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Atrial Size (atrial + size)

Distribution by Scientific Domains
Medical Sciences100%
Distribution within Medical Sciences
Cardiovascular Disease73%
General & Internal Medicine21%

Kinds of Atrial Size

  • leave atrial size
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    Selected Abstracts

    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]

    Predictive Capability of Left Atrial Size Measured by CT, TEE, and TTE for Recurrence of Atrial Fibrillation Following Radiofrequency Catheter Ablation

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2010
    SACHIN S. PARIKH M.D.
    Background: Recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) has been well established and is in part related to left atrial (LA) size. The purpose of this study was to assess the predictive capability of LA diameter (LAD) and LA volume (LAV) by echocardiography and computed tomography (CT) to determine success in patients undergoing RFCA of AF. Methods: Eighty-eight patients with paroxysmal or persistent AF who had undergone RFCA and had a prior transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), and CT were enrolled in the study. TTE LADs and LV ejection fraction as well as TEE LADs and LAVs in three views were recorded. CT LAVs were also recorded. Clinical parameters prior to ablation as well as at 1-year follow-up were assessed. Results: A total of 40 (45%) patients with paroxysmal AF and 48 (55%) patients with persistent AF were analyzed. Paroxysmal AF patients had a RFCA success rate of 88% at 1 year with persistent AF patients having a 52% success rate (P < 0.001). A CT-derived LAV , 117 cc was associated with an odds ratio (OR) for recurrence of 4.8 (95% confidence interval [CI]=[1.4,16.4], P = 0.01) while a LAV ,130 cc was associated with an OR for recurrence of 22.0 (95% CI =[2.5,191.0], P = 0.005) after adjustment for persistent AF. Conclusions: LA dimensions and AF type are highly predictive of AF recurrence following RFCA. LAV by CT has significant predictive benefit over standard LADs in severely enlarged atria even after adjustment for AF type. (PACE 2010; 532,540) [source]

    Reverse Electrical Remodeling of the Atria Post Cardioversion in Patients Who Remain in Sinus Rhythm Assessed by Signal Averaging of the P-Wave

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2007
    NAGIB CHALFOUN M.D.
    Objectives: This study was designed to determine whether the signal-averaged electrocardiogram of the P-wave (SAPW) is an independent predictor of recurrence of atrial fibrillation (AF) post cardioversion (CV), and to assess atrial remodeling using SAPW. Background: There are limited electrophysiologic data to predict the recurrence of AF post-CV. The electrical remodeling that occurs post-CV is poorly understood. Methods: Sixty-four patients with persistent AF undergoing CV were prospectively enrolled. SAPW parameters were measured the day of CV and repeated at 1 month. These SAPW parameters were compared to other baseline indices for the recurrence of AF. Results: Sixty patients (94%) had successful CV. At 1 month, 22 (37%) maintained sinus rhythm (SR). The SAPW total duration decreased significantly in those who remained in SR (159 ms ± 19 to 146 ms ± 17; P < 0.0001). Only the duration of AF (46 ± 50 days vs 147 ± 227 days, P = 0.03) and the presence of left ventricular hypertrophy (LVH, 12% vs 65%, P = 0.0006) were significantly associated with recurrence of AF. Atrial size strongly correlated with the SAPW duration in patients who remained in SR (R2= 0.67, P = 0.003) but not in those who returned to AF (R2= 0.11, P = 0.65). Conclusions: Atrial electrical reverse remodeling occurs in patients with AF who maintain SR post-CV. This remodeling is likely inversely related to the duration of AF and LVH. SAPW duration does not predict recurrence of AF post-CV. [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]

    Role of Transthoracic Echocardiography in Atrial Fibrillation

    ECHOCARDIOGRAPHY, Issue 4 2000
    RICHARD W. ASINGER M.D.
    Atrial fibrillation is a major clinical problem that is predicted to be encountered more frequently as the population ages. The clinical management of atrial fibrillation has become increasingly complex as new therapies and strategies have become available for ventricular rate control, conversion to sinus rhythm, maintenance of sinus rhythm, and prevention of thromboembolism. Clinical and transthoracic echocardiographic features are important in determining etiology and directing therapy for atrial fibrillation. Left atrial size, left ventricular wall thickness, and left ventricular function have independent predictive value for determining the risk of developing atrial fibrillation. Left atrial size may have predictive value in determining the success of cardioversion and maintaining sinus rhythm in selected clinical settings but has less value in the most frequently encountered group, patients with nonvalvular atrial fibrillation, in whom the duration of atrial fibrillation is the most important feature. When selecting pharmacological agents to control ventricular rate, convert to sinus rhythm, and maintain normal sinus rhythm, transthoracic echocardiography (TTE) allows noninvasive evaluation of left ventricular function and hence guides management. The combination of clinical and transthoracic echocardiographic features also allows risk stratification for thromboembolism and hemorrhagic complications in atrial fibrillation. High-risk clinical features for thromboembolism supported by epidemiological observations, results of randomized clinical trials, and meta-analyses include rheumatic valvular heart disease, prior thromboembolism, congestive heart failure, hypertension, older (> 75 years old) women, and diabetes. Small series of cases also suggest those with hyperthyroidism and hypertrophic cardiomyopathy are at high risk. TTE plays a unique role in confirming or discovering high-risk features such as rheumatic valvular disease, hypertrophic cardiomyopathy, and decreased left ventricular function. Validation of the risk stratification scheme used in the Stroke Prevention in Atrial Fibrillation-III trial is welcomed by clinicians who are faced daily with balancing the benefit and risks of anticoagulation to prevent thromboembolism inpatients with atrial fibrillation. [source]

    Heritability of left atrial size in the Tecumseh population

    EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 7 2002
    P. Palatini
    Abstract Background ,Little is known about the determinants of atrial size, and no study has analyzed whether genetic factors are involved in the pathogenesis of LA enlargement. Materials and methods We studied the heritability of echocardiographic left atrial size in 290 parents from the Tecumseh Blood Pressure Study and 251 children from the Tecumseh Offspring Study. All data from the parents and children were obtained at the same field office in Tecumseh, USA. Left atrial dimension was determined echocardiographically in accordance with American Society of Echocardiography guidelines with the use of leading-edge-to-leading-edge measurements of the maximal distance between the posterior aortic root wall and the posterior left atrial wall at end systole. Results For correlation between the left atrial dimensions of the parents and their offspring, several models were generated to adjust the atrial dimensions in both groups for an increasing number of clinical variables. After removing the effect of age, gender, height, weight, skinfold thickness, and systolic blood pressure, parent,child correlation for left atrial size was 0·19 (P = 0·007). Further adjustment for left ventricular mass and for measuring left ventricular diastolic function increased the correlation to 0·25 (P = 0·001). Conclusions ,The present data indicate that heredity can explain a small but definite proportion of the variance in left atrial dimension. [source]

    First time and repeat cardioversion of atrial tachyarrhythmias , a comparison of outcomes

    INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2010
    A. Arya
    Summary Introduction:, Repeat cardioversion may be necessary in over 50% of patients with persistent atrial fibrillation (AF), but identifying responders remains challenging. This study evaluates the long-term success of direct current cardioversion (DCCV) and the clinical and echocardiographical parameters that influence them, in over 1000 sedation-cardioversion procedures undertaken at Eastbourne General Hospital between 1996 and 2006. Methods:, A total of 770 patients of mean age (SD) 70.1(10.1) underwent 1013 DCCVs (first n = 665, repeat n = 348) for atrial tachyarrhythmias from 1996 to 2006. Time to persistent arrhythmia recurrence was compared between first and multiple DCCV, and the effect of age, gender, presence of heart disease, left atrial size, fractional shortening, arrhythmia duration, anti-arrhythmic drug therapy (AAD) and other concomitant cardiac medication was evaluated using the Kaplan,Meier method and Cox's Proportional-hazards model. Results:, In all, 33% of first and 29% of repeat DCCVs were in sinus rhythm (SR) at 12 months (m). There was no difference in median time to arrhythmia recurrence (SE) between first and multiple procedures: 1.5 ± 0.1 m (1.3,1.7) and 1.5 ± 0.0 m (1.4,1.6) respectively, p = 0.45. AAD use was significantly higher, arrhythmia duration shorter and more diabetic patients underwent repeat procedures. Amiodarone, OR 0.56, p = 0.04, sotalol, OR 0.61, p = 0.02 and arrhythmia duration, < 6 m, OR 0.72, p = 0.03 were independent predictors of improved outcome in first procedures only. In patients undergoing first procedures on amiodarone or sotalol, median time to arrhythmia recurrence was longer and 12 m SR rates higher, 6.0 ± 2.4 m (42%) than those who had a repeat procedure on the same medication, 1.5 ± 0.1 m (33%), p = 0.06. Conclusions:, The efficacy of first and subsequent DCCV procedures is similar, achieving a similar proportion of SR maintenance at 1 year. However, the benefits of AAD therapy are the greatest following first time procedures. Concomitant AAD therapy should be considered for all first time procedures for persistent AF. [source]

    Long-Term Outcome of Atrial Fibrillation Ablation: Impact and Predictors of Very Late Recurrence

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2010
    ANITA WOKHLU M.D.
    Long-Term Outcome of AF Ablation. Introduction: Ablation eliminates atrial fibrillation (AF) in studies with 1 year follow-up, but very late recurrences may compromise long-term efficacy. In a large cohort, we sought to describe the determinants of delayed recurrence after AF ablation. Methods and Results: Seven hundred and seventy-four patients with AF (428 paroxysmal [PAF, 55%] and 346 persistent or longstanding persistent [PersAF, 45%]) underwent wide area circumferential ablation (WACA, 62%) or pulmonary vein isolation (38%). Over 3.0 ± 1.9 years, there were 135 recurrences in PAF patients and 142 in PersAF patients. AF elimination was achieved in 61% of patients with PersAF at 2 years after last ablation and in 71% of patients with PAF (P = 0.04). This finding was related to a higher initial rate of very late recurrence in PersAF. From 1.0 to 2.5 years, the recurrence increased by 20% (from 37% to 57%) in PersAF patients versus only 12% (from 27% to 39%) in PAF patients. Independent predictors of overall recurrence included diabetes (HR 1.9 [1.3,2.9], P = 0.002) and PersAF (HR 1.6 [1.2,2.0], P < 0.001). Independent predictors of very late recurrence included PersAF (HR 1.7 [1.1,2.7], P = 0.018) and WACA (HR 1.8 [1.1,2.7], P = 0.018), while diabetes came close to significance. In PAF patients, left atrial size >45 mm was identified as an AF-type specific predictor (HR 2.4 [1.3,4.7], P = 0.009), whereas in PersAF patients, no unique predictors were identified. Conclusion: Late recurrences reduced the long-term efficacy of AF ablation, particularly in patients with PersAF and underlying cardiovascular diseases. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1071-1078) [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]

    Effect of Electrical and Structural Remodeling on Spatiotemporal Organization in Acute and Persistent Atrial Fibrillation

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2002
    JOSEPH G. AKAR M.D.
    Spatiotemporal Organization in Atrial Fibrillation.Introduction: Atrial fibrillation (AF) may originate from discrete sites of periodic activity. We studied the effect of structural and electrical remodeling on spatiotemporal organization in acute and persistent AF. Methods and Results: Atrial effective refractory periods (AERPs) were recorded from five different sites at baseline and after pacing in acute AF (n = 8 dogs) and persistent AF (n = 8). Four persistent AF dogs subsequently were cardioverted to sinus rhythm to allow AERP recovery. Periodicity was quantified by calculating power spectra on left atrial electrograms obtained from a 64-electrode basket catheter. Left atrial size was measured by intracardiac echocardiography and structural changes were assessed by electron microscopy. Mean AERPs decreased after pacing in acute (128 ± 16 msec to 108 ± 29 msec, P < 0.001) and persistent AF (135 ± 16 msec to 104 ± 24 msec, P < 0.0001). AERP recovery was established after 7 days of sinus rhythm. Structural changes were mild in acute AF, severe in persistent AF, and remained severe after AERP recovery. A single dominant frequency was identified in 94% of acute AF bipoles, 57% in persistent AF, and 76% after AERP recovery. Average correlation coefficient was 0.82 among acute AF bipoles, 0.63 in persistent AF, and 0.73 after AERP recovery. Conclusion: Transition from acute to persistent AF is associated with loss of spatiotemporal organization. A single dominant frequency recruits the majority of the left atrium in acute AF. Persistent AF, however, is associated with structural remodeling and dominant frequency dispersion. Recovery of refractoriness only partially restores spatiotemporal organization, indicating a major role for structural remodeling in the maintenance of persistent AF. [source]

    Plasma Homocysteine, B Vitamins, and Amino Acid Concentrations in Cats with Cardiomyopathy and Arterial Thromboembolism

    JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 5 2000
    M.A. McMichael
    Arterial thromboembolism (ATE) is a common complication of cats with cardiomyopathy (CM), but little is known about the pathophysiology of ATE. In people, high plasma concentrations of homocysteine and low B vitamin concentrations are risk factors for peripheral vascular disease. In addition, low plasma arginine concentrations have been linked to endothelial dysfunction. The purpose of this study was to compare concentrations of homocysteine, B vitamins, and amino acids in plasma of normal cats to those of cats with CM and ATE. Plasma concentrations of homocysteine, vitamin B6, vitamin B12, folate, and amino acids were measured in 29 healthy cats, 27 cats with CM alone, and 28 cats with both CM and ATE. No differences were found between groups in homocysteine or folate. Mean vitamin B12 concentration (mean ± standard deviation) was lower in cats with ATE (866 ± 367 pg/mL) and cats with CM (939 ± 389 pg/mL) compared with healthy controls (1,650 ± 700 pg/mL; P < .001). Mean vitamin B6 concentration was lower in cats with ATE (3,247 ± 1,215 pmol/mL) and cats with CM (3,200 ± 906 pmol/mL) compared with healthy control animals (4,380 ± 1,302 pmol/mL; P= .005). Plasma arginine concentrations were lower in cats with ATE (75 ± 33 nmol/mL) compared with cats with CM (106 ± 25 nmol/mL) and healthy control animals (96 ± 25 nmol/ mL; P < .001). Vitamin B12 concentration was significantly correlated with left atrial size. We interpret the results of this study to suggest that vitamin B12 and arginine may play a role in CM and ATE of cats. [source]

    Evaluation of Atrial Thrombus Formation and Atrial Appendage Function in Patients with Pacemaker by Transesophageal Echocardiography

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2006
    ABOLFATH ALIZADEH M.D.
    Background: Physiologic pacing is claimed to be superior to ventricular pacing in as much as it entails lower risk of atrial fibrillation, stroke, and atrial remodeling. There are few data on the relation between atrioventricular (AV) synchrony and atrial clot formation. Utilizing transesophageal echocardiography (TEE), this study sought to evaluate the effect of AV synchrony loss on left atrial physiology, atrial stasis, and clot formation. Methods: We conducted a cross-sectional study on patients with both AV and ventricular pacing with left ventricular ejection fraction (LVEF) >30%. TEE enabled us to explore atrial and pacing leads thrombi and measure left atrial appendage (LAA) flow velocity Results: A total 72 patients (mean age, 65 ± 11.7) were enrolled in the study. The pacing mode was VVI in 53% and AV sequential in 47% of patients. LVEF (mean ± SD; %) was 53.3 ± 6.2% in ventricular pacing mode and 52.2 ± 6.6 in physiologic pacing mode. Thrombus formation on pacing lead (<10 mm in 97% of patients) was observed in 32% of all the patients (23% in patients with AV sequential pacing mode and 39% with VVI mode). Left atrial appendage flow velocity (LAA-FV) was significantly higher among the patients with AV sequential pacing mode (49.44 ± 18 cm/s vs 40.94 ± 19.4 cm/s, P value = 0.02). LAA-FV >40 cm/s was detected in 60% of the patients, 60% of whom were in physiologic mode. Left atrial size was significantly larger among the patients with VVI pacing mode (42.3 ± 2.3 mm vs 37.79 ± 4.5 mm, P = 0.001). Multivariate analysis showed no relation between LAA-FV and age, hypertension, diabetes mellitus, left atrial size, and left ventricular function. Only one patient had right atrial clot. There was no thrombus in the ventricles and atrial appendage. Conclusion: Long-term loss of AV synchrony induced by VVI pacing is associated with the impairment of LAA contraction. Thrombus formation in the LAA is not increased by VVI pacing in patients with relatively good left ventricular (LV) function and sinus rhythm. [source]

    P Wave Duration and Morphology Predict Atrial Fibrillation Recurrence in Patients with Sinus Node Dysfunction and Atrial-Based Pacemaker

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2002
    ANTONIO DE SISTI
    DE SISTI, A., et al.: P Wave Duration and Morphology Predict Atrial Fibrillation Recurrence in Patients with Sinus Node Dysfunction and Atrial-Based Pacemaker. P wave duration and morphology have never been systematically evaluated as markers of AF in patients with a conventional indication to pacing. This study correlated sinus P wave duration and morphology and the incidence of AF in patients with sinus node dysfunction (SND), previous history of AF before implant, and atrial-based pacemaker. Included were 140 patients (86 men, 54 women; mean age 71.8 ± 10.4 years) with recurrent paroxysmal AF and who received a DDD (128 patients) or AAI (12 patients) pacemaker for SND. Forty-nine patients had structural heart disease. Sinus P wave duration and morphology was evaluated in leads II, III. Twenty-two patients had an abnormal P wave morphology, diphasic (+/-) in 5 and notched (+/+) in 17. The basic pacemaker rate was programmed between 60 and 70 beats/min. Rate responsive function was activated in 65 patients. During a follow-up of 27.6 ± 17.8 months, AF was documented in 87 patients. Forty-four patients developed permanent AF, following at least one episode of paroxysmal AF in 26 cases. Statistical analysis used Cox model regression. Univariate predictors of AF (P < 0.10) were drugs (mean: 2 ± 1.4) and DC shock before pacing (16/140 patients), P wave duration (mean 112.5 ± 24.6 ms), basic pacemaker rate (mean 68 ± 5 beats/min), and drugs in the follow-up (mean 1.2 ± 0.94). Multivariate analysis showed that P wave duration (b = 0.013, s.e. = 0.004; P = 0.003), and drugs before pacing (b = 0.2; s.e.= 0.08; P < 0.01) resulted in a significant independent predictor of AF. Actuarial incidence of patients free of AF at 30 months was 35%: 56% in patients with a P wave < 120 ms, and 13% in those with P wave , 120 ms (P < 0.01 by Score test). Univariate predictors of permanent AF were drugs and DC shock before pacing, left atrial size (mean 39 ± 6 mm), P wave duration, abnormal P wave morphology (22/140 patients), and drugs in the follow-up. Multivariate analysis showed that P wave morphology was the most important predictor of permanent AF (b = - 0.56, s.e.= 0.2; P = 0.008). Incidence of patients free of permanent AF at 30 months was 69%: 74% in patients with normal P wave, compared to 28% in the case of abnormal P wave morphology (P < 0.01). P wave duration and morphology are good markers of postpacing AF recurrence in patients with SND and an atrial-based pacemaker. This observation suggests that intra- and interatrial conduction disturbances be extensively evaluated before implantation, and the indication for atrial resynchronization procedures be reevaluated. [source]

    Left Bundle Branch Block in Type 2 Diabetes Mellitus: A Sign of Advanced Cardiovascular Involvement

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2004
    Eliscer Guzman M.D., F.A.C.C.
    Objective: To evaluate left bundle branch block (LBBB) as an indicator of advanced cardiovascular involvement in diabetic (DM) patients by examining left ventricular systolic function and proteinurea. Methods: Data of 26 diabetic patients with left bundle branch block (DM with LBBB) were compared with data of 31 diabetic patients without left bundle branch block (DM without LBBB) and 18 nondiabetic patients with left bundle branch block (non-DM with LBBB). The inclusion criteria were age >45 years, and diabetes mellitus type 2 of >5 years. Results: Mean ages of patients in DM with LBBB, DM without LBBB, and non-DM with LBBB groups were 67 ± 8, 68 ± 10, and 65 ± 10 years, respectively (P = NS). Females were 65%, 61%, and 61%, respectively (P = NS). Left ventricular ejection fraction in DM with LBBB was significantly lower than in DM without LBBB and non-DM with LBBB (30 ± 10% vs 49 ± 12% and 47 ± 8%, P < 0.01). Left ventricular end-diastolic volume was significantly higher in DM with LBBB than in DM without LBBB and non-DM with LBBB (188.6 ± 16.4 mL vs 147.5 ± 22.3 mL and 165.3 ± 15.2 mL, P < 0.03). Similarly, left ventricular end-systolic volume was significantly higher in DM with LBBB than in DM without LBBB and non-DM with LBBB (135.4 ± 14.7 mL vs 83.7 ± 9.5 mL and 96.6 ± 18.4 mL, P < 0.02). No statistically significant difference was seen in left atrial size. Proteinurea in DM with LBBB (79.4 ± 18.9 mg/dL) was significantly higher than in DM without LBBB (35.6 ± 8.5 mg/dL, P < 0.05) and non-DM with LBBB (12 ± 3.5 mg/dL, P < 0.05); however, there was no significant difference in Hb A1c levels in DM with LBBB and DM without LBBB (9.01% vs 7.81%, P = NS). Conclusions: Left bundle branch block in diabetic patients indicates advanced cardiovascular involvement manifesting with more severe left ventricular systolic dysfunction and proteinurea compared to both diabetic patients without left bundle branch block and nondiabetic patients with left bundle branch block. [source]

    Prevention of Atrial Fibrillation in Cardiac Surgery: Time to Consider a Multimodality Pharmacological Approach

    CARDIOVASCULAR THERAPEUTICS, Issue 1 2010
    Kwok M. Ho
    Atrial fibrillation (AF) is very common within the first 5 days of cardiac surgery. It is associated with significant morbidity including stroke, ventricular arrhythmias, myocardial infarction, heart failure, acute kidney injury, prolonged hospital stay, and also short- and long-term mortality. The underlying mechanisms of developing AF after cardiac surgery are multifactorial; risk factors may include advanced age, withdrawal of beta-blockers and angiotensin-converting-enzyme inhibitors, valve surgery, obesity, increased left atrial size, and diastolic dysfunction. There are many pharmacological options in preventing AF, but none of them are effective for all patients and they all have significant limitations. Beta-blockers may reduce the incidence of AF by more than a third, but bradycardia, hypotension, or exacerbation of heart failure often limit their utility postoperatively. Recent evidence suggests that class III antiarrhythmic drugs, sotalol and amiodarone, are more effective than beta-blockers, but they both share similar hemodynamic side effects of beta-blockers. Magnesium, antiinflammatory drugs such as statins, omega fatty acids, and low-dose corticosteroids also have some efficacy and they have the advantages of not causing significant hemodynamic side effects. Data on effectiveness of calcium channel blockers, digoxin, alpha-2 agonists, sodium nitroprusside, and N-acetylcysteine are more limited. Because the pathogenesis of AF is multifactorial, a combination of drugs with different pharmacological actions may have additive or synergistic effect in preventing AF after cardiac surgery. Randomized controlled trials evaluating the effectiveness of a multimodality pharmacological approach in patients at high-risk of AF after cardiac surgery are needed. [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]