scholarly journals Conduction left-to-right and right-to-left across the crista terminalis

2001 ◽  
Vol 280 (4) ◽  
pp. H1683-H1691 ◽  
Author(s):  
Kunihiro Matsuo ◽  
Kikuya Uno ◽  
Celeen M. Khrestian ◽  
Albert L. Waldo
Keyword(s):  
Atrial Fibrillation ◽  
Inferior Vena ◽  
Conduction Block ◽  
Vena Cava ◽  
Atrial Pacing ◽  
Crista Terminalis ◽  
Cycle Lengths ◽  
Bachmann’S Bundle ◽  
Atrial Activation ◽  
The Right

A line of block between the vena cava and the crista terminalis (CT) region is important for atrial flutter (AFL), but whether it is fixed or functional is controversial. To test the hypothesis that conduction across the CT normally occurs, but when block occurs in this region it is functional, we analyzed atrial activation during right and left atrial pacing (cycle lengths of 500–130 ms), AFL, and atrial fibrillation in 15 dogs with sterile pericarditis and 7 normal dogs. Electrograms from 396 right, left, and septal atrial sites were simultaneously recorded. Activation across the CT occurred during atrial pacing, AFL, and atrial fibrillation. Activation wave fronts from the right to the left atrium and vice versa traveled over several routes, including Bachmann's bundle and inferior to the inferior vena cava, as well as across the CT. In these models, there is no fixed conduction block across the CT, and when block in the CT region occurs, as during AFL, it is functional.

Thoracic vein ablation terminates chronic atrial fibrillation in dogs

2004 ◽  
Vol 286 (6) ◽  
pp. H2072-H2077 ◽  
Author(s):  
Angela M. Park ◽  
Chung-Chuan Chou ◽  
Paul C. Drury ◽  
Yuji Okuyama ◽  
Anish Peter ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Chronic Atrial Fibrillation ◽  
Atrial Pacing ◽  
Bipolar Electrodes ◽  
Cycle Lengths ◽  
Activation Cycle

The thoracic vein hypothesis of chronic atrial fibrillation (AF) posits that rapid, repetitive activations from muscle sleeves within thoracic veins underlie the mechanism of sustained AF. If this is so, thoracic vein ablation should terminate sustained AF and prevent its reinduction. Six female mongrel dogs underwent chronic pulmonary vein (PV) pacing at 20 Hz to induce sustained (>48 h) AF. Bipolar electrodes were used to record from the atria and thoracic veins, including the vein of Marshall, four PVs, and the superior vena cava. Radio frequency (RF) application was applied around the PVs and superior vena cava and along the vein of Marshall until electrical activity was eliminated. Computerized mapping (1,792 electrodes, 1 mm resolution) was also performed. Sustained AF was induced in 30.6 ± 6.5 days, and ablation was done 17.3 ± 8.5 days afterward. Before ablation, the PVs had shorter activation cycle lengths than the atria, and rapid, repetitive activations were observed in the PVs. All dogs converted to sinus rhythm during ( n = 4 dogs) or within 90 min of completion of RF ablation. Rapid atrial pacing afterward induced only nonsustained (<60 s) AF in all dogs. Average AF cycle lengths after reinduction were significantly ( P = 0.01) longer (183 ± 31.5 ms) than baseline (106 ± 16.2 ms). There were no activation cycle length gradients after RF application. We conclude that thoracic vein ablation converts canine sustained AF into sinus rhythm and prevents the reinduction of sustained AF. These findings suggest that thoracic veins are important in the maintenance of AF in dogs.

Selective vagal innervation of sinoatrial and atrioventricular nodes in canine heart

1986 ◽  
Vol 251 (4) ◽  
pp. H764-H773 ◽  
Author(s):  
J. L. Ardell ◽  
W. C. Randall
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Vein ◽  
Inferior Vena ◽  
Vena Cava ◽  
Atrial Pacing ◽  
Canine Heart ◽  
Right Pulmonary Artery ◽  
Vagal Innervation ◽  
The Right ◽  
Adjacent Segments

Parasympathetic pathways mediating chronotropic and dromotropic responses to cervical vagal stimulation were determined from sequential, restricted, intrapericardial dissection around major cardiac vessels. Although right cervical vagal input evoked significantly greater bradycardia, supramaximal electrical stimulation of either vagus produced similar ventricular rates, both with and without simultaneous atrial pacing. Dissection of the triangular fat pad at the junction of the inferior vena cava-inferior left atrium (IVC-ILA) invariably eliminated all vagal input to the atrioventricular (AV) nodal region. Yet IVC-ILA dissection had minimal influence on evoked-chronotropic responses to either cervical vagal or stellate ganglia stimulation. Respective intrapericardial projection pathways, from either right or left vagi, are sufficiently distinct to allow unilateral parasympathetic denervation of the sinoatrial (SA) and atrioventricular (AV) nodal regions. Left vagal projections to the SA and AV nodal regions course primarily along and between the right pulmonary artery and left superior pulmonary vein. Right vagal projections to the SA and AV nodal regions are somewhat more diffuse but concentrate around the right pulmonary vein complex and adjacent segments of the right pulmonary artery. We conclude there are parallel, yet functionally distinct, inputs from right and left vagi to the SA and AV nodal regions.

scholarly journals P1246 The Eustachian valve: a structure not so innocent

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T E Graca Rodrigues ◽  
R Placido ◽  
C David ◽  
S Goncalves ◽  
F J Pinto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Inferior Vena Cava ◽  
Atrial Septal Defect ◽  
Right Atrium ◽  
Septal Defect ◽  
Inferior Vena ◽  
Vena Cava ◽  
Eustachian Valve ◽  
The Right

Abstract Background The eustachian valve is an embryological remnant of the inferior vena cava (IVC) valve. It is usually absent or inconspicuous and has no known function in the normal adult. However, there are reports suggesting that the EV is not as innocent as we thought. The EV can be a site of infective vegetations or be mistaken for a thrombus or tumor. The EV can also make interventional procedures (closure of ASD (atrial septal defect) or ablation for atrial flutter) more laborious. Clinical Case A 80 year-old female patient was referred to the emergency department after an episode of acute palpitations, right chest pain, followed by syncope. She had a previous medical history of type 2 diabetes and epilepsy. On admission she was normotensive (104/67mmHg). The ECG showed atrial fibrillation with heart rate of 180 beats per minute. The echocardiogram show slight dilation of the right ventricle and bilateral atrial dilatation. The blood tests documented an elevated D-dimers 2,73 μg/mL, troponin (hs-TNT 27ng/L) and NT-proBNP 4339pg/ml, with a normal renal function. Computed tomographic (CT) pulmonary angiography revealed filling defects on the segmentar and subsegmentar inferior lobes, compatible with the diagnosis of pulmonary embolism and also revealed a dilatation of the main pulmonary trunk (35mm). Based on this result the patient start anticoagulation with low molecular weight heparin and heart rate control with bisoprolol. However besides of this strategy the patient remain in atrial fibrillation without a controlled hear rate and an transesophageal echocardiography (TOE) was performed. The TOE shown a small freely mobile mass – thombi - at the inferior vena cava-right atrium (IVC-RA) junction tethered at the eustachian valve; a small atrial septal defect (4mm) – ostium secundum type – with a left to right shunt; and a preserved biventricular function (figure 1). Based on this exams we optimize the therapy with digoxin and amiodarone with a good control of the heart rate and patient was discharge on warfarine, bisoprolol and digoxin asymptomatic and to be reevaluated on cardiology clinic. Discussion/Conclusion: The eustachian valve in adult is an embryological remainder of the fetal venous sinus valve. This structure is located in the right atrium and is a common, not pathological, echocardiographic finding. It is known that a small percentage of the pulmonary embolisms, thrombi are discovered in the right side of the heart; however, their presence on the Eustachian valve is very unusual. Besides this in our particular case in the present we will have also to ensure that the anticoagulation is effective to avoid that the trombi migrates into the systemic circulation by the atrial septal defect. Abstract P1246 Figure.

scholarly journals An uncommon case of inferior vena cava injury during atrial fibrillation ablation

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Manuela Pastoricchio ◽  
Andrea Dell’Antonio ◽  
Massimo Zecchin ◽  
Elisabetta Bianco ◽  
Annalisa Zucca ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Abdominal Pain ◽  
Catheter Ablation ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Open Repair ◽  
Vena Cava ◽  
Intracardiac Echocardiography ◽  
Uncommon Case ◽  
The Right

Abstract A 64-year-old man underwent catheter ablation (CA) of atrial fibrillation with intracardiac echocardiography (ICE) assistance. As the probe was advanced toward the right atrium, sudden abdominal pain was felt by the patient with hypotension and tachycardia requiring fluids and vasopressors for hemodynamic stabilization. The inferior vena cava (IVC) was injured by the passing probe and open repair was then performed. To our knowledge, this is the first reported case of symptomatic IVC laceration by the probe used for ICE during CA.

scholarly journals Ultrasound Diagnosis of Congestion in the Pulmonary and Systemic Circulations in Patients with Atrial Fibrillation and Chronic Heart Failure

2021 ◽  
Author(s):  
Venera Kirillova ◽  
Andrey Smorgon ◽  
Alla Garganeeva ◽  
Roman Batalov ◽  
Viktor Meshchaninov ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Heart Failure ◽  
Inferior Vena Cava ◽  
Pulmonary Vein ◽  
Inferior Vena ◽  
Vena Cava ◽  
Average Pressure ◽  
Superior Pulmonary Vein ◽  
The Right

Abstract BackgroundFluid retention is one of the most common reasons for the heart failure decompensation. The purpose of the study is to estimate the sensitivity, specificity of the ultrasound method for evaluating congestive phenomena in the systemic and pulmonary circulations in patients with the atrial fibrillation (AF) and chronic heart failure (CHF).MethodsThe study includes 28 patients with the paroxysmal AF with and without CHF, who were planned for the radiofrequency pulmonary veins isolation. The maximum and minimum diameters of the right superior pulmonary vein and inferior vena cava on exhalation were measured echocardiographically. An average pressure in the right and left atria was measured intraoperatively. Сorrelation between the maximum and minimum diameters of the right superior pulmonary vein and an average pressure in the left atria and between inferior vena cava on exhalation and an average pressure in the right atria was calculated. The sensitivity, specificity of ultrasound methods for evaluating congestive phenomena in the systemic and pulmonary circulations was evaluated.ResultsThere was positive correlation between the minimum diameter of right superior pulmonary vein and invasive mean pressure in the left atrium (R=0.65, P<0.05), between invasive measured mean pressure in the right atrium and the diameter of the inferior vena cava on exhalation (R=0.49, P<0.05). Sensitivity of the method – maximum diameters of the right superior pulmonary vein greater than 21.7 mm are ultrasound criteria for venous pulmonary hypertension is 75%, specificity – 86%. Sensitivity of the method minimum diameters of the right superior pulmonary vein greater than 10.5 mm are ultrasound criteria for venous pulmonary hypertension is 85%, specificity – 86%. The sensitivity of the inferior vena cava diameter exceeding 18,5 mm on exhalation is 100%, the specificity is 92%.ConclusionsThe new ultrasound method of congestion diagnostics in the pulmonary circulation by the maximum and/or minimum diameter of the right superior pulmonary vein can be effectively applied in clinical practice in the same way as the well-known technique of congestion diagnostics in the systemic circulation by the diameter of the inferior vena cava in patients with the atrial fibrillation and chronic heart failure.

scholarly journals The effect of hemodialysis on echocardiographic parameters and on supraventricular cardiac arrhythmias

2020 ◽  
Vol 11 (3) ◽  
pp. 29-34
Author(s):  
Oleg V. Likhachev-Mishchenko ◽  
Alexey A. Kornienko ◽  
Larisa A. Khaisheva ◽  
Anastasia V. Duzhikova ◽  
Natalia A. Kornienko ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Dialysis Session ◽  
Supraventricular Arrhythmias ◽  
Before And After ◽  
Echocardiographic Parameters ◽  
The Right

Relevance. Supraventricular arrhythmias are frequent comorbid conditions in patients with end-stage renal failure undergoing dialysis. The prevalence of atrial fibrillation (AF) in this group of patients is higher than in the general population and is associated with increased mortality. Aim. To analyze the effect of a dialysis session on echocardiographic parameters and to assess their relationship with the occurrence of supraventricular arrhythmias and AF during hemodialysis. Material and methods. The study included 78 patients on hemodialysis. All patients underwent Holter electrocardiography monitoring, taking into account the heart rate before and after dialysis, the number and duration of AF episodes associated with the dialysis session. Using echocardiography, which was performed before and after the dialysis procedure, all patients were also evaluated for the presence of left ventricular (LV) hypertrophy, impaired systolic and diastolic function, as well as LV myocardial mass, sizes of the left atrium, its volume, volume of the right atrium and LV ejection fraction. Results. An analysis of the differences in echocardiographic parameters before and after dialysis showed a significantly larger volume of the left atrium, the volume of the right atrium, the width of the inferior vena cava, and the parameter P(early transmitral velocity) before dialysis compared with the state after dialysis. Also, AF paroxysms were recorded much more frequently after dialysis. The volume of the left atrium 32 mm and the right atrium 30 mm (limit values) were observed much more often in patients before dialysis. A relationship was found between an increased number of paroxysms of atrial fibrillation and a decrease in the volume of the right atrium 5 mm and the left atrium 7 mm after dialysis. No correlation was found between the mass of the LV and the volume of the left atrium. Conclusions. 1. The age and duration of dialysis therapy in hemodialysis patients are associated with an increased risk of atrial fibrillation. 2. A decrease in the volumes of the right and left atriums after the hemodialysis procedure has a positive correlation with paroxysmal AF. 3. The hemodialysis procedure leads to a decrease in the volumes of the right and left atriums, as well as the width of the inferior vena cava and a decrease in the speed of movement of the mitral valve in early diastole. 4. No relationship was found between the volume of the left atrium and the mass of the LV myocardium in patients on hemodialysis.

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