Left Atrial Remodeling Assessed by Transthoracic Echocardiography Predicts Left Atrial Appendage Flow Velocity in Patients With Paroxysmal Atrial Fibrillation
Atai WatanabeShinya SuzukiHiroto KanoSyunsuke MatsunoHideaki TakaiYuko KatoTakayuki OtsukaTokuhisa UejimaYuji OikawaKazuyuki NagashimaHajime KirigayaTakashi KuniharaKoichi SagaraNaohide YamashitaHitoshi SawadaTadanori AizawaJunji YajimaTakeshi Yamashita
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Atrial fibrillation (AF) is associated with an increased risk of stroke and other thromboembolic events. Left atrial (LA) thrombus formation is closely related to LA dysfunction, particularly to decreased LA appendage flow velocity (LAA-FV) in patients with AF. We estimated LAA-FV using parameters noninvasively obtained by transthoracic echocardiography (TTE) in patients with paroxysmal AF.Echocardiographic and clinical parameters were assessed in 190 patients with nonvalvular paroxysmal AF showing sinus heart rhythm during transesophageal echocardiography (TEE) and TTE.LAA-FV (60 ± 22 cm/s) significantly correlated with the time interval between the initiation of the P-wave on ECG and that of the A-wave of transmitral flow on TTE (PA-TMF, correlation coefficient, -0.32; P < 0.001), LA dimension (LAD, -0.31; P < 0.001), septal a' velocity of tissue Doppler imaging (TDI, 0.35; P < 0.001), E/e' ratio (-0.28, P < 0.001), E velocity of transmitral flow (-0.20, P = 0.008), E/A ratio of transmitral flow (-0.18, P = 0.02), CHA2DS2-VASc score (-0.15, P = 0.04), and BNP plasma level (-0.32, P = 0.002). Multivariate analysis revealed that PA-TMF (standardized partial regression coefficient, -0.17; P = 0.03), a' velocity (0.24, P = 0.004), and LAD (-0.20, P = 0.01) were independent predictors of LAA-FV (multiple correlation coefficient R, 0.44; P < 0.001).Parameters of atrial remodeling, ie, decreased a' velocity, increased LAD, and PA-TMF during sinus rhythm may be useful predictors of LA blood stasis in patients with nonvalvular PAF. LAA-FV can be estimated using these TTE parameters instead of TEE.Keywords:
P wave
Doppler imaging
Atrial fibrillation is the most frequent sustained arrhythmia. It is associated with higher morbidity and mortality of patients. Cryoablation was introduced to the current practise in cardiac surgery as a non-pharmacological method of therapy of atrial fibrillation. The aim of the study was to assess the effect of surgical ablation of atrial fibrillation on the attainment and maintenance of sinus rhythm in patients undergoing concomitant cardiac surgery.Ninety four consecutive patients with atrial fibrillation (paroxysmal, persistent or permanent) were followed up prospectivelly. The mean age was 67.8 years; there were 39 (41.5%) women in the study group. Forty two patients (44.7%) had paroxysmal or persistent atrial fibrillation and 52 (55.3%) of them had permanent atrial fibrillation before surgery. Patients with permanent atrial fibrillation had significantly bigger preoperative left atrial diameter (51.2 versus 46.6 mm) and more severe tricuspid regurgitation (grade 2.3/4 versus grade 1.4/4) compared to the group with paroxysmal and persistent atrial fibrillation. Mitral valve surgery was significantly more frequent in patients with permanent atrial fibrillation too. Operations were performed between January 2005 and July 2006 using flexible argon-based cryoablative device. Sinus rhythm was achieved statistically significantly more frequently in patients with preoperative paroxysmal and persistent atrial fibrillation in comparison with patients with permanent atrial fibrillation--at discharge, 1, 3.5 and 6 months after operation (90.5-96.3 % versus 50-65.9%). At 12 months it was only statistical trend (84.6% versus 63.3%). Kaplan-Meier analysis demonstrated a 79.4% freedom from atrial fibrillation at 12 months. Preoperative atrial size and duration of atrial fibrillation were the most significant negative predictors of maintenance of sinus rhythm. Four patients (9.3%) required postoperative permanent pacemaker placement. Ischemic stroke occured in 5 (5.3%) patients. Thirty-day motality was 12.9% (12 patients).Perioperative ablation of atrial fibrillation using cryoenergy is effective therapeutic method for restoring and maintenance of sinus rhythm in relatively high proportion of patients. The most significant predictors of late recurrence are preoperative atrial size and duration of atrial fibrillation. This non-pharmacological method should be routinely used in patients undergoing concomitant cardiac surgery.
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Cryoablation
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Objective To Provide clinical references for explaining atrial fibrillation maintaining mechanism,by analyzing the f wave and left atrial inner dimension in patients with atrial fibrillation.Methods A total of 391 cases of atrial fibrillation was collected from January 2008 to January 2011 in our hospital,then 50 cases were selected randomly from chronic atrial fibrillation and 50 cases from paroxysmal atrial fibrillation.The amplitude of f wave,timing,f-f interval and left atrial dimension,and so on,were measured,then made a statistics analysis of the results.Results The index above in the Paroxysmal atrial fibrillation group are lower than that of the persistent atrial fibrillation,except inner diameter.There were statistic differences between the two groups(P0.05).Conclusion The increase of left atrial dimension,the shorten of refractory period of atrium maybe the pathological mechanism of atrial fibrillation.
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Paroxysmal atrial fibrillation
Atrium (architecture)
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Objective To investigate the hypercoagulation state markers in patients with atrial fibrillation and their clinical significance.Methods Sixty patients with chronic atrial fibrillation were divided into two groups,one group having no heart failure(group one,n=30) and the other having heart failure(group two,n=30).There were two age-matched and sex-matched control groups,the normal sinus rhythm group including 40 patients with cardiovascular disease but in sinus rhythm and normal heart function, the health control group including 33 healthy subjects.The plasma fibrin D-dimer was assayed using enzyme linked immunoassay.Fibrinogen(Fg) was measured.Results Compared with the healthy control group and the normal sinus rhythm group,patients with atrial fibrillation(group one) had significant increase of fibrin D-dimer(474.5) μg/L((220.0)-(843.9) μg/L) and Fg((3.74)±(0.76)) g/L,patients with atrial fibrillation and heart failure(group two) had significant increase of fibrin Ddimer(657.9) μg/L((365.8)-(1448.6) μg/L) and Fg((4.25)±(0.95)) g/L,(P(0.05)).Plasma Fg and D-dimer level were higher in group two than that in group one,(P(0.05)).In atrial fibrillation patients with left atrial diameter≥40 mm,Plasma Fg and(D-dimer) level were higher than those with left atrial diameter40 mm(P(0.05)).Conclusion Patients with atrial fibrillation show evidence of hypercoagulation,which may be correlated with the atrial thrombogenesis.In patients with atrial fibrillation,heart failure and left atrial diameter effect the levels of plasma Ddimer and Fg.
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Objective To investigate the relationship between left atrial dimension and atrial fibrillation of coronaray heart disease.Methods The coronaray heart disease patients were divided into three groups,non-atrial fibrillation(group 1),paroxysmal atrial fibrillation(group 2),atrial fibrillation(group 3).Results The rate of atrial fibrillation is increased obviously than normal left atrial dimension.Conclusion The rat of atrial fibrillation in larger left atrial dimension is higher.
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Objective: Treatment of atrial fibrillation, a risk factor for morbidity and mortality, by left atrial ablation is a less complex procedure which is increasingly performed in conjunction with surgery for various heart diseases. Although restoration of sinus rhythm is effective initially, atrial fibrillation may recur. We investigated factors predicting the time until its recurrence. Methods: Between January 2003 and December 2005, 162 consecutive patients (52.5% male, age 69 ± 8.7 years) with permanent atrial fibrillation underwent concomitant left atrial ablation and isolated or combined mitral valve surgery (42.6%), isolated or combined aortic valve surgery (32.1%), and isolated or combined coronary artery bypass grafting (24.1%). Ablation was performed by microwave (n = 93, 57.4%) or radiofrequency (n = 69, 42.6%) technology. Follow-up was after 3, 6, 12 months and yearly thereafter. Predictive values of variables for postoperative atrial fibrillation were examined using techniques of univariate and multivariate survival analysis (proportional hazards regression). Results: Eight patients died perioperatively and 13 during follow-up (not ablation related). Two patients were lost to follow-up. At last follow-up (19 ± 11.3 months), 86 patients (62%) were in stable sinus rhythm, 73 (52%) without antiarrhythmic drugs, and 43 (31%) were in atrial fibrillation. Predictors for the time until recurrence of atrial fibrillation in a multivariate model were preoperative atrial fibrillation duration (hazard ratio 1.005, 95% confidence interval 1.003–1.007, p < 0.001) and left atrial diameter (hazard ratio 1.056, 95% confidence interval 1.020–1.093, p = 0.002). Overall, sinus rhythm conversion rate was 75% when preoperative atrial fibrillation duration was less than 2 years, but 42% in longer lasting atrial fibrillation with left atrial dilatation (>50 mm). Age, gender, primary heart disease, history of thromboembolism or cardioversion, presence of concomitant diseases, EuroScore, left ventricular size and function, aortic cross-clamp time, ablation technology, and treatment with antiarrhythmic drugs did not predict rhythm outcome. Conclusions: Preoperative atrial fibrillation duration and left atrial diameter predict the time until atrial fibrillation recurrence after concomitant left atrial ablation, whereas age, type of primary cardiac surgery, ablation technology and antiarrhythmic therapy do not.
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Univariate analysis
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Flutter
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Introduction: P-wave duration (PWD) is an electrocardiographic (ECG) marker reflecting atrial conduction, and studies have shown that its prolongation is associated with atrial fibrillation.Areas covered: This review addresses the relationship between PWD and atrial fibrillation, how anatomic and physiologic changes in the atria potentiate the risk for atrial fibrillation, and how these atrial anatomic and physiologic changes relate to PWD. Other P-wave related entities, such as P-wave terminal force in V1, PR interval, and P wave axis are also addressed.Expert commentary: Atrial fibrillation is a manifestation of the underlying atrial disease. Fibrotic collagen deposition interrupts the electrical flow and thus can potentiate the transition from sinus rhythm to atrial fibrillation. PWD is an ECG parameter that provides insight into the intricacies of the atria and could be a useful marker for assessing the risk for atrial fibrillation. The main obstacle for broad utilization of PWD is that it is not routinely reported on the printout of the electrocardiogram.
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Fibrillation
PR interval
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A method of recording intensified atrial ECG (IAECG) is described. A total of 150 subjects were examined by this technique including 60 with the normal sinus rhythm and 90 with atrial fibrillation. A certain homogeneity between P atrial waves and the intensified waves of atrial fibrillation was observed over time in the same patients in the presence of prominent heterogeneity of individual types of atrial fibrillation. Characteristic features of the atrial complexes revealed in patients with atrial fibrillation may be of importance for the differential diagnosis, as well as for the assessment and prediction of therapy efficacy. They also appear to be essential in solving a number of theoretical questions concerned with the genesis of both atrial fibrillation and other heart rhythm irregularities.
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Objective To analyze the relationship between left atrial change and atrial fibrillation.Methods Fifty-four patients who had persistent atrial fibrillation in electrocardiogram and dynamic-electrocardiogram were enrolled in group A,52 patients who had paroxysmal atrial fibrillation in group B,and other 54 patients who only had P wave broaden in electrocardiogram in group C.Left atrial size was measured by ultrasoundcardiogram in all patients and the maximum P wave duration(Pmax),the minimum P wave duration(Pmin),P wave dispersion(Pdisp) were measured by 12-leads electrocardiogram in patients of group B and group C.Results The patients who had evident P incisurae and Pdisp increasing tend to suffer from fibrillation;the larger left atrium was,the higher the possibility of atrial fibrillation was,the left atrium diameter of persistent atrial fibrillation was larger than that of paroxysmal atrial fibrillation.Conclusion The patients with left atrial enlargement and Pmax and Pdisp increasing tend to suffer from atrial fibrillation.
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Paroxysmal atrial fibrillation
Atrium (architecture)
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Atrial fibrillation is a serious heart diseases, which is associated on the risk of death, and thus an early detection of atrial fibrillation is necessary. We have investigated spectral pattern of electrocardiogram in relation to atrial fibrillation. The utilized feature of electrocardiogram is RR interval. RR interval is the time interval between a two-consecutive R peaks. A series of RR intervals in a time segment is converted to a signal with a frequency domain. The frequency components are investigated to find the components which significantly associate to atrial fibrillation. A segment is defined as atrial fibrillation or normal segments by considering a defined number of atrial fibrillation RR in the segment. Using clinical data of 23 patients with atrial fibrillation, we find that the frequency components could be used to indicate atrial fibrillation.
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RR interval
Fibrillation
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