of intervals during inspiration. The modulation pattern was frequency independent, with in-phase oscillations and short time delays (0.40 +/- 0.15 s) for respiratory frequencies in the range 0.1-0.4 Hz. Ventricular patterns were affected by AV conduction type. In patients with fixed AV conduction, ventricular intervals displayed oscillations strongly coupled (gamma(RR)(2)= 0.97 +/- 0.03) and in phase with respiration (phi(RR) = 1.08 +/- 0.80 rad). Differently, in patients with variable AV conduction, respiratory oscillations were secondary to Wencheback rhythmicity, resulting in a decreased level of coupling (gamma(RR)(2)= 0.50 +/- 0.21). Simulations with a simplified model of AV conduction showed ventricular patterns to originate from the combination of a respiratory modulated atrial input with the functional properties of the AV node. The paradoxical frequency-independent modulation pattern of atrial interval, the short time delays, and the complexity of ventricular rhythm characterize respiratory arrhythmia during AFL and distinguish it from normal RSA. These peculiar features can be explained by assuming a direct mechanical action of respiration on AFL reentrant circuit. PMID:19023018

Masè, Michela; Disertori, Marcello; Ravelli, Flavia

2009-01-01

423

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

PubMed Central

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

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

2010-01-01

424

Electrical activity of human atrial fibres at frequencies corresponding to atrial flutter.  

PubMed

Little information is available about rate dependent changes in electrical activity of human myocardial cells. We therefore studied, in vitro, the electrical activity of adult human atrial fibres driven at frequencies near that of atrial flutter by means of the standard microelectrode technique. Thirty two atrial samples exhibiting "normal" responses with fast upstroke were selected. At very high frequencies, the action potential (AP) upstroke arose from the repolarisation phase of the preceding AP in spite of marked frequency induced shortening of the plateau. As the stimulation rate was progressively increased, the take off potential (TOP) was less and less negative and the maximal rate of depolarisation (Vmax) decreased. Moreover, in most preparations, a clear alternation between two types of action potentials occurred. Calcium channel inhibitors cobalt (5 mM) or diltiazem (5 x 10(-6) M) shortened AP duration, increased Vmax and markedly reduced alternation. Sodium channel inhibitors, tetrodotoxin (7.5 10(-6) M) or lignocaine (10(-5) M) shortened AP duration and induced a transient increase in Vmax. Ouabain (10(-6) M) prolonged AP duration, decreased Vmax, enhanced alternation and finally suppressed the 1:1 capture of the atrial tissue. Our results show that, at high driving rates corresponding to the frequencies of atrial flutter, slight variations in action potential duration induced by drugs are associated with marked concomitant variations in Vmax and probably with consequent modifications of the conduction velocity. PMID:2550131

Lauribe, P; Escande, D; Nottin, R; Coraboeuf, E

1989-02-01

425

Multisite pacing for prevention of atrial tachyarrhythmias: potential mechanisms  

Microsoft Academic Search

OBJECTIVESTo determine the effects of single-, dual-, triple- and quadruple-site atrial pacing on atrial activation and refractoriness in normal canine hearts.BACKGROUNDMultisite pacing has been suggested to be superior to single-site pacing for prevention of atrial tachyarrhythmias. However, the underlying electrophysiological mechanisms are undetermined at the moment, as is the rationale for the selection of pacing locations and the number of

Ruediger Becker; Reinhard Klinkott; Alexander Bauer; Julia C Senges; Kirsten D Schreiner; Frederik Voss; Wolfgang Kuebler; Wolfgang Schoels

2000-01-01

426

Focal para-hisian atrial tachycardia with dual exits.  

PubMed

Focal atrial tachycardias (AT) in the right atrium (RA) tend to cluster around the crista terminalis, coronary sinus (CS) region, tricuspid annulus, and para-hisian region. In most cases, the AT focus can be identified by careful activation mapping, and completely eliminated by radiofrequency (RF) catheter ablation. However, RF ablation near the His bundle (HB) carries a risk of inadvertent damage to the atrioventricular (AV) conduction system. Here we describe a patient with an AT originating in the vicinity of the AV node, which was successfully ablated earlier from non-coronary aortic cusp (NCC), and recurred with an exit from para-hisian location. Respiratory excursions of the catheter were associated with migration to the area of HIs. This was successfully ablated during controlled apnoea, using 3D electroanatomic mapping. PMID:23993015

Lawrance Jesuraj, M; Sharada, K; Sridevi, C; Narasimhan, C

2013-01-01

427

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

PubMed

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

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

2013-08-01

428

Prolonged atrial fibrillation following generalised tonic-clonic seizures  

PubMed Central

We describe two male patients with focal epilepsy in whom transitory episodes of atrial fibrillation (AF) lasting for up to 25 hours were detected in the context of generalised tonic-clonic seizures (GTCS). In five of seven previously published cases of transitory AF associated with epileptic seizures, AF was also associated with GTCS, suggesting a pathophysiological link via GTCS-related increase in sympathetic tone and release of catecholamines. Importantly, AF increases the risk of thromboembolic cerebral ischemia, prompting the question of whether antithrombotic preventive treatment should be initiated in people with pharmacoresistant epilepsy and prolonged peri-ictal AF. Furthermore, AF can considerably impair cardiac output and may, via this mechanism, contribute to the risk of sudden unexpected death in epilepsy following GTCS.

Surges, Rainer; Moskau, Susanna; Viebahn, Bettina; Schoene-Bake, Jan-Christoph; Schwab, Joerg O.; Elger, Christian E.

2014-01-01

429

Focal para-hisian atrial tachycardia with dual exits  

PubMed Central

Focal atrial tachycardias (AT) in the right atrium (RA) tend to cluster around the crista terminalis, coronary sinus (CS) region, tricuspid annulus, and para-hisian region. In most cases, the AT focus can be identified by careful activation mapping, and completely eliminated by radiofrequency (RF) catheter ablation. However, RF ablation near the His bundle (HB) carries a risk of inadvertent damage to the atrioventricular (AV) conduction system. Here we describe a patient with an AT originating in the vicinity of the AV node, which was successfully ablated earlier from non-coronary aortic cusp (NCC), and recurred with an exit from para-hisian location. Respiratory excursions of the catheter were associated with migration to the area of HIs. This was successfully ablated during controlled apnoea, using 3D electroanatomic mapping.

Lawrance Jesuraj, M.; Sharada, K.; Sridevi, C.; Narasimhan, C.

2013-01-01