scholarly journals A Case of Atrial Tachycardia Circulating around a Left Atrial Roof Scar with Diabetes Mellitus and Renal Failure on Hemodialysis

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Naoko Hijioka ◽  
Masashi Kamioka ◽  
Hitoshi Suzuki ◽  
Yasuchika Takeishi
Keyword(s):  
Renal Failure ◽  
Volume Change ◽  
Left Atrial ◽  
Atrial Tachycardia ◽  
Low Voltage ◽  
Close Contact ◽  
Three Dimensional ◽  
Atrial Remodeling ◽  
Anatomical Structures ◽  
Slow Conduction

Introduction. Little is known about the effects of volume change by hemodialysis (HD) and mechanical stress caused by an anatomical structure being in contact with the left atrium on the progression of atrial remodeling. We experienced a case of atrial tachycardia (AT) in a patient who had left atrial (LA) scarring at the LA roof and a low-voltage area with slow conduction around the LA scar as components of AT circuit. Here, we present the conceivable hypothesis of the LA scar and the low-voltage area formation. Our concept can be useful in developing a strategy for ablation in a patient with chronic renal failure (CRF) on HD.Case Report. A 65-year-old man with CRF on HD was referred for AT ablation. Three-dimensional electroanatomical mapping revealed that the AT conducted around an LA scar in a counterclockwise fashion. There was a slow conduction area at the superior side of the LA scar, where the AT was terminated during the ablation. Computed tomography indicated a close relationship between the LA and the anatomical structures (ascending aorta and pulmonary artery).Conclusion. Volume change by HD and close contact of anatomical structures to the LA can promote atrial remodeling, resulting in AT occurrence.

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 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.

scholarly journals Circulating proteomic patterns in AF related left atrial remodeling indicate involvement of coagulation and complement cascade

2018 ◽  
Author(s):  
Jelena Kornej ◽  
Petra Büttner ◽  
Elke Hammer ◽  
Beatrice Engelmann ◽  
Borislav Dinov ◽  
...  
Keyword(s):  
Disease Progression ◽  
Left Atrial ◽  
Low Voltage ◽  
Interaction Analysis ◽  
Proteome Analysis ◽  
Atrial Remodeling ◽  
Complement Cascade ◽  
Label Free ◽  
Therapeutic Success ◽  
Protein Protein Interaction

AbstractBackgroundLeft atrial (LA) electro-anatomical remodeling and diameter increase in atrial fibrillation (AF) indicates disease progression and is associated with poor therapeutic success. Furthermore, AF leads to a hypercoagulable state, which in turn promotes the development of a substrate for AF and disease progression in the experimental setting. The aim of this study was to identify pathways associated with LA remodeling in AF patients using untargeted proteomics approach.MethodsPeripheral blood samples of 48 patients (62±10 years, 63% males, 59% persistent AF) undergoing AF catheter ablation were collected before ablation. 24 patients with left atrial low voltage areas (LVA), defined as <0.5 mV, and 24 patients without LVA were matched for age, gender and CHA2DS2-VASc score. Untargeted proteome analysis was performed using LC-ESI-Tandem mass spectrometry in a label free intensity based workflow. Significantly different abundant proteins were identified and used for pathway analysis and protein-protein interaction analysis.ResultsAnalysis covered 280 non-redundant circulating plasma proteins. The presence of LVA correlated with 30 differentially abundant proteins of coagulation and complement cascade (q<0.05).ConclusionsThis pilot proteomic study identified plasma protein candidates associated with electro-anatomical remodeling in AF and pointed towards an imbalance in coagulation and complement pathway, tissue remodeling and inflammation

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 Age and impaired left atrial performance are associated with increased atrial fibrosis in patients with paroxysmal and persistent atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
V Traykov ◽  
R Radoslavova ◽  
D Boychev ◽  
V Konstantinova ◽  
D Marchov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Low Voltage ◽  
Pulmonary Veins ◽  
Three Dimensional ◽  
Persistent Atrial Fibrillation ◽  
Strain Imaging ◽  
Electroanatomical Mapping ◽  
Custom Made ◽  
The Difference

Abstract Background Atrial performance assessed by strain imaging is used as a surrogate for left atrial (LA) structural remodelling. Presence of low voltage zones (LVZs) detected by three-dimensional electroanatomical mapping in patients with atrial fibrillation (AF) denotes more expressed extrapulmonary substrate potentially leading to worse outcomes following pulmonary vein isolation (PVI) for the treatment of AF. Purpose The current study aims to investigate the association between strain imaging parameters from echocardiography and the presence and extent of LVZs derived from LA electroanatomical mapping in patients undergoing AF ablation. Methods Seventy-eight patients (58 males, 74%) aged 59±9.48 years undergoing PVI for paroxysmal (35 patients, 49%) or persistent AF were prospectively studied. Preprocedural echocardiography included LA strain imaging assessing global LA strain (LAS) and regional strain of the basolateral region (RSLB). During the procedure, LA electroanatomical mapping during paced atrial rhythm was performed in all patients obtaining a LA voltage map. All LA maps were analysed offline using a custom-made software calculating the zone of low bipolar voltage &lt;0.5 mV (LVZ&lt;0.5mV) and the total LA endocardial area excluding pulmonary veins antra. LVZ&lt;0.5mv was expressed as an absolute value and as percentage of the whole LA area. Results Patients aged more than 65 years (N=21, 27%) demonstrated a larger area of LVZ&lt;0.5mV: 25.5±17.8 cm2 vs. 9.4±10.6 cm2 in those younger than 65 years, P=0.001. This corresponded to a higher proportion of the LA area demonstrating LVZ&lt;0.5mV in patients older than 65 years: 22.6±14.6% vs. 8.9±11.8% in those younger than 65 years, P&lt;0.0001. Twenty-nine of 78 patients (37.1%) had preprocedural LAS&lt;20% and 23 (29.5%) demonstrated RSLB of &lt;21%. Patients with LAS &lt;20% had a higher total LVZ&lt;0.5mV: 20.3±16.6 cm2 vs. 9.8±12.1 cm2 in patients with LAS≥20% at baseline, P=0.004. This equaled to 17.7±15.6% vs. 9.5±11.9% of total LA area, respectively (P=0.011). Patients with RSLB&lt;21% also demonstrated larger areas of LVZ&lt;0.5mV in the LA: 21.6±17.9 cm2 vs. 10.39±11.83 cm2 in the patients with RSLB ≥21%, P=0.012. Expressed as a proportion of the whole LA area the difference remained significant: 18.8±17.1% vs. 9.9±11.6%, respectively P=0.01. Conclusion Older age and impaired LA performance assessed by LA strain imaging are associated with larger areas of LVZ&lt;0.5mV possibly reflecting more expressed LA fibrotic changes in patients with paroxysmal and persistent AF. These findings might serve in the preprocedural selection of the patients undergoing catheter ablation of AF. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): Bulgarian Society of Cardiology

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