P1006Conduction disorders in patients with congenital heart disease and right atrial volume overload: an intraoperative epicardial mapping study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Houck ◽  
E A H Lanters ◽  
P Knops ◽  
P C Van De Woestijne ◽  
J W Roos-Hesselink ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Volume Overload ◽  
Right Atrial ◽  
Conduction Time ◽  
Epicardial Mapping ◽  
Mapping Study ◽  
Crista Terminalis ◽  
Atrial Tachyarrhythmias ◽  
Conduction Disorders ◽  
Arrhythmogenic Substrate

Abstract Background Various atrial regions may contribute to the arrhythmogenic substrate for atrial tachyarrhythmias, including atrial fibrillation (AF), in patients with right atrial (RA) volume overload in congenital heart disease (CHD). It is widely recognized that structural and electrical remodelling of the RA occurs, but a previous endovascular mapping study showed that the left atrium (LA) was also affected in patients with atrial septal defect (ASD). The role of Bachmann's bundle (BB) and posterior left atrium (PLA) is yet unknown. Purpose To quantify and compare prevalence and severity of conduction disorders during sinus rhythm between atrial regions in patients with CHD and RA volume overload, using intraoperative high-resolution epicardial mapping. Methods Thirty-one patients (female: n=18, age: 48.5±13.8 years, history of AF: n=5) undergoing cardiac surgery for secundum ASD (n=18), sinus venosus defect (n=11) or isolated partial abnormal pulmonary venous return (n=2) were included. Intra-operative epicardial mapping (N=128/192 electrodes, interelectrode distance: 2mm) of the RA, BB, LA and PLA was performed during sinus rhythm. Conduction delay (CD) and block (CB) were quantified per region as proportion (%), length of lines (mm) and maximum conduction time (Δ local activation time between two adjacent electrodes). Results Proportion of CD on BB was 3.9% (2.3–4.9), RA 3.1% (1.9–3.8), PLA 2.4% (1.2–3.6) and LA 2.3% (1–3) and was higher on BB compared to PLA (p=0.002) and LA (p<0.001) but not RA (p=0.063). Proportion of CB on BB was 2.1% (1.2–5.4), RA 2.2% (1.1–3.4), PLA 0.8% (0.1–2.4) and LA 0.8% (0.3–1.6) and was smaller on LA compared to BB (p=0.001) and RA (p=0.004). There were no significant differences in length of CD/CB lines between regions, except that length of the longest CB line per patient was longer in the RA compared to LA (p=0.008). Maximum conduction time was highest in the RA (median 40ms) as opposed to BB (31ms), LA (21ms) and PLA (18ms; all p<0.0083 with Bonferroni correction), suggesting conduction disorders were more severe in the RA. For sub analysis, the RA surface was divided into 1) the crista terminalis region and 2) the lateral RA wall. In the crista terminalis region, proportions of CD and CB were higher, CD/CB lines were longer and maximum conduction times were higher (all p<0.05). Differences between patients with and without AF were solely observed on BB: patients with AF had a higher proportion and longer lines of CB (p<0.05), though outcomes should be interpreted with caution due to the small number of patients with AF. Conclusions In adult patients with CHD and RA volume overload, both RA and BB were affected by conduction disorders. More specifically, conduction disorders in the RA were mainly concentrated in the crista terminalis region. These findings suggest that not only the RA but also BB may be involved in the arrhythmogenic substrate for atrial tachyarrhythmias in these patients. Acknowledgement/Funding Dutch Heart Foundation [no 2012T0046]; LSH-Impulse [no 40-43100-98-008]; CVON [no 914728] and VIDI [no 91717339] to N.M.S. de Groot.

scholarly journals Distribution of Conduction Disorders in Patients With Congenital Heart Disease and Right Atrial Volume Overload

2020 ◽  
Vol 6 (5) ◽  
pp. 537-548 ◽  
Author(s):  
Charlotte A. Houck ◽  
Eva A.H. Lanters ◽  
Annejet Heida ◽  
Yannick J.H.J. Taverne ◽  
Pieter C. van de Woestijne ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Volume Overload ◽  
Right Atrial ◽  
Atrial Volume ◽  
Conduction Disorders ◽  
Right Atrial Volume

Arrhythmias in congenital heart disease

2020 ◽  
pp. 259-276
Author(s):  
Alexander Van De Bruaene ◽  
Shouvik Haldar ◽  
Krishnakumar Nair
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Scientific Data ◽  
Right Atrial ◽  
Ebstein Anomaly ◽  
Adequate Knowledge ◽  
Arrhythmogenic Substrate ◽  
End Stage Heart Failure ◽  
End Stage

Patients with congenital heart disease are prone to the entire spectrum of atrial and ventricular arrhythmias. The arrhythmia can be related to the malformation itself (e.g. Wolff–Parkinson–White in Ebstein anomaly), structural remodelling due to ageing/longer life expectancy (e.g. atrial fibrillation), mode of repair (e.g. intra-atrial re-entry tachycardia after right atrial incision or monomorphic ventricular tachycardia after tetralogy of Fallot repair), and severe ventricular dysfunction in those with end-stage heart failure. Therefore, adequate knowledge of the congenital heart defect, its current haemodynamics and arrhythmogenic substrate, precise assessment, and risk stratification will lead to appropriate arrhythmia management. This chapter discusses the diagnosis, assessment, and management of arrhythmia in two adult patients with congenital heart disease. The aim is to offer practical advice for managing these patients, supported by scientific data.

scholarly journals Identification of Low-voltage Areas: A Unipolar, Bipolar and Omnipolar Perspective

2021 ◽  
Author(s):  
Mathijs S. van Schie ◽  
Rohit K. Kharbanda ◽  
Charlotte A. Houck ◽  
Eva A.H. Lanters ◽  
Yannick J.H.J. Taverne ◽  
...  
Keyword(s):  
Low Voltage ◽  
Volume Overload ◽  
Surrogate Markers ◽  
Epicardial Mapping ◽  
Atrial Volume ◽  
Bipolar Voltage ◽  
Voltage Mapping ◽  
Arrhythmogenic Substrate ◽  
Different Types ◽  
Mapping Techniques

Background - Low-voltage areas (LVA) are commonly considered surrogate markers for an arrhythmogenic substrate underlying tachyarrhythmias. It remains challenging to define a proper threshold to classify LVA and it is unknown whether unipolar, bipolar and the recently introduced omnipolar voltage mapping techniques are complementary or contradictory in classifying LVAs. Therefore, this study examined similarities and dissimilarities in unipolar, bipolar and omnipolar voltage mapping and explored the relation between various types of voltages and conduction velocity (CV). Methods - Intra-operative epicardial mapping (interelectrode distance 2mm, ±1900 sites) was performed during sinus rhythm in 21 patients (48±13 years, 9 male) with atrial volume overload. Cliques of 4 electrodes (2x2 mm) were used to calculate the maximal unipolar (V uni,max ), bipolar (V bi,max ) and omnipolar (V omni,max ) voltages and mean CV. Areas with V bi,max or V omni,max ≤0.5 mV were defined as LVA. Results - V uni,max was not only larger than V bi,max but also larger than V omni,max (7.08 [4.22-10.59] mV vs. 5.27 [2.39-9.56] mV and 5.77 [2.58-10.52] mV respectively, P<0.001). In addition, the largest bipolar clique voltage was on average 1.66 (range: 1.0 - 59.0) times larger to the corresponding perpendicular bipolar voltage pair. LVAs identified by a bipolar or omnipolar threshold corresponded to a broad spectrum of unipolar voltages and, even though CV was generally decreased, still high CVs and large unipolar voltages were found in these LVAs. Conclusions - In patients with atrial volume overload, there were considerable discrepancies in the different types of LVAs. Additionally, identification of LVAs was hampered by considerable directional differences in bipolar voltages. Even using directional independent omnipolar voltage to identify LVAs, high CVs and large unipolar voltages are present within these areas. Therefore, a combination of low unipolar and low omnipolar voltage may be more indicative of 'true' LVAs.

scholarly journals First-in-children epicardial mapping of the heart: unravelling arrhythmogenesis in congenital heart disease

2020 ◽  
Vol 32 (1) ◽  
pp. 137-140
Author(s):  
Rohit K Kharbanda ◽  
Mathijs S van Schie ◽  
Wouter J van Leeuwen ◽  
Yannick J.H.J Taverne ◽  
Charlotte A Houck ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Pressure Overload ◽  
Scar Tissue ◽  
Epicardial Mapping ◽  
Conduction Disorders ◽  
Paediatric Patients

Abstract Patients with congenital heart disease (CHD) are prone to develop atrial and ventricular arrhythmias. Multiple factors throughout life contribute to arrhythmogenicity substrate such as (i) (longstanding) volume and/or pressure overload, (ii) scar tissue, (iii) ageing-related structural remodelling, (iv) cardiovascular risk factors and (v) tachycardia-induced remodelling. At present, it is unknown whether, and to what extent, paediatric patients with CHD have atrial or ventricular conduction disorders early in life and whether there is a correlation between duration of volume/pressure overload and extensiveness of conduction disorders. To investigate this, we initiated high-resolution intraoperative epicardial mapping in paediatric patients with CHD undergoing primary open-heart surgery.

scholarly journals Simultaneous endo-epicardial mapping of the human sinus node in patients undergoing cardiac surgery

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Kharbanda ◽  
F.J Wesselius ◽  
Y.J.H.J Taverne ◽  
C Kik ◽  
F.R.N Van Schaagen ◽  
...  
Keyword(s):  
Conduction Velocity ◽  
Sinus Node ◽  
Conduction Block ◽  
Electrode Spacing ◽  
Conduction Time ◽  
Epicardial Mapping ◽  
Atrial Wall ◽  
Activation Patterns ◽  
Conduction Disorders ◽  
The Right

Abstract Introduction Conduction disorders in the right atrium (RA) are predominantly observed in the superior part. Presence of the sinoatrial node (SAN) in this region could be contributing to increased heterogeneity in activation patterns. However, mapping studies focusing on SAN activation are scarce. Purpose The aim of the present study was to analyze activation patterns of the human SAN during sinus rhythm. Methods A dataset containing simultaneous endo-epicardial mapping data (256 electrodes, inter-electrode spacing: 2mm) of RA was screened for focal activation patterns (FAPs) potentially arising from SAN activation (SN-FAP). Conduction time, endo-epicardial delay and electrogram morphology (R/S-ratio) were described in the surrounding 1cm of SN-FAPs. Areas of conduction block (CB) were defined as conduction delays of ≥12ms and endo-epicardial asynchrony (EEA) as activation time differences of exact opposite electrodes of ≥15ms. Results In 20 patients (75% male, 66±7 years) a total of 28 SN-FAPs with unique activation patterns were observed only in superior RA (n=22) and mid RA (n=6). Conduction velocity of SN-FAPs was 1.3m/s [0.8–2.5] and percentage of EEA was 5% [2–18]. Conduction velocity was lower when lines of CB were present within 6mm of the SN-FAPs (p=0.040). Significantly larger R-peaks were observed in mid RA compared to superior RA. (mid R/S-ratio:0.15 [0.067–0.34] vs. superior R/S-ratio:0.045 [0.026–0.062], p=0.004). Conclusions Conduction velocities around the SAN area are comparable to the remainder of the atria. SN-FAPs occurred in both superior and mid RA, suggesting presence of multiple exit sites of the SAN. Furthermore, inter-individual differences in rS-morphology indicate that SAN activation may originate from multiple layers within the atrial wall. Funding Acknowledgement Type of funding source: None

scholarly journals Atrial dilation as a substrate for atrial fibrillation in the canine complete chronic atrioventricular block model

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Smoczynska ◽  
H.D.M Beekman ◽  
R.W Chui ◽  
S Rajamani ◽  
M.A Vos
Keyword(s):  
Atrial Fibrillation ◽  
Atrioventricular Block ◽  
Volume Overload ◽  
Right Atrial ◽  
Funding Source ◽  
Private Company ◽  
Structural Remodeling ◽  
2D Echocardiography ◽  
Atrial Enlargement ◽  
The Right

Abstract Background Atrial fibrillation (AF) is the most common cardiac arrhythmia treated in clinical practice. Structural remodeling is characterized by atrial enlargement and contributes to the therapeutic resistance in patients with long-standing AF. Purpose To study the atrial arrhythmogenic and echocardiographic consequences induced by volume overload in the complete chronic atrioventricular block (CAVB) dog. Methods Echocardiographic and electrophysiological data was obtained in 14 anaesthetized Mongrel dogs, in acute AV-block (AAVB), after 6 weeks of CAVB (CAVB6) and CAVB10. Left atrial (LA) volume was determined with 2D echocardiography by using the biplane method. An electrocardiogram and monophasic action potentials (MAP) at the right atrial (RA) free wall were recorded. Atrial effective refractory period (AERP) was determined by continuous programmed electrical stimulation (PES) of 20 beats with a cycle length of 400 ms and an extrastimulus with decremental design until refractoriness was reached. A continuous PES protocol of 20 beats with an extrastimulus 5 ms longer than the AERP was applied for 150 seconds to trigger AF. After 5 min without arrhythmias, autonomic neuromodulation was performed by intravenous infusion (IV) of acetylcholine (1,5μg/kg/min to 6,0μg/kg/min) for 20 min followed by prompt IV infusion of isoprenaline (3μg/min) until the atrial heart rate increased by 20 bpm. PES with an extrastimulus was repeated for 150 seconds to induce AF. Results LA volume increased from 13.7±3.2 ml at AAVB to 20.5±5.9 ml* at CAVB6, and 22.7±6.0 ml* at CAVB10 (Fig. 1A). AERP was similar at AAVB, CAVB6, and CAVB10 (115.8±11.9, 117.3±11.7, and 106.8±12.1 ms respectively). Repetitive AF paroxysms of &gt;10 seconds were induced in 1/14 (7%) dogs at AAVB, 1/11 (9%) at CAVB6, and 5/10 (50%)* at CAVB10 (*p&lt;0.05) upon PES (Fig. 1B). Combined neuromodulation and PES did not increase the AF inducibility rate, but prolonged the longest episode of AF in the inducible dogs from 55±49 seconds to 236±202 seconds* at CAVB10 (Fig. 1C). LA volume was higher in inducible dogs 25.0±4.9 ml compared to 18.4±4.2 ml in non-inducible dogs at CAVB10. Conclusion Sustained atrial dilation forms a substrate for repetitive paroxysms of AF. Neuro-modulation prolongs AF episode duration in susceptible dogs. This animal model can be used to study structural remodeling of the atria and possible therapeutic advances in the management of AF. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Amgen Research

Cardiorenal effects of lidocaine and procaine amide in the conscious dog

1975 ◽  
Vol 228 (5) ◽  
pp. 1440-1445 ◽  
Author(s):  
WJ Mandel ◽  
MM Laks ◽  
AI Arieff ◽  
K Obayashi ◽  
H Hayakawa ◽  
...  
Keyword(s):  
Renal Function ◽  
Cardiac Conduction ◽  
Right Atrial ◽  
Acute Administration ◽  
Conduction Time ◽  
Conscious Dog ◽  
Av Conduction ◽  
Renal Flow ◽  
The Right ◽  
Procaine Amide

Simultaneous measurements of hemodynamics, arterioventricular (AV) conduction, and renal functioner were obtained in conscious dogs. Catheters were implanted for the long-term measurement of central aortic, right ventricular, and pulmonary artery pressure. AV conduction was assessed following surgical implantation of multipolar electrode plaques in the area of the bundle of His, as well as on the epicardium of the right and left atria and ventricles. Renal function was assessed utilizing standard techniques. Following control measurements, lidocaine, 1 mg/kg, or procaine amide, 10 mg/kg, was administered intravenously. Subsequently, serial measurements were obtained for a 90-min period. No significant changes in hemodynamics were observed following either drug. Procaine amide produced a significant increase in heart rate and a minimal increase in QRS duration associated with a decrease in low right atrial to His bundle conduction time. However, no significant changes in cardiac conduction were observed after lidocaine administration. Renal function was unaffected by lidocaine but significantly depressed by procaine amide, as demonstrated by a decrease in GFR and effective renal flow. In summary, acute administration of procaine amide significantly alters renal function in the conscious dog with minimal effects on AV conduction and hemodynamics.

Long-Term Outcome After Ablation of Right Atrial Tachyarrhythmias After the Surgical Repair of Congenital and Acquired Heart Disease

2015 ◽  
Vol 115 (12) ◽  
pp. 1705-1713 ◽  
Author(s):  
Ignasi Anguera ◽  
Paolo Dallaglio ◽  
Rosa Macías ◽  
Javier Jiménez-Candil ◽  
Rafael Peinado ◽  
...  
Keyword(s):  
Heart Disease ◽  
Surgical Repair ◽  
Right Atrial ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Atrial Tachyarrhythmias ◽  
Acquired Heart Disease

scholarly journals Choroidal Thickness in Children with Congenital Heart Disease Measured by Spectral Domain Optical Coherence Tomography

2021 ◽  
Author(s):  
Fatoş Alkan ◽  
Semra Şen ◽  
Ercüment Cavdar ◽  
Senol Senolsun
Keyword(s):  
Optical Coherence Tomography ◽  
Oxygen Saturation ◽  
Choroidal Thickness ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Volume Overload ◽  
Spectral Domain ◽  
Control Group ◽  
Optical Coherence ◽  
Ct Measurements

Objective: The main reason for complications in congenital heart diseases (CHD) is decreased blood oxygen saturation and polycythemia which are typical for cyanosis. These parameters may promote the damage of the retina because haemodynamic regulation is essential for the structural and functional integrity of the macular subfields. The aim of this study was to evaluate choroidal thickness (CT) measurements in children with CHD using spectral domain optical coherence tomography (OCT). Methods: This prospective study compared 30 CHD and 30 healthy control children. CT was examined with spectralis spectral-domain OCT (Retinascan RS-3000; Nidek). CT was obtained at the subfovea, 500 μm and 1000 μm nasal to the fovea (N500, N1000) and 500 μm and 1000 μm temporal to the fovea (T500, T1000). Only the right eye values were used for statistical comparisons between the groups. The domain cardiac lesions were divided physiologically into two categories: volume overload and cyanotic. Results: Mean age was 11.0±3.5 years in CHD childrens and 10.9±3.6 years in the control group (p=0.971). Children with CHD had no statistically significant CT measurements compared with healthy controls (p>0.05). Conclusion: Although in high haematocrit, low oxygen saturation or the presence of the volume overload in the history of CHD patients, our data suggests that patients with CHD show normal CT. The reason may be medical and surgical treatment of hypoxia, erythrocytosis and volume overload in CHD patients.

Adult congenital heart disease

2020 ◽  
pp. 225-254
Author(s):  
Andrew Hilton
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Anatomical Variation ◽  
Critically Ill Patient ◽  
Crista Terminalis ◽  
Echocardiographic Examination ◽  
Adult Congenital ◽  
The Right

The prevalence of congenital heart disease (CHD) in adults is increasing and many of these are likely to be admitted to the intensive care unit (ICU). Some of these patients may have undiagnosed CHD, usually relatively simple lesions such as atrial and ventricular septal defects. Occasionally, these may be more complex lesions (e.g. Ebstein’s anomaly) that even if unrecognized earlier in life can still allow survival into adulthood. Whether simple or complex, CHD can complicate the management of the critically ill patient, particularly if shunting or heart failure is present. The critical care echocardiographer is required to both recognize both normal anatomical variation and definite abnormal structural abnormalities in the adult patient. The aim of this chapter is to familiarize the echocardiographer with common anatomical variants, such as remnants of the right valve of the sinus venosus and crista terminalis, and present a careful and systematic approach to echocardiographic examination that may reliably identify relatively simple undiagnosed CHD in the adult.

Sign in / Sign up

Export Citation Format

Share Document