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PubMed1995

Snare removal of a telectronics accufix atrial J retention wire.

A voluntary recall of the Telectronics Accufix models 330-801 and 329-701 "J"-shaped atrial pacemaker leads has been issued because of fracture and extrusion of the J-shaped retention wire. Such extrusion can result in laceration of the atrium or surrounding vascular structures. Herein we describe a patient with a fractured and extruded retention wire that was snared and removed percutaneously; the atrial lead was left intact, and pacing function was satisfactory. This unique procedure can be used to avoid the morbidity associated with percutaneous lead extraction or thoracotomy and to prevent potential dislodgment and embolization of the retention wire during lead extraction.

Child↗
PubMed2004

[Clinical features and diagnostic evaluation of heart failure in the elderly].

The diagnosis of heart failure in the elderly frequently represents a clinical challenge. Atypical symptoms and signs and confounding comorbid conditions are common situations in old patients with heart failure and may obscure the clinical picture, complicating the diagnostic evaluation. Furthermore in the elderly, especially in female gender with a long-lasting history of hypertension, heart failure commonly may ensue as a consequence of a predominating impairment of the diastolic function with normal or near-normal preserved systolic function. Echocardiography represents the gold standard for the confirmation of the clinical suspicion of heart failure and may provide detailed information about left and right ventricular dimensions and function, atrial dimensions, valvular function and pericardium. For this reason it is recommended as part of initial diagnostic evaluation in almost all cases of heart failure. However, the low diagnostic accuracy of the clinical picture in elderly patients with suspected heart failure, as suggested by the international guidelines, requires the corroboration of the clinical suspicion with the help of "first-line" traditional investigations like ECG and chest X-ray. Recently natriuretic peptides (B-type natriuretic peptide [BNP] and NT-proBNP) have emerged as an attracting "tool" to support the clinical signs in patients with suspected heart failure. In this review we discuss about the opportunity that BNP and NT-proBNP would be relevant in the diagnostic process of elderly patients with suspected heart failure.

Aged↗
PubMed2005

[Clinical efficacy of endoscopic epicardial microwave ablation for isolated atrial fibrillation].

OBJECTIVE: To assess the efficacy of endoscopic epicardial microwave ablation, a new completely endoscopic technique, for isolated atrial fibrillation (AF). METHODS: From July to October of 2004, 5 patients with isolated permanent AF underwent this procedure. We performed epicardial microwave ablation using FLEX10 probe under the guide of VasoView 5 endoscope. The probe was placed around left and right pulmonary vein orifices, the microwave application was set 65 W/90 s, and a continuous ablation line was obtained encircling the pulmonary veins. Echocardiography and electrocardiography were carried out in all patients before and after operation. RESULTS: Five patients received electrical conversion after ablation. Average ablation time was 35.0 min and average procedure time was 2.5 h without any procedure-related complications. At the 3-month, 6-month and 12-month follow-up, 4 patients (80%) were in sinus rhythm, associated with a reduced left atrial diameter and an improved cardiac function. CONCLUSION: Endoscopic epicardial microwave ablation for isolated atrial fibrillation appears to be safe and effective.

Adult↗
PubMed1991

[Pulmonary venous flow patterns in normal subjects and cardiac patients: a transesophageal echocardiographic study].

The aim of this study is, first, to analyze pulmonary venous flow velocity (PVFV) pattern in normal subjects and second, to compare it with the various diseased state. PVFV was recorded in eleven normal volunteers, five patients with lone atrial fibrillation, twenty eight patients with valvular heart diseases and six patients with cardiomyopathy using transesophageal color Doppler echocardiography by placing the sample volume at the junction of the left superior pulmonary vein and left atrium. PVFV in normal subjects demonstrated distinct four waveforms: due to atrial systole (AS wave) and diastole (AD wave), and due to ventricular systole (VS wave) and diastole (VD wave). PVFV changed with respiration in normal subjects. The peak velocity of VD wave was increased with inspiration (p less than 0.001). The ratio of velocity VS/VD was increased during expiration (p less than 0.01). The ratio of area AD + VS/VD was significantly decreased with inspiration (p less than 0.01). We feel that this is the normal variation in pulmonary venous return during respiration , influenced by changes in the venous return on the right side of the heart. In all patients with atrial fibrillation, AS and AD waves were disappeared. The negative deflection occasionally observed was due to mitral valve closure. In patients with mitral stenosis, the peak velocity of VD wave was significantly decreased compared to that of normal subjects, but it was not significantly different between the patients with mitral valve replacement and normal subjects. The peak velocity of VD wave was also correlated with pressure half time among the patients with mitral stenosis, mitral valve replacement and mitral commissurotomy. On the other hand, it was significantly increased in patients with mitral regurgitation and returned to normal level after the operation. The peak velocity of VS wave was correlated with the left atrial dimension among the patients with mitral valve diseases except these with mitral regurgitation. In patients with mitral regurgitation, the peak velocity was decreased compared to that of normal subjects and reversed flow was seen in half of the patients. Also, it was decreased in patients with dilated cardiomyopathy and increased in patients with hypertrophic cardiomyopathy. In conclusion, PVFV is influenced not only by changes of venous return with respiration but also by the left atrial size, presence or absence of MS or MR, left atrial or left ventricular systolic and diastolic function in the various diseased states.

Adult↗
PubMed1993

Cardiac variables and blood pressure as determinants of left ventricular inflow velocities.

The determinants of the left ventricular diastolic transmitral flow pattern, measured by use of Doppler velocimetry, were assessed in 40 patients referred for hypertension. The ratio of the atrial to early filling peak velocity (A/E ratio) averaged 0.82 +/- 0.23, BP 156 +/- 19/100 +/- 13 mmHg and left ventricular mass 220 +/- 57. In multiple regression analysis the A/E ratio was independently and positively related to age (P < 0.001) and BP (P < 0.001) and inversely to the fractional shortening of the left ventricular internal diameter (P < 0.01) and left atrial size at end-systole (P < 0.05); these variables accounted for 71% of the variance of the A/E ratio. The peak flow velocity during atrial contraction was positively and independently related to age (P < 0.001), BP (P < 0.05) and heart rate (P < 0.05); early filling velocity decreased with age (P < 0.001) and was positively related to heart rate (P < 0.01), left atrial diameter (P < 0.01) and fractional shortening (P < 0.001). The weak positive associations of the A/E ratio with left ventricular mass (r = 0.32; P < 0.05) and wall thickness (r = 0.38; P < 0.05) did not persist in multiple regression analysis. In conclusion, the left ventricular diastolic filling indexes are related to age, BP, left atrial size and to systolic left ventricular function but left ventricular structural variables, as measured by echocardiography, are not significantly involved.

Adult↗
PubMed2005

[Value of electrocardiographic treadmill test for rate control strategy in permanent atrial fibrillation].

AIM: of our study was to determine the correlation between physical activity tolerance assesed by exercise tolerance test (ETT) and dynamics of change of echocardiographic parameters of left atrium (LA) and left ventricle (LV) in standard transtoracic echocardiography (TTE) in long-term follow up of patients with persistent nonvalvular atrial fibrillation (AF). MATERIALS AND METHODS: We studied 67 patients (W/M: 23/44; mean age 63.2 +/- 7.1 years) with persistent AF lasting longer than 1 month. Rate control strategy targeted resting heart rate 70-90/min. All study subject underwent ETT in order to assess their exercise capacity. Before ETT we performed TTE in all patients and calculated the area of LA (LAar), longitudinal and saggital diameter of LA (LAlax, LAsax), LV end-diastolic diameter (LVEDD) and LV shortening fraction (FS). TTE was performed again in 2 and 12 months after beginning of observation. RESULTS: Using variation analysis we established the correlation between time of ETT in patients with persistent AF and dynamics of change of specific echocardiographic parameters in 12 months follow-up. In patients with ETT time <60 sec we observed statistically significant rise of LAar from 26.5 +/- 6.1 to 29.6 +/- 4.9 cm2 (p < 0.05; ANOVA) and deterioration of LV function assessed with FS from 35.6 +/- 5.3% on the beginning to 31.7 +/- 7.4% at the end of study (p < 0.02; ANOVA). There was no correlation between time of ETT and dynamics of change of other echocardiographic parameters in patients with time of ETT >60 sec. CONCLUSIONS: Time of exercise tolerance test limited with heart failure symptoms is an independent factor predicting dynamics of change of chosen echocardiographic parameters of left heart in long-term observation of patients with persistent atrial fibrillation.

Aged↗
PubMed1994

[Recovery of mechanical atrial function following atrial fibrillation].

To evaluated the recovery of atrial function following atrial fibrillation, we followed 66 patients with atrial fibrillation cardioverted to sinus rhythm. Over 3 months of follow-up we performed transmitral pulsed Doppler echocardiography. The results were evaluated according to the etiology, duration of atrial fibrillation, left atrial dimension and modality of cardioversion. We observed a significant increase in both peak A wave velocity and percent atrial contribution to total left ventricular filling after 1 month in hypertensive patients and after 3 months in ischemic patients. The recovery of atrial mechanical function was earlier in patients with recent atrial fibrillation (< 24 hours) and in patients with normal left atrium. These results may have implications in guiding the duration of anticoagulant therapy after cardioversion.

Aged↗
PubMed1984

Anatomic correction of transposition of the great arteries associated with ventricular septal defect: midterm results in 50 patients.

From May 1977 to August 1982 50 patients who were 1.5 to 44 months old underwent anatomic correction of transposition of the great arteries (TGA) and closure of ventricular septal defect (VSD) at our institution. Thirty-nine patients underwent preliminary pulmonary arterial banding. Hospital mortality was 32%: four patients died as a result of technical problems, seven as a result of associated lesions, three of pulmonary hypertension, and two of left ventricular failure. Three other patients died after the first postoperative month (one of mediastinitis, one at reoperation for a residual VSD, and one of pulmonary hypertension). All 31 survivors are in excellent clinical condition and are in sinus rhythm after a mean follow-up period of 31 +/- 14 months. Twenty-five patients were reinvestigated by echocardiography (M mode and two-dimensional) and/or catheterization. Parameters of left ventricular contractility were within normal limits, but systolic aortic diameter was larger than normal (p less than .01). Seven patients had stenosis of the right ventricular outflow tract and five of these required reoperation. The two persistent problems with the anatomic correction of TGA associated with VSD are a relatively high operative mortality and secondary right outflow tract stenosis. However, use of this procedure results in better left ventricular function and fewer arrhythmias than does use of atrial repair techniques and also results in the use of the anatomically left ventricle as the systemic ventricle.

Cineangiography↗
PubMed2006

Conversion to sinus rhythm by ablation improves quality of life in patients submitted to mitral valve surgery.

BACKGROUND: Atrial fibrillation can be successfully treated with surgical ablation, but the effect of restoring sinus rhythm on the quality of life has yet to be established. We evaluate the effects of left atrial ablation combined with mitral valve surgery on health-related quality of life in patients with permanent atrial fibrillation. METHODS: Ninety-one consecutive patients with permanent atrial fibrillation underwent mitral valve surgery at our division. The last 53 also received left atrial ablation by means of monopolar radiofrequency and excision of the left appendage. The patients were divided into two groups according to the median total score obtained at the Short Form 36 Health Survey used to evaluate their quality of life (ie, the good quality of life group [n = 54] and the poor quality of life group [n = 37]). RESULTS: Preoperative and intraoperative data of the two groups were similar. In-hospital mortality and morbidity were similar in both groups. Sinus rhythm was obtained in 68% of patients (36 of 53) treated with left atrial ablation and it occurred spontaneously in 10% of patients (4 of 38) treated for the mitral pathology only. At follow-up, there was no difference between the groups in ejection fraction, left atrial diameter, mitral dysfunction, tricuspidal regurgitation, and New York Heart Association functional class. Using stepwise logistic regression, only the presence of sinus rhythm was associated with better quality of life. CONCLUSIONS: In patients submitted to mitral surgery, conversion to sinus rhythm by left atrial ablation can significantly improve the health-related quality of life.

Aged↗
PubMed1991

Left ventricular myocardial edema. Lymph flow, interstitial fibrosis, and cardiac function.

We hypothesized that both acute and chronic accumulation of myocardial interstitial edema (extravascular fluid [EVF]) would compromise cardiac function. We also postulated that excess fluid within the myocardial interstitial space would potentiate interstitial fibrosis, thus further compromising function. Dogs were divided into three groups: 1) control, 2) chronic pulmonary hypertensive with right heart failure, and 3) chronic arterial hypertensive. The quantity of EVF, expressed as the unitless blood-free (wet weight-dry weight)/dry weight ratio, and interstitial fibrosis (collagen content) were determined and correlated with cardiac function at baseline and after acute elevation of coronary venous pressure and reduction of cardiac lymph flow. Control EVF was 2.90 +/- 0.20 (mean +/- SD), which increased to 3.45 +/- 0.16 after acute (3-hour) elevation of coronary sinus pressure. This EVF significantly compromised cardiac function. The EVF in chronically hypertensive dogs and in dogs with chronic right heart pressure elevations was 3.50 +/- 0.30 and 3.50 +/- 0.08, respectively. End-diastolic left ventricular interstitial fluid pressure increased from a control value of 14.9 +/- 3.1 (at EVF = 2.9) to 24.8 +/- 3.7 (at EVF = 3.5). An EVF of 3.5 produced approximately 30% reduction of the heart's ability to maintain cardiac output at a left atrial pressure of 15 mm Hg. The compromised function in these chronic models is exacerbated after acute elevation of coronary venous pressure and reduction of cardiac lymph flow. Collagen levels were elevated by at least 20% in the chronic hypertensive dogs and in the nonhypertrophied left ventricles of dogs with chronic right heart pressure elevation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1969

Studies in clinical shock and hypotension: VI. Relationship between left and right ventricular function.

Left ventricular end diastolic (LVEDP) and mean right atrial (RAP) pressures were recorded simultaneously in 30 patients with shock (14 acute myocardial infarction, 10 acute pulmonary embolism or severe bronchopulmonary disease, and 6 sepsis). Myocardial infarction was characterized by a predominant increase in LVEDP, pulmonary disease by a predominant increase in RAP, and sepsis by a normal relationship between LVEDP and RAP. In all three groups a significant positive correlation was noted between RAP and LVEDP, with the regression line in cor pulmonale deviated significantly toward the RAP axis and the regression line in myocardial infarction exhibiting a zero RAP intercept at an elevated LVEDP.Low cardiac outputs with elevated LVEDP in myocardial infarction indicated severe left ventricular failure. Low outputs with elevated RAP in cor pulmonale were consistent with right ventricular overload. Although cardiac outputs often were normal in sepsis, low outputs with elevated cardiac filling pressures in some patients were consistent with a hemodynamic or humoral-induced generalized depression of cardiac performance.Vasoconstrictor and inotropic drugs often produced a functional disparity between the two ventricles, with the gradient between LVEDP and RAP increasing, apparently because of an increase in left ventricular work or an inadequacy of left ventricular oxygen delivery. Acute plasma volume expansion with dextran in patients with pulmonary vascular disease resulted in a somewhat more rapid rise in RAP than in LVEDP. In septic and myocardial infarction shock, however, LVEDP and RAP usually rose proportionally, with the absolute rise of LVEDP surpassing that of RAP. Although the absolute level of the central venous pressure thus may not be a reliable indicator of left ventricular function in shock, changes in venous pressure during acute plasma volume expansion should serve as a fairly safe guide to changes in LVEDP.

Journal Article↗
PubMed2003

Stress echocardiography using transesophageal atrial pacing in rats.

BACKGROUND: Echocardiography is increasingly used for noninvasive evaluation of cardiac function and morphology in small animal models of cardiovascular diseases. The aims of this study were to develop a simple method for stress echocardiography in rats and to evaluate left ventricular function of the postinfarct remodeling heart during stress induced by rapid atrial pacing. METHODS: Myocardial infarction (MI) was induced in rats by ligation of left coronary artery. Rats with 3 week-old MI (n = 9) and sham operation (n = 7) were examined with transthoracic echocardiography during stress induced by transesophageal pacing. The stress protocol consisted of examinations at baseline; during 2 different pacing rates, at 360 and 600 bpm; and during recovery. Systolic blood pressure was measured at each step. RESULTS: Stroke volume decreased at pacing with 600 bpm in both groups compared with baseline and to pacing at 360 bpm (sham group, 0.15 +/- 0.01 vs 0.24 +/- 0.02 mL; MI group, 0.13 +/- 0.01 vs 0.31 +/- 0.02 mL, P <.05). Cardiac index increased at 360 bpm pacing compared with baseline and remained constant at the higher pacing rate in the sham-operated rats (246 +/- 34 vs 192 +/- 25 mL/kg, P <.05). In the MI rats, cardiac index decreased at 600 bpm pacing compared with baseline (195 +/- 9 vs 235 +/- 15 mL/kg, P <.01). Systolic blood pressure did not change during the stress protocol in the groups. CONCLUSION: Stress echocardiography induced by transesophageal pacing in rats is a feasible and simple method for evaluation of left ventricular function. This method may be useful for noninvasive evaluation of left ventricular function under stress conditions in small animal models of heart diseases.

Animals↗
PubMed1990

[A new Doppler echocardiography parameter of diastolic ventricular function].

The evaluation of flow velocities in left ventricular inflow tract (LVIT) by Doppler echocardiography gives information about the diastolic ventricular function. In late diastole, shortly after the flow velocity of atrial contraction V(A), we notice in the left ventricular outflow tract (LVOT) a laminar flow velocity directed to the aortic valve. The purpose of this study was to compare this flow velocity V(A*) in the LVOT with the flow velocity of the atrial contraction V(A), and the flow velocity of early diastole V(E) in LVIT, to determine whether such comparison would provide information concerning diastolic function. We studied three groups: 39 patients with left ventricular hypertrophy (HY) (mean age 56 +/- 12 y, 77% male), 41 patients with coronary heart disease (KHK) (mean age 53 +/- 10 y, 85% male) and 41 healthy subjects (N) (mean age 50 +/- 16 y, 51% male); all three groups were studied by pulsed Doppler from apical 4 chamber view in LVOT for maximal velocity (Vmax-A*) and time velocity integral of A* (TVI-A*), and in LVIT for maximal velocity of early diastole (Vmax-E), maximal velocity of atrial contraction (Vmax-A), ratio Vmax-E/Vmax-A, and the time velocity integrals (TVI-E, TVI-A). A slight correlation between Vmax-A* and Vmax-A was found (r = .60), being nearly the same as for TVI-A* and TVI-A (r = .64).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Radiofrequency ablation of atrial fibrillation.

UNLABELLED: Twenty-five patients (16 males, mean age 46 years) underwent radiofrequency ablation because of either paroxysmal (13 patients) or persistent atrial fibrillation (12 patients). Ablation aimed at earliest activation of spontaneous and catheter-induced repetitive ectopy in left and right atria and appendages, and pulmonary veins. Catheter-induced repetitive ectopy was defined as acute onset of a burst of rapid atrial premature beats on touching the wall, sustained irritability while at the spot and acute termination of rapid activity upon release of the catheter. Post-ablation patients received antiarrhythmic drugs to prevent tachycardias, thereby allowing reversal of atrial remodeling. RESULTS: Lone atrial fibrillation was present in 19 patients, 4 patients had hypertension and 2 patients coronary artery disease with preserved left ventricular function. The median duration of the history of atrial fibrillation was 4 years (range 1-14 years) and the median number of antiarrhythmic drug failures 5 (range 1-6). Ablation was successful, i.e. no recurrences of atrial fibrillation with or without antiarrhythmic drugs in eight patients (32%) during a median follow-up of 28 months (range 18-52). The median number of foci was 3 (range 2-6) and 2 (range 1-7) in the successfully and unsuccessfully treated patients, respectively. Minor complications occurred in three patients. CONCLUSIONS: Radiofrequency ablation of atrial fibrillation aiming at spontaneous and catheter-induced repetitive ectopy is a safe procedure. However, it is only successful in one third of the patients. Further investigations are warranted to identify the ideal patient, as well as to develop better ablation strategies.

Anti-Arrhythmia Agents↗
PubMed1970

The effect of physical training upon the mechanical and metabolic performance of the rat heart.

The dynamic and metabolic performance of rats conditioned by a swimming program (CH) and hearts of sedentary rats (SH) was studied in an isolated working rat heart apparatus. Heart rate, filling pressure, and afterload were controlled or kept constant, and heart weights were comparable in both groups. When compared with SH, CH had increased cardiac output and cardiac work. Atrial pacing at more rapid rates caused greater differences in these functions, and left ventricular pressure and maximal rate of pressure rise (dp/dt) became higher in CH than in SH. Atrial pacing was associated in CH with increased oxygen consumption but in SH by increased lactate and pyruvate production. When atrial filling pressure was elevated in order to perform ventricular function curves, CH showed greater dynamic responses than SH. There were also greater increments in oxygen consumption, and the ratio of aerobic to anaerobic energy production was also higher in CH. The mechanism of increasing oxygen consumption during stress in CH was mainly by improved coronary flow. In SH coronary flow did not change, but extraction of oxygen from the perfusing fluid increased. The results indicate that in physically trained rats the function of the heart as a pump is improved. These hearts have greater aerobic and mechanical reserve than hearts of sedentary animals. These effects appear to be at least partially due to improved mechanisms of oxygen delivery.

Animals↗
PubMed1995

[Syncopal ventricular tachycardia complicating paroxysmal atrial fibrillation in severe myocardial ischemia].

The authors report two cases of spontaneous paroxysmal atrial fibrillation closely followed by syncopal ventricular tachycardia resulting in cardiac arrest requiring defibrillation. Both patients, men aged 62 and 64 years, had a past history of myocardial infarction without arrhythmias; atrial fibrillation occurred during severe myocardial ischaemia; coronary arteriography showed tight stenoses of the left main coronary artery with normal left ventricular function. Ventricular tachycardia (or fibrillation) during spontaneous paroxysmal atrial fibrillation is a rare occurrence. This sequence of events has been described in patients with accessory conduction pathways or in hypertrophic cardiomyopathy. It is an exceptionally rare complication of ischemic heart disease with only a very few previously reported cases. Myocardial ischaemia is probably the cause of the arrhythmia in together with irregularity of the ventricular contractions responsible for long cycle-short cycle sequences which are particularly arrhythmogenic and changes in sympathetic tone.

Atrial Fibrillation↗