Abstract 18427: Rotors and Focal Sources for Human Atrial Fibrillation Are Spatially and Temporally Stable

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Vijay Swarup ◽  
Tina Baykaner ◽  
Junaid Zaman ◽  
James Daubert ◽  
John Hummel ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Science Studies ◽  
Right Atrial ◽  
Spiral Arms ◽  
Physiological Analysis ◽  
Rotor Core ◽  
The Stability ◽  
Contact Electrodes ◽  
Human Atrial Fibrillation

Introduction: Several groups now report electrical rotors or focal sources sustaining human atrial fibrillation (AF) after it has been triggered. However, some groups report stable sources while others report transient rotational activity. Hypothesis: We hypothesized that AF rotors would be spatially stable in a large multi center experience, using phase mapping. Methods: We prospectively mapped AF in 277 patients (181 persistent, 61±12 years) at 6 centers in the FIRM-registry, using basket catheters with 64 contact electrodes per atrium. AF was mapped by RhythmView (Topera Inc) before ablation. FIRM uses phase analysis and dynamic physiological analysis of repolarization and conduction. AF propagation movies were interpreted by each operator to assess the stability and dynamics of AF sources in multiple maps over tens of minutes prior to ablation. Results: Sources were identified in 258 of 260 of patients in whom AF was mapped (99%), for 2.8±1.4 sources/patient. Patients showed 1.8±1.1 left atrial and 1.1±0.8 right atrial sources. On FIRM mapping, each source was stable for 4196±6360 cycles, with no difference between patients with paroxysmal vs persistent AF (4290±5847 vs 4150±6604, p=0.78), or right vs left atrial sources (p=0.26) (Figure). Rotors showed precession ('wobble') in ~2 cm2 areas, and spiral arms disorganized (‘fibrillatory conduction)’ beyond a spatial domain that varied around each rotor core for each patient, and between patients. Conclusions: Rotors and focal sources for human AF are stable for thousands of cycles during mapping using FIRM. These data show that AF rotors are distinct from macro-reentry. Notably, rotors precess within small atrial regions, and emanating spiral arms disorganize variably into the fibrillatory milieu in agreement with basic science studies. These results provide a rationale for FIRM-guided ablation at AF sources, and explain why rotors have been difficult to detect using traditional mapping approaches.

Influence of atrial fibrillation on microRNA expression profiles in left and right atria from patients with valvular heart disease

2012 ◽  
Vol 44 (3) ◽  
pp. 211-219 ◽  
Author(s):  
Nicola Cooley ◽  
Mark J. Cowley ◽  
Ruby C. Y. Lin ◽  
Silvana Marasco ◽  
Chiew Wong ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Mirna Expression ◽  
Valvular Heart Disease ◽  
Left Atrial ◽  
Expression Profiles ◽  
Artery Bypass ◽  
Expression Patterns ◽  
Right Atrial ◽  
Detectable Effect

Chronic atrial fibrillation (AF) is a complication associated with the dilated atria of patients with valvular heart disease and contributes to worsened pathology. We examined microRNA (miRNA) expression profiles in right and left atrial appendage tissue from valvular heart disease (VHD) patients. Right atrial (RA) appendage from patients undergoing coronary artery bypass grafting and left atrial (LA) appendage from healthy hearts, not used for transplant, were used as controls. There was no detectable effect of chronic AF on miRNA expression in LA tissue, but miRNA expression in RA was strongly influenced by AF, with 47 miRNAs (15 higher, 32 lower) showing differential expression between the AF and control sinus rhythm groups. VHD induced different changes in miRNA expression in LA compared with RA. Fifty-three (12 higher, 41 lower) miRNAs were altered by VHD in LA, compared with 5 (4 higher, 1 lower) in RA tissue. miRNA profiles also differed between VHD-LA and VHD-RA (13 higher, 26 lower). We conclude that VHD and AF influence miRNA expression patterns in LA and RA, but these are affected differently by disease progression and by the development of AF. These findings provide new insights into the progression of VHD.

scholarly journals Influence of left atrial geometry on rotor core trajectories in a model of atrial fibrillation

2015 ◽  
Author(s):  
Konstantinos N Tzortzis ◽  
Caroline H Roney ◽  
Norman A Qureshi ◽  
Fu Siong Ng ◽  
Phang Boon Lim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Rotor Core

P426Routine use of transoesophageal echocardiography in patients with atrial fibrillation or atrial flutter undergoing cardioversion

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Etsadashvili ◽  
N Kuridze ◽  
T Kavtiashvili ◽  
T S Chaligava ◽  
V Chumburidze
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Left Atrial ◽  
Anticoagulation Therapy ◽  
Transoesophageal Echocardiography ◽  
Right Atrial ◽  
Cardiac Thrombus ◽  
Group 2 ◽  
Anticoagulated Patients ◽  
Group 1

Abstract Background. According to the recent guidelines, effective anticoagulation is recommended for a minimum of 3 weeks before the cardioversion of Atrial Fibrillation/Atrial Flutter. Transoesophageal echocardiography (TOE) could be considered, but is not mandatory to exclude/confirm the cardiac thrombus before the cardioversion in adequately anticoagulated patients. Aim of the study was to reveal the incidence of thrombus or spontaneous echo contrasting (SEC) by TOE before cardioversion, despite effective anticoagulation. Material and methods. Patients, where TOE was performed to evaluate the evidence of thrombus/SEC before the cardioversion of AF/Atrial flutter at our clinic in period of 2016-2018, were studied. Incidence of intracardiac thrombus and its relation to patients’ gender, age, hypertension, diabetes, atrial diameter, LVEF, duration of Atrial Fibrillation/Atrial flutter, as well as to anticoagulation regimen were evaluated. Results. All patients received recommended anticoagulation therapy, DOACs or VKAs, for a minimum of 3 weeks before the TOE. Finally 180 patients were divided in two groups: group 1 (121 patients) without evidence of thrombus and group 2 (59 patients) where TOE revealed the thrombus. Thrombus was found in 37 (20.5%) patients, and SEC was found in 22 (12.2%) patients. There were no difference between the two groups with respect to: gender (85 male (70%) in group 1 vs. 38 male (64%) in group 2, p = NS), age (62.8 ± 8.73 vs. 63.0 ± 9.04, p = NS), hypertension (78 (64.4%) vs. 44 (74.6%), p = NS), diabetes (17 (14%) vs. 7 (12%), p = NS), CHAD2DS2-VASc score (2.2 ± 1.8 vs. 2.4 ± 4.0, p = NS), LVEF (48.1 ± 7.1% vs. 46.4 ± 7.3%, p = NS), duration of arrhythmia (7.7 ± 11.6 months vs. 9.7 ± 14.0 months, p = NS), type on anticoagulation (DOACs 59 (48.3%) vs. 30 (50.8%), p = NS, VKA (Warfarin) 54 (44.6%) vs. 29 (49.1%), p = NS)) respectively. Only difference in atrial diameter was found statistically significant between the two groups: left atrial diameter (42.6 ± 3.3mm vs. 45.3 ± 3.6mm, p < 0.001) and right atrial diameter (39.4 ± 3.3mm vs. 40.8 ± 2.3mm, p = 0.001) respectively. Conclusion. Thrombus/SEC could persist despite the effective anticoagulation therapy for ≥3 weeks. Therefore all patients should perform TOE before the cardioversion to avoid the incidence of stroke.

Left Atrial Tachycardia After Right Atrial Separation for Chronic Atrial Fibrillation with Atrial Septal Defects

1999 ◽  
Vol 22 (10) ◽  
pp. 1547-1549 ◽  
Author(s):  
TAIJIRO SUEDA ◽  
KATSUHIKO IMAI ◽  
HIDEYUKI NAGATA ◽  
KAZUMASA ORIHASHI ◽  
YUICHIRO MATSUURA
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Atrial Tachycardia ◽  
Chronic Atrial Fibrillation ◽  
Right Atrial ◽  
Septal Defects ◽  
Atrial Septal Defects

scholarly journals Elevated Left and Right Atrial Pressures Long‐Term After Atrial Septal Defect Correction: An Invasive Exercise Hemodynamic Study

2021 ◽  
Author(s):  
Zarmiga Karunanithi ◽  
Mads Jønsson Andersen ◽  
Søren Mellemkjær ◽  
Mathias Alstrup ◽  
Farhad Waziri ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Artery ◽  
Left Atrial ◽  
Septal Defect ◽  
Filling Pressure ◽  
Right Atrial ◽  
Peak Exercise ◽  
Exercise Response ◽  
V Wave

Background Despite correction of the atrial septal defect (ASD), patients experience atrial fibrillation frequently and have increased morbidity and mortality. We examined physical capacity, cardiac performance, and invasive hemodynamics in patients with corrected ASD. Methods and Results Thirty‐eight corrected patients with isolated secundum ASD and 19 age‐matched healthy controls underwent right heart catheterization at rest and during exercise with simultaneous expired gas assessment and echocardiography. Maximum oxygen uptake was comparable between groups (ASD 32.7±7.7 mL O 2 /kg per minute, controls 35.2±7.5 mL O 2 /kg per minute, P =0.3), as was cardiac index at both rest and peak exercise. In contrast, pulmonary artery wedge v wave pressures were increased at rest and peak exercise (rest: ASD 14±4 mm Hg, controls 10±5 mm Hg, P =0.01; peak: ASD 25±9 mm Hg, controls 14±9 mm Hg, P =0.0001). The right atrial v wave pressures were increased at rest but not at peak exercise. The transmural filling pressure gradient (TMFP) was higher at peak exercise among patients with ASD (10±6 mm Hg, controls 7±3 mm Hg, P =0.03). One third of patients with ASD demonstrated an abnormal hemodynamic exercise response defined as mean pulmonary artery wedge pressure ≥25 mm Hg and/or mean pulmonary artery pressure ≥35 mm Hg at peak exercise. These patients had significantly elevated peak right and left atrial a wave pressures, right atrial v wave pressures, pulmonary artery wedge v wave pressures, and transmural filling pressure compared with both controls and patients with ASD with a normal exercise response. Conclusions Patients with corrected ASD present with elevated right and in particular left atrial pressures at rest and during exercise despite preserved peak exercise capacity. Abnormal atrial compliance and systolic atrial function could predispose to the increased long‐term risk of atrial fibrillation. Registration Information clinicaltrials.gov. Identifier: NCT03565471.

Abstract 16829: Isolated Left Atrial, Biatrial or Right Atrial Dilatation - Association With Low Voltage Areas in Patients With Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Timm Seewoester ◽  
Borislav Dinov ◽  
Sotirios Nedios ◽  
Gerhard Hindricks ◽  
Jelena Kornej
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Left Atrial ◽  
Low Voltage ◽  
Multivariable Analysis ◽  
Left Atrial Volume ◽  
Right Atrial ◽  
Atrial Volume ◽  
Model Based ◽  
Male Sex

Background: Left atrial volume (LAV) and low voltage areas (LVA) are markers for impaired outcome after ablation of atrial fibrillation (AF). Some studies reported the importance of increased right atrial volume (RAV) as a predictor for arrhythmia recurrences in AF patients. Hypothesis: to investigate association between the LAV/RAV ratio and LVA presence. Methods: Patients undergoing first AF ablation with pre-procedural cardiovascular magnetic resonance (CMR) imaging were included. LVA were assessed peri-procedurally using high-density 3D maps and defined as <0.5 mV. LAV was determined using a biplane model based on cine 4- and 2-chamber views, RAV using a monoplane model based on the cine 4-chamber view. Both volumes were indexed to body surface areas, and the LAV/RAV ratio was calculated. LAV/RAV ratio >1 indicated isolated LA dilatation, ratio ≤1 was defined as biatrial/isolated RA dilatation. Results: The study population included 184 patients (Age 63±10 years, 34% women, 58% persistent AF, 22% LVA). There were 148 (80%) patients with isolated LA dilatation. In univariable analysis, isolated LA dilatation was associated with LVAs (OR 6.803, 95% CI 1.395-26.514, p=0.016). This association remained robust in multivariable model after adjustment for persistent AF, CHA 2 DS 2 -VASc score, renal function, and heart rate (OR 5.981, 95%CI 1.256-28.484, p=0.025). Using ROC analysis, LAV/RAV ratio (AUC 0.668, 95% CI 0.585-0.751, p<0.001, Figure) was significant predictor for LVA. Biatrial/isolated RA dilatation occurred in 36 (20%) patients. On multivariable analysis, after adjustment for age, persistent AF, and renal function, male sex remained significantly associated with biatrial/isolated RA dilatation (OR 3.040, 95% CI 1.050-8.802, p=0.040). Conclusions: LAV/RAV ratio is useful for the prediction of LVA in AF. Isolated LA dilatation was associated with LVA presence, while male sex remained associated with biatrial/isolated RA dilatation and less LVA.

scholarly journals P1699 A case of atrial myxoma presenting with acute stroke

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Gray ◽  
J Brassil ◽  
N Jepson
Keyword(s):  
Atrial Fibrillation ◽  
Hypertrophic Cardiomyopathy ◽  
Signal Intensity ◽  
Left Atrial ◽  
Patent Foramen Ovale ◽  
Atrial Myxoma ◽  
Right Atrial ◽  
Foramen Ovale ◽  
Apical Hypertrophic Cardiomyopathy ◽  
Right Atrial Myxoma

Abstract A 73-year-old female presented with sudden reduced level of consciousness on the background of rheumatoid arthritis and dyslipidaemia. On examination she had a Glascow Coma Score of 12 and an irregularly irregular pulse. The electrocardiograph confirmed atrial fibrillation and showed widespread T wave inversion. A computed tomography cerebral angiogram showed an acute basilar artery occlusion. She was transferred to a tertiary centre where she had successful endovascular clot retrieval. An urgent transthoracic echocardiogram (figure 1) showed apical hypertrophy, normal systolic function and a large right atrial mass. The left atrial size was normal. A transoesophageal echocardiogram (figure 3) confirmed a large pedunculated mobile mass with a hypermobile septum consistent with a patent foramen ovale. There was no right to left doppler flow, however the atrial mass obstructed the course, and a bubble study was positive. The cardiac magnetic resonance image (figure 2) showed a 47 x 48 mm pedunculated lesion within the right atrium, arising from the intraventricular septum, demonstrating moderate T2 signal intensity, and intermediate T1 signal intensity, with avid enhancement, consistent with a right atrial myxoma. There was increased apical wall thickening at 15mm which confirmed apical hypertrophic cardiomyopathy. An open surgical resection and left atrial appendage ligation was performed on day 11 of admission. Histopathology confirmed an atrial myxoma. She had an excellent neurological recovery with only mild diplopia. The mechanism of stroke was likely atrial fibrillation secondary to increased left atrial pressure from apical hypertrophic cardiomyopathy. However, the unexpected finding of a right atrial myxoma with a corresponding patent foramen ovale provides a second possible mechanism. Abstract P1699 Figure. Right atrial Myxoma

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