Home About us Contact
|
Home About us Contact | ||
|
|
||
Left Atrium (leave + atrium)
Selected AbstractsThe Relationship Between Endocardial Voltage and Regional Volume in Electroanatomical Remodeled Left Atria in Patients with Atrial Fibrillation: Comparison of Three-Dimensional Computed Tomographic Images and Voltage MappingJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2009JAE HYUNG PARK B.Sc. Background: Long-standing atrial fibrillation (AF) changes left atrial (LA) morphology, and the LA size is related to recurrence after radiofrequency catheter ablation (RFCA). We hypothesize that LA morphology, based on embryological origin, affects the outcome of RFCA. Methods: We analyzed 3D computed tomographic (CT) images of LA in 70 patients with AF (54 males, 55.6 ± 10.5 years old, paroxysmal AF (PAF):persistent AF (PeAF) = 32:38) who underwent RFCA. Each LA image was divided into venous atrium (VA), anterior LA (ALA), LA appendage (LAA), and both antrum. Absolute and relative volumes were calculated, and the lengths of linear ablation sites were measured. Results: (1) In patients with the mean LA voltage , 2.0 mV, LA volume, especially ALA, was larger (P < 0.01) compared to those with LA voltage > 2.0 mV. (2) The total LA volume was significantly larger (P < 0.01) and LAA voltages (P < 0.05) and conduction velocities (P < 0.05) were lower in patients with PeAF than in those with PAF. (3) In patients with recurrence, LA volume was generally larger (P < 0.01) than in those without recurrence. In PAF patients with recurrence, the relative volume of ALA was significantly larger (P < 0.01) than those without recurrence. Conclusions Morphologically remodeled LA has low endocardial voltage, and enlargement of ALA is more significant in electroanatomically remodeled LA. The disproportional enlargement of ALA was observed more often in PAF patients with recurrence after ablation than those without recurrence. [source] Is Atrial Fibrillation Ablation a Futile Effort in Patients Who Have Markedly Enlarged Left Atria?PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2010ANDREA M. RUSSO M.D. First page of article [source] Coronary Artery Fistulas: A Review of the Literature and Presentation of Two Cases of Coronary Fistulas with Drainage into the Left AtriumCONGENITAL HEART DISEASE, Issue 3 2007Scott Ceresnak MD Abstract We report 2 cases of infants presenting with a murmur shortly after birth and diagnosed with coronary artery fistulas with drainage into the left atrium. The first infant had a fistulous communication between the left main coronary artery and the left atrial appendage and presented with signs and symptoms of heart failure. The infant was repaired surgically in the first week of life. The second infant was asymptomatic and had a fistulous communication between the right coronary artery and the left atrium. The infant will have the fistula closed in the cardiac catheterization laboratory when the child is older. The literature on coronary artery fistulas is reviewed, and the diagnosis and management of coronary artery fistulas is discussed. [source] Extension of Bronchogenic Carcinoma Through Pulmonary Vein into the Left Atrium Detected by EchocardiographyECHOCARDIOGRAPHY, Issue 2 2004Milind Y Desai M.D. This is the case of a 46-year-old female recently diagnosed with a squamous cell bronchogenic carcinoma that spread through the pulmonary veins into the left atrium. This mass was initially seen on surface echocardiography as emanating from the pulmonary vein and subsequently confirmed to be arising from the right superior pulmonary vein by transesophageal echocardiography. (ECHOCARDIOGRAPHY, Volume 21, February 2004) [source] Drainage of the Inferior Vena Cava to the Left AtriumECHOCARDIOGRAPHY, Issue 2 2003Haran Burri M.D. Drainage of the inferior vena cava to the left atrium is an extremely unusual congenital heart disease. We describe a 54-year-old woman, in whom the diagnosis was suggested by transthoracic echocardiography, and then confirmed by a transesophageal exam and magnetic resonance imaging, which also revealed an associated secundum atrial septal defect. Surgical management involved reconstruction of the interatrial septum to include the inferior vena cava in the right atrium. The few previously reported cases in the literature are reviewed. (ECHOCARDIOGRAPHY, Volume 20, February 2003) [source] The Rupture of Periaortic Infective Aneurysm into the Left Atrium and the Left Ventricular Outflow Tract: Preoperative Diagnosis by Transthoracic EchocardiographyECHOCARDIOGRAPHY, Issue 3 2002Ewa Lastowiecka M.D. We present a rare complication of infective endocarditis, perforated periaortic abscess with fistulous communication between the aortic root, the left atrium, and the left ventricular outflow tract. Preoperative transthoracic echocardiographic diagnosis was confirmed intraoperatively. The patient was treated successfully by aortic homograft implantation. [source] Primary Cardiac Angiosarcoma of Left AtriumJOURNAL OF CARDIAC SURGERY, Issue 5 2009Cally K.L. Ho F.R.C.S. We report an extremely rare case of primary angiosarcoma originating from the left atrium in a 70-year-old woman. This represents the ninth reported case of left-sided cardiac angiosarcoma in the English literature. Analysis of all nine cases shows that this malignant neoplasm occurs more in female patients with a mean age of 60 years, unlike the right-sided one which typically affects male patients in their early 40s. The prognosis of this tumor is extremely poor with life expectancy lying between 3 to 34 months despite early diagnosis by imaging and multimodality treatment. [source] Surgical Technique for Massive Mural Thrombus in the Left AtriumJOURNAL OF CARDIAC SURGERY, Issue 5 2007Masaru Yoshikai M.D. The fresh autologous pericardium was used to cover the roughened left atrial endocardium after the removal of the mural thrombus. This procedure seems useful to prevent not only the perioperative thromboembolism caused by the dislodgement of the fragmented small thrombus but also any long-term future thrombus formation by creating a smooth surface layer with the autologous pericardium. [source] Left Superior Vena Cava Draining into the Left Atrium, Associated with Partial Anomalous Pulmonary Venous Connection: Surgical CorrectionJOURNAL OF CARDIAC SURGERY, Issue 4 2005Andrea Quarti M.D. Although intra-atrial rerouting techniques, in patients with no connecting vein, have proved to be reliable and successful, in many cases the extracardiac repair is preferable. We report a case of a 5-month-old patient with a not connected left superior vena cava draining into the left atrium, associated with atrial septal defect and partial anomalous pulmonary venous connection. The correction has been achieved by rerouting the pulmonary venous return into the left atrium and by transposition of the left vena cava on the right appendage. [source] Ablation of Posteroseptal and Left Posterior Accessory Pathways Guided by Left Atrium,Coronary Sinus Musculature Activation SequenceJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2008RÓBERT PAP M.D. Introduction: While some posteroseptal and left posterior accessory pathways (APs) can be ablated on the tricuspid annulus or within the coronary venous system, others require a left-sided approach. "Fragmented" or double potentials are frequently recorded in the coronary sinus (CS), with a smaller, blunt component from left atrial (LA) myocardium, and a larger, sharp signal from the CS musculature. Methods and Results: Forty patients with posteroseptal or left posterior AP were included. The LA,CS activation sequence was determined at the earliest site during retrograde AP conduction. Eleven APs (27.5%) were ablated on the tricuspid annulus (right endocardial), 9 (22.5%) inside the coronary venous system (epicardial), and 20 (50%) on the mitral annulus (left endocardial). A "fragmented" or double "atrial" potential was recorded in all patients inside the CS at the earliest site during retrograde AP conduction. Sharp potential from the CS preceded the LA blunt component (sharp/blunt sequence) in all patients with an epicardial AP, and in 10 of 11 (91%) patients with a right endocardial AP. Therefore, 18 of 19 (95%) APs ablated by a right-sided approach produced this pattern. The reverse sequence (blunt/sharp) was recorded in 19 of 20 (95%) patients with a left endocardial AP. Conclusion: During retrograde AP conduction, the sequence of LA,CS musculature activation,as deduced from analysis of electrograms recorded at the earliest site inside the CS,can differentiate posteroseptal and left posterior APs that require left heart catheterization from those that can be eliminated by a totally venous approach. [source] Unusual Activation of the Left Atrium After Ablation of a Perimitral Flutter: What is the Mechanism?JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2008SÉBASTIEN KNECHT M.D. No abstract is available for this article. [source] Esophageal Luminal Temperature Measurement Underestimates Esophageal Tissue Temperature During Radiofrequency Ablation Within the Canine Left Atrium: Comparison Between 8 mm Tip and Open Irrigation CathetersJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2008JENNIFER E. CUMMINGS M.D. Introduction: Evaluation of luminal temperature during left atrial ablation is used clinically; however, luminal temperature does not necessarily reflect temperature within the esophageal wall and poses a risk of atrioesophageal fistula. This animal study evaluates luminal esophageal temperature and its relation to the temperature of the external esophageal tissue during left atrial lesions using the 8 mm solid tip and the open irrigated tip catheters (OIC). Methods and Results: A thermocouple was secured to the external surface of the esophagus at the level of the left atrium of the dogs. Luminal esophageal temperature was measured using a standard temperature probe. In four randomized dogs, lesions were placed using an 8 mm solid tip ablation catheter. In six randomized dogs, lesions were placed using the 3.5 mm OIC. The average peak esophageal tissue temperature when using the OIC was significantly higher than that of the 8 mm tip catheter (88.6°C ± 15.0°C vs. 62.3°C ± 12.5°C, P < 0.05). Both OIC and 8 mm tip catheter had significantly higher peak tissue temperatures than luminal temperatures (OIC: 88.6°C ± 15.0°C vs 39.7°C ± 0.82°C, P < 0.05) (8 mm: 62.3°C ± 12.5°C vs 39.0 ± 0.5°C, P < 0.05). Both catheters achieved peak temperatures faster in the tissue as compared to the lumen of the esophagus, although the tissue temperature peaked significantly faster for the OIC (OIC: 25 seconds vs 90 seconds, P < 0.05) (8 mm: 63 seconds vs 105 seconds, P < 0.05). Conclusion: Despite the significant difference in actual tissue temperatures, no significant difference was observed in luminal temperatures between the OIC and 8 mm tip catheter. [source] A Novel Finding,Isolated Marshall's Ligament Rhythm After Catheter Ablation and Reconnection of the Marshall's Ligament with the Left Atrium After an Adenosine Bolus in One Patient with Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 11 2007TA-CHUAN TUAN M.D. No abstract is available for this article. [source] Structural Changes Following Linear Ablation in the Left Atrium for Treatment of Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2007REBECCA MCCALL B.V.C.Des. No abstract is available for this article. [source] Long Insulated Pathway in the Left AtriumJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2007SÉBASTIEN KNECHT M.D. [source] Clinical Implications of Reconnection Between the Left Atrium and Isolated Pulmonary Veins Provoked by Adenosine Triphosphate after Extensive Encircling Pulmonary Vein IsolationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2007HITOSHI HACHIYA M.D. Introduction: Dormant pulmonary vein (PV) conduction can be provoked by adenosine triphosphate (ATP) after extensive encircling pulmonary vein isolation (EEPVI). However, the clinical implication of reconnection between the left atrium (LA) and isolated PVs provoked by ATP (ATP-reconnection) remains unknown. Methods and Results: We studied the clinical consequences of ATP-reconnection during intravenous isoproterenol infusion (ISP-infusion). EEPVI severs conduction between the LA and ipsilateral PVs at their junction. Radiofrequency energy is applied at a distance from the PV ostia guided by double Lasso catheters placed within the ipsilateral superior and inferior PVs. This study comprised 82 patients (67 men, 56 ± 9 years old) with atrial fibrillation (AF) who underwent injection of ATP during ISP infusion after successful EEPVI (ATP(+) group). We compared clinical characteristics of 170 patients who underwent earlier EEPVI prior to our use of ATP injection after successful EEPVI (ATP(N/D) group) with those of ATP(+) group patients who underwent one session of EEPVI. ATP-reconnection occurred in 34 (41%) of 82 ATP(+) group patients. Additional radiofrequency applications were performed to eliminate ATP-reconnection in all ipsilateral PVs. Continuous ATP-reconnection of more than 20 seconds duration occurred in six (7.3%) of 82 patients. A total of 102 (60%) of 170 patients in the ATP(N/D) group had no recurrence of AF, whereas 60 (73%) of 82 ATP(+) group patients who underwent only one EEPVI session have had no recurrence of AF in a 6.1 ± 3.3-month follow-up period (P = 0.04). Conclusion: Radiofrequency application for provoked ATP-reconnection may reduce clinical AF recurrence. [source] Fibrillating Areas Isolated within the Left Atrium after Radiofrequency Linear Catheter AblationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2006THOMAS ROSTOCK M.D. Introduction: Nonpulmonary vein sources have been implicated as potential drivers of atrial fibrillation (AF). This observational study describes regions of fibrillating atrial tissue isolated inadvertently from the left atrium (LA) following linear catheter ablation for AF. Methods and Results: We report four patients with persistent/permanent AF who underwent pulmonary vein isolation with additional linear lesions and who presented with recurrent AF (mean AF cycle length [AFCL] 175,270 ms). Further catheter ablation resulted in the inadvertent electrical isolation of significant areas of the LA in which AF persisted at the same AFCL as was measured prior to disconnection, despite the restoration of sinus rhythm (SR) in all other left and right atrial areas, strongly suggesting that these islands were driving the remaining atria into fibrillation. The disconnected areas were located in the lateral LA, including the left atrial appendage (LAA) in three patients (limited to the LAA in one) and in the posterior LA in one patient. These isolated fibrillating regions represented 15,24% of the global LA surface, as estimated by electroanatomic mapping. Conclusion: Fibrillation can be maintained within electrically isolated regions of the LA following catheter ablation of AF, demonstrating the importance of atrial drivers in the maintenance of AF. Further mapping of these drivers is needed to characterize their mechanism and thereby allow for a more specific ablation strategy. [source] Three-Dimensional Anatomy of the Left Atrium by Magnetic Resonance Angiography: Implications for Catheter Ablation for Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2006MOUSSA MANSOUR M.D. Background: Pulmonary vein isolation (PVI) has become one of the primary treatments for symptomatic drug-refractory atrial fibrillation (AF). During this procedure, delivery of ablation lesions to certain regions of the left atrium can be technically challenging. Among the most challenging regions are the ridges separating the left pulmonary veins (LPV) from the left atrial appendage (LAA), and the right middle pulmonary vein (RMPV) from the right superior (RSPV) and right inferior (RIPV) pulmonary veins. A detailed anatomical characterization of these regions has not been previously reported. Methods: Magnetic resonance angiography (MRA) was performed in patients prior to undergoing PVI. Fifty consecutive patients with a RMPV identified by MRA were included in this study. Ridges associated with the left pulmonary veins were examined in an additional 30 patients who did not have a RMPV. Endoluminal views were reconstructed from the gadolinium-enhanced, breath-hold three-dimensional MRA data sets. Measurements were performed using electronic calipers. Results: The width of the ridge separating the LPV from the LAA was found to be 3.7 ± 1.1 mm at its narrowest point. The segment of this ridge with a width of 5 mm or less was 16.6 ± 6.4 mm long. The width of the ridges separating the RMPV from the RSPV and the RIPV was found to be 3.0 ±1.5 mm and 3.1 ±1.8 mm, respectively. There were no significant differences between LPV ridges for patients with versus without a RMPV. Conclusion: The width of the ridges of atrial tissue separating LPV from the LAA and the RMPV from its neighboring veins may explain the technical challenge in obtaining stable catheter positions in these areas. A detailed assessment of the anatomy of these regions may improve the safety and efficacy of catheter ablation at these sites. [source] Esophageal Temperature During Radiofrequency-Catheter Ablation of Left Atrium: A Three-Dimensional Computer Modeling StudyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2006FERNANDO HORNERO M.D., Ph.D. Introduction: There is current interest in finding a way to minimize thermal injury in the esophagus during radiofrequency-catheter ablation of the left atrium. Despite the fact that the esophageal temperature is now being monitored during ablation, the influence of different anatomic and technical factors on the temperature rise remains unknown. Methods and Results: We implemented a three-dimensional computational model that included atrial tissue, epicardial fat, esophagus, aorta, and lung, all linked by connective tissue. The finite-element method was used to calculate the esophageal temperature distribution during a procedure of constant-temperature ablation with an 8-mm electrode, under different tissue conditions. Results showed that the distance between electrode and esophagus was the most important anatomic factor in predicting the esophageal temperature rise, the composition of the different tissues being of lesser importance. The measurement of the esophageal temperature in different sites of the lumen offered differences up to 3.7°C, especially for a short electrode,esophagus distance (5 mm). The difference in the convective cooling by circulating blood around electrode and endocardium did not show a significant influence on the esophageal temperature rise. Conclusion: Computer results suggest that (1) the electrode,esophagus distance is the most important anatomic factor; (2) the incorrect positioning of an esophageal temperature probe could give a low reading for the maximum temperature reached in the esophagus; and (3) the different cooling effect of the circulating blood flow at different atrial sites has little impact on the esophageal temperature rise. [source] Real-Time Monitoring of Luminal Esophageal Temperature During Left Atrial Radiofrequency Catheter Ablation for Atrial Fibrillation: Observations About Esophageal Heating During Ablation at the Pulmonary Vein Ostia and Posterior Left AtriumJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2006CHRISTIAN PERZANOWSKI M.D. Introduction: Left atrial radiofrequency catheter ablation (RFA) is gaining acceptance as treatment for drug-refractory atrial fibrillation (AF). This therapy has been associated with esophageal injury and atrioesophageal fistula formation causing death. Methods: We describe 3 patients undergoing catheter ablation for AF during real-time monitoring of luminal esophageal temperature. Results: We observed heating of the esophagus during short duration low power RFA, at either the left or right pulmonary vein ostia. Cryoablation at the pulmonary vein ostium in one patient resulted in esophageal cooling. Furthermore, we observed that fluoroscopic localization of the ablation catheter at a site apparently distant from the esophagus is not adequate to assure avoidance of ablation-induced esophageal heating. Conclusions: Real-time monitoring of luminal esophageal position and temperature is feasible, enhances recognition of esophageal heating, and may add useful information beyond that provided by fluoroscopic assessment of esophageal position. There is a potential role for esophageal monitoring to help avoid thermal injury to the esophagus during catheter ablation for atrial fibrillation. [source] Demonstration of Electrical and Anatomic Connections Between Marshall Bundles and Left Atrium in Dogs: Implications on the Generation of P Waves on Surface ElectrocardiogramJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2002CHIKAYA OMICHI M.D. Marshall Bundle and P Wave.Introduction: The muscle bundles within the ligament of Marshall (LOM) are electrically active. The importance of these muscle bundles (Marshall bundle [MB]) to atrial activation and the generation of the ECG P wave is unclear. Methods and Results: We used optical mapping techniques to study epicardial activation patterns in isolated perfused left atrium in four dogs. In another seven dogs, P waves were studied before and after in vivo radiofrequency (RF) ablation of the connection between coronary sinus (CS) and the LOM. Computerized mapping was performed before and after RF ablation. Optical mapping studies showed that CS pacing resulted in broad wavefronts propagating from the middle and distal LOM directly to the adjacent left atrium (LA). Serial sections showed direct connection between MB and LA near the orifice of the left superior pulmonary vein in two dogs. In vivo studies showed that MB potentials were recorded in three dogs. After ablation, the duration of P waves remained unchanged. In the other four dogs, MB potentials were not recorded. Computerized mapping showed that LA wavefronts propagated to the MB region via LA-MB connection and then excited the CS. After ablation, the activation of CS muscle sleeves is delayed, and P wave duration increased from 65.3 ± 14.9 msec to 70.5 ± 17.2 msec (P = 0.025). Conclusion: In about half of the normal dogs, MB provides an electrical conduit between LA free wall and CS. Severing MB alters the atrial activation and lengthens the P wave. MB contributes to generation of the P wave on surface ECG. [source] Characterization of Paroxysmal and Persistent Atrial Fibrillation in the Human Left Atrium During Initiation and Sustained EpisodesJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2002GJIN NDREPEPA M.D. Characterization of AF in the LA.Introduction: Atrial fibrillation (AF) in the left atrium (LA) is poorly defined in terms of regional differences in the degree of organization, characteristics of paroxysmal and persistent variants, and electrophysiologic events that develop at the onset of episodes. Methods and Results: The study population consisted of 21 patients (15 men and 6 women; mean age 58 ± 9.4 years) with paroxysmal (10 patients) or persistent (11 patients) AF. Mapping of the LA during sustained episodes and the onset of AF was performed with a 64-electrode basket catheter. At the onset of AF, repetitive beats starting with atrial premature complexes and ending with generation of the earliest fibrillatory activity were defined as intermediary rhythm. Patients with paroxysmal AF had longer AF cycle lengths and more pronounced regional differences than patients with persistent AF. In total, AF cycle lengths in the LA in patients with persistent AF were 20% shorter than in patients with paroxysmal AF. Initiation of AF was preceded by an intermediary rhythm of 5.5 ± 2.5 cycles (6.3 ± 2.7 cycles in paroxysmal AF vs 4.2 ± 1.0 cycles in persistent AF; P = 0.026). At the onset of AF, the earliest generators of fibrillatory activity were located more frequently in the posterior wall of the LA. Conclusion: AF in the LA displays substantial regional differences in terms of AF cycle lengths and degree of organization. Patients with persistent AF have shorter cycle lengths and a higher degree of disorganized activity than patients with paroxysmal AF. Intermediary rhythms play an important role in initiation of AF via activation of generator regions in the LA. [source] Temperature-Sensitive Focal Atrial Tachycardia in the Left AtriumJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2000G. ANDRÉ NG M.B.CH.B., Ph.D. Temperature-Sensitive Focal Atrial Tachycardia. Temperature sensitivity has not been reported in focal atrial tachycardia. We describe a patient with a left atrial tachycardia whose tachycardia rate was affected by hot and cold drinks. The elTects were still evident after autonomic blockade. The arrhythmia focus was located at the entrance of the left upper pulmonary vein. Radiofrequency ablation was carried out, which proved to be difficult, but it was successful after several applications of energy, suggesting an epicardial location of the arrhytbmia focus. Sensitivity of atrial tachycardia rate to the temperature of food or drink ingested suggests a left atrial focus with a posterior and possibly epicardial location. [source] Percutaneous Retrieval of a Broken Catheter from the Left Atrium in an AdultJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2002ANGELO BRUNO RAMONDO M.D. We performed a percutaneous retrieval of a broken catheter from the left atrium in an adult patient using transseptal left heart catheterization and a helical basket guidewire. To our knowledge, this is the first description of such a therapeutical option for a foreign body lodged in the left atrium of an adult patient. [source] Myocardium Extending from the Left Atrium onto the Pulmonary Veins: A Comparison Between Subjects with and Without Atrial FibrillationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2001MINORU TAGAWA TAGAWA, M., et al.: Myocardium Extending from the Left Atrium onto the Pulmonary Veins: A Comparison Between Subjects with and Without Atrial Fibrillation. Rapid discharges from the myocardium extending from the left atrium onto the pulmonary vein (PV) have been shown to initiate AF, and AF may be eradicated by the catheter ablation within the PV. However, if there is any difference in the distribution patterns of the myocardial sleeve onto the PV between the subjects with and without AF is to be determined. Twenty-one autopsied hearts were examined. Eleven patients previously had AF before death and another 10 patients had normal sinus rhythm as confirmed from the medical records including ECGs before death. After exposing the heart, the distance to the peripheral end of the myocardium was measured from the PV-atrial junction in each PV. Then, the PVs were sectioned and stained and the distal end of myocardium and the distribution pattern were studied. The anteroposterior diameter of the left atrium was also measured. In 74 of 84 PVs, the myocardium extended beyond the PV-atrial junction. The myocardium was localized surrounding the vascular smooth muscle layer forming a myocardial sleeve. The peripheral end of the myocardial sleeve was irregular and the maximal and minimal distances were measured in each PV. The myocardium extended most distally in the superior PVs compared to the inferior ones and the maximal distance to the peripheral end was similar between the AF and non-AF subjects (8.4 ± 2.8 vs 8.7 ± 4.4 mm for the left superior and 6.5 ± 3.5 vs 5.1 ± 3.9 mm for the right superior PV, respectively). A significant difference was found in the maximal distance in the inferior PVs: 7.3 ± 4.6 vs 3.3 ± 2.8 mm for the left (P < 0.05) and 5.7 ± 2.4 vs 1.7 ± 1.9 mm for the right inferior PV (P < 0.001) in the subjects with and without AF, respectively. The diameter of left atrium was slightly dilated in AF patients but insignificantly (4.1 ± 0.1 vs 3.6 ± 0.1 cm, P > 0.07). The myocytes on the PV were less uniform and surrounded by more fibrosis in patients with AF compared to those without AF. In conclusion, the myocardium extended beyond the atrium-vein junction onto the PVs. The distribution patterns of the myocardium was almost similar between subjects with and without AF, but the histology suggested variable myocytes in size and fibrosis in patients with AF. [source] Focal Atrial Tachycardia Originating from the Left Atrial Appendage: Electrocardiographic and Electrophysiologic Characterization and Long-Term Outcomes of Radiofrequency AblationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2007WANG YUN-LONG M.D. Introduction: This study sought to investigate electrophysiologic characteristics and radiofrequency ablation (RFA) in patients with focal atrial tachycardia (AT) arising from the left atrial appendage (LAA). Methods: This study included seven patients undergoing RFA with focal AT. Activation mapping was performed during tachycardia to identify an earlier activation in the left atria and the LAA. The atrial appendage angiography was performed to identify the origin in the LAA before and after RFA. Results: AT occurred spontaneously or was induced by isoproterenol infusion rather than programmed extrastimulation and burst atrial pacing in any patient. The tachycardia demonstrated a characteristic P-wave morphology and endocardial activation pattern. The P wave was highly positive in inferior leads in all patients. Lead V1 showed upright or biphasic (±) component in all patients. Lead V2,V6 showed an isoelectric component in five patients or an upright component with low amplitude (<0.1 mV) in two patients. Earliest endocardial activity occurred at the distal coronary sinus (CS) ahead of P wave in all seven patients. Mean tachycardia cycle length was 381 ± 34 msec and the earliest endocardial activation at the successful RFA site occurred 42.3 ± 9.6 msec before the onset of P wave. RFA was acutely successful in all seven patients. Long-term success was achieved in seven of the seven over a mean follow-up of 24 ± 5 months. Conclusions: The LAA is an uncommon site of origin for focal AT (3%). There were consistent P-wave morphology and endocardial activation associated with this type of AT. The LAA focal ablation is safe and effective. Long-term success was achieved with focal ablation in all patients. [source] Successful Transcatheter Closure of an Aorto-Left Atrial FistulaCONGENITAL HEART DISEASE, Issue 6 2007Malek M. El Yaman MD ABSTRACT Aorto-left atrial fistula is a rare entity in which the integrity of the aortic root bordering the left atrium is disrupted. The clinical presentation is highly variable, depending predominantly on the size of the fistula and the pressure difference between the aorta and the left atrium. Surgical repair was the standard treatment. Recently, however, there have been reports of successful transcatheter closure. We report a 32-year-old male with Shone's syndrome who had multiple prior surgical procedures including aortic and mitral valve replacements. He presented with an aorto-left atrial fistula that was successfully closed percutaneously using an Amplatzer atrial septal defect device. [source] Coronary Artery Fistulas: A Review of the Literature and Presentation of Two Cases of Coronary Fistulas with Drainage into the Left AtriumCONGENITAL HEART DISEASE, Issue 3 2007Scott Ceresnak MD Abstract We report 2 cases of infants presenting with a murmur shortly after birth and diagnosed with coronary artery fistulas with drainage into the left atrium. The first infant had a fistulous communication between the left main coronary artery and the left atrial appendage and presented with signs and symptoms of heart failure. The infant was repaired surgically in the first week of life. The second infant was asymptomatic and had a fistulous communication between the right coronary artery and the left atrium. The infant will have the fistula closed in the cardiac catheterization laboratory when the child is older. The literature on coronary artery fistulas is reviewed, and the diagnosis and management of coronary artery fistulas is discussed. [source] Cor Triatriatum Sinister with and without Left Ventricular Inflow Obstruction: Visualization of the Entire Supravalvular Membrane by Real-time Three-dimensional Echocardiography.CONGENITAL HEART DISEASE, Issue 6 2006Impact on Clinical Management of Individual Patient ABSTRACT We present 4 cases of cor triatriatum in whom the diagnosis was correctly made by 2-dimensional transthoracic echocardiography, which showed the supravalvular left atrial membrane that divides the left atrium into 2 chambers. The pulmonary veins were connected normally to the proximal left atrial chamber and the left atrial appendage was connected to the distal left atrial chamber. In 1 patient there was evidence of severe pulmonary venous obstruction to the mitral valve by Doppler examination, while in the other three, there was no venous obstruction. Patients were then examined by real-time 3-dimensional echocardiography (RT3DE, using ×4 matrix array transducer connected to Sonos 7500 echocardiographic system Phillips, Andover, Mass, USA). This showed the exact morphology of the membrane and led to cancellation of planed surgical intervention in 1 case in which the membrane was only a broad band crossing the left atrial cavity. In addition to delineating the exact morphology of the intracavitary anomaly, this novel echocardiographic imaging modality should be an additive tool to better understand the natural history of these nonobstructive left atrial membranes via longitudinal follow-up of these patients. [source] Giant Right Atrium in an AdultECHOCARDIOGRAPHY, Issue 10 2008Vignendra Ariyarajah M.D. Massive right atrial (RA) enlargement is certainly more common in children than in adults, owing to rare congenital anomalies. Indeed, the largest description of such chamber enlargement was noted in a child, where the RA volume was reported to be 900 ml. We now report one of the largest descriptions of the RA in an adult, in absence of tricuspid stenosis and other common adult associations of RA abnormality, such as chronic pulmonary disease, severe mitral valvular pathology with pulmonary hypertension, and pulmonary embolism or infarct. The RA volume was estimated to be well over 500 ml and was notably disproportionate to that of the left atrium and either ventricle. [source] | |||||||||||||