Using a high-pitch dual-source CT (DSCT), we aimed to quantify the amounts of contrast media, radiation doses, and image qualities in patients undergoing pulmonary vein (PV) isolation.The study enrolled 60 patients who were randomly assigned in a 1: 1: 1 ratio to undergo ECG-gated 64-slice multidetector computed tomography (MDCT; group I, n = 20), ECG-gated 128-DSCT (group II, n = 20), and nongated 128-DSCT (group III, n = 20). The total amount of contrast media was lower in groups II and III compared with group I (I: 54.7 ± 5.6, II: 26.6 ± 2.7, and III: 28.7 ± 6.9 mL, P < 0.001). The CT dose index was lower in groups II and III compared with group I (I: 73.1 ± 5.2, II: 3.5 ± 0.1, and III: 3.7 ± 0.1 mGy, P < 0.001). The dose length product was lower in groups II and III compared with group I (I: 1154.8 ± 82.8, II: 75.4 ± 2.3, and III: 77.2 ± 1.9 mGy × cm, P < 0.001). The total CT effective radiation dose was lower in groups II and III compared with group I (I: 16.2 ± 1.2, II: 1.1 ± 0.1, and III: 1.1 ± 0.1 mSv, P < 0.001). The total CT scan duration was shorter in group III compared with groups I and II (I: 30.8 ± 2.2, II: 23.4 ± 3.6, and III: 16.0 ± 2.4 minutes, P < 0.001). There were no significant differences in quality for integrated electroanatomical mapping (EAM) and parameters associated with PV isolation among the 3 groups.Nongated 128-DSCT provides sufficient image quality to allow integrated EAM while exposing the patient to less contrast media, lower radiation doses, and shorter CT scan durations.
Background:The difference between left atrial (LA) and systemic coagulation activity in paroxysmal atrial fibrillation (PAF) is unclear.Methods and Results:We enrolled 100 patients with PAF who underwent AF ablation. Warfarin was stopped 1 day before the procedure. LA volume index and LA emptying fraction were measured by 64-slice multidetector computed tomography. Immediately after transseptal puncture, blood samples were simultaneously collected from the LA and systemic circulation (SC). In addition, to evaluate the effect of warfarin on D-dimer levels we recruited an additional 27 PAF patients on continuous warfarin. Even in patients with low CHADS2scores (mean 0.59±0.68) and during sinus rhythm, the prevalence of positive LA-D-dimer (≥0.5 µg/ml) was greater than that of SC-D-dimer (23% vs. 10%, P<0.01). The LA-D-dimer-positive patients had a larger mean LA volume index and reduced LA emptying fraction than the LA-D-dimer-negative patients. Multiple logistic regression analysis revealed that LA volume index was independently correlated with positive LA-D-dimer (odds ratio 2.245, 95% confidence interval 1.194−4.626, P=0.0112). The prevalence of positive LA-D-dimer was significantly lower in patients taking continuous warfarin, than in those on discontinuous warfarin (3.7% vs. 23%, P=0.025).Conclusions:An enlarged LA volume index was associated with high LA coagulation status in patients with paroxysmal AF. Adequate warfarin control during AF catheter ablation may reduce the prevalence of positive LA-D-dimer. (Circ J 2015; 79: 61–69)
Abstract Introduction The predictive value of left atrial volume (LAV) in atrial fibrillation (AF) is known, but the relationship of right atrial volume (RAV) and biatrial volume (BAV) with AF recurrence after pulmonary vein isolation (PVI) is not clear. Cardiac magnetic resonance (CMR) imaging allows us to more precisely quantify atrial volume. We investigated LAV, RAV, and BAV as predictors of AF recurrence following PVI in AF patients. Methods and Results We assessed 100 AF patients (age = 59.8 ± 9.5 years, 74 males, 26 females) who underwent nonenhanced CMR before their first PVI. LAV and RAV were measured using CMR. All patients were in sinus rhythm during CMR. BAV was calculated as the sum of LAV and RAV. During the 8‐month follow‐up, AF recurrence occurred in 23 patients. LAV, RAV, and BAV were significantly greater in patients with AF recurrence than in those without (LAV, 103.7 ± 25.8 vs 81.8 ± 24.2 mL, P < 0.001; RAV, 109.4 ± 27.0 vs 82.2 ± 19.6 mL, P < 0.001; BAV, 213.1 ± 46.7 vs 164.1 ± 38.7 mL, P < 0.001). Multivariate logistic regression analysis revealed that increased LAV, RAV, and BAV were significantly correlated with AF recurrence. The area under the receiver operation characteristic curve for BAV showed the largest value compared to that of LAV or RAV alone. Conclusions LAV, RAV, and BAV were independent predictors of AF recurrence after PVI. Quantifying BAV may additionally improve prognostic stratification compared with LAV or RAV.
Systolic anterior motion (SAM) can be caused by multifactorial mechanisms, including structural, morphological and functional factors. We report an unusual case of a 76-year-old woman presenting with SAM associated with constrictive pericarditis. Echocardiography showed no septal hypertrophy but SAM and left ventricular outflow tract obstruction and moderate mitral regurgitation. The restoration of diastolic function after complete pericardiectomy successfully eliminated it.
A 33-year-old woman presented with coccyx pain since her first vaginal delivery. On lateral plain radiographs, the tailbone was subluxated and dislocated ventrally. A 33-year-old woman presented with dyspepsia and coccyx pain. Since her first vaginal delivery, she had been experiencing discomfort during defecation followed by coccyx pain, which was persistent even after 18 months. Her condition gradually worsened, including difficulty in defecating and a sensation of residual stool. She had no obesity or adverse obstetric outcomes. Physical examination revealed coccyx pain during movements such as sitting and standing, and the pain was greatest when the patient was placed in a prone position. There was localized tenderness on the coccyx. On lateral plain radiographs, the coccyx was subluxated and displaced ventrally (Figure 1). Computed tomography also showed coccyx subluxation, but no other intra-abdominal lesions were noted. Hence, analgesics and laxatives were prescribed. Postpartum coccydynia is a common symptom, which is often treated without proper evaluation of the patient's condition for traumatic injuries such as fracture, subluxation, and dislocation. Dystocia, obesity (body mass index ≥27), and more than two deliveries are associated with a high prevalence of tailbone dislocation.1 The treatment of traumatic tailbone dislocation remains controversial. Although normalizing the anatomical structure by manipulation of the dislocated fragment would seem plausible, manual repair by a transrectal approach could be highly invasive. Therefore, conservative treatment is considered, including the administration of analgesics, exercise therapy, local anesthesia, and avoiding painful positions. Caudal osteotomy is another treatment of choice for patients with chronic postpartum coccyx pain.2, 3 In our patient, the pain and difficulty in defecating were relieved by analgesics and laxatives; therefore, conservative treatment was successful. The pain that increased in the prone position was attributed to the subluxation of the tailbone to the ventral side. Coccyx pain results from abnormal mobility of the coccyx. There are many attachments to the coccyx and sacrococcygeal region. Stretching of the anterior sacrococcygeal ligament and traction of the pelvic parietal fascia in the prone position may cause coccyx pain.4 On the basis of expanded Postacchini and Massobrio classification, this case falls under type IV, which is often associated with coccydynia.5 Subluxation or dislocation of the coccyx during delivery usually results in the posterior dislocation as the fetal head pushes the coccyx backward. The reason for the anterior dislocation, in this case, may be that the tailbone, once dislocated posteriorly, gradually shifted ventrally because of daily activities performed after delivery such as sitting. Therefore, when women present with persistent pain in the buttock and a physical examination shows a localized tenderness in the coccyx, a subluxation of the coccyx related to vaginal delivery would be suspected. Furthermore, a history of worsening coccyx pain in a prone position may indicate anterior subluxation, rather than posterior. In such cases, in addition to the physical examination, a plain roentgenogram is useful for diagnosis. None declared. None declared. The authors have stated explicitly that there are no conflicts of interest in connection with this article. Written informed consent was obtained from the patient for publication of this case report and accompanying images.
