scholarly journals Paradoxical doppler echocardiographic parameters during recovery of left atrial contractility after spontaneous conversion from paroxysmal atrial fibrillation to sinus rhythm

2020 ◽  
Vol 22 (6) ◽  
pp. 302-304
Author(s):  
Hironori Murakami ◽  
Daisuke Hotta ◽  
Gregory W. Ruhnke
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Echocardiographic Parameters ◽  
Spontaneous Conversion

scholarly journals Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ahmet Demirkiran ◽  
Raquel P. Amier ◽  
Mark B. M. Hofman ◽  
Rob J. van der Geest ◽  
Lourens F. H. J. Robbers ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Flow Velocity ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Peak Flow ◽  
Thrombus Formation ◽  
Clinical Value ◽  
4D Flow ◽  
Ssfp Cine

AbstractThe pathophysiology behind thrombus formation in paroxysmal atrial fibrillation (AF) patients is very complex. This can be due to left atrial (LA) flow changes, remodeling, or both. We investigated differences for cardiovascular magnetic resonance (CMR)-derived LA 4D flow and remodeling characteristics between paroxysmal AF patients and patients without cardiac disease. In this proof-of-concept study, the 4D flow data were acquired in 10 patients with paroxysmal AF (age = 61 ± 8 years) and 5 age/gender matched controls (age = 56 ± 1 years) during sinus rhythm. The following LA and LA appendage flow parameters were obtained: flow velocity (mean, peak), stasis defined as the relative volume with velocities < 10 cm/s, and kinetic energy (KE). Furthermore, LA global strain values were derived from b-SSFP cine images using dedicated CMR feature-tracking software. Even in sinus rhythm, LA mean and peak flow velocities over the entire cardiac cycle were significantly lower in paroxysmal AF patients compared to controls [(13.1 ± 2.4 cm/s vs. 16.7 ± 2.1 cm/s, p = 0.01) and (19.3 ± 4.7 cm/s vs. 26.8 ± 5.5 cm/s, p = 0.02), respectively]. Moreover, paroxysmal AF patients expressed more stasis of blood than controls both in the LA (43.2 ± 10.8% vs. 27.8 ± 7.9%, p = 0.01) and in the LA appendage (73.3 ± 5.7% vs. 52.8 ± 16.2%, p = 0.04). With respect to energetics, paroxysmal AF patients demonstrated lower mean and peak KE values (indexed to maximum LA volume) than controls. No significant differences were observed for LA volume, function, and strain parameters between the groups. Global LA flow dynamics in paroxysmal AF patients appear to be impaired including mean/peak flow velocity, stasis fraction, and KE, partly independent of LA remodeling. This pathophysiological flow pattern may be of clinical value to explain the increased incidence of thromboembolic events in paroxysmal AF patients, in the absence of actual AF or LA remodeling.

scholarly journals Clinical Outcomes of low-voltage area-guided left atrial linear ablation for non-paroxysmal atrial fibrillation patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260834
Author(s):  
Hao-Tien Liu ◽  
Chia-Hung Yang ◽  
Hui-Ling Lee ◽  
Po-Cheng Chang ◽  
Hung-Ta Wo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Low Voltage ◽  
Reverse Remodeling ◽  
Voltage Mapping ◽  
Linear Ablation

Background The therapeutic effect of low-voltage area (LVA)-guided left atrial (LA) linear ablation for non-paroxysmal atrial fibrillation (non-PAF) is uncertain. We aimed to investigate the efficacy of LA linear ablation based on the preexisting LVA and its effects on LA reverse remodeling in non-PAF patients. Methods We retrospectively evaluated 145 consecutive patients who underwent radiofrequency catheter ablation for drug-refractory non-PAF. CARTO-guided bipolar voltage mapping was performed in atrial fibrillation (AF). LVA was defined as sites with voltage ≤ 0.5 mV. If circumferential pulmonary vein isolation couldn’t convert AF into sinus rhythm, additional LA linear ablation was performed preferentially at sites within LVA. Results After a mean follow-up duration of 48 ± 33 months, 29 of 145 patients had drugs-refractory AF/LA tachycardia recurrence. Low LA emptying fraction, large LA size and high extent of LVA were associated with AF recurrence. There were 136 patients undergoing LA linear ablation. The rate of linear block at the mitral isthmus was significantly higher via LVA-guided than non-LVA-guided linear ablation. Patients undergoing LVA-guided linear ablation had larger LA size and higher extent of LVA, but the long-term AF/LA tachycardia-free survival rate was higher than the non-LVA-guided group. The LA reverse remodeling effects by resuming sinus rhythm were noted even in patients with a diseased left atrium undergoing extensive LA linear ablation. Conclusions LVA-guided linear ablation through targeting the arrhythmogenic LVA and reducing LA mass provides a better clinical outcome than non-LVA guided linear ablation, and outweighs the harmful effects of iatrogenic scaring in non-PAF patients.

Abstract TP231: Echocardiographically Identified Left Atrial Enlargement is Associated With Non-valvular Paroxysmal Atrial Fibrillation (PAF) and is a Surrogate for PAF Associated Risk for Embolic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Adeniyi O Molajo
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Stroke Risk ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Ecg Monitoring ◽  
Ambulatory Ecg ◽  
Ambulatory Ecg Monitoring

Introduction: Paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation are risk factors for systemic embolism including stroke. Both are indication for anticoagulation. Many patients with stroke in sinus rhythm are shown on ambulatory ECG monitoring to have PAF. PAF is difficult to diagnose on ambulatory ECG monitoring. A persistent marker for PAF will be useful to identify need for anticoagulant to reduce stroke risk due to PAF. Echocardiographic variable with a high predictive value for PAF is desirable. Objective: The purpose of the study was to investigate the relationship between left atrial (LA) size and proneness to paroxysmal atrial fibrillation and assess its reliability as a surrogate for diagnosing non valvular PAF. Method: Echo Database for patients with measured LA volume index, in sinus rhythm without history of intervention for atrial fibrillation, pharmacological therapy, and cardioversion or ablation therapy over a seven year period was reviewed. Patients with enlarged LA Volume index (>28ml/M 2 ) were selected. Seven Day ambulatory ECG monitoring was performed in these patients, ResultEchocardiogram data of 245 patients were available for analysis. 41 had greater than mild mitral valve regurgitation and were excluded from further analysis. Age range was 37-93. 99 were male. 211 patients had LA volume index data available. In 8 patients in sinus rhythm on ambulatory ECG, LA volume index was mildly increased (28-34 ml/M 2) In 16 patients with PAF on ambulatory ECG, LA volume index was mildly increased (28-34 ml/M 2 ) In 100 patients with PAF on ambulatory ECG, LA volume index was moderately increased (35-40 ml/M 2 ) In 88 patients with PAF on ambulatory ECG, LA volume index was severely increased (>40 ml/M 2 ) Conclusion: In patients with moderately and severely enlarged LA volume index, there was a high prevalence of paroxysmal atrial fibrillation on ambulatory ECG monitoring. Left Atrial volume index could serve as an echocardiographic surrogate for PAF and identify indication for anticoagulation to reduce stroke risk. It Is More Easily Identifiable Surrogate For PAF Than Ambulatory ECG Monitoring In Stroke Risk Assessment.

Left Atrial Appendage Aneurysm with Paroxysmal Atrial Fibrillation

2012 ◽  
Vol 15 (1) ◽  
pp. 1 ◽  
Author(s):  
Yu-Jen Shih ◽  
Yi-Chang Lin ◽  
Yi-Ting Tsai ◽  
Chih-Yuan Lin ◽  
Chung-Yi Lee ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Surgical Intervention ◽  
Atrial Appendage ◽  
Atrial Tachyarrhythmia ◽  
Large Aneurysm ◽  
Left Atrial Appendage Aneurysm

Aneurysm of the left atrial appendage is extremely rare, and afflicted patients most commonly present with atrial tachyarrhythmia or thromboembolism. For these patients, resection of the aneurysm is the recommended and preferred therapy. We present the case of a 57-year-old woman who was found incidentally to have a large aneurysm of the left atrial appendage presenting as atrial fibrillation. After surgical intervention with resection of the aneurysm and a Cox maze III procedure, the patient recovered and was discharged in sinus rhythm.

scholarly journals Clinical determinants of early spontaneous conversion to sinus rhythm in patients with atrial fibrillation

2021 ◽  
Author(s):  
N. A. H. A. Pluymaekers ◽  
E. A. M. P. Dudink ◽  
B. Weijs ◽  
K. Vernooy ◽  
D. E. J. Hartgerink ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Standard Of Care ◽  
Volume Index ◽  
Current Standard ◽  
Left Atrial Volume Index ◽  
First Onset ◽  
Spontaneous Conversion

Abstract Background The current standard of care for acute atrial fibrillation (AF) focuses primarily on immediate restoration of sinus rhythm by cardioversion, although AF often terminates spontaneously. Objective To identify determinants of early spontaneous conversion (SCV) in patients presenting at the emergency department (ED) because of AF. Methods An observational study was performed of patients who visited the ED with documented AF between July 2014 and December 2016. The clinical characteristics and demographics of patients with and without SCV were compared. Results We enrolled 943 patients (age 69 ± 12 years, 47% female). SCV occurred within 3 h of presentation in 158 patients (16.8%). Logistic regression analysis showed that duration of AF <24 h [odds ratio (OR) 7.7, 95% confidence interval (CI) 3.5–17.2, p < 0.001], left atrial volume index <42 ml/m2 (OR 1.8, 95% CI 1.2–2.8, p = 0.010), symptoms of near-collapse at presentation (OR 2.4, 95% CI 1.2–5.1, p = 0.018), a lower body mass index (BMI) (OR 0.9, 95% CI 0.91–0.99, p = 0.028), a longer QTc time during AF (OR 1.01, 95% CI 1.0–1.02, p = 0.002) and first-detected AF (OR 2.5, 95% CI 1.6–3.9, p < 0.001) were independent determinants of early SCV. Conclusion Early spontaneous conversion of acute AF occurs in almost one-sixth of admitted patients during a short initial observation in the ED. Spontaneous conversion is most likely to occur in patients with first-onset, short-duration AF episodes, lower BMI, and normal left atrial size.

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