scholarly journals “Stunning” of the left atrium after spontaneous conversion of atrial fibrillation to sinus rhythm

1998 ◽  
Vol 32 (7) ◽  
pp. 2081-2086 ◽  
Author(s):  
Eric K Louie ◽  
Dong Liu ◽  
Sandra I Reynertson ◽  
Henry S Loeb ◽  
Thomas L McKiernan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Spontaneous Conversion

scholarly journals Termination of atrial fibrillation during pharmacological cardioversion in the goat requires inter-atrial synchronisation of conduction

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
V Sobota ◽  
A Van Hunnik ◽  
S Zeemering ◽  
G Gatta ◽  
D Opacic ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Conduction Velocity ◽  
Right Atrium ◽  
Path Length ◽  
Cycle Length ◽  
Final Phase ◽  
Periodic Activity ◽  
Bachmann’S Bundle

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): ITN Networks PersonalizeAF: Personalized Therapies for Atrial Fibrillation. A Translational Approach, No. 860974; CATCH ME: Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly, No. 633196; MAESTRIA: Machine Learning and Artificial Intelligence for Early Detection of Stroke and Atrial Fibrillation, No. 965286; AFib-TrainNet: EU Training Network on Novel Targets and Methods in Atrial Fibrillation, No. 675351 Netherlands Heart Foundation: CVON2014-09, RACE V Reappraisal of Atrial Fibrillation: Interaction between hyperCoagulability, Electrical remodeling, and Vascular Destabilization in the Progression of Atrial Fibrillation Background Few studies report on mechanisms leading to termination of atrial fibrillation (AF). Purpose To characterise electrophysiological parameters and conduction patterns during the transition from AF to sinus rhythm under various conditions of AF termination. Methods A retrospective evaluation of 6 goat studies was performed. AF was maintained for 3-4 weeks in 29 animals. Four animals were in SR. Unipolar electrograms were acquired with one 249-electrode array/atrium. Pharmacological termination of AF was evoked by various drugs; AP14145 (n = 5), PA6 (n = 7), XAF-1407 (n = 9) vernakalant (n = 8). In animals with sinus rhythm, AF was acutely induced and terminated spontaneously. Baseline AF and ≤3 recordings of the last 10 seconds preceding AF termination were analysed. Intervals with temporal continuous and periodic activity were distinguished in the recordings. AF cycle length (AFCL), conduction velocity and path length were determined for each interval. Results In total, 85 AF terminations were recorded. Switches between temporal continuous and periodic activity were seen frequently during AF. However, termination of AF was always preceded by a phase of periodic activity (PA). The final phase of PA persisted for a median number of 21 [IQR 10-28] cycles in the left atrium and somewhat shorter in the right atrium, Table 1. This final phase of PA was accompanied by a profound bi-atrial increase of AFCL, conduction velocity and path length and a disappearance of inter-atrial cycle length differences. Equipotent changes were not observed in the preceding PAs. During the final AF beats, the number of wave fronts were low, 1 or 2. Interestingly, 92% of the patterns during the last beats of AF involved the Bachmann’s bundle as main source of atrial conduction. Conclusion AF termination is preceded by an increased organisation of fibrillatory conduction, associated with abrupt prolongation of the path length. Propagation in atrial free walls regularly originated from the Bachmann’s bundle. These findings suggest that AF termination was not a random process but follows common spatiotemporal patterns. Final period of temporal organisation Left atrium Right atrium Final PA start Final PA end Final PA start Final PA end Af cycle length (ms) 163 ± 37 204 ± 50* 146 ± 44 207 ± 49* Conduction velocity (cm/s) 77 ± 15 96 ± 25* 83 ± 20 103 ± 24* Path Length (cm) 12.2 ± 2.7 19.3 ± 6.3* 12.0 ± 4.1 21.2 ± 6.4* Length of final periodic activity (beats) NA 21 [IQR 10-28] NA 15 [IQR 10- 25] Electrophysiological changes during the final period periodic activity (PA). Wilcoxon signed rank test. *p <0.05NA= not available

scholarly journals Experience of pharmacological cardioversion with refralon in persistent atrial fibrillation and flutter according to the data of the cardiology department of Orenburg regional clinical hospital

2021 ◽  
Vol 28 (3) ◽  
pp. 13-20
Author(s):  
L. K. Kozlova ◽  
N. V. Sokolova ◽  
A. V. Sivkova ◽  
A. E. Kamyshanova ◽  
O. Y. Abramova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Total Dose ◽  
Left Atrium ◽  
Persistent Atrial Fibrillation ◽  
Clinical Hospital ◽  
The Third ◽  
Cardiology Department ◽  
The Mean ◽  
Medical Histories

Aim. To assess the effectiveness and safety of refralon based cardioversion on the experience of the cardiology department of Orenburg Regional Clinical Hospital.Methods. The archival medical histories of 14 patients with persistent atrial fibrillation (AF) and 2 patients with persistent atrial flutter (AFL) (overall 16 patients), who underwent an attempt to restore sinus rhythm with refralon, were analyzed. The mean age of the patients was 51.7±10.4 years. The mean duration of AF/AFL since its last detection was 8.0±6.5 weeks (from 8 days to 8 months). Fifteen patients had hypertension, 3 of them had coronary artery disease (CAD), and 1 patient had CAD with type 2 diabetes mellitus. One of the patients had lone AF. Before cardioversion, all patients underwent the following examination: clinical and biochemical blood tests, clinical urine tests, electrocardiography (ECG), echocardiography (Echo), transesophageal Echo, Holter ECG, the determination of the level of thyroid-stimulating hormone, thyroxine, electrolytes, including potassium and magnesium.Results. According to Echo, initially, the transverse size of the left atrium in patients was 4.3±0.3 cm. Its increase was noted in 68.7% of patients (from 4.3 to 5.0 cm). Restoration of sinus rhythm after the first step of refralon administration at a dose of 10 μg/kg was achieved in 8 patients, after the second step of administration (total dose 20 μg/kg) - in 5 patients and after the third step (total dose 30 μg/kg) - in 2 patients. In 1 patient, restoration of sinus rhythm was not achieved after the administration of the third bolus. Out of 15 patients with restored sinus rhythm, AF recurrence occurred in three. In one of the patients with successful cardioversion, the sinus rhythm was restored the next day. The duration of the last episode of AF and the size of the left atrium did not significantly affect the effectiveness of cardioversion and amounted to 62±54 days and 4.3±0.35 cm, respectively, in patients with successful cardioversion, and with a recurrence of AF - 34.3±28 days and 4.2±0.35 cm (p=0.2; р=0.6). The efficacy of cardioversion with refralon was 71.4% in patients with AF, and 100% in patients with AFL. No adverse events of refralon were found in patients.Conclusion. At the time of discharge, sinus rhythm was recorded in 12 out of 16 patients (75%). The ineffectiveness of cardioversion with refralon was noted only in patients with AF; in all patients with AFL the sinus rhythm was restored.

scholarly journals Delayed sinus rhythm restoration after thoracoscopic left atrium fragmentation (а report of two cases)

2020 ◽  
Vol 11 (4) ◽  
pp. 90-95
Author(s):  
Sergey A. Vachev ◽  
Sergey V. Korolev ◽  
Alexandr S. Zotov ◽  
Robert I. Khabazov ◽  
Alexander V. Troitskiy
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Persistent Atrial Fibrillation ◽  
Clinical Cases

The article presents two clinical cases of delayed restoration of the sinus rhythm in patients with long-term persistent atrial fibrillation after the procedure of thoracoscopic radiofrequency fragmentation of the left atrium. The necessity of continuing attempts to restore the sinus rhythm up to the end of the "blind period" (90 days) is discussed.

scholarly journals Timing of cardioversion in atrial fibrillation: the sooner the better?

2020 ◽  
Vol 22 (Supplement_L) ◽  
pp. L41-L43
Author(s):  
Piera Capranzano ◽  
Valeria Calvi
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Rate Control ◽  
Limited Resources ◽  
Psychological Burden ◽  
Treatment Pathway ◽  
Recent Onset ◽  
Wait And See ◽  
Costs Of Treatment ◽  
Spontaneous Conversion

Abstract Management of recent-onset (<36 h) atrial fibrillation (AF) in the emergency room is highly variable, particularly concerning the type and timing of cardioversion, and the logistics of the treatment pathway. In clinical practice, it is fairly common for patients with recent-onset AF an attempt at re-establishing sinus rhythm, either with electric or pharmacologic cardioversion, as soon as feasible. Nonetheless, a ‘wait-and-see’ approach, and potentially delayed cardioversion, could represent a valid alternative to early cardioversion, considering that, often, in recent-onset AF, sinus rhythm is re-established spontaneously, thus repealing the need for active cardioversion, hence avoiding the possible risks of treatment. These concepts form the rationale for a recent multicentric randomized trial, Rate Control vs. Electrical Cardioversion Trial 7 – Acute Cardioversion vs. Wait and See (RACE 7 ACWAS), comparing the efficacy of delayed cardioversion, within 48 h from symptoms onset, in case of lack of spontaneous conversion, with early cardioversion in symptomatic patients with recent-onset AF. In patients presenting to the emergency department with recent-onset, symptomatic AF, a wait-and-see approach was non-inferior to early cardioversion in maintaining the sinus rhythm at 4 weeks. Nonetheless a system employing a delayed cardioversion strategy increases the costs of treatment, complicates the treatment pathway, and could represent a psychological burden for the patients. Accordingly, delayed cardioversion could not represent a practical choice for many hospitals with limited resources and without an adequate outpatient organization.

Abstract 13747: Investigation of the Probability of Spontaneous Conversion From Atrial Fibrillation to Sinus Rhythm Utilizing Continuous Rhythm Monitoring

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Paul D Ziegler ◽  
Efstratios I Charitos
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Time Course ◽  
Hierarchical Regression ◽  
Related Factors ◽  
Blue Line ◽  
Spontaneous Conversion ◽  
Af Recurrence ◽  
Red Line

Introduction: Atrial fibrillation (AF) recurrence or spontaneous conversion to sinus rhythm (SR) are regarded as random events. Hypothesis: We hypothesized that the probability of spontaneous conversion to SR decreases as more time is spent in AF. We attempt to quantify this phenomenon and investigate factors that can affect this probability. Methods: Cardiac rhythm histories of 1195 patients (age 73.0 ± 10.1, follow-up: 349 ± 40 days; 14533 AF episodes) with implantable devices were reconstructed and analyzed. No patients received cardioversion, AF ablation, or any obvious AF therapies during follow-up. Patients with no AF recurrence or continuous AF during follow up were excluded. Hierarchical regression methods were employed to investigate the time course of the probability of rhythm change and factors that influence it. Results: Probabilities of spontaneous conversion from AF to SR (solid blue line) and recurrence of AF in patients with SR (solid red line) are shown in the Figure. For patients in AF , spontaneous conversion probability significantly decreases with time spent in AF and plateaus after ~7 days (dotted blue line). Similarly for patients in SR, increasing time in SR reduces the probability of developing AF (solid red line) and plateaus after ~7 days (dotted red line). Patient age (p<0.001), LVEF (p<0.05) and presence of coronary artery disease (p<0.01) significantly influence the spontaneous conversion probabilities independent from AF burden. Conclusions: Spontaneous SR conversion or AF recurrence diminishes with increasing time spent in AF or SR, respectively, and are influenced by several patient-related factors. These findings suggest that patients should be closely monitored after AF recurrence or SR conversion.

scholarly journals Left atrium regional voltage analysis in sinus rhythm in patients undergoing atrial fibrillation ablation

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P489-P489
Author(s):  
I. Menduina ◽  
E. Caballero ◽  
M. Diaz-Escofet ◽  
P. Martin ◽  
J. Novoa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Atrial Fibrillation Ablation

P1431Radiofrequency ablation of left atrium in patients with mitral valve replacement. The future of surgical treatment for atrial fibrillation in mitral valve disease?

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Utyasheva ◽  
I V Abdulyanov ◽  
M A Sungatullin ◽  
I I Vagizov
Keyword(s):  
Atrial Fibrillation ◽  
Surgical Treatment ◽  
Mitral Valve ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Pulmonary Veins ◽  
Pacemaker Implantation ◽  
Valve Prosthesis ◽  
Diagnostic Center ◽  
Valve Pathology

Abstract Aims   The evaluation of sinus rhythm preservation after surgical treatment of atrial fibrillation by left-atrial RFA in patients with mitral valve prosthetics. Materials and methods  A prospective, randomized study was performed in the interregional clinical and diagnostic center of Kazan in 2011-2018 which were included 136 patients with mitral valve pathology and persistent AF. The average age of patients was 57 ± 5, the gender division was dominated by female patients  and made up 97 (58.4%). All patients underwent either mitral valve prosthesis with mechanical prosthesis Meding-2 which made up 96 (70.5%) or biological prosthesis Carpantier-Edwards which made up 40 (29.4%). Radiofrequency isolation of the left atrium and pulmonary veins was performed by standard procedure by Cox-IV which doesn’t include the right atrium tissue. Results and discussion: In the early post surgical period, recovery of sinus rhythm was observed in 111 (81.6%) patients. Cardiac Pacemaker Implantation was performed in 1 (0.73%) case.  The results of the study were assessed after surgical treatment in 22 ± 5 months, the sinus rhythm was preserved in 99 patients from the study group and made up 72.7%. Conclusion Radiofrequency ablation  the left atrium provides long-term preservation of sinus rhythm in the treatment of patients with atrial fibrillation and mitral valve pathology.

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