scholarly journals New Discovery of Left Atrial Macroreentry Tachycardia: Originating from the Spontaneous Scarring of Left Atrial Anterior Wall

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Xuefeng Zhu ◽  
Hongxia Chu ◽  
Jianping Li ◽  
Chunxiao Wang ◽  
Wenjing Li ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Left Atrial ◽  
Atrial Tachycardia ◽  
Low Voltage ◽  
Area Under The Curve ◽  
Anterior Wall ◽  
Female Age ◽  
Gender And Age ◽  
History Of ◽  
And Gender

Aims. This study sought to describe left atrial macroreentry tachycardia (LAMRT) originating from the spontaneous scarring of left atrial anterior wall (LAAW) and its clinical and electrophysiological characteristics, mechanisms, and the formation of substrates. Methods and Results. 9 of 123 patients (89% female, age 79.78 ± 5.59 years) had LAMRT originating from the LAAW with no cardiac surgery or prior left atrial (LA) ablation. The mean tachycardia cycle length (TCL) was 241.67 ± 38.00 milliseconds. Spontaneous scars areas and low voltage areas (LVAs) in the LAAW were found in all patients. Successful ablation of the critical isthmus caused termination of the LAMRT and was not inducible in all patients. Arrhythmogenic substrates of LAMRT were the spontaneous scars of LAAW, which matched with the aorta or/and pulmonary artery contact area. The area under the curve (AUC) of age and combination of gender and age for predicting the LAMRT originating from the LAAW were 0.918 and 0.951, respectively, with a cutoff value of ≥73.5 years of age and gender (female) predicting LAMRT with 88.9% sensitivity and 89% specificity. Conclusion. Combination of gender and age provides a simple and useful criterion to distinguish LAMRT from cavotricuspid isthmus- (CTI-) dependent atrial tachycardia in macroreentry atrial tachycardia (MRAT) in patients without a history of surgery or ablation. Aorta or/and pulmonary artery contacting LA may be related to spontaneous scars. Ablation the isthmus eliminated LAMRT in all patients.

scholarly journals New Discovery of Left Atrial Macroreentry Tachycardia: Originating from the Spontaneous Scarring of Left Atrial Anterior Wall

2021 ◽  
Author(s):  
Xuefeng Zhu ◽  
Hongxia Chu ◽  
Jianping Li ◽  
Chunxiao Wang ◽  
Wenjing Li ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Left Atrial ◽  
Atrial Tachycardia ◽  
Low Voltage ◽  
Area Under The Curve ◽  
Anterior Wall ◽  
Female Age ◽  
Gender And Age ◽  
History Of ◽  
And Gender

Abstract Aims: This study sought to describe originating from the spontaneous scarring of left atrial anterior wall (LAAW) left atrial macroreentry tachycardia (LAMRT) clinical and electrophysiological characteristics, mechanisms, the formation of substrates.Methods and Results: 9 of 123 patients (89% female, age 79.78±5.59 years) had LAMRT originating from the LAAW and no cardiac surgery or prior left atrial (LA) ablation. The mean tachycardia cycle length (TCL) was 241.67±38.00 milliseconds. Spontaneous scars areas and low voltage areas (LVAs) in the LAAW were found in all patients. Successful ablation of the critical isthmus caused terminated of the LAMRT and was not inducible in all patients. Arrhythmogenic substrates of LAMRT were the spontaneous scars of LAAW, which matched with the aorta or/and pulmonary artery contact area. The area under the curve (AUC) of age and combination of gender and age for predicting the LAMRT originating from the LAAW were 0.918 and 0.951, respectively, with a cutoff value of ≥73.5 years of age and gender (female) predicting LAMRT with 88.9% sensitivity and 89% specificity.Conclusion: Combination of gender and age provides a simple and useful criterion to distinguish LAMRT from cavo-tricuspid isthmus (CTI) -dependent atrial tachycardia in macroreentry atrial tachycardia (MRAT) in patients without a history of surgery or ablation. Aorta or/and pulmonary artery contacting LA may be related to spontaneous scars. Ablation the isthmus eliminated LAMRT in all patients.

scholarly journals New discovery of left atrial macroreentry tachycardia: originating from the spontaneous scarring of left atrial anterior wall

2021 ◽  
Author(s):  
zhu xuefeng ◽  
hongxia chu ◽  
jianping li ◽  
chunxiao wang ◽  
wenjing li ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Left Atrial ◽  
Atrial Tachycardia ◽  
Low Voltage ◽  
Area Under The Curve ◽  
Anterior Wall ◽  
Female Age ◽  
Gender And Age ◽  
History Of ◽  
And Gender

Aims: This study sought to describe originating from the spontaneous scarring of left atrial anterior wall (LAAW) left atrial macroreentry tachycardia (LAMRT) clinical and electrophysiological characteristics, mechanisms, the formation of substrates. Methods and Results: 9 of 123 patients (89% female, age 79.78±5.59 years) had LAMRT originating from the LAAW and no cardiac surgery or prior left atrial (LA) ablation. The mean tachycardia cycle length (TCL) was 241.67±38.00 milliseconds. Spontaneous scars areas and low voltage areas (LVAs) in the LAAW were found in all patients. Successful ablation of the critical isthmus caused terminated of the LAMRT and was not inducible in all patients. Arrhythmogenic substrates of LAMRT were the spontaneous scars of LAAW, which matched with the aorta or/and pulmonary artery contact area. The area under the curve (AUC) of age and combination of gender and age for predicting the LAMRT originating from the LAAW were 0.918 and 0.951, respectively, with a cutoff value of ≥73.5 years of age and gender (female) predicting LAMRT with 88.9% sensitivity and 89% specificity. Conclusion: Combination of gender and age provides a simple and useful criterion to distinguish LAMRT from cavo-tricuspid isthmus (CTI) -dependent atrial tachycardia in macroreentry atrial tachycardia (MRAT) in patients without a history of surgery or ablation. Aorta or/and pulmonary artery contacting LA may be related to spontaneous scars. Ablation the isthmus eliminated LAMRT in all patients.

scholarly journals Presence of low voltage area predicts atrial tachyarrhythmia inducibility with atrial burst pacing after pulmonary vein isolation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Kawai ◽  
K Nagaoka ◽  
S Takase ◽  
K Sakamoto ◽  
H Ikuta ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Low Voltage ◽  
Past History ◽  
Univariate Analysis ◽  
Atrial Tachyarrhythmia ◽  
Chads2 Score ◽  
Atrial Capture ◽  
History Of

Abstract Background Induction of atrial fibrillation (AF)/atrial tachycardia (AT) by atrial burst pacing following ablation procedure may reflect the presence of residual substrates in the atria that maintain AF. However, the relation between the inducibility and left atrial low voltage area (LVA) has not been established. Methods Fifty-nine patients (65 years old, 43 males) with persistent AF who underwent pulmonary vein isolation (PVI)-based ablation were studied. All patients underwent left atrial voltage mapping during sinus rhythm and atrial burst pacing after PVI. Atrial burst pacing was performed with 30-beat at an amplitude of 10V from the ostium of the coronary sinus; increasing from 240 to 320 ppm in steps of 20 ppm or failure to 1:1 atrial capture. Inducibility was defined as AF/AT lasting more than 5 minutes following burst pacing. Left atrial LVA and other co-variates were analyzed with regard to burst pacing positivity. Results AF/AT was induced by burst pacing in 23 patients (39%). Univariate analysis revealed that past history of stroke, CHADS2 score and presence of left atrial LVA were significantly associated with the inducibility of AF/AT. Multivariate analysis revealed that only the presence of LVA was associated with the inducibility (OR 1.5: per 10% increase; p=0.04). We focused on the relationship between the extent of LVA and burst positivity. AF/AT inducibility increased as low voltage area increased, and it was as high as 72.7% when low voltage area was more than 20% (P<0.05). Interestingly, induced arrhythmia type was AT rather than AF when low voltage area was more than 20%. Conclusions Presence of left atrial LVA is an independent predictor of atrial tachyarrhythmia inducibility after PVI in patients with persistent AF. A large amount of low voltage area is related to AT inducibility rather than AF. Extent of LVA and burst positivity Funding Acknowledgement Type of funding source: None

Independent Older Adult’s IADL and Executive Function According to Cognitive Performance

2020 ◽  
Vol 40 (3) ◽  
pp. 183-189
Author(s):  
Orit Lahav ◽  
Noomi Katz
Keyword(s):  
Executive Function ◽  
Cognitive Assessment ◽  
Daily Living ◽  
Screening Tool ◽  
Cognitive Screening ◽  
Female Age ◽  
Gender And Age ◽  
Cognitive Levels ◽  
And Gender ◽  
Independent Elderly

Participation in Instrumental Activities of Daily Living (IADL) is essential in occupational therapy aiming to improve the life situation of elderly. Effective executive function (EF) is important to successful functioning in IADL. The purpose of this study was to examine EF and IADL performance differences according to cognitive levels as measured by the Montreal Cognitive Assessment (MoCA), age, and gender. In all, 80 elderly (49% female; age M = 73.4) were assessed at home, with Weekly Calendar Planning Activity (WCPA-10), IADL scale, and MoCA as a cognitive screening tool for dividing into normal cognitive (NC) level and mild cognitive impairment (MCI). The comparison between the MoCA groups on the WCPA-10 and IADL shows significant differences between the groups; gender and age differed only in IADL. IADL and WCPA-10 performance among independent elderly relates to their cognitive level. We suggest that intervention that will focus on EF may assist in improving performance and maintaining participation in occupation.

scholarly journals P970 Significant differences in atrial structural and functional parameters leading to differing mechanisms of atrial fibrillation in athletes compared to non-athletes

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Trivedi ◽  
G Claessen ◽  
L Stefani ◽  
D Flannery ◽  
P Brown ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Endurance Athletes ◽  
Healthy Controls ◽  
Age And Gender ◽  
History Of ◽  
And Gender

Abstract Background/Introduction: There is an increased incidence of atrial fibrillation (AF) in endurance athletes. We sought to evaluate the likely mechanistic basis for this phenomenon. Methods 36 endurance athletes in sinus rhythm, with a previous history of AF (ATH-AF) were compared to age and gender matched endurance athletes with no prior history of AF (ATH), non athletes with paroxysmal AF (NONATH-AF) and age and gender matched healthy controls (CONTROL). A detailed transthoracic echocardiogram was performed with all groups in sinus rhythm, with detailed left atrial (LA) and left ventricular (LV) measurements, including strain analysis. Results All athletes had increased LA and LV size when compared with healthy controls (Table 1). Non athletes with paroxysmal AF had increased LA size when compared with controls. However, indexed LA/LV ratio was preserved in athletes and similar to healthy individuals, whilst AF patients had significantly increased LA/LV ratio. Athletes with AF had higher e’ velocity and lower E/e’, whereas e’ was reduced and E/e’ elevated in non-athlete AF patients. Athletes had impaired LA reservoir and contractile strain, and reduced LV global longitudinal strain (GLS) compared with healthy controls. Conclusions Compared to healthy controls, athletes have reduced LA and LV strain, with preserved LV diastolic function and LA/LV ratio. In contrast, altered diastolic function with differential increase in LA volume was observed in AF patients. The increased risk of AF in athletes is likely mediated by different mechanistic processes other than an atrial myopathy consequent to diastolic dysfunction as observed in non-athletes with AF. Table 1. LA and LV parameters Parameter ATH-AF ATH NONATH-AF CONTROL P value LVEDV indexed (ml/m2) 84 ± 12 79 ± 14 57 ± 10 51 ± 13 <0.001 LVESV indexed (ml/m2) 35 ± 6 34 ± 7 25 ± 8 27 ± 33 0.02 LV ejection fraction (%) 58 ± 4 56 ± 4 56 ± 10 58 ± 8 0.586 LV global longitudinal strain (%) 19.2 ± 1.7 18.9 ± 2.1 21 ± 3.1 21.7 ± 2.9 <0.001 e’ vel (cm/s) 10 ± 2 10 ± 3 8 ± 2 9 ± 2 0.007 E/e’ 5.7 ± 1.3 5.9 ± 1.8 9.1 ± 3.3 7.5 ± 1.5 <0.001 LAV max indexed (ml/m2) 45 ± 11 43 ± 12 38 ± 11 27 ± 8 <0.001 Indexed LAV/LVEDV ratio 0.5 ± 0.1 0.6 ± 0.2 0.7 ± 0.2 0.5 ± 0.1 <0.001 LA reservoir strain (%) 27.2 ± 4.8 28.2 ± 3.7 27.9 ± 8.4 33.2 ± 7.0 <0.001 LA conduit strain (%) 14.2 ± 4.5 14.4 ± 4.0 14.9 ± 5.5 16.6 ± 6.3 0.182 LA contractile strain (%) 13.0 ± 3.1 13.8 ± 3.6 13.0 ± 5.1 16.6 ± 3.1 <0.001 LV = left ventricular, LAV = left atrial volume, LA = left atrial

scholarly journals Predictive value of various Doppler-derived parameters of atrial conduction time for successful atrial fibrillation ablation

2015 ◽  
Vol 2 (4) ◽  
pp. 99-107 ◽  
Author(s):  
Miriam Shanks ◽  
Lucas Valtuille ◽  
Jonathan B Choy ◽  
Harald Becher
Keyword(s):  
Predictive Value ◽  
Left Atrial ◽  
Atrial Tachycardia ◽  
Atrial Remodeling ◽  
Conduction Time ◽  
Left Atrial Remodeling ◽  
Af Ablation ◽  
Atrial Conduction Time ◽  
Pulsed Wave Doppler ◽  
History Of

Various Doppler-derived parameters of left atrial electrical remodeling have been demonstrated to predict recurrence of atrial fibrillation (AF) after AF ablation. The aim of this study was to compare three Doppler-derived measures of atrial conduction time in patients undergoing AF ablation, and to investigate their predictive value for successful procedure. In 32 prospectively enrolled patients undergoing the first AF ablation, atrial conduction time was estimated by measuring the time delay between the onset of P-wave on the surface ECG to the peak of the a′-wave on the pulsed-wave Doppler and color-coded tissue Doppler imaging of the left atrial lateral wall, and to the peak of the A-wave on the pulsed-wave Doppler of the mitral inflow. There was a significant difference in the baseline atrial conduction time measured by different echocardiographic techniques. Most (88%) patients had normal or only mildly dilated left atrium. At 6 months, 12 patients (38%) had recurrent AF/atrial tachycardia. The duration of history of AF was the only predictor of AF/atrial tachycardia recurrence following the first AF ablation (P=0.024; OR 1.023, CI 1.003–1.044). A combination of normal left atrial volume and history of paroxysmal AF of ≤48 months was associated with the best outcome. Predictive value of the Doppler derived parameters of atrial conduction time may be reduced in the early stages of left atrial remodeling. Future studies may determine which echocardiographic parameter correlates best with the extent of left atrial remodeling and is most predictive of successful AF ablation.

P1021Low incidence of atrial tachycardia following ablation of low voltage areas in sinus rhythm for persistent atrial fibrillation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Lepillier ◽  
X Copie ◽  
W Escande ◽  
M Niro ◽  
O Paziaud ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Atrial Tachycardia ◽  
Low Voltage ◽  
Pulmonary Veins ◽  
Left Atrial Volume ◽  
Persistent Atrial Fibrillation ◽  
Anterior Wall ◽  
Rf Ablation ◽  
Efficient Strategy

Abstract .  Background: Dedicated ablation strategies for persistent atrial fibrillation (AF) have shown a limited success rate with frequent atrial tachycardia (AT) occurrence. Recent studies suggest that atrial arrhythmogenic sites are related to tissular heterogeneities and increased fibrosis can be identified as reduced bipolar voltage areas. . Purpose: Targeting low voltage areas (LVA) in addition to PVI may represent an efficient strategy for the ablation of persistent AF, and may limit the risk of AT recurrence. . Methods: We prospectively included consecutive patients with symptomatic persistent AF. The ablation strategy consisted of the following steps: circumferential pulmonary vein isolation (CPVI), Sinus rhythm restoration by electrical cardioversion, voltage map performed in sinus rhythm. Complementary RFA was guided by low voltage areas (0.2-0.4 mV). Success was defined as freedom from AF/ atrial flutter or atrial arrhythmia at 12 months or more. . Results:  101 patients (mean age: 62.5 +/- 10.4 years, men 73%) were included with persistent AF or long standing AF (7%). Procedure time was: 154 ± 25 min and fluoroscopy time: 184 ± 90 sec. Time of RFA was 44.7 +/- 12 min. Mean LA volume was 182 +/- 38 mL. LVA were found in 50 patients (49.5%). The distribution of these areas was:  30 anterior wall 29.7%), 21 septum (20.7%), 19 roof (18.8%), 5 inferior (4.9%), 11 left appendage (10.8%), 6 posterior (5.9%), 3 mitral isthmus (3%). RF ablation was realized for all LVA and homogenisation was attempt. After a single procedure at a mean FU of 12 months, 72.3% of patients were free of symptomatic AF. 27 patients had recurrence of atrial AF: 7 permanent, 15 persistent and 5 paroxysmal AF. Predictive factors of recurrence of AF were: long standing persistent AF, large left atrial volume (> 205 mL), shorts AF cycle length (< 168 ms) and reduce LEVF (< 45%). Atrial tachycardia occurred in 5 patients (4,9%). Mechanisms of AT were: typical cavo-tricuspid flutter in one patient, peri-mitral flutter in 2 patients, and atrial focal tachycardia (close to pulmonary veins) in 2 patients. . Conclusion: These results suggest that PVI with complementary RF ablation guided on low voltage areas is an efficient strategy for symptomatic persistent AF, and reduce the recurrence of AT following this ablation strategy.

scholarly journals P917 Additional value of atrial parameters evaluated by echocardiography on the scales of cardioembolic risk in atrial fibrillation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Moral ◽  
A Panaro ◽  
E Ballesteros ◽  
M Morales ◽  
J M Frigola ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Risk Estimation ◽  
Area Under The Curve ◽  
Heart Rhythm ◽  
Morphological Parameters ◽  
Anticoagulant Treatment ◽  
Atrial Thrombus ◽  
History Of ◽  
Atrial Area

Abstract Background Atrial morphological parameters may influence the presence of atrial thrombus, a factor strongly associated with cardiac thromboembolism, independently of those included in the CHA2DS2-VASc risk estimation scale in patients with a history of atrial fibrillation (AF). The aim of our study was to evaluate this possible association by transthoracic echocardiography (TTE). Methods Prospective multicenter study including 401 patients with a history of AF, in which a TTE and a transesophageal echocardiogram (TEE) were performed for evaluation of atrial thrombus between 2016-2019. The parameters included in the CHA2DS2-VASc scale, the heart rhythm at the time of the study and the anticoagulant treatment performed, as well as the atrial morphological parameters were collected. Results Twenty-three patients (6%) presented with atrial thrombus in TEE. The left atrial area (28 ± 6cm2 vs 33 ± 6cm2; p < 0.001), the presence of AF during the study (83% vs 17%; p = 0.002) and CHA2DS2-VASc (1.7 ± 1.5cm2 vs 3.0 ± 1.3cm2; p < 0.001) were associated with the presence of atrial thrombus. The left atrial area was a diagnostic predictor of atrial thrombus (area under the curve = 73%; p = 0.001): a value >30cm2 presented a sensitivity of 79% and a specificity of 70% to detect its presence. Logistic regression analysis, including heart rhythm during the study and anticoagulant treatment, showed that CHA2DS2-VASc (OR = 1.5; CI95%=1.1-1.9; p = 0.003) and left atrial area >30cm2 (OR = 5.2;CI 95% =1.7-16.0; p = 0.004) were independent predictors of atrial thrombus presence. Conclusions The left atrial area is associated with the presence of atrial thrombus in patients with a history of AF independently of the CHA2DS2-VASc scale, heart rhythm during the study, and anticoagulant treatment. This parameter should be evaluated to be included in the cardioembolic risk scales.

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