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Atrial Diameter (atrial + diameter)

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Medical Sciences100%

Kinds of Atrial Diameter

  • leave atrial diameter
    		•

    Selected Abstracts

    Correlation of Left Atrial Diameter by Echocardiography and Left Atrial Volume by Computed Tomography

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2009
    IRENE HOF M.D.
    Introduction: For patients undergoing catheter ablation of atrial fibrillation (AF), left atrial size is a predictor of recurrence of AF during follow-up. For this reason, major clinical trials have used a left atrial diameter (LAD) of more than 5.0 or 5.5 cm, assessed by echocardiography, as an exclusion criterion for patients deemed candidates for ablation of AF. However, whether LAD accurately reflects true left atrial size has not been systematically investigated. Therefore, the purpose of this study was to test the hypothesis that LAD, measured by echocardiography, accurately correlates to left atrial volume measured by computed tomography (CT). Methods and Results: We included 50 patients (mean age 56 ± 12 years, five female) with symptomatic AF (40% paroxysmal, 60% persistent), referred for catheter ablation. In each patient, transthoracic echocardiography was performed. Additionally, all patients underwent CT using a 64-slice CT scanner. Left atrial volume was calculated by manually tracing left atrial area on each CT cross-sectional image. Patients had a mean LAD measured by echocardiography of 4.5 ± 0.7 cm, ranging from 2.9 to 5.7 cm. Left atrial volume measured by CT ranged from 67 mL to 270 mL with a mean value of 146 ± 49 mL. A poor correlation was noted between LAD and left atrial volume, r = 0.49 (P < 0.001). Conclusion: LAD measured by echocardiography correlates poorly with left atrial volume measured by CT in patients with AF. As a result, selecting patients with AF for treatment with catheter ablation should not be based on an echocardiographic-derived LAD alone. [source]

    Does Left Atrial Size Predict Mortality in Asymptomatic Patients with Severe Aortic Stenosis?

    ECHOCARDIOGRAPHY, Issue 2 2010
    Grace Casaclang-Verzosa M.D.
    Background: We assessed the hypothesis that diastolic function represented by left atrial size determines the rate of development of symptoms and the risk of all-cause mortality in asymptomatic patients with severe aortic stenosis (AS). Methods: From a database of 622 asymptomatic patients with isolated severe AS (velocity by Doppler , 4 m/sec) followed for 5.4 ± 4 years, we reviewed the echocardiograms and evaluated Doppler echocardiographic indices of diastolic function. Prediction of symptom development and mortality by left atrial diameter with and without adjusting for clinical and echocardiographic parameters was performed using Cox proportional-hazards regression analysis. Results: The age was 71 ± 11 years and 317 (62%) patients were males. The aortic valve mean gradient was 46 ± 11 mmHg, and the Doppler-derived aortic valve area was 0.9 ± 0.2 cm2. During follow-up, symptoms developed in 233 (45%), valve surgery was performed in 290 (57%) and 138 (27%) died. Left atrial enlargement was significantly correlated with symptom development (P < 0.05) but the association diminished after adjusting for aortic valve area and peak velocity (P = 0.2). However, atrial diameter predicted death independent of age and gender (P = 0.007), comorbid conditions (P = 0.03), and AS severity and Doppler parameters of diastolic function (P = 0.002). Conclusion: Diastolic function, represented as left atrial diameter, is related to mortality in asymptomatic patients with severe AS. (ECHOCARDIOGRAPHY 2010;27:105-109) [source]

    Clinical and Echocardiographic Risk Factors for Embolization in the Presence of Left Atrial Thrombus

    ECHOCARDIOGRAPHY, Issue 5 2007
    Ela Sahinbas Kavlak
    Aims: The aim of our study was to evaluate the factors leading to embolization in patients with left atrial thrombi (LAT). With this purpose, we retrospectively analyzed clinical, transthoracic, transesophageal echocardiographic data of patients with LAT in the transesophageal echocardiographic evaluation. Methods and Results: One hundred ninety-two patients with LAT not on anticoagulant therapy were divided into two groups according to the presence of prior ischemic stroke. The group with ischemic stroke included more patients with sinus rhythm and less patients with mitral stenosis. They had smaller left atrial diameter, more left atrial appendage spontaneous echo-contrast, higher appendage ejection fraction, and emptying velocity. Conclusion: Once the thrombus has been formed, cerebral embolization seems to be higher in patients with relatively preserved appendage ejection fraction and emptying velocity. Presence of atrial appendage spontaneous echo-contrast also favor embolization. Factors leading to embolization seem to differ in some respects from the causes of thrombus formation. [source]

    Impact of Body Mass Index on Markers of Left Ventricular Thickness and Mass Calculation: Results of a Pilot Analysis

    ECHOCARDIOGRAPHY, Issue 3 2005
    Ranjini Krishnan M.D.
    Specific correlations between body mass index (BMI) and left ventricular (LV) thickness have been conflicting. Accordingly, we investigated if a particular correlation exists between BMI and echocardiographic markers of ventricular function. Methods: A total of 122 patients, referred for routine transthoracic echocardiography, were included in this prospective pilot study using a 3:1 randomization approach. Patient demographics were obtained using a questionnaire. Results: Group I consisted of 80 obese (BMI was >30 kg/m2), Group II of 16 overweight (BMI between 26 and 29 kg/m2), and Group III of 26 normal BMI (BMI < 25 kg/m2) individuals. No difference was found in left ventricular wall thickness, LV end-systolic cavity dimension, fractional shortening (FS), or pulmonary artery systolic pressure (PASP) among the groups. However, mean LV end-diastolic cavity dimension was greater in Group I (5.0 ± 0.9 cm) than Group II (4.6 ± 0.8 cm) or Group III (4.4 ± 0.9 cm; P < 0.006). LV mass indexed to height2.7 was also significantly larger in Group I (61 ± 21) when compared to Group III (48 ± 19; P < 0.001). Finally, left atrial diameter (4.3 ± 0.7 cm) was also larger (3.8 ± 0.6 and 3.6 ± 0.7, respectively; P < 0.00001).Discussion: We found no correlation between BMI and LV wall thickness, FS, or PASP despite the high prevalence of diabetes and hypertension in obese individuals. However, obese individuals had an increased LV end-diastolic cavity dimension, LV mass/height2.7, and left atrial diameter. These findings could represent early markers in the sequence of cardiac events occurring with obesity. A larger prospective study is needed to further define the sequence of cardiac abnormalities occurring with increasing BMI. [source]

    EFFECT OF PARAPROSTHETIC MODERETE TO SEVERE MITRAL REGURGITATION ON EMBOLIC EVENTS IN PATIENTS WITH PROSTHETIC MITRAL VALVES

    ECHOCARDIOGRAPHY, Issue 5 2004
    C. Cevik
    Thromboembolism is the major chronic risk for patients with mechanical prosthetic heart valves. Although optimal oral anticoagulantion is the key determinant for embolic events (EE) in these patients; other factors also contribute to this complication. We studied the prevalence and determinants of embolic events in patients with mitral prosthetic heart valves undergoing transesophageal echocardiography (TEE). 210 patients (86 male and 124 female, mean age 45.1 +/, 9.6 years) underwent a TEE study for evaluation of prosthetic valve functions. Clinical and TEE findings of the patients were as follows: Atrial fibrillation in 132 (%62) patients, prosthetic valve thrombus in 55 (%26) suboptimal INR (INR < 1.8) in 61 (%29) pts, left atrial spontenous echocardiographic contrast (SEC) in 31 (%14) patients, paraprosthetic moderete-severe mitral regurgitation (MR) in 28 (%13), left atrial (LA) and/or left atrial appendix (LAA) thrombus in 41 (%19), LA and/or LAA outflow velocities <0.25 m/sn in 21 patiens (%10), left atrial diameter >6 cm in 47 (%22). 72 patients had a history of EE in the previous 6 months (%34). In no patients were there any EE in the presence of paraprosthetic moderate to severe MR. Both with univariate and multivariate analysis presence of prosthetic valve and LA and/or LAA thrombus, absence of paraprosthetic moderete-severe MR, suboptimal INR, atrial fibrillation were found to be independent predictors for embolic events. Conclusions: Although the presence of prosthetic valve and LA and/or LAA thrombus, suboptimal INR, and AF predict EE, clinical and echocardiographic data support the protective effect of paraprosthetic moderate to severe MR against EE in pts with mitral prosthetic valves. [source]

    Mitral Valve Replacements in Redo Patients with Previous Mitral Valve Procedures: Mid-Term Results and Risk Factors for Survival

    JOURNAL OF CARDIAC SURGERY, Issue 5 2008
    Tankut Hakki Akay M.D.
    Patients and Methods: Between September 1989 and December 2003, 62 redo patients have undergone mitral valve replacements due to subsequent mitral valve problems. Preoperative, operative, and postoperative data were analyzed retrospectively and evaluated for risk factors affecting hospital mortality, mid- and long-term survival. Results: The hospital mortality was 6.4%. The one-, five-, and 10-year actuarial survival rates were 94%± 2%, 89%± 6%, and 81 ± 9%. New York Heart Association (NYHA) functional class IV, low left ventricular ejection fraction (<35%), increased left ventricular end-diastolic diameter (LVEDD) > 50 mm, female gender, pulmonary edema, and urgent operations were found to be risk factors in short-term survival. NYHA functional class IV, low left ventricular ejection fraction, increased LVEDD, and increased left atrial diameter (LA > 60 mm) were risk factors in mid-term survival. Conclusion: Redo mitral valve surgery with mechanical prosthesis offers encouraging short- and mid-term survival. NYHA functional class IV, low left ventricular ejection fraction, and increased left ventricular diameters were especially associated with increased short- and mid-term mortality. Earlier surgical management before the development of severe heart failure and myocardial dysfunction would improve the results of redo mitral valve surgery. [source]

    Predictors of Failure to Cure Atrial Fibrillation with the Mini-Maze Operation

    JOURNAL OF CARDIAC SURGERY, Issue 1 2004
    Zoltan A. Szalay M.D.
    A reduction in the number of right and left atrial incisions could decrease the operative time. The aim of this study was to assess the results of a mini-maze operation and to define predictors of its failure. Methods: Between 1995 and 2000, 72 patients (mean age 64 ± 9 years) undergoing cardiac surgery had a concomitant mini-maze operation for symptomatic chronic atrial fibrillation. Three and 12 months postoperatively, heart rhythm and left atrial transport functions were assessed by electrophysiology, echocardiography, and magnetic resonance imaging. Multivariate analysis was performed to identify predictors of failure of the mini-maze operation. Results: Operative mortality was 1.4% (1/72). Death during follow-up occurred in 5.6% of patients (4/71), in one due to chronic heart failure. After 1 year, 80% of patients (48/60) were either in sinus rhythm (n = 43; 72%) or had a pacemaker (n = 5; 8%) implanted due to sick sinus syndrome. Intermittent and chronic atrial fibrillation was found in 20% of patients (12/60). Preoperative duration of atrial fibrillation (p = 0.05), preoperative left atrial diameter (p = 0.001), preoperative right atrial diameter (p = 0.02), a reduced left ventricular ejection fraction (p = 0.03), an increased left ventricular end-diastolic diameter (p = 0.04), and the presence of mitral valve stenosis (p = 0.001) were found to be univariate predictors of failure of the mini-maze operation 1 year postoperatively. Multivariate analysis defined preoperative diagnosis of mitral valve stenosis (p = 0.005; OR 117.5), longer duration of preoperative atrial fibrillation (p = 0.01; OR 1.33), and increased preoperative left ventricular end-systolic diameter (p = 0.02; OR 1.2) as incremental independent risk factors for failure of the mini-maze operation to cure chronic atrial fibrillation. Conclusion: The mini-maze operation is a safe procedure with similar results to that of Cox's Maze-III operation. The less-invasive mini-maze operation could be applicable even to patients with severely reduced left ventricular function, in whom complex cardiac surgery has to be performed concomitantly as well as in those presenting severe comorbidities. (J Card Surg 2004;19:1-6) [source]

    Correlation of Left Atrial Diameter by Echocardiography and Left Atrial Volume by Computed Tomography

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2009
    IRENE HOF M.D.
    Introduction: For patients undergoing catheter ablation of atrial fibrillation (AF), left atrial size is a predictor of recurrence of AF during follow-up. For this reason, major clinical trials have used a left atrial diameter (LAD) of more than 5.0 or 5.5 cm, assessed by echocardiography, as an exclusion criterion for patients deemed candidates for ablation of AF. However, whether LAD accurately reflects true left atrial size has not been systematically investigated. Therefore, the purpose of this study was to test the hypothesis that LAD, measured by echocardiography, accurately correlates to left atrial volume measured by computed tomography (CT). Methods and Results: We included 50 patients (mean age 56 ± 12 years, five female) with symptomatic AF (40% paroxysmal, 60% persistent), referred for catheter ablation. In each patient, transthoracic echocardiography was performed. Additionally, all patients underwent CT using a 64-slice CT scanner. Left atrial volume was calculated by manually tracing left atrial area on each CT cross-sectional image. Patients had a mean LAD measured by echocardiography of 4.5 ± 0.7 cm, ranging from 2.9 to 5.7 cm. Left atrial volume measured by CT ranged from 67 mL to 270 mL with a mean value of 146 ± 49 mL. A poor correlation was noted between LAD and left atrial volume, r = 0.49 (P < 0.001). Conclusion: LAD measured by echocardiography correlates poorly with left atrial volume measured by CT in patients with AF. As a result, selecting patients with AF for treatment with catheter ablation should not be based on an echocardiographic-derived LAD alone. [source]

    Biphasic versus Monophasic Cardioversion in Shock-Resistant Atrial Fibrillation:

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2003
    A Randomized Clinical Trial
    Introduction: Cardioversion of atrial fibrillation using monophasic transthoracic shocks occasionally is ineffective. Biphasic cardioversion requires less energy than monophasic cardioversion, but its efficacy in shock-resistant atrial fibrillation is unknown. Thus, we compared the efficacy of cardioversion using biphasic versus monophasic waveform shocks in patients with atrial fibrillation previously refractory to monophasic cardioversion. Methods and Results: Fifty-six patients with prior failed monophasic cardioversion were randomized to either a 360-J monophasic damped sinusoidal shock or biphasic truncated exponential shocks at 150 J, followed by 200 J and then 360 J, if necessary. If either waveform failed, patients were crossed over to the other waveform. The primary endpoint was defined as the proportion of patients achieving sinus rhythm following initial randomized therapy. Stepwise multivariate logistic regression examined independent predictors of shock success, including patient age, sex, left atrial diameter, body mass index, drug therapy, and waveform. Twenty-eight patients were randomized to the biphasic shocks and 28 to the monophasic shocks. Sinus rhythm was restored in 61% of patients with biphasic versus 18% with monophasic shocks (P = 0.001). Seventy-eight percent success was achieved in patients who crossed over to the biphasic shock after failing monophasic cardioversion, whereas only 33% were successfully cardioverted with a monophasic shock after crossover from biphasic shock (P = 0.02). Overall, 69% of patients who received a biphasic shock at any point in the protocol were cardioverted successfully, compared to 21% with the monophasic shock (P < 0.0001). The type of shock was the strongest predictor of shock success (P = 0.0001) in multivariate logistic regression. Conclusion: An ascending sequence of 150-, 200-, and 360-J transthoracic biphasic cardioversion shocks are successful more often than a single 360-J monophasic shock. Thus, biphasic shocks should be the recommended configuration of choice for all cardioversions. (J Cardiovasc Electrophysiol, Vol. 14, pp. 868-872, August 2003) [source]

    Atrial Size Reduction as a Predictor of the Success of Radiofrequency Maze Procedure for Chronic Atrial Fibrillation in Patients Undergoing Concomitant Valvular Surgery

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2001
    MIEN-CHENG CHEN M.D.
    Radiofrequency Maze Procedure and Atrial Size.Introduction: Previous studies showed that the surgical maze procedure can restore sinus rhythm and atrial transport function in patients with chronic atrial fibrillation (AF). However, no previous studies discussed the association of atrial size reduction and the success of sinus conversion by the radiofrequency (RF) maze procedure for chronic AF. Methods and Results: A total of 119 chronic AF patients undergoing valvular operations were included in this study. Sixty-one patients received RF and cryoablation to create lesions in both atria to simulate the surgical maze II or III procedure (RF maze II or RF maze III; 13 patients, group 1) or a modified maze pattern (RF maze "IV"; 48 patients, group 2). The other 58 patients who underwent valvular operations alone without the maze procedure served as control (group 3). At 3-month follow-up after operation, sinus rhythm was restored in 73%, 81%, and 11% of patients in groups 1, 2 and 3, respectively. Preoperative left and right atrial sizes were not statistically significant predictors of sinus conversion by the RF maze procedure. However, as a result of postoperative reduction of atrial sizes, postoperative left atrial diameter was significantly smaller in patients who had sinus conversion by the RF maze procedure than in patients who did not regain sinus rhythm (45.0 ± 7.0 mm vs 51.0 ± 8.0 mm; P = 0.03). Postoperative right atrial area of patients who had sinus conversion by the RF maze procedure also was significantly smaller than that of patients who did not regain sinus rhythm (18.1 ± 4.4 cm2 vs 28.5 ± 8.2 cm2; P = 0.008). Conclusion: Atrial size reduction appears to predict the success of sinus conversion with the RF maze procedure used in conjunction with valvular surgery. [source]

    Pulmonary Vein Morphology Before and After Segmental Isolation in Patients with Atrial Fibrillation

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2005
    MAREHIKO UEDA
    Background: The morphology of the pulmonary veins (PVs) before and after segmental isolation of the PVs has not been sufficiently characterized. Methods and Results: Multi-slice computed tomography was performed before and 3 ± 1 months after ablation in 30 patients with atrial fibrillation who underwent PV isolation. Before ablation, PV narrowing (,25% luminal reduction) was found in nine (8%) PVs. After ablation, de novo PV narrowing was found in 24 PVs (26%) and was detected only in the supero-inferior direction in 14 PVs (58%). The diameter reduction inside the PVs after ablation was greater in the supero-inferior direction (14 ± 12%) than in the antero-posterior direction (9 ± 13%; P < 0.0001). In the ablated PVs, the PV trunk was shorter than before ablation (P < 0.0001). The reduction in the diameters of both the PV ostium and the ablation site in the ablated PVs, as well as the diameter of the PV ostium in the nonablated PVs, correlated with the decrease in the left atrial diameter. Shortening of the PV trunk correlated with the severity of PV narrowing, but it was not related to the percent diameter reduction of the left atrium. PV narrowing before or after ablation did not result in any clinical consequences. Conclusions: PV narrowing is present in about 10% of PVs before ablation. Asymmetric luminal reduction and longitudinal shrinkage of the PV trunk occur after ablation. Reverse remodeling of the PV and contraction of the PV wall may contribute to the reduction in the PV diameter. PV morphology should be assessed with multi-directional views to avoid missing heterogeneous legions. [source]

    Can Simple Doppler Measurements Estimate Interatrial Conduction Time?

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1p2 2003
    DRAGOS COZMA
    COZMA, D., et al.: Can Simple Doppler Measurements Estimate Interatrial Conduction Time?Prolongation of the interatrial conduction time (ia-CT) is considered an important factor in the pathophysiology of atrial fibrillation (AF) and as a criterion to perform multisite atrial pacing. Measurement of ia-CT requires an electrophysiologic study. The aim of this study was to compare echocardiographic with electrophysiologic measurements to determine if they are correlated. Methods and Results: The study included 32 consecutive patients who underwent electrophysiologic studies. We measured ia-CT between the high right atrium and the distal coronary sinus. In all patients we measured P wave duration, left atrial diameter and area, and ia-CT by Doppler echocardiography was measured as the difference in time intervals between the QRS onset and the tricuspid A wave, and the QRS onset and the mitral A wave (DT). Ia-CT was statistically correlated with DT(r = 0.79, P < 0.0001), but not with P wave duration or left atrial dimensions. Conclusions: Measurement DT may be reliable to estimate ia-CT without invasive procedure. Accordingly, DT could be used as a simple selection criterion when considering patients for atrial resynchronization therapy. (PACE 2003; 26[Pt. II]:436,439) [source]

    The effect of low-carbohydrate diet on left ventricular diastolic function in obese children

    PEDIATRICS INTERNATIONAL, Issue 2 2010
    Cenap Zeybek
    Abstract Background:, This study was conducted to evaluate left ventricle (LV) functions using conventional and tissue Doppler imaging in childhood obesity and to identify the effects of diet on LV diastolic functions. Methods:, Conventional and tissue Doppler echocardiographic measurements were compared in 34 obese children and 24 age- and gender-matched lean controls. Fasting plasma glucose, insulin and homeostatic model assessment of insulin resistance levels were also obtained. Thirty-one of the obese children were subjected to a low-carbohydrate diet and their follow-up measurements were obtained after 6 months. Results:, Left atrial diameter, LV mass and LV mass index were higher in obese children than in lean controls. Lateral mitral myocardial early diastolic (Em) and peak Em/myocardial late diastolic (Am) were lower, and mitral E/Em and lateral mitral myocardial isovolumetric relaxation time were higher in obese subjects than in lean controls. Insulin and homeostatic model assessment of insulin resistance levels were higher in obese patients and decreased significantly after diet. After diet therapy, lateral mitral Em and peak Em/Am, were increased, mitral E/Em and myocardial isovolumetric relaxation time were decreased. Conclusions:, Obesity predisposes children to increased preload reserve, left ventricular subclinical diastolic dysfunction and deterioration in diastolic filling. Weight reduction with a low-carbohydrate diet seems to be associated with significant improvement in LV diastolic function and a decrease in diastolic filling, as well as causing reversal in insulin resistance seen in obese children. [source]

    Effect of Obesity on P-Wave Parameters in a Chinese Population

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2010
    Ph.D., Tong Liu M.D.
    Objective: To study the association between obesity and P-wave duration and dispersion (Pd) in order to evaluate the potential risk for atrial fibrillation development in Chinese subjects using the definitions applied for Asian populations. Methods: The study population consisted of 40 obese (body mass index (BMI) , 25 Kg/m2, according to the World Health Organization classification for the Asian population) subjects and 20 age- and sex-matched normal weight controls. Maximum P-wave duration (Pmax), minimum P-wave duration (Pmin), and Pd were carefully measured using a 12-lead electrocardiogram, while the presence of interatrial block (IAB; P , 110 ms) was assessed. Results: There were no significant differences between the two groups regarding age, sex, history of hypertension or diabetes, and hyperlipidemia. Compared to controls, BMI, left atrial diameter (LAD), and interventricular septal thickness were increased, while Pmax (111.9 ± 9.3 vs 101.1 ± 6.0 ms, P < 0.01) and Pd (47.9 ± 9.3 vs 31.8 ± 6.9 ms, P < 0.01) were significantly prolonged in the obese group. Pmin was similar between the two groups. The prevalence of IAB was significantly greater in the obese subjects. Pearson's correlation analysis showed that there were positive correlations between Pd and BMI (r = 0.6, P < 0.001), as well as between Pd and LAD (r = 0.366, P < 0.05). Conclusion: Our data suggest that obesity is associated with increased Pmax and Pd, and increased prevalence of IAB, parameters that have been associated with atrial fibrillation. The correlation of these electrocardiogram parameters with LAD indicates an association between increased BMI and atrial remodeling in Asian subjects. Ann Noninvasive Electrocardiol 2010;15(3):259,263 [source]

    P-Wave Duration and Dispersion in Obese Subjects

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2008
    Feridun Kosar M.D.
    Background: Although previous studies have documented a variety of electrocardiogram (ECG) abnormalities in obesity, P-wave alterations, which represent an increased risk for atrial arrhythmia, have not been studied very well in these patients. The aim of the present study was to evaluate P-wave duration and P dispersion (Pd) in obese subjects, and to investigate the relationship between P-wave measurements, and the clinical and echocardiographic variables. Methods: The study population consisted of 52 obese and 30 normal weight control subjects. P-wave duration and P-wave dispersion were calculated on the 12-lead ECG. As echocardiographic variables, left atrial diameter (LAD), left ventricular end-diastolic, and end-systolic diameters (LVDD and LVSD), left ventricular ejection fraction (LVEF), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), and left ventricular mass (LVM) of the obese and the control subjects were measured by means of transthoracic echocardiography. Results: There were statistically significant differences between obese and controls as regards to Pmax (maximum P-wave duration) and Pd (P dispersion) (P < 0.001 and P < 0.001, respectively). Pmin (minimum P wave duration) was similar in both groups. Correlation analysis showed that Pd in the obese patients was related to any the clinical and echocardiographic parameters including BMI, LAD, LVDD, IVST, LVPWT, and LVM. Conclusion: Our data suggest that obesity affects P-wave dispersion and duration, and changes in P dispersion may be closely related to the clinical and the echocardiographic parameters such as BMI, LAD, IVST, LVPWT, and LVM. [source]

    P Wave Dispersion Predicts Recurrence of Paroxysmal Atrial Fibrillation in Patients with Atrioventricular Nodal Reentrant Tachycardia Treated with Radiofrequency Catheter Ablation

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2006
    Basri Amasyali M.D.
    Background: Paroxysmal atrial fibrillation (AF) recurs in up to one-third of patients with atrioventricular nodal reentrant tachycardia (AVNRT) treated with slow pathway ablation. Therefore, identification of patients at risk for recurrence of AF after slow pathway ablation is important because of the necessity for additional therapies. The purpose of this study was to determine whether successful slow pathway ablation influences P wave parameters and whether these parameters predict the recurrence of paroxysmal AF in patients with both AVNRT and paroxysmal AF after ablation. Methods: Thirty-six patients with AVNRT and documented paroxysmal AF (Group 1) were compared to 36 age-matched controls with AVNRT only (Group 2). P wave durations and P dispersion were measured before and after ablation. Results: No significant differences were observed between P wave parameters observed before and after ablation. Maximum P wave durations (Pmax) and P dispersion (Pdisp) were significantly higher in Group 1 than in Group 2 (P < 0.001 for both) whereas minimum P wave durations did not differ between groups, both before and after ablation. Ten patients (28%) in Group-1 had recurrence of AF during a mean follow-up of 34 ± 11 months. Univariate predictors of AF recurrence were Pdisp ,35.5 ms (P < 0.010), left atrial diameter >40 mm (P < 0.010), mitral or aortic calcification (P < 0.010), Pmax ,112 ms (P < 0.050), valvular heart disease (P < 0.050), and atrial vulnerability (induction of AF lasting >30 second) after ablation (P < 0.050). However, only Pdisp ,35.5 ms (P < 0.050) and left atrial diameter >40 mm (P < 0.010) were independent predictors of AF recurrences. Conclusion: This study suggests that P wave dispersion could identify patients with AVNRT susceptible to recurrence of AF after slow pathway ablation. [source]

    Pilot Study: Noninvasive Monitoring of Oral Flecainide's Effects on Atrial Electrophysiology during Persistent Human Atrial Fibrillation Using the Surface Electrocardiogram

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2005
    Daniela Husser M.D.
    Background: The relation between flecainide's plasma level and its influence on human atrial electrophysiology during acute and maintenance therapy of atrial fibrillation (AF) is unknown. Therefore, this study determined flecainide plasma levels and atrial fibrillatory rate obtained from the surface ECG during initiation and early maintenance of oral flecainide in patients with persistent lone AF and assessed their relationship. Methods and Results: In 10 patients (5 males, mean age 63 ± 14 years, left atrial diameter 46 ± 3 mm) with persistent lone AF, flecainide was administered as a single oral bolus (day 1) followed by 200,400 mg/day (days 2,5). The initial 300 mg flecainide bolus resulted in therapeutic plasma levels in all patients (range 288,629 ng/ml) with no side effects. Flecainide plasma levels increased on day 3 and remained stable thereafter. Day 5 plasma levels were lower (508 ± 135 vs 974 ± 276 ng/ml, P = 0.009) in patients with daily mean flecainide doses of 200 mg compared to patients with higher maintenance doses. Fibrillatory rate obtained from the surface electrocardiogram measuring 378 ± 17 fpm at baseline was reduced to 270 ± 18 fpm (P < 0.001) after the flecainide bolus but remained stable thereafter. Fibrillatory rate reduction was independent of flecainide plasma levels or clinical variables. Conclusion: A 300 mg oral flecainide bolus is associated with electrophysiologic effects that are not increased during early maintenance therapy in persistent human lone AF. In contrast to drug plasma levels, serial analysis of fibrillatory rate allows monitoring of individual drug effects on atrial electrophysiology. [source]

    Cardiac involvement in systemic sclerosis assessed by tissue-doppler echocardiography during routine care: A controlled study of 100 consecutive patients

    ARTHRITIS & RHEUMATISM, Issue 6 2008
    Christophe Meune
    Objective To assess the prevalence of primary cardiac complications in a large population of patients with systemic sclerosis (SSc), using recently developed echocardiographic techniques. Methods We prospectively studied 100 consecutive patients (mean ± SD age 54 ± 14 years; 86 women) presenting with SSc without pulmonary arterial hypertension or clinical manifestations of heart failure. All patients underwent standard echocardiography, along with measurements of longitudinal velocities by tissue Doppler imaging (TDI) to assess left ventricular (LV) and right ventricular (RV) contractility and LV diastolic function. Results were compared with those in 26 age- and sex-matched healthy controls. Results Patients with SSc had a wider mean left atrial diameter and impaired relaxation compared with the controls. A trend was observed toward a smaller LV ejection fraction (EF) in the patients (mean ± SD 64.9 ± 0.6%) than in the controls (67.2 ± 0.7%), as well as higher pulmonary artery pressure (mean ± SD 33.3 ± 0.6 mm Hg versus 30.8 ± 1.0 mm Hg). LVEF was <55% in 7 patients versus none of the controls. Peak systolic mitral annular velocity as measured by TDI was <7.5 cm/second in 14 patients versus none of the controls (P = 0.040). Mitral annulus early diastolic velocity was <10 cm/second in 30 patients versus 2 of the controls (P = 0.022). Fifteen patients and none of the controls had reduced peak systolic tricuspid annular velocity (P = 0.039). The TDI results correlated with each other, but not with lung abnormalities or other disease characteristics. Conclusion Depression of LV and RV systolic and LV diastolic function is common in patients with SSc and is due to primary myocardial involvement. Considering the major contributions of TDI, the addition of this simple technique to standard measurements may improve the detection of heart involvement in patients with SSc. [source]