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Atrial Wall (atrial + wall)
Selected AbstractsAtrial Tachycardia Originating from the Upper Left Atrial Septum: Demonstration of Transseptal Interatrial Conduction Using the Infolded Atrial WallsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2006KOJI KUMAGAI M.D. We report a rare case of atrial tachycardia (AT) originating from the upper left atrial septum. Electroanatomic mapping of both atria demonstrated that the earliest atrial activation during AT occurred at the upper left atrial septum 26 msec before the onset of the P wave, followed by the mid-right atrial septum (10 msec before the onset of the P wave) and then the upper right atrial septum just adjacent to the left septal AT site (1 msec before the onset of the P wave), indicating detour pathway conduction from the upper left to the upper right atrium. Embryologically, it was suggested that the superior components of the secondary atrial septum are made by the infolded atrial walls and could develop a transseptal detour pathway involving the left-side atrial septal musculature, the superior rim of the oval fossa and the right-side atrial septal musculature. A single radiofrequency application targeting the upper left atrial septum successfully abolished the AT. [source] Differential levels of tissue hypoxia in the developing chicken heartDEVELOPMENTAL DYNAMICS, Issue 1 2006Jamie Wikenheiser Abstract Tissue hypoxia plays a critical role in normal development, including cardiogenesis. Previously, we showed that oxygen concentration, as assessed by the hypoxia indicator EF5, is lowest in the outflow tract (OFT) myocardium of the developing chicken heart and may be regulating events in OFT morphogenesis. In this study, we identified additional areas of the embryonic chicken heart that were intensely positive for EF5 within the myocardium in discrete regions of the atrial wall and the interventricular septum (IVS). The region of the IVS that is EF5-positive includes a portion of the developing central conduction system identified by HNK-1 co-immunostaining. The EF5 positive tissues were also specifically positive for nuclear-localized hypoxia inducible factor 1, (HIF-1,), the oxygen-sensitive component of the hypoxia inducible factor 1 (HIF-1) heterodimer. The pattern of the most intensely EF5-stained myocardial regions of the atria and IVS resemble the pattern of the major coronary vessels that form in later stages within or immediately adjacent to these particular regions. These vessels include the sinoatrial nodal artery that is a branch of the right coronary artery within the atrial wall and the anterior/posterior interventricular vessels of the IVS. These findings indicate that a portion of the developing central conduction system and the patterning of coronary vessels may be subject to a level of regulation that is dependent on differential oxygen concentration within cardiac tissues and subsequent HIF-1 regulation of gene expression. Developmental Dynamics 235:115,123, 2006. © 2005 Wiley-Liss, Inc. [source] Atrial Dissection-Like Appearance Caused by Ileus Due to Metastatic Renal Cell CarcinomaECHOCARDIOGRAPHY, Issue 7 2006Mehmet Dogan M.D. Atrial dissection is an uncommon entity, defined as a gap from the mitral or tricuspid annular area to the interatrial septum or atrial wall, creating a new chamber with or without communication into the true left or right atrium. We present the interesting images of an atrial dissection-like appearance in the right atrium, which was actually caused by an ileus due to metastatic renal cell carcinoma in a 82-year-old man. The causes of true atrial dissection were also briefly discussed. [source] Heritability of left atrial size in the Tecumseh populationEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 7 2002P. 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] Symbiosis of Mycale (Mycale) vansoesti sp. nov. (Porifera, Demospongiae) with a coralline alga from North Sulawesi (Indonesia)INVERTEBRATE BIOLOGY, Issue 3 2006Barbara Calcinai Abstract. The symbiotic association between the new sponge species Mycale vansoesti and the coralline alga Amphiroa sp. from the Bunaken Marine Park (North Sulawesi, Indonesia) is described. The alga completely pervades the sponge. The color of the sponge ectosome is white, both on the external surface and on the atrial wall, but where the alga is present the sponge takes on the light pink color of the alga. The sponge spicular complement is characterized by mycalostyles, anisochelae of two types, sigmas (often "C" shaped), and extremely abundant toxas organized in bundles forming toxadragma. In the association, the sponge shows very low silicate value, and consequently the alga represents the main skeleton of the sponge. On the other hand, the sponge affects the morphology of the alga, leading to a cylindrical shape, with thalli running parallel to the sponge surface. This association seems to be obligate for the sponge, as we found no sponges of this species living in isolation. [source] External Security Stitch for Retrograde Cardioplegia CannulaJOURNAL OF CARDIAC SURGERY, Issue 4 2009Davide Gabbieri M.D. However, this maneuver is time consuming, often implies the loss of surgical exposure, and exposes again the coronary sinus to the risk of iatrogenic injuries. We describe the use of an external security stitch through the muscular right atrial wall to avoid the displacement of a retrograde cardioplegia catheter and analyze the anatomic conditions which predispose to this complication. [source] Experience with the Hansen Robotic System for Atrial Fibrillation Ablation,Lessons Learned and Techniques Modified: Hansen in the Real WorldJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 11 2009OUSSAMA M. WAZNI M.D. Introduction: The Hansen robotic system has only recently been used in the United States for catheter ablation procedures in humans. Atrial fibrillation (AF) ablation may be performed utilizing this system. We report our management of complications with early experience of this system. Methods and Results: All 71 patients in whom the system was utilized were included. In all patients, a 2-operator technique was to be employed; one operator manipulates the ablation catheter via the robot and the other manipulates the circular mapping and intracardiac echocardiogram catheters. There was no procedure-related mortality. All vascular complications occurred in the first 25 procedures performed. There were 6 intraoperative procedural-related complications. These included significant vascular complications (n = 4), one of whom required iliac vein stenting, and 2 cardiac tamponade (one related to a pop-phenomenon),successfully treated by pericardiocentesis. Early complications (n = 3) were 1 tamponade several hours post-procedure, 1 vascular complication, and 1 pericarditis. Late complications included 5 patients with severe pulmonary vein stenosis (all in first 27 patients) and 1 patient with gastroparesis. All complications were successfully managed without persistent morbidity and occurred earlier in our experience. This led to specific alterations in our vascular access and ablation techniques. These include the use of a longer 14 Fr sheath, through which the robotic sheath is more safely advanced. The choice of ablation catheter and titration of power, particularly when the catheter has a perpendicular orientation to the atrial wall, is also important. Conclusions: The suggested modifications may make the system easier to use with the potential to reduce complications. [source] Acute Effect of Circumferential Pulmonary Vein Isolation on Left Atrial SubstrateJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2009AMEYA R. UDYAVAR M.D. Introduction: The left atrial (LA) substrate plays an important role in the maintenance of atrial fibrillation (AF). However, little is known about the acute effect of circumferential pulmonary vein isolation (CPVI). This study was to investigate the acute change of LA activation, voltage and P wave in surface electrocardiogram (ECG) after CPVI. Methods and Results: Electroanatomic mapping (NavX) was performed in 50 patients with AF (mean age = 54 ± 10 years, 36 males) who underwent only CPVI. The mean peak-to-peak bipolar voltage and total activation time of LA were obtained during sinus rhythm before and immediately after CPVI. The average duration and amplitude of P waves in 12-lead ECG were also analyzed before and after CPVI. Change in the earliest LA breakthrough sites could cause decreased LA total activation time. Downward shift in the breakthrough site was inversely proportional to the proximity of the breakthrough site to the radiofrequency lesions. A shortening of P-wave duration and decrease in voltage after CPVI were observed after CPVI. Patients with recurrent AF had less voltage reduction in the atrial wall 1 cm from the circumferential PV lesions compared with those without recurrent AF (60.1 ± 11.7% vs 74.1 ± 6.6%, P = 0.002). Reduction of voltage ,64.4% in this area after CPVI is related with recurrent AF. Conclusion: CPVI could result in acute change of LA substrate, involving LA activation and voltage. Less reduction of voltage in the atrial wall adjacent to the circumferential PV lesions after CPVI may be associated to the recurrence of AF. [source] Detection of Inadvertent Catheter Movement into a Pulmonary Vein During Radiofrequency Catheter Ablation by Real-Time Impedance MonitoringJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2004PETER CHEUNG M.D. Introduction: During radiofrequency ablation to encircle or isolate the pulmonary veins (PVs), applications of radiofrequency energy within a PV may result in stenosis. The aim of this study was to determine whether monitoring of real-time impedance facilitates detection of inadvertent catheter movement into a PV. Methods and Results: In 30 consecutive patients (mean age 53 ± 11 years) who underwent a left atrial ablation procedure, the three-dimensional geometry of the left atrium, the PVs, and their ostia were reconstructed using an electroanatomic mapping system. The PV ostia were identified based on venography, changes in electrogram morphology, and manual and fluoroscopic feedback as the catheter was withdrawn from the PV into the left atrium. Real-time impedance was measured at the ostium, inside the PV at approximately 1 and 3 cm from the ostium, in the left atrial appendage, and at the posterior left atrial wall. There was an impedance gradient from the distal PV (127 ± 30 ,) to the proximal PV (108 ± 15 ,) to the ostium (98 ± 11 ,) in each PV (P < 0.01). There was no significant impedance difference between the ostial and left atrial sites. During applications of radiofrequency energy, movement of the ablation catheter into a PV was accurately detected in 80% of the cases (20) when there was an abrupt increase of ,4 , in real-time impedance. Conclusion: There is a significant impedance gradient from the distal PV to the left atrium. Continuous monitoring of the real-time impedance facilitates detection of inadvertent catheter movement into a PV during applications of radiofrequency energy. (J Cardiovasc Electrophysiol, Vol. 15, pp. 1-5, June 2004) [source] Heart inflow tract of the African lungfish Protopterus dolloiJOURNAL OF MORPHOLOGY, Issue 1 2005José M. Icardo Abstract We report a morphologic study of the heart inflow tract of the African lungfish Protopterus dolloi. Attention was paid to the atrium, the sinus venosus, the pulmonary vein, and the atrioventricular (AV) plug, and to the relationships between all these structures. The atrium is divided caudally into two lobes, has a common part above the sinus venosus, and appears attached to the dorsal wall of the ventricle and outflow tract through connective tissue covered by the visceral pericardium. The pulmonary vein enters the sinus venosus and runs longitudinally toward the AV plug. Then it fuses with the pulmonalis fold and disappears as an anatomic entity. However, the oxygenated blood is directly conveyed into the left atrium by the formation of a pulmonary channel. This channel is formed cranially by the pulmonalis fold, ventrally by the AV plug, and caudally and dorsally by the atrial wall. The pulmonalis fold appears as a wide membranous fold which arises from the left side of the AV plug and extends dorsally to form the roof of the pulmonary channel. The pulmonalis fold also forms the right side of the pulmonary channel and sequesters the upper left corner of the sinus venosus from the main circulatory return. The AV plug is a large structure, firmly attached to the ventricular septum, which contains a hyaline cartilaginous core surrounded by connective tissue. The atrium is partially divided into two chambers by the presence of numerous pectinate muscles extended between the dorsal wall of the atrium and the roof of the pulmonary channel. Thus, partial atrial division is both internal and external, precluding the more complete division seen in amphibians. The present report, our own unpublished observations on other Protopterus, and a survey of the literature indicate that not only the Protopterus, but also other lungfish share many morphologic traits. J. Morphol. 263:30,38, 2005. © 2004 Wiley-Liss, Inc. [source] ICD Implantation in Infants and Small Children: The Extracardiac TechniquePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2006THOMAS KRIEBEL M.D. Background: There is no clear methodology for implantation of an internal cardioverter-defibrillator (ICD) in infants and small children. The aim of this study was to assess efficacy and safety of an extracardiac ICD implantation technique in pediatric patients. Patients and Methods: An extracardiac ICD system was implanted in eight patients (age: 0.3,8 years; body weight: 4,29 kg). Under fluoroscopic guidance a defibrillator lead was tunneled subcutaneously starting from the anterior axillar line along the course of the 6th rib until almost reaching the vertebral column. After a partial inferior sternotomy, bipolar steroid-eluting sensing and pacing leads were sutured to the atrial wall (n = 2) and to the anterior wall of the right ventricle (n = 8). The ICD device was implanted as "active can" in the upper abdomen. Sensing, pacing, and defibrillation thresholds (DFTs) as well as impedances were verified intraoperatively and 3 months later, respectively. Results: In seven of eight patients, intraoperative DFT between subcutaneous lead and device was <15 J. In the eighth patient ICD implantation was technically not feasible due to a DFT >20 J. During follow-up (mean 14.5 months) appropriate and effective ICD discharges were noted in two patients. DFT remained stable after 3 months in four of six patients retested. A revision was required in one patient due to lead migration and in another patient due to a lead break. Conclusions: In infants and small children, extracardiac ICD implantation was technically feasible. Experience and follow-up are still limited. The course of the DFT is unknown, facing further growth of the patients. [source] Postpacemaker Implant Pericarditis: Incidence and Outcomes with Active-Fixation LeadsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2002SOORI SIVAKUMARAN SIVAKUMARAN, S., et al.: Postpacemaker Implant Pericarditis: Incidence and Outcomes with Active Fixation Leads. Pericarditis has been noted as a potential complication of pacemaker implantation. This study evaluated the risk of developing pericarditis following pacemaker implantation with active-fixation atrial leads. Included were 1,021 consecutive patients (mean age 73.4 ± 0.4 years, range 16,101 years; 45.2% women) undergoing new pacemaker system implantation between 1991 and 1999 who were reviewed for the complication of pericarditis. The incidence and outcomes of postimplantation pericarditis in patients receiving active-fixation atrial leads were compared to those not receiving these leads. Of 79 patients who received active-fixation atrial leads, 4 (5%) developed pericarditis postpacemaker implantation. Of 942 patients with passive-fixation atrial leads or no atrial lead (i.e., a ventricular lead only), none developed pericarditis postoperatively (P < 0.001). Of patients receiving active-fixation ventricular leads only (n = 97), none developed pericarditis. No complications were apparent at the time of implantation in patients who developed pericarditis. Pleuritic chest pain developed between 1 and 28 hours postoperatively. Three patients had pericardial rubs without clinical or echocardiographic evidence of tamponade. They were treated conservatively with acetylsalicylic acid or ibuprofen and their symptoms resolved without sequelae in 1,8 days. One patient (without pericardial rub) died due to cardiac tamponade on postoperative day 6. Postmortem examination revealed hemorrhagic pericarditis with no gross evidence of lead perforation. Pericarditis complicates pacemaker implantation in significantly more patients who receive active-fixation atrial leads. It may be precipitated by perforation of the atrial lead screw through the thin atrial wall. Patients developing postoperative pericarditis should be followed closely due to the risk of cardiac tamponade. [source] Phased-Array Intracardiac Echocardiography for Guiding Transseptal Catheter Placement: Utility and Learning CurvePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 4 2002SUSAN B. JOHNSON JOHNSON, S.B., et al.: Phased-Array Intracardiac Echocardiography for Guiding Transseptal Catheter Placement: Utility and Learning Curve. The utility of a new intracardiac 64-element, phased-array, longitudinal ultrasound imaging system for guiding transseptal catheterization was assessed during 69 crossing attempts in 45 dogs because of the inherent limitations of fluoroscopy and mechanical ultrasound. Multifrequency (7.5,8.5 MHZ) imaging of the membranous fossa ovalis, posterior left atrium, and left atrial appendage was conducted from the right atrium. Contact of the Brockenbrough needle with the interatrial septum as reflected by membranous fossa ovalis "tenting" was uniformly identified. Transseptal crossing and advancement of the dilator and sheath were adequately imaged because of deeper ultrasound tissue penetration. Transseptal catheterization was successfully accomplished in 44 of 45 dogs: on the first attempt in 40 and with additional attempts in 4 and confirmed by direct far-field imaging of nonagitated saline injection via the sheath. Total transseptal catheterization time was 3.0 ± 1.8 minutes. Unsuccessful first attempts and/or subsequent sheath pullback into the right atrium with catheter manipulation were also readily recognized. Insertion of the transseptal needle beyond the ultrasound imaging plane resulted in perforation of the posterior left atrial wall in three attempts. Accompanying effusions in these animals and three others related to subsequent intracardiac ablation catheter manipulation were readily identified and monitored echocardiographically. In conclusion, phased-array intracardiac imaging provides a highly reliable means of guiding transseptal access to the left atrium. In addition, inadvertent complications such as perforation and pericardial effusion development can be readily recognized. [source] Internal Atrial Defibrillation During Electrophysiological Studies and Focal Atrial Fibrillation Ablation ProceduresPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2001MARTIN R. KARCH KARCH, M.R., et al.: Internal Atrial Defibrillation During Electrophysiological Studies and Focal Atrial Fibrillation Ablation Procedures. Induction of sustained AF during electrophysiological studies requires electrical cardioversion to restore sinus rhythm for continuation of the electrophysiological study and mapping procedure. The study included 104 consecutive patients (age 59 ± 12 years, 74 men), who were in stable sinus rhythm at the beginning of the electrophysiological study, underwent internal atrial defibrillation (IAD) of AF (> 15 minutes) that was induced during electrophysiological study. In 21 patients, AF was regarded to be the clinical problem (group I), and in the remaining 83 patients other arrhythmias represented the primary target of the electrophysiological study (group II). A 7.5 Fr cardioversion catheter (EP Medical) equipped with a distal array was used and placed in the left pulmonary artery and a proximal array of the same size was located along the lateral right atrial wall. All patients were successfully cardioverted with a mean energy of 6.2 ± 4.0 J. In 18 (78%) of 21 group I patients and in 12 (14%) of 81 group II patients, AF recurred 3.7 ± 3.4 and 2.4 ± 1.4 times during electrophysiological study, respectively. The IAD shock did not suppress focal activity, thus the mapping of atrial foci responsible for AF could be continued even after several IADs. No IAD related complications occurred during the study. In conclusion, (1) IAD can be safely and successfully performed during electrophysiological study without using narcotic drugs or high electric energies; (2) IAD does not suppress focal activity; and (3) even if AF recurs frequently during the electrophysiological study, IAD can be performed several times without significant time delay. [source] Mapping of Atrial Activation Patterns After Inducing Contiguous Radiofrequency Lesions: An Experimental StudyPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2001FRANCISCO J. CHORRO CHORRO, F.J., et al.: Mapping of Atrial Activation Patterns After Inducing Contiguous Radiofrequency Lesions: An Experimental Study. High resolution mapping techniques are used to analyze the changes in atrial activation patterns produced by contiguous RF induced lesions. In 12 Langendorff-perfused rabbit hearts, left atrial activation maps were obtained before and after RF induction of epicardial lesions following a triple-phase sequential protocol: (phase 1) three separate lesions positioned vertically in the central zone of the left atrial wall; (phase 2) the addition of two lesions located between the central lesion and the upper and lower lesions; and (phase 3) the placement of four additional lesions between those induced in the previous phases. In six additional experiments a pathological analysis of the individual RF lesions was performed. In phase 1 (lesion diameter = 2.8 ± 0.2 mm, gap between lesions = 3 ± 0.8 mm), the activation process bordered the lesions line in two (2.0-ms cycles) and four experiments (1.0-ms cycles). In phase 2, activation bordered the lesions line in eight (2.0-ms cycles, P < 0.01 vs control) and nine experiments (1.0-ms cycles, P < 0.001), and in phase 3 this occurred in all experiments except one (both cycles, P < 0.001 vs control). In the experiments with conduction block, the increment of the interval between activation times proximal and distal to the lesions showed a significant correlation to the length of the lesions (r = 0.68, P < 0.05, 100-ms cycle). In two (17%) experiments, sustained regular tachycardias were induced with reentrant activation patterns around the lesions line. In conclusion, in this acute model, atrial RF lesions with intact tissue gaps of 3 mm between them interrupt conduction occasionally, and conduction block may be frequency dependent. Lesion overlap is required to achieve complete conduction block lines. Tachycardias with reentrant activation patterns around a lesions line may be induced. [source] Atrial Tachycardia Originating from the Upper Left Atrial Septum: Demonstration of Transseptal Interatrial Conduction Using the Infolded Atrial WallsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2006KOJI KUMAGAI M.D. We report a rare case of atrial tachycardia (AT) originating from the upper left atrial septum. Electroanatomic mapping of both atria demonstrated that the earliest atrial activation during AT occurred at the upper left atrial septum 26 msec before the onset of the P wave, followed by the mid-right atrial septum (10 msec before the onset of the P wave) and then the upper right atrial septum just adjacent to the left septal AT site (1 msec before the onset of the P wave), indicating detour pathway conduction from the upper left to the upper right atrium. Embryologically, it was suggested that the superior components of the secondary atrial septum are made by the infolded atrial walls and could develop a transseptal detour pathway involving the left-side atrial septal musculature, the superior rim of the oval fossa and the right-side atrial septal musculature. A single radiofrequency application targeting the upper left atrial septum successfully abolished the AT. [source] Cardiac amyloidosis: MR imaging findings and T1 quantification, comparison with control subjectsJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2007Gabriele A. Krombach MD Abstract In cardiac amyloidosis an interstitial deposition of amyloid fibrils causes concentric thickening of the atrial and ventricular walls. We describe the results of tissue characterization of the myocardium by T1 quantification and MRI findings in a patient with cardiac amyloidosis. The T1 time of the myocardium was elevated compared to that in individuals without amyloidosis. The T1 time of the myocardium was 1387 ± 63 msec (mean value obtained from four measurements ± standard deviation [SD]) in the patient with cardiac amyloidosis, while the reference value obtained from the myocardium of 10 individuals without known myocardial disease was 1083 ± 33 msec (mean value ± SD). In combination with other MR findings suggestive of amyloidosis, such as homogeneous thickening of the ventricular and atrial walls, thickening of the valve leaflets, restrictive filling pattern, and reduction of systolic function, T1 quantification may increase diagnostic confidence. J. Magn. Reson. Imaging 2007;25:1283,1287. © 2007 Wiley-Liss, Inc. [source] | |||||||||||||