atrial conduction time
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Author(s):  
Patrick Müller ◽  
Bob Weijs ◽  
Nadine M. A. A. Bemelmans ◽  
Andreas Mügge ◽  
Lars Eckardt ◽  
...  

AbstractAtrial fibrillation (AF) is a major cause of cardiovascular morbidity and mortality. To early detect and to avoid AF-related complications, several cardiac imaging modalities and approaches aim to quantify the severity of the underlying atrial cardiomyopathy (i.e., the extent of atrial remodeling). However, most established cardiac imaging modalities just incorporate single components of atrial remodeling and do not reflect the complete multifactorial process, which may contribute to their limited predictive value. Echocardiography-derived PA-TDI duration is a sophisticated echocardiographic parameter to assess total atrial conduction time and directly reflects both electrical and structural changes to the atria. Therefore, PA-TDI duration provides a more comprehensive quantification of the extent of atrial remodeling than other imaging modalities. In this article we review the role of PA-TDI duration as a marker of atrial remodeling and summarize the available data on PA-TDI duration to identify patients at risk for AF, as well as to guide AF management. Moreover, we discuss how to assess PA-TDI duration and provide recommendations on the implementation of PA-TDI duration into routine clinical care. Graphic abstract


2021 ◽  
Vol 12 ◽  
Author(s):  
Ryuichi Kambayashi ◽  
Hiroko Izumi-Nakaseko ◽  
Ai Goto ◽  
Kazuya Tsurudome ◽  
Hironori Ohshiro ◽  
...  

Oseltamivir has been shown to prolong the atrial conduction time and effective refractory period, and to suppress the onset of burst pacing-induced atrial fibrillation in vitro. To better predict its potential clinical benefit as an anti-atrial fibrillatory drug, we performed translational studies by assessing in vivo anti-atrial fibrillatory effect along with in vivo and in vitro electropharmacological analyses. Oseltamivir in intravenous doses of 3 (n = 6) and 30 mg/kg (n = 7) was administered in conscious state to the persistent atrial fibrillation model dogs to confirm its anti-atrial fibrillatory action. The model was prepared by tachypacing to the atria of chronic atrioventricular block dogs for > 6 weeks. Next, oseltamivir in doses of 0.3, 3 and 30 mg/kg was intravenously administered to the halothane-anesthetized intact dogs to analyze its in vivo electrophysiological actions (n = 4). Finally, its in vitro effects of 10–1,000 μM on IK,ACh, IKur, IKr, INa and ICaL were analyzed by using cell lines stably expressing Kir3.1/3.4, KV1.5, hERG, NaV1.5 or CaV1.2, respectively (n = 3 for IK,ACh and IKr or n = 6 for IKr, INa and ICaL). Oseltamivir in doses of 3 and 30 mg/kg terminated the atrial fibrillation in 1 out of 6 and in 6 out of 7 atrial fibrillation model dogs, respectively without inducing any lethal ventricular arrhythmia. Its 3 and 30 mg/kg delayed inter-atrial conduction in a frequency-dependent manner, whereas they prolonged atrial effective refractory period in a reverse frequency-dependent manner in the intact dogs. The current assay indicated that IC50 values for IK,ACh and IKr were 160 and 231 μM, respectively, but 1,000 µM inhibited INa, ICaL and IKur by 22, 19 and 13%, respectively. The extent of INa blockade was enhanced at faster beating rate and more depolarized resting membrane potential. Oseltamivir effectively terminated the persistent atrial fibrillation, which may be largely due to the prolongation of the atrial effective refractory period and inter-atrial conduction time induced by IK,ACh and IKr inhibitions along with INa suppression. Thus, oseltamivir can exert a powerful anti-atrial fibrillatory action through its ideal multi-channel blocking property; and oseltamivir would become a promising seed compound for developing efficacious and safe anti-atrial fibrillatory drugs.


Author(s):  
Iosif Karantoumanis ◽  
Ioannis Doundoulakis ◽  
Stefanos Zafeiropoulos ◽  
Kostas Oikonomou ◽  
Pantelis Makridis ◽  
...  

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Albert J Rogers ◽  
Paul J Wang ◽  
Nitish Badhwar

Introduction: Delta waves associated with atrioventricular accessory pathways (APs) may manifest with autonomic tone, heart rate, and rhythm changes. Rarely, drugs like sotalol can block AV nodal conduction, revealing latent WPW, one treatable cause of sudden death. Case report: A 38-year-old man was admitted for sotalol loading due to frequent typical atrial flutter and SVT and a desire to avoid catheter ablation. He had a history of cardiac arrest with adenosine and tachycardia-induced cardiomyopathy. After recovery, cardiac MRI showed a normal heart without scar. Admission 12-lead ECG ( Figure A ) revealed normal sinus rhythm without other abnormality. With administration of sotalol, the patient developed a wide complex rhythm ( Figure B ). Interpretation of the rhythm indicated presence of a latent AP and a repeat ECG ( Figure C ) confirmed manifest preexcitation. After consenting to electrophysiology study, the patient developed a short RP tachycardia ( Figure D ) which terminated with Valsalva. The patient underwent successful catheter ablation of the pathway located at the anterior floor of the coronary sinus body and the cavotricuspid isthmus. Discussion: The differential diagnosis for a wide complex rhythm in this setting includes rate-related aberrancy, idioventricular rhythm, phase 4 aberrancy, and preexcitation from an AP. Shortened and consistent PR intervals in the tracing lead to preexcitation as the only possible mechanism. APs that are capable of anterograde conduction but are not manifest in sinus rhythm are termed latent APs. Conditions that may cause this phenomenon include opposite autonomic effects on the AP and the AV node, increased atrial conduction time, or concealed retrograde conduction into the AP. Sotalol typically increases the retrograde effective refractory period of the AP but has variable anterograde effect. Sotalol has not previously been reported to reveal a latent AP but may have acted through one of the stated mechanisms.


Author(s):  
Catherina Tjahjadi ◽  
Yasmine L Hiemstra ◽  
Pieter van der Bijl ◽  
Stephan M Pio ◽  
Marianne Bootsma ◽  
...  

Abstract Aims Atrial fibrillation (AF) is frequently observed in hypertrophic cardiomyopathy (HCM) and is associated with poor clinical outcome. Total atrial conduction time, estimated by tissue Doppler imaging (TDI), the so-called PA-TDI duration, reflects the left atrial (LA) structural and electrical remodelling. The aim of this study was to evaluate the association between PA-TDI and new-onset AF in patients with HCM. Methods and results From a large cohort of patients with HCM, 208 patients (64% male, mean age 53 ± 14 years) without AF were selected. PA-TDI duration was measured from the onset P wave on electrocardiogram to the peak A′ wave of the lateral LA wall using TDI. The incidence of new-onset AF was 20% over a median follow-up of 7.3 (3.5–10.5) years. Patients with incident AF had longer PA-TDI duration when compared with patients without AF (133.7 ± 23.0 vs. 110.5 ± 30.0 ms, P < 0.001). PA-TDI duration was independently associated with new-onset AF (hazard ratio: 1.03, 95% confidence interval: 1.01–1.05, P < 0.001). Conclusion Prolonged PA-TDI duration was independently associated with new-onset AF in patients with HCM. This novel parameter could be useful to risk-stratify patients with HCM who are at risk of having AF.


EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Eichenlaub ◽  
H Lehrmann ◽  
B Mueller-Edenborn ◽  
J Allgeier ◽  
R Weber ◽  
...  

Abstract Background/Introduction Left atrial (LA) fibrosis is associated with increased arrhythmia recurrence rates after pulmonary vein isolation (PVI) and increased stroke risk in patients with atrial fibrillation (AF). So far, detection and quantification of LA fibrosis is only feasible by invasive electrophysiological mapping of low-voltage-substrate (LVS) or delayed enhancement areas in MRI. Purpose The aim of this study was to assess the distribution and extent of atrial fibrosis by non-invasive ECG-Imaging (ECGI) in patients with persistent AF prior to PVI. Methods Thirty-seven consecutive patients (66 ± 9 years, 84% male) presenting for their first PVI were included. Patients with AF were cardioverted into sinus rhythm (SR). One day prior to AF ablation procedure, patients underwent ECGI in SR using the 252-electrode-array (CardioInsight) and a low-X-ray-dose, non-injected cardiac CT-scan to assess the relationship between ECGI-electrodes and cardiac epicardial structures. Prior to PVI, high-density biatrial voltage and activation maps were acquired in SR (CARTO-3). Localization and extent of atrial LVS (relevant fibrosis: LA-LVS: ≥5cm2 at <0.5mV threshold) and biatrial activation times depicted by CARTO were compared with atrial activation/conduction times assessed by non-invasive ECGI.  Presence of LA-LVS was classified according to its extent into 3 stages and compared to the inter- and intraatrial conduction delay in ECGI. Results Relevant atrial fibrosis was found in 17/37(46%) patients. Presence of biatrial LVS resulted in a linear increase of the biatrial activation time in CARTO-SR-maps (146 ± 18ms in patients without LVS vs 184 ± 27ms in patients with LVS, p < 0.001) and in non-invasive ECGI (133 ± 11ms vs 170 ± 20ms, p < 0.001). Both the extent of biatrial LVS and invasively measured total activation time correlated well with non-invasive total atrial conduction time (TACT) in ECGI (r = 0.91 and r = 0.82, respectively, figure). Moreover, the extent of LA-LVS showed an excellent correlation to TACT in ECGI (r = 0.89). A combination of inter-atrial (RA-LA) conduction delay and TACT in ECGI allowed to quantify the extent of LA-LVS and to distinguish between three stages of LA-LVS: Stage 1 (minimal LA-LVS: 1 ± 2cm2): ECGI revealed rapid RA&LA activation with short TACT 132 ± 9ms; Stage 2 (moderate LA-LVS: 14 ± 8cm2 involving the anteroseptal LA) was associated with delayed LA activation and prolonged TACT measuring 161 ± 7ms; Stage 3 (extensive LA-LVS involving the anteroseptal and posterior LA: 26 ± 17cm2) was characterized by a significantly delayed LA activation with a TACT of 178 ± 24ms in ECGI. Conclusion Analysis of interatrial conduction delay and total atrial conduction time (TACT) in non-invasive ECGI allows accurate staging of patients with arrhythmogenic atrial LVS who present an increased risk for arrhythmia recurrences and stroke. Abstract Figure.


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