WorldWideScience

Sample records for atrial fibrillation undergoing

  1. Galectin-3 in patients undergoing ablation of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Nicolas Clementy

    2014-11-01

    Conclusions: Persistent type of atrial fibrillation is an independent predictor of higher Galectin-3 concentration. This biomarker of fibrosis may be implied in the mechanisms of atrial remodeling and maintenance of atrial fibrillation, and thus be helpful for the design of therapeutic strategy in patients with atrial fibrillation.

  2. Galectin-3 in patients undergoing ablation of atrial fibrillation

    OpenAIRE

    Nicolas Clementy; Eric Piver; Nazih Benhenda; Anne Bernard; Bertrand Pierre; Edouard Siméon; Laurent Fauchier; Jean-Christophe Pagès; Dominique Babuty

    2014-01-01

    Background: Mechanisms of maintenance of atrial fibrillation are known to include fibrosis. Galectin-3, as a biomarker of fibrosis, may be a valuable marker of atrial remodeling. We sought to find whether there was a link between clinical features and higher galectin-3 levels in patients with atrial fibrillation. Methods: Serum concentrations of Galectin-3 were determined in a consecutive series of patients addressed for ablation of atrial fibrillation. Results: One-hundred-and-eighty-s...

  3. Atrial Ectopics Precipitating Atrial Fibrillation

    OpenAIRE

    Johnson Francis

    2015-01-01

    Holter monitor tracing showing blocked atrial ectopics and atrial ectopic precipitating atrial fibrillation is being demonstrated. Initially it was coarse atrial fibrillation, which rapidly degenerated into fine atrial fibrillation.

  4. Anticoagulation in patients with atrial fibrillation undergoing coronary stent implantation.

    Science.gov (United States)

    Bernard, A; Fauchier, L; Pellegrin, C; Clementy, N; Saint Etienne, C; Banerjee, A; Naudin, D; Angoulvant, D

    2013-09-01

    In patients with atrial fibrillation (AF) undergoing coronary stent implantation, the optimal antithrombotic strategy is unclear. We evaluated whether use of oral anticoagulation (OAC) was associated with any benefit in morbidity or mortality in patients with AF, high risk of thromboembolism (TE) (CHA2DS2-VASC score ≥ 2) and coronary stent implantation. Among 8,962 unselected patients with AF seen between 2000 and 2010, a total of 2,709 (30%) had coronary artery disease and 417/2,709 (15%) underwent stent implantation while having CHA2DS2-VASC score ≥ 2. During follow-up (median=650 days), all TE, bleeding episodes, and major adverse cardiac events (i.e. death, acute myocardial infarction, target lesion revascularisation) were recorded. At discharge, 97/417 patients (23%) received OAC, which was more likely to be prescribed in patients with permanent AF and in those treated for elective stent implantation. The incidence of outcome event rates was not significantly different in patients treated and those not treated with OAC. However, in multivariate analysis, the lack of OAC at discharge was independently associated with increased risk of death/stroke/systemic TE (relative risk [RR] =2.18, 95% confidence interval [CI] 1.02-4.67, p=0.04), with older age (RR =1.12, 1.04-1.20, p=0.003), heart failure (RR =3.26, 1.18-9.01, p=0.02), and history of stroke (RR =18.87, 3.11-111.11, p=0.001). In conclusion, in patients with AF and high thromboembolic risk after stent implantation, use of OAC was independently associated with decreased risk of subsequent death/stroke/systemic TE, suggesting that OAC should be systematically used in this patient population. PMID:23846210

  5. Atrial Fibrillation: Diagnosis

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Atrial Fibrillation Atrial Fibrillation: Diagnosis Past Issues / Winter 2015 Table of Contents ... of your body's cells and organs. Read More "Atrial Fibrillation" Articles Atrial Fibrillation / Who Is at Risk for ...

  6. Atrial fibrillation

    NARCIS (Netherlands)

    Lip, Gregory Y H; Fauchier, Laurent; Freedman, Saul B; Van Gelder, Isabelle; Natale, Andrea; Gianni, Carola; Nattel, Stanley; Potpara, Tatjana; Rienstra, Michiel; Tse, Hung-Fat; Lane, Deirdre A

    2016-01-01

    Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, and increases in prevalence with increasing age and the number of cardiovascular comorbidities. AF is characterized by a rapid and irregular heartbeat that can be asymptomatic or lead to symptoms such as palpitations, dys

  7. Atrial fibrillation

    DEFF Research Database (Denmark)

    Olesen, Morten S; Nielsen, Morten W; Haunsø, Stig;

    2014-01-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting 1-2% of the general population. A number of studies have demonstrated that AF, and in particular lone AF, has a substantial genetic component. Monogenic mutations in lone and familial AF, although rare, have been recognized...

  8. Atrial Fibrillation and Stroke

    Science.gov (United States)

    ... Find People About NINDS NINDS Atrial Fibrillation and Stroke Information Page Table of Contents (click to jump ... done? Clinical Trials What is Atrial Fibrillation and Stroke? Atrial fibrillation (AF) describes the rapid, irregular beating ...

  9. Atrial Fibrillation: Treatment

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Atrial Fibrillation Atrial Fibrillation: Treatment Past Issues / Winter 2015 Table of Contents Treatment for atrial fibrillation depends on how often you have symptoms, how ...

  10. Living with Atrial Fibrillation

    Science.gov (United States)

    ... Topics » Atrial Fibrillation » Living With Atrial Fibrillation Explore Atrial Fibrillation What Is... Types Other Names Causes Who Is at Risk Signs & Symptoms Diagnosis Treatments Prevention Living With Clinical Trials Links Related Topics Arrhythmia ...

  11. Connexin Remodeling Contributes to Atrial Fibrillation

    OpenAIRE

    Michelle M Jennings; J Kevin Donahue

    2013-01-01

    Atrial fibrillation significantly contributes to mortality and morbidity through increased risk of stroke, heart failure and myocardial infarcts. Investigations of mechanisms responsible for the development and maintenance of atrial fibrillation have highlighted the importance of gap junctional remodeling. Connexins 40 and 43, the major atrial gap junctional proteins, undergo considerable alterations in expression and localization in atrial fibrillation, creating an environment conducive to s...

  12. Temporal changes in patient characteristics and prior pharmacotherapy in patients undergoing radiofrequency ablation of atrial fibrillation

    DEFF Research Database (Denmark)

    Karasoy, Deniz; Gislason, Gunnar Hilmar; Hansen, Jim; Olesen, Jonas Bjerring; Torp-Pedersen, Christian; Johannessen, Arne; Hansen, Morten Lock

    2013-01-01

    Trends in patient selection and pharmacotherapy before radiofrequency ablation (RFA) of atrial fibrillation are not well studied. We examined temporal trends in RFA utilization on a nationwide scale in Denmark.......Trends in patient selection and pharmacotherapy before radiofrequency ablation (RFA) of atrial fibrillation are not well studied. We examined temporal trends in RFA utilization on a nationwide scale in Denmark....

  13. Atrial fibrillation.

    Science.gov (United States)

    Lip, Gregory Y H; Fauchier, Laurent; Freedman, Saul B; Van Gelder, Isabelle; Natale, Andrea; Gianni, Carola; Nattel, Stanley; Potpara, Tatjana; Rienstra, Michiel; Tse, Hung-Fat; Lane, Deirdre A

    2016-01-01

    Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, and increases in prevalence with increasing age and the number of cardiovascular comorbidities. AF is characterized by a rapid and irregular heartbeat that can be asymptomatic or lead to symptoms such as palpitations, dyspnoea and dizziness. The condition can also be associated with serious complications, including an increased risk of stroke. Important recent developments in the clinical epidemiology and management of AF have informed our approach to this arrhythmia. This Primer provides a comprehensive overview of AF, including its epidemiology, mechanisms and pathophysiology, diagnosis, screening, prevention and management. Management strategies, including stroke prevention, rate control and rhythm control, are considered. We also address quality of life issues and provide an outlook on future developments and ongoing clinical trials in managing this common arrhythmia. PMID:27159789

  14. Atrial fibrillation - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000237.htm Atrial fibrillation - discharge To use the sharing features on this ... have been in the hospital because you have atrial fibrillation . This condition occurs when your heart beats faster ...

  15. Atrial fibrillation or flutter

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000184.htm Atrial fibrillation or flutter To use the sharing features on this page, please enable JavaScript. Atrial fibrillation or flutter is a common type of abnormal ...

  16. Atrial Fibrillation: Complications

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Atrial Fibrillation Atrial Fibrillation: Complications Past Issues / Winter 2015 Table of Contents ... has two major complications—stroke and heart failure. Atrial Fibrillation and Stroke Click to enlarge image This illustration ...

  17. Atrial Fibrillation in Children

    Science.gov (United States)

    ... Pressure High Blood Pressure Tools & Resources Stroke More Atrial Fibrillation in Children Updated:Jul 18,2016 Does your ... content was last reviewed on 04/16/14. Atrial Fibrillation • Introduction • What is Atrial Fibrillation? • Why AFib Matters • ...

  18. Atrial Fibrillation Factsheet

    Science.gov (United States)

    Atrial Fibrillation Atrial fibrillation, often called AFib or AF, is the most common type of heart arrhythmia. An arrhythmia is when the ... Atrium Sinoatrial Node (pacemaker) Atrioventricular Node Left Atrium Atrial Fibrillation AFib Facts 1 • An estimated 2.7–6. ...

  19. Atrial fibrillation (acute onset)

    OpenAIRE

    Lip, Gregory Y. H.; Watson, Timothy

    2008-01-01

    Acute atrial fibrillation is rapid, irregular, and chaotic atrial activity of less than 48 hours' duration. It resolves spontaneously within 24 to 48 hours in over 50% of people. In this review we have included studies on patients with onset up to 7 days previously. Risk factors for acute atrial fibrillation include increasing age, CVD, alcohol abuse, diabetes, and lung disease.Acute atrial fibrillation increases the risk of stroke and heart failure.

  20. Atrial Fibrillation and Hyperthyroidism*

    OpenAIRE

    2005-01-01

    Atrial fibrillation occurs in 10 – 15% of patients with hyperthyroidism. Low serum thyrotropin concentration is an independent risk factor for atrial fibrillation. Thyroid hormone contributes to arrythmogenic activity by altering the electrophysiological characteristics of atrial myocytes by shortening the action potential duration, enhancing automaticity and triggered activity in the pulmonary vein cardio myocytes. Hyperthyroidism results in excess mortality from increased incidence of circu...

  1. How Is Atrial Fibrillation Treated?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Is Atrial Fibrillation Treated? Treatment for atrial fibrillation (AF) depends on ... too much thyroid hormone). Who Needs Treatment for Atrial Fibrillation? People who have AF but don't have ...

  2. How Is Atrial Fibrillation Diagnosed?

    Science.gov (United States)

    ... Atrial Fibrillation » How Is Atrial Fibrillation Diagnosed? Explore Atrial Fibrillation What Is... Types Other Names Causes Who Is at Risk Signs & Symptoms Diagnosis Treatments Prevention Living With Clinical Trials Links Related Topics Arrhythmia ...

  3. Atrial Fibrillation and Heart Failure

    Directory of Open Access Journals (Sweden)

    William G. Stevenson, M.D

    2008-07-01

    Full Text Available Atrial fibrillation is common in heart failure patients and is associated with increased mortality. Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy. It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect. Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of anti-arrhythmic drug therapy. Data from randomized trials demonstrating a survival benefit for patients undergoing an ablation procedure for atrial fibrillation are still lacking. Ablation of the AV junction and permanent pacing remain a treatment alternative in otherwise refractory cases. Placement of a biventricular system may prevent or reduce negative consequences of chronic right ventricular pacing. Current objectives and options for treatment of atrial fibrillation in heart failure patients are reviewed.

  4. Factors related to sinus rhythm at discharge after radiofrequency ablation of permanent atrial fibrillation in patients undergoing mitral valve surgery.

    Science.gov (United States)

    Rostagno, Carlo; Gelsomino, Sandro; Capecchi, Irene; Rossi, Alessandra; Montesi, Gian Franco; Stefàno, Pier Luigi

    2016-04-01

    Late recovery of sinus rhythm is unusual in patients with permanent AF treated by (radiofrequency) RF maze procedure during mitral valve surgery. Identification of clinical and instrumental preoperative factors predictive of early success of RF ablation in patients with permanent AF undergoing mitral valve surgery may improve selection of subjects to obtain long-term results. Hundred and thirty consecutive patients with permanent AF and mitral valve disease underwent modified RF maze procedure during concomitant mitral valve surgery. Rheumatic valve disease (61 pts) and mitral valve prolapse (41 pts) were the more common aetiology of valve abnormalities. Mitral valve replacement was performed in 54 % of patients and mitral valve repair in the remaining 46 %. Four patients died after surgery. At discharge, 87 patients (69 %) were in sinus rhythm (group 1) and 43 patients in AF persisted (group 2). At an average 24-month follow-up, sinus rhythm was present in 67 % of patients, and 33 % were in atrial fibrillation. In this period, late recovery of sinus rhythm was observed only in five patients, while eight discharged in sinus rhythm developed again atrial fibrillation. Among preoperative parameters at univariate analysis female sex, atrial fibrillation >24 months, left atrial diameter >54 mm, left atrial area >24 cm(2), rheumatic valve disease and NYHA class were associated with persistence of AF. At Cox regression multivariate analysis, increased left atrial area (OR 1.07 per unit increase-95 % CI 1.01-1.131) and rheumatic aetiology of valve disease (OR 4.52, 95 % CI 1.65-12.4) were associated with persistence of AF at hospital discharge. Persistence of AF after RF ablation in patients undergoing mitral valve surgery is related to aetiology, e.g. rheumatic valve disease, and to increasing left atrial diameter. Due to low rate of late recovery of sinus rhythm, indication to RF ablation associated with MV surgery should be carefully considered in patients with large

  5. Renal Impairment and Prognosis of Patients with Atrial Fibrillation Undergoing Coronary Intervention - The AFCAS Trial.

    Directory of Open Access Journals (Sweden)

    Heli M Lahtela

    Full Text Available Renal impairment is a well-known risk factor for cardiovascular complications, but the effect of different stages of renal impairment on thrombotic/thromboembolic and bleeding complications in patients with atrial fibrillation (AF undergoing percutaneous coronary intervention (PCI remains largely unknown. We sought to evaluate the incidence and clinical impact of four stages of renal impairment in patients with AF undergoing PCI.We assessed renal function by estimated glomerular filtration rate (eGFR and outcomes in 781 AF patients undergoing PCI by using the data from a prospective European multicenter registry. End-points included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE and bleeding events at 12 months.A total of 195 (25% patients had normal renal function (eGFR ≥90 mL/min, 290 (37% mild renal impairment (eGFR 60-89, 263 (34% moderate renal impairment (eGFR 30-59 and 33 (4% severe renal impairment (eGFR <30. Degree of renal impairment remained an independent predictor of mortality and MACCE in an adjusted a Cox regression model. Even patients with mild renal impairment had a higher risk of all-cause mortality (HR 2.25, 95%CI 1.02-4.98, p=0.04 and borderline risk for MACCE (HR 1.56, 95%CI 0.98- 2.50, p=0.06 compared to those with normal renal function.Renal impairment is common in patients with AF undergoing PCI and even mild renal impairment has an adverse prognostic effect in these patients requiring multiple antithrombotic medications.

  6. The Safety of Dabigatran Versus Warfarin in Patients Undergoing Atrial Fibrillation Ablation

    Directory of Open Access Journals (Sweden)

    Luis I. Garcia, MD; Kartikya Ahuja, MD; Mark A. Mascarenhas, MD; Anthony Aizer, MD; Neil Bernstein, MD; Scott A. Bernstein, MD; Steve J. Fowler, MD; Douglas S. Holmes, MD; David S. Park, MD; Larry Chinitz, MD

    2014-02-01

    Full Text Available The safety and optimal strategy of the use of dabigatran versus uninterrupted warfarin in atrial fibrillation ablation is currently unclear. We performed a retrospective analysis between July 2011-October 2012 of all patients undergoing an AF ablation who received uninterrupted warfarin therapy (199 and the routine cessation of Dabigatran therapy (126 4 days pre-ablation. Major safety endpoints included: pericardial effusion (requiring pericardiocentesis, peripheral thromboembolism, CVA, and groin hematoma requiring blood transfusion. Minor endpoints included pericardial effusion and groin hematoma. Dabigatran was restarted the following day after ablation. The warfarin group was older, had a higher CHADS2, CHA2DS2VASc and HASBLED scores and greater prevalence of aortic plaque. The major complication rate was 2.0% in the warfarin group and 2.4% in the dabigatran group (P= 0.83. The minor complication rate was 2.5% in the warfarin group and <1% in the dabigatran group (P= 0.27. In the dabigatran group, there was one renal thromboembolic event 4 days post-ablation. All patients in the warfarin group who suffered a major complication required a blood transfusion. Cessation of dabigatran therapy 4 days pre AF ablation has a comparable safety profile to uninterrupted warfarin therapy.

  7. The radiation risks for patients undergoing electrophysiology treatment of atrial fibrillation

    International Nuclear Information System (INIS)

    Full text: Atrial Fibrillation (AF) Ablations are complex electrophysiology (EP) procedures that have the potential to deliver significant radiation risk to the patient. The nature of AF is such that many patients require more than one procedure before a 'successful' outcome is achieved. This analysis aims to provide a better understanding of the radiation risks involved in EP treatment of AF. Methods Records for imaging procedures performed between January 1997 and May 2011 were reviewed. Analysis identified 439 AF ablation procedures on 293 patients (71 % male, median age 58, range 21-85). In total, these patients underwent 866 separate cardiac diagnostic, interventional, electrophysiology and device implant procedures. Effective Dose (E) estimates were derived for all procedures. 35% of patients had> I AF procedure (I patient undergoing 5). Actuarial analysis suggests freedom from return for follow-up AF ablation at 5 years of 65%. Reviewing all cardiac imaging histories for the 293 patients shows 60% had> I procedure (5% having >4) and 44% underwent cardiac procedures other than AF ablations. E for individual procedures ranged to 28 mSv with cumulative E for AF and all cardiac procedures ranging to 38 mSv and 80 mSv respectively. Many patients also underwent CT procedures to acquire 3D datasets for use in AF ablations (risk not assessed here). These findings suggest that the true radiation risk associated with AF ablation treatment is greater than that reported for an individual procedure. Every effort must therefore be taken to pursue techniques and technologies that limit radiation risk in these procedures.

  8. Anticoagulation in atrial fibrillation

    OpenAIRE

    Steinberg, Benjamin A; Piccini, Jonathan P.

    2014-01-01

    Atrial fibrillation increases the risk of stroke, which is a leading cause of death and disability worldwide. The use of oral anticoagulation in patients with atrial fibrillation at moderate or high risk of stroke, estimated by established criteria, improves outcomes. However, to ensure that the benefits exceed the risks of bleeding, appropriate patient selection is essential. Vitamin K antagonism has been the mainstay of treatment; however, newer drugs with novel mechanisms are also availabl...

  9. Limited posterior left atrial linear radiofrequency ablation for patients with chronic atrial fibrillation undergoing rheumatic valvular heart surgery

    Institute of Scientific and Technical Information of China (English)

    王均志; 杜日映; 丁会霞; 柏本健; 王刚; 崔国方; 钟志欢

    2004-01-01

    @@ Since 1996, we have begun to successfully treat atrial fibrillation (AF) with the maze procedure, replacing surgical incisions with radiofrequency (RF) ablation.1,2 Recent data show that the posterior wall of the left atrium seems to be a critical area for the occurrence and the maintenance of AF in patients with valvular heart disease. The objective of this study was to evaluate whether limited surgical RF ablation of the posterior region of the left atrium is safe and effective in curing chronic AF in patients also suffering from valvular heart disease.

  10. Can Atrial Fibrillation Be Prevented?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. How Can Atrial Fibrillation Be Prevented? Following a healthy lifestyle and taking ... risk for heart disease may help you prevent atrial fibrillation (AF). These steps include: Following a heart healthy ...

  11. Anticoagulation in atrial fibrillation.

    Science.gov (United States)

    Steinberg, Benjamin A; Piccini, Jonathan P

    2014-01-01

    Atrial fibrillation increases the risk of stroke, which is a leading cause of death and disability worldwide. The use of oral anticoagulation in patients with atrial fibrillation at moderate or high risk of stroke, estimated by established criteria, improves outcomes. However, to ensure that the benefits exceed the risks of bleeding, appropriate patient selection is essential. Vitamin K antagonism has been the mainstay of treatment; however, newer drugs with novel mechanisms are also available. These novel oral anticoagulants (direct thrombin inhibitors and factor Xa inhibitors) obviate many of warfarin's shortcomings, and they have demonstrated safety and efficacy in large randomized trials of patients with non-valvular atrial fibrillation. However, the management of patients taking warfarin or novel agents remains a clinical challenge. There are several important considerations when selecting anticoagulant therapy for patients with atrial fibrillation. This review will discuss the rationale for anticoagulation in patients with atrial fibrillation; risk stratification for treatment; available agents; the appropriate implementation of these agents; and additional, specific clinical considerations for treatment. PMID:24733535

  12. Atrial Fibrillation (AF or AFib)

    Science.gov (United States)

    ... Pressure High Blood Pressure Tools & Resources Stroke More Atrial Fibrillation (AF or AFib) Updated:Feb 10,2016 What ... to the Terms and Conditions and Privacy Policy Atrial Fibrillation • Introduction • What is Atrial Fibrillation? • Why AFib Matters • ...

  13. Preventing bleeding and thromboembolic complications in atrial fibrillation patients undergoing surgery

    Directory of Open Access Journals (Sweden)

    Charles André

    2015-08-01

    Full Text Available Neurologists feel uneasy when asked about temporary anticoagulant interruption for surgery in patients with atrial fibrillation (AF. Rational decisions can be made based on current scientific evidence. Method Critical review of international guidelines and selected references pertaining to bleeding and thromboembolism during periods of oral anticoagulant interruption. Results Withholding oral anticoagulants leads to an increased risk of perioperative thromboembolism, depending on factors such as age, renal and liver function, previous ischemic events, heart failure etc. Surgeries are associated with a variable risk of bleeding - from minimal to very high. Individualized decisions about preoperative drug suspension, bridging therapy with heparin and time to restart oral anticoagulants after hemostasis can significantly reduce these opposing risks. Conclusion Rational decisions can be made after discussion with all Health care team professionals involved and consideration of patient fears and expectations. Formal written protocols should help managing antithrombotic treatment during this delicate period.

  14. Atrial Fibrillation and Pacing Algorithms

    OpenAIRE

    Terranova, Paolo; Severgnini, Barbara; Valli, Paolo; Dell'Orto, Simonetta; Greco, Enrico Maria

    2006-01-01

    Pacing prevention algorithms have been introduced in order to maximize the benefits of atrial pacing in atrial fibrillation prevention. It has been demonstrated that algorithms actually keep overdrive atrial pacing, reduce atrial premature contractions, and prevent short-long atrial cycle phenomenon, with good patient tolerance. However, clinical studies showed inconsistent benefits on clinical endpoints such as atrial fibrillation burden. Factors which may be responsible for neutral results ...

  15. Atrial Fibrillation and Heart Failure

    Directory of Open Access Journals (Sweden)

    Jens Seiler

    2008-07-01

    Full Text Available Atrial fibrillation is common in heart failure patients and is associated with increased mortality.  Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy.  It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect.  Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of anti-arrhythmic drug therapy.  Data from randomized trials demonstrating a survival benefit for patients undergoing an ablation procedure for atrial fibrillation are still lacking.  Ablation of the AV junction and permanent pacing remain a treatment alternative in otherwise refractory cases.  Placement of a biventricular system may prevent or reduce negative consequences of chronic right ventricular pacing.  Current objectives and options for treatment of atrial fibrillation in heart failure patients are reviewed. 

  16. Effects of perioperative statin treatment on postoperative atrial fibrillation and cardiac mortality in patients undergoing coronary artery bypass grafting: a propensity score analysis

    Directory of Open Access Journals (Sweden)

    Ayşegül Kunt

    2015-08-01

    Full Text Available Aim To evaluate the effect of perioperative statin treatment on postoperative atrial fibrillation and cardiac mortality in patients undergoing coronary artery bypass grafting. Methods A total of 1890 patients who underwent isolated coronary artery bypass were analyzed retrospectively, of which 425 patients (22.4% older than 70 were included in the study. The demographic properties, preoperative, operative and postoperative data and other medications of these patients were recorded. Continuous preoperative and postoperative atorvastatin therapy were received by 124 (29.17% patients; 301 (70.82% patients were matched to a control group (no-statin group. The two groups were matched by propensity score analysis in terms of atrial fibrillation development and cardiac mortality. Results Medical history, medical treatment, cardiovascular history, and operative characteristics demonstrated significant heterogeneity in both groups. Postoperative atrial fibrillation was similar in both groups. Before propensity score matching, the percentages of patients in postoperative atrial fibrillation with respect to Atorvastain-group and No-statin-group were 13.71 and 10.3 respectively; however, those were 13.71 and 14.51 after matching. In a multivariate regression analysis, five-vessel bypass (odds ratio OR, 2.354; 95% confidence interval CI, 0.99 to 5.57 was an independent predictor of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. In-hospital mortality was higher in the Atorvastatin-group compared with the No-statingroup: 124 (8.9% versus 301 (3.7%, respectively; p=0.027. Conclusion Perioperative atorvastatin treatment is not found to be associated with reduced postoperative atrial fibrillation and cardiac mortality in patients undergoing isolated coronary artery bypass grafting above the age of seventy years.

  17. The Atrial Fibrillation Ablation Pilot Study

    DEFF Research Database (Denmark)

    Arbelo, Elena; Brugada, Josep; Hindricks, Gerhard;

    2014-01-01

    AIMS: The Atrial Fibrillation Ablation Pilot Study is a prospective registry designed to describe the clinical epidemiology of patients undergoing an atrial fibrillation (AFib) ablation, and the diagnostic/therapeutic processes applied across Europe. The aims of the 1-year follow-up were to analyse...... left atrial tachycardia, and 4 patients died (1 haemorrhagic stroke, 1 ventricular fibrillation in a patient with ischaemic heart disease, 1 cancer, and 1 of unknown cause). CONCLUSION: The AFib Ablation Pilot Study provided crucial information on the epidemiology, management, and outcomes of catheter...

  18. What Is Atrial Fibrillation?

    Science.gov (United States)

    ... regular beat. Certain cells in your heart make electric signals that cause the heart to contract and pump blood. These electrical signals show up on an elec- trocardiogram (ECG) recording. Your doctor can read your ECG to find out if the electric signals are normal. In atrial fibrillation (AFib), the ...

  19. Lesson Five Atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    鲁端; 吴文烈

    2003-01-01

    @@ Atrial fibrillation(AF) may occur in paroxysmaland persistent forms. It may be seen in normal subjects,particularly during emotional stress or follow-ing surgery,exercise, or acute alcoholic intoxication.It also may occur in patients with heart or lungdisease who develop acute hypoxia, hypercapnia,ormetabolic or hemodynamic derangements.

  20. Stroke prevention in atrial fibrillation.

    NARCIS (Netherlands)

    Verheugt, F.W.A.

    2006-01-01

    The only major and potentially fatal risk for patients with atrial fibrillation is the development of systemic thromboembolism. Stroke occurs five times more frequently in patients with atrial fibrillation than in comparable patients in sinus rhythm. The yearly incidence of stroke in atrial fibrilla

  1. ATRIAL FIBROSIS IS A MORPHOLOGICAL BASIS OF ATRIAL FIBRILLATION

    OpenAIRE

    DRAPKINA O.M.; A. V. Emelyanov

    2015-01-01

    Mechanisms of atrial fibrosis including the role of serotonin in the development of this lesion in patients with atrial fibrillation are presented. New approaches to the treatment of atrial fibrillation aimed at atrial fibrosis reduction are discussed.

  2. Periprocedural anticoagulation of patients undergoing pericardiocentesis for cardiac tamponade complicating catheter ablation of atrial fibrillation.

    Science.gov (United States)

    Lin, Tao; Bai, Rong; Chen, Ying-wei; Yu, Rong-hui; Tang, Ri-bo; Sang, Cai-hua; Li, Song-nan; Ma, Chang-sheng; Dong, Jian-zeng

    2015-01-01

    Anticoagulation of patients with cardiac tamponade (CT) complicating catheter ablation of atrial fibrillation (AF) is an ongoing problem. The aim of this study was to survey the clinical practice of periprocedural anticoagulation in such patients. This study analyzed the periprocedural anticoagulation of 17 patients with CT complicating AF ablation. Emergent pericardiocentesis was performed once CT was confirmed. The mean drained volume was 410.0 ± 194.1 mL. Protamine sulfate was administered to neutralize heparin (1 mg neutralizes 100 units heparin) in 11 patients with persistent pericardial bleeding and vitamin K1 (10 mg) was given to reverse warfarin in 3 patients with supratherapeutic INR (INR > 2.1). Drainage catheters were removed 12 hours after echocardiography confirmed absence of intrapericardial bleeding and anticoagulation therapy was restored 12 hours after removing the catheter. Fifteen patients took oral warfarin and 10 of them were given subcutaneous injection of LMWH (1 mg/kg, twice daily) as a bridge to resumption of systemic anticoagulation with warfarin. Two patients with a small amount of persistent pericardial effusion were given LMWH on days 5 and 13, and warfarin on days 6 and 24. The dosage of warfarin was adjusted to keep the INR within 2-3 in all patients. After 12 months of follow-up, all patients had no neurological events and no occurrence of delayed CT. The results showed that it was effective and safe to resume anticoagulation therapy 12 hours after removal of the drainage catheter. This may help to prevent thromboembolic events following catheter ablation of AF. PMID:25503659

  3. Risk Factors for Atrial Fibrillation

    OpenAIRE

    Krijthe, Bouwe

    2013-01-01

    textabstractAtrial fibrillation is a common cardiac arrhythmia that is characterized by rapid disorganized atrial electrical activity resulting in absence of atrial contractions. It is diagnosed on the basis of typical findings on an electrocardiogram (ECG). The characteristic ECG findings are absence of P-waves, and an irregular heart rate. Symptoms of atrial fibrillation include palpitations, dyspnea, reduced exercise capacity, chest pain and dizziness, but it often goes without symptoms. A...

  4. Management of atrial fibrillation

    OpenAIRE

    Vergara, Pasquale; Della Bella, Paolo

    1997-01-01

    Atrial fibrillation (AF) is associated with increases in the risk of mortality, congestive heart failure, and stroke. Medical treatment is aimed at preventing thrombo-embolic complications and reducing symptoms and consequences related to the arrhythmia. In the first section of this review, we discuss the principles of mainstream oral anticoagulant therapy and the possible advantages of the new oral anticoagulants. In the second section, we review the catheter ablation approaches to paroxysma...

  5. Anticoagulation in Atrial Fibrillation

    OpenAIRE

    Ahmad, Yousif; YH Lip, Gregory

    2012-01-01

    Patients with atrial fibrillation (AF) are at increased thromboembolic risk, and they suffer more severe strokes with worse outcomes. Most thromboembolic complications of AF are eminently preventable with oral anticoagulation, and the increasing numbers of AF patients mean antithrombotic therapy is the most crucial management aspect of this common arrhythmia. Despite the proven efficacy of warfarin, a string of limitations have meant that it is underused by physicians and patients alike. This...

  6. Rivaroxaban in atrial fibrillation

    OpenAIRE

    Giorgi MA; Miguel LS

    2012-01-01

    Mariano A Giorgi,1,2 Lucas San Miguel31Cardiology Service, Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”, 2Department of Pharmacology, School of Medicine, Universidad Austral, 3Department of Cardiology and Cardiovascular Surgery, FLENI, Buenos Aires, ArgentinaAbstract: Warfarin is the traditional therapeutic option available to manage thromboembolic risk in atrial fibrillation. The hemorrhagic risk with warfarin de...

  7. Antithrombotic therapy in anticoagulated patients with atrial fibrillation presenting with acute coronary syndromes and/or undergoing percutaneous coronary intervention/stenting

    Directory of Open Access Journals (Sweden)

    Benjamin J. Wrigley

    2010-07-01

    Full Text Available The management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary inter vention/stenting cannot be done according to a regimented common protocol, and stroke and bleeding risk stratification schema should be employed to individualize treatment options. A delicate balance is needed between the prevention of thromboembolism, against recurrent cardiac ischemia or stent thrombosis, and bleeding risk. New guidance from a consensus document of the European Society of Cardiology Working Group on Thrombosis, endorsed by the European Heart Rhythm Association and the European Association ofPercutaneous Cardiovascular Interventions on the management of Antithrombotic Therapy in Atrial Fibrillation Patients Presenting with Acute Coronary Syndrome and/or Undergoing Percutaneous Coronary Intervention/Stenting has sought to clarify some of the major issues and problems surrounding this practice, and will allow clinicians to make much more informed decisions when faced with treating such patients.

  8. Hyperuricemia and Atrial Fibrillation.

    Science.gov (United States)

    Maharani, Nani; Kuwabara, Masanari; Hisatome, Ichiro

    2016-07-27

    The importance of atrial fibrillation (AF) as a cause of mortality and morbidity has prompted research on its pathogenesis and treatment. Recognition of AF risk factors is essential to prevent it and reduce the risk of death. Hyperuricemia has been widely accepted to be associated with the incidence of paroxysmal or persistent AF, as well as to the risk of AF in post cardiovascular surgery patients. The possible explanations for this association have been based on their relation with either oxidative stress or inflammation. To investigate the link between hyperuricemia and AF, it is necessary to refer to hyperuricemia-induced atrial remodeling. So far, both ionic channel and structural remodeling caused by hyperuricemia might be plausible explanations for the occurrence of AF. Inhibition of xanthine oxidase and nicotinamide adenine dinucleotide phosphate (NADPH)-oxidase, or the use of antioxidants, along with serum uric acid (SUA) level reduction to prevent inflammation, might be useful. Uric acid transporters (UATs) play a key role in the regulation of intracellular uric acid concentration. Intracellular rather than serum uric acid level is considered more important for the pathogenesis of AF. Identification of UATs expressed in cells is thus important, and targeting UATs might become a potential strategy to reduce the risk of hyperuricemia-induced atrial fibrillation. PMID:27396561

  9. Atrial fibrillation in the elderly

    Institute of Scientific and Technical Information of China (English)

    Roberto A.Franken; Ronaldo F.Rosa; Silvio CM Santos

    2012-01-01

    This review discusses atrial fibrillation according to the guidelines of Brazilian Society of Cardiac Arrhythmias and the Brazilian Cardiogeriatrics Guidelines. We stress the thromboembolic burden of atrial fibrillation and discuss how to prevent it as well as the best way to conduct cases of atrial fibrillatios in the elderly, reverting the arrhythmia to sinus rhythm, or the option of heart rate control. The new methods to treat atrial fibrillation, such as radiofrequency ablation, new oral direct thrombin inhibitors and Xa factor inhibitors, as well as new antiarrhythmic drugs, are depicted.

  10. Evaluation of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Francis E. Marchlinski

    2008-05-01

    Full Text Available Atrial fibrillation (AF is a supraventricular tachyarrhythmia characterized by uncoordinated atrial activation. On the ECG fibrillatory (f waves (rapid oscillations with variable amplitude, shape and timing replace normal P waves. Ventricular response becomes irregular and rapid depending of the intrinsic electrophysiological properties of the AV node1 and the balance between vagal and sympathetic tone1. The presence of an irregularly pulse is a clinical sign that can be quickly and reliably identified in any healthcare situation and, indicates AF with a high sensitivity and specificity (95% and 75%, respectively. If the irregularity last for more than 20 seconds the specificity reaches 98% 2-4. Identification of AF can be done by using manual pulse palpation in those presenting with a variety of symptoms. It is desirable to check the blood pressure and pulse in all patients who present with breathlessness, dyspnea, palpitations, syncope, dizziness or chest discomfort. Furthermore, many patients presenting with an acute stroke are found to be in AF albeit asymptomatic with respect to non-neurologic complaints. The finding of a sustained irregular wide QRS complex tachycardia may be suspicious of AF conducted with bundle brunch aberrancy or over an accessory pathway, and in patients with A-V sequential pacemakers can reflect an inadequate configuration with ventricular tracking of sensed atrial activity.

  11. Incidence and Severity of Coronary Artery Disease in Patients with Atrial Fibrillation Undergoing First-Time Coronary Angiography

    OpenAIRE

    Kralev, Stefan; Schneider, Kathrin; Lang, Siegfried; Süselbeck, Tim; Borggrefe, Martin

    2011-01-01

    Background In standard reference sources, the incidence of coronary artery disease (CAD) in patients with atrial fibrillation (AF) ranged between 24 and 46.5%. Since then, the incidence of cardiovascular risk factors (CRF) has increased and modern treatment strategies (“pill in the pocket”) are only applicable to patients without structural heart disease. The aim of this study was to investigate the incidence and severity of CAD in patients with AF. Methods From January 2005 until December 20...

  12. Primary prevention of atrial fibrillation with beta-blockers in patients with end-stage renal disease undergoing dialysis

    OpenAIRE

    Ting-Tse Lin; Jiun-Yang Chiang; Min-Tsun Liao; Chia-Ti Tsai; Juey Jen Hwang; Fu-Tien Chiang; Jiunn-Lee Lin; Lian-Yu Lin

    2015-01-01

    Current evidence suggests that beta-blocker lower the risk of development of atrial fibrillation (AF) and in-hospital stroke after cardiac surgery. This study was to assess whether beta-blockers could decrease incidence of new-onset AF in patients with end stage renal disease (ESRD). We identified patients from a nation-wide database called Registry for Catastrophic Illness, which encompassed almost 100% of the patients receiving dialysis therapy in Taiwan from 1995 to 2008. Propensity score ...

  13. Postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting or cardiac valve surgery: intraoperative use of landiolol

    OpenAIRE

    Nakanishi Kazuhiro; Takeda Shinhiro; Kim Chol; Kohda Shusuke; Sakamoto Atsuhiro

    2013-01-01

    Abstract Background Landiolol hydrochloride is a new β-adrenergic blocker with a pharmacological profile that suggests it can be administered safely to patients who have sinus tachycardia or tachyarrhythmia and who require heart rate reduction. This study aimed to investigate whether intraoperative administration of landiolol could reduce the incidence of atrial fibrillation (AF) after cardiac surgery. Methods Of the 200 consecutive patients whose records could be retrieved between October 20...

  14. Incidence and severity of coronary artery disease in patients with atrial fibrillation undergoing first-time coronary angiography.

    Directory of Open Access Journals (Sweden)

    Stefan Kralev

    Full Text Available BACKGROUND: In standard reference sources, the incidence of coronary artery disease (CAD in patients with atrial fibrillation (AF ranged between 24 and 46.5%. Since then, the incidence of cardiovascular risk factors (CRF has increased and modern treatment strategies ("pill in the pocket" are only applicable to patients without structural heart disease. The aim of this study was to investigate the incidence and severity of CAD in patients with AF. METHODS: From January 2005 until December 2009, we included 261 consecutive patients admitted to hospital with paroxysmal, persistent or permanent AF in this prospective study. All patients underwent coronary angiography and the Framingham risk score (FRS was calculated. Patients with previously diagnosed or previously excluded CAD were excluded. RESULTS: The overall incidence of CAD in patients presenting with AF was 34%; in patients >70 years, the incidence of CAD was 41%. The incidence of patients undergoing a percutaneous coronary intervention (PCI or coronary artery bypass graft (CABG was 21%. Patients with CAD were older (73±8 years vs 68±10 years, p = 0.001, had significantly more frequent hypercholesterolemia (60% vs 30%, p<0.001, were more frequent smokers (26% vs 13%, p = 0.017 and suffered from angina more often (37% vs 2%, p<0.001. There was a significant linear trend among the FRS categories in percentage and the prevalence of CAD and PCI/CABG (p<0.0001. CONCLUSIONS: The overall incidence of CAD in patients presenting with AF was relatively high at 34%; the incidence of PCI/CABG was 21%. Based upon increasing CRF in the western world, we recommend a careful investigation respecting the FRS to either definitely exclude or establish an early diagnosis of CAD--which could contribute to an early and safe therapeutic strategy considering type Ic antiarrhythmics and oral anticoagulation.

  15. Atrial Fibrillation and Heart Failure

    OpenAIRE

    Jens Seiler; Tedrow, Usha B.; Stevenson, William G

    2008-01-01

    Atrial fibrillation is common in heart failure patients and is associated with increased mortality.  Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy.  It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect.  Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of a...

  16. Atrial Fibrillation and Heart Failure

    OpenAIRE

    William G. Stevenson, M.D; Usha B. Tedrow, M.D; Jens Seiler, M.D

    2008-01-01

    Atrial fibrillation is common in heart failure patients and is associated with increased mortality. Pharmacologic trials have not shown any survival benefit for a rhythm control over a rate control strategy. It has been suggested that sinus rhythm is associated with a survival benefit, but that the risks of anti-arrhythmic drug treatment and poor efficacy offset the beneficial effect. Catheter ablation for atrial fibrillation can establish sinus rhythm without the risks of anti-arrhythmic dru...

  17. Antithrombotic therapy in atrial fibrillation.

    OpenAIRE

    Chin, B.; Lip, G. Y.

    1996-01-01

    OBJECTIVE: To review the evidence for antithrombotic therapy in patients with nonrheumatic atrial fibrillation. QUALITY OF EVIDENCE: Five primary prevention trials and one secondary prevention trial compare antithrombotic therapy with placebo or no treatment. Two trials also determine the efficacy and safety of acetylsalicylic acid. MAIN FINDINGS: Warfarin reduces the risk of stroke by 68%. The effect is consistent in all identifiable groups of patients with nonrheumatic atrial fibrillation, ...

  18. Stroke prevention in atrial fibrillation.

    OpenAIRE

    Michael Katsnelson,; Sebastian Koch; Tatjana Rundek

    1997-01-01

    Non-valvular atrial fibrillation is a common and from a neurological perspective the most significant cardiac arrhythmia with a growing world-wide incidence. It also carries a significant associated morbidity and mortality, with cardioembolic strokes arguably being the most disabling sequelae. This brief review will highlight the important studies and the latest treatment modalities available for stroke prevention in patients with non-valvular atrial fibrillation.

  19. Prognostic value of strain and strain rate in the prediction of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting: a systematic literature review

    Directory of Open Access Journals (Sweden)

    Leila Bigdelu

    2016-03-01

    Full Text Available Introduction: Atrial fibrillation (AF is a common dysrhythmia postoperatively after coronary artery bypass grafting (CABG. Myocardial strain and strain-rate imaging is used for the assessment of postoperative atrial fibrillation (POAF as a new echocardiographic method. Methods: PubMed and Scopus were searched thoroughly using the following search terms: (strain and strain rate AND (atrial fibrillation OR AF on March 2015 to find English articles in which the strain and strain-rate echocardiographic imaging had been used for the evaluation of AF in patients undergone CABG. Full text of the relevant papers was fully reviewed for data extraction.Result: Of overall 6 articles found in PubMed, 10 records found in Scopus and 4 articles found through reference list search, only 6 papers fully met the inclusion criteria for further assessment and data extraction. The results of strain and strain-rate assessment showed that in total of 542 patients undergoing CABG, POAF occurred in 106 patients. Studies showed that the reduction of left atrial (LA strain rate is correlated with AF. Consistently, the results of present review showed that LA strain and strain-rate in patients who developed AF postoperatively after CABG are significantly reduced, suggesting that strain and strain-rate could be a predictor of POAF.Conclusion: Based on the obtained results, strain and strain-rate is a suitable and accurate echocardiographic technique in the assessment of left atrial function , and it might be helpful to detect the patients who are at high risk of POAF.

  20. Evaluation of the Pulmonary Veins and Left Atrial Volume using Multidetector Computed Tomography in Patients Undergoing Catheter Ablation for Atrial Fibrillation

    OpenAIRE

    Ito, Hiroki; Dajani, Khaled A.

    2009-01-01

    Catheter ablation is an evolving treatment option in patients with atrial fibrillation. Contrast enhanced electrocardiogram-gated multi-detector computed tomography (MDCT) has rapidly evolved over the past few years into an important tool in the diagnosis of coronary atherosclerosis. There is increasing recognition that MDCT is a useful tool to evaluate non-coronary structures, such as cardiac chambers, valves, the coronary sinus and adjacent structures including pulmonary veins. In particula...

  1. Postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting or cardiac valve surgery: intraoperative use of landiolol

    Directory of Open Access Journals (Sweden)

    Nakanishi Kazuhiro

    2013-01-01

    Full Text Available Abstract Background Landiolol hydrochloride is a new β-adrenergic blocker with a pharmacological profile that suggests it can be administered safely to patients who have sinus tachycardia or tachyarrhythmia and who require heart rate reduction. This study aimed to investigate whether intraoperative administration of landiolol could reduce the incidence of atrial fibrillation (AF after cardiac surgery. Methods Of the 200 consecutive patients whose records could be retrieved between October 2006 and September 2007, we retrospectively reviewed a total of 105 patients who met the inclusion criteria: no previous permanent/persistent AF, no permanent pacemaker, no renal insufficiency requiring dialysis, and no reactive airway disease, etc. Landiolol infusion was started after surgery had commenced, at an infusion rate of 1 μg/kg/min, titrated upward in 3–5 μg/kg/min increments. The patients were divided into 2 groups: those who received intraoperative β-blocker therapy with landiolol (landiolol group and those who did not receive any β-blockers during surgery (control group. An unpaired t test and Fisher’s exact test were used to compare between-group differences in mean values and categorical data, respectively. Results Seventeen of the 105 patients (16.2% developed postoperative atrial fibrillation: 5/57 (8.8% in the landiolol group and 12/48 (25% in the control group. There was a significant difference between the two groups (P=0.03. The incidence of AF after valve surgery and off-pump coronary artery bypass grafting was lower in the landiolol group, although the difference between the groups was not statistically significant. Conclusions Our retrospective review demonstrated a marked reduction of postoperative AF in those who received landiolol intraoperatively. A prospective study of intraoperative landiolol for preventing postoperative atrial fibrillation is warranted.

  2. Prognostic impact of hs-CRP and IL-6 in patients undergoing radiofrequency catheter ablation for atrial fibrillation

    DEFF Research Database (Denmark)

    Henningsen, Kristoffer Mads Aaris; Nilsson, Brian; Bruunsgaard, Helle;

    2008-01-01

    Aim. The aim of this study was to assess the predictive value of inflammatory markers in patients with paroxysmal/ persistent atrial fibrillation (AF) treated with radiofrequency (RF) catheter ablation. Methods. Forty-six consecutive patients, mean age 55 years (range 31 - 81 yrs), with paroxysmal...... history of paroxysmal or persistent AF treated with RF catheter ablation, elevated levels of IL-6 and hs-CRP before ablation are independent predictors of recurrence of AF Udgivelsesdato: 2008/12/31...... or persistent AF were treated with either segmental or circumferential pulmonary vein isolation ablation technique. All patients presented with sinus rhythm on inclusion. Holter monitoring lasting at least 14 days was performed before ablation and after 3 months. Recurrent symptomatic AF or atrial...

  3. Prevention of Recurrent Atrial Fibrillation and Bi-Atrial Resynchronization

    OpenAIRE

    Evrard, P.; Sakalihasan, Natzi; R. Garcia; Van Laere, Anne-Sophie; Patterson, B.

    1999-01-01

    After conversion of atrial fibrillation, it is important to maintain sinus rhythm. In addition antiarrhythmic drugs, biatrial resynchronization seems to prevent recurrences of atrial fibrillation in patients with interatrial conduction block: local experience.

  4. Who Is at Risk for Atrial Fibrillation?

    Science.gov (United States)

    ... Who Is at Risk for Atrial Fibrillation? Explore Atrial Fibrillation What Is... Types Other Names Causes Who Is at Risk Signs & Symptoms Diagnosis Treatments Prevention Living With Clinical Trials Links Related Topics Arrhythmia ...

  5. Obstructive sleep apnea in atrial fibrillation patients.

    Science.gov (United States)

    Arias, Miguel A; Alonso-Fernández, Alberto; García-Río, Francisco; Sánchez, Ana; López, Juana M; Pagola, Carlos

    2006-06-28

    A high prevalence of obstructive sleep apnea has been demonstrated in patients with atrial fibrillation. Our comments want to emphasize the importance of identifying and treating a large proportion of patients with atrial fibrillation who have undiagnosed obstructive sleep apnea as an additional preventive strategy for atrial fibrillation patients. PMID:16309764

  6. Atrial fibrillation post cardiac bypass surgery

    OpenAIRE

    Mostafa, Ashraf; EL-Haddad, Mohamed A.; Shenoy, Maithili; Tuliani, Tushar

    2012-01-01

    Atrial fibrillation occurs in 5-40% patients after coronary artery bypass graft surgery. Atrial fibrillation increases mortality and morbidity in the post-operative period. We sought to conduct a comprehensive review of literature focusing on pathophysiology, risk factors, prevention and treatment of post coronary artery bypass graft atrial fibrillation.

  7. Surgical Ablation of Atrial Fibrillation

    OpenAIRE

    Ramlawi, Basel; Abu Saleh, Walid K.

    2015-01-01

    The Cox-maze procedure for the restoration of normal sinus rhythm, initially developed by Dr. James Cox, underwent several iterations over the years. The main concept consists of creating a series of transmural lesions in the right and left atria that disrupt re-entrant circuits responsible for propagating the abnormal atrial fibrillation rhythm. The left atrial appendage is excluded as a component of the Maze procedure. For the first three iterations of the Cox- maze procedure, these lesions...

  8. Atrial fibrillation and delayed gastric emptying.

    Directory of Open Access Journals (Sweden)

    Isadora C Botwinick

    Full Text Available BACKGROUND: Atrial fibrillation and delayed gastric emptying (DGE are common after pancreaticoduodenectomy. Our aim was to investigate a potential relationship between atrial fibrillation and DGE, which we defined as failure to tolerate a regular diet by the 7(th postoperative day. METHODS: We performed a retrospective chart review of 249 patients who underwent pancreaticoduodenectomy at our institution between 2000 and 2009. Data was analyzed with Fisher exact test for categorical variables and Mann-Whitney U or unpaired T-test for continuous variables. RESULTS: Approximately 5% of the 249 patients included in the analysis experienced at least one episode of postoperative atrial fibrillation. Median age of patients with atrial fibrillation was 74 years, compared with 66 years in patients without atrial fibrillation (p = 0.0005. Patients with atrial fibrillation were more likely to have a history of atrial fibrillation (p = 0.03. 92% of the patients with atrial fibrillation suffered from DGE, compared to 46% of patients without atrial fibrillation (p = 0.0007. This association held true when controlling for age. CONCLUSION: Patients with postoperative atrial fibrillation are more likely to experience delayed gastric emptying. Interventions to manage delayed gastric function might be prudent in patients at high risk for postoperative atrial fibrillation.

  9. Surgical Ablation of Atrial Fibrillation.

    Science.gov (United States)

    Ramlawi, Basel; Abu Saleh, Walid K

    2015-01-01

    The Cox-maze procedure for the restoration of normal sinus rhythm, initially developed by Dr. James Cox, underwent several iterations over the years. The main concept consists of creating a series of transmural lesions in the right and left atria that disrupt re-entrant circuits responsible for propagating the abnormal atrial fibrillation rhythm. The left atrial appendage is excluded as a component of the Maze procedure. For the first three iterations of the Cox- maze procedure, these lesions were performed using a surgical cut-and-sew approach that ensured transmurality. The Cox-Maze IV is the most currently accepted iteration. It achieves the same lesion set of the Cox- maze III but uses alternative energy sources to create the transmural lesions, potentially in a minimally invasive approach on the beating heart. High-frequency ultrasound, microwave, and laser energy have all been used with varying success in the past. Today, bipolar radiofrequency heat or cryotherapy cooling are the most accepted sources for creating linear lesions with consistent safety and transmurality. The robust and reliable nature of these energy delivery methods has yielded a success rate reaching 90% freedom from atrial fibrillation at 12 months. Such approaches offer a significant long-term advantage over catheter-based ablation, especially in patients having longstanding, persistent atrial fibrillation with characteristics such as dilated left atrial dimensions, poor ejection fraction, and failed catheter ablation. Based on these improved results, there currently is significant interest in developing a hybrid ablation strategy that incorporates the superior transmural robust lesions of surgical ablation, the reliable stroke prevention potential of epicardial left atrial appendage exclusion, and sophisticated mapping and confirmatory catheter-based ablation technology. Such a minimally invasive hybrid strategy for ablation may lead to the development of multidisciplinary "Afib teams" to

  10. QUest for the Arrhythmogenic Substrate of Atrial fibRillation in Patients Undergoing Cardiac Surgery (QUASAR Study): Rationale and Design.

    Science.gov (United States)

    van der Does, Lisette J M E; Yaksh, Ameeta; Kik, Charles; Knops, Paul; Lanters, Eva A H; Teuwen, Christophe P; Oei, Frans B S; van de Woestijne, Pieter C; Bekkers, Jos A; Bogers, Ad J J C; Allessie, Maurits A; de Groot, Natasja M S

    2016-06-01

    The heterogeneous presentation and progression of atrial fibrillation (AF) implicate the existence of different pathophysiological processes. Individualized diagnosis and therapy of the arrhythmogenic substrate underlying AF may be required to improve treatment outcomes. Therefore, this single-center study aims to identify the arrhythmogenic areas underlying AF by intra-operative, high-resolution, multi-site epicardial mapping in 600 patients with different heart diseases. Participants are divided into 12 groups according to the underlying heart diseases and presence of prior AF episodes. Mapping is performed with a 192-electrode array for 5-10 s during sinus rhythm and (induced) AF of the entire atrial surface. Local activation times are converted into activation and wave maps from which various electrophysiological parameters are derived. Postoperative cardiac rhythm registrations and a 5-year follow-up will show the incidence of postoperative and persistent AF. This project provides the first step in the development of a tool for individual AF diagnosis and treatment. PMID:26935733

  11. Surgical Treatment of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Naghmeh Moshtaghi

    2008-12-01

    Full Text Available Atrial fibrillation is the most prevalent permanent arrhythmia. It may be associated with other cardiac pathologies which need surgical treatment. Various types of surgery including the traditional cut-sew operations and operations using different energy sources are currently in use. In comparison with medical treatment, surgery is safe, effective, and has reliable results.

  12. Personalized management of atrial fibrillation

    DEFF Research Database (Denmark)

    Kirchhof, Paulus; Breithardt, Günter; Aliot, Etienne;

    2013-01-01

    The management of atrial fibrillation (AF) has seen marked changes in past years, with the introduction of new oral anticoagulants, new antiarrhythmic drugs, and the emergence of catheter ablation as a common intervention for rhythm control. Furthermore, new technologies enhance our ability to de...

  13. What Are the Signs and Symptoms of Atrial Fibrillation?

    Science.gov (United States)

    ... Twitter. What Are the Signs and Symptoms of Atrial Fibrillation? Atrial fibrillation (AF) usually causes the heart's lower ... Chest pain Dizziness or fainting Fatigue (tiredness) Confusion Atrial Fibrillation Complications AF has two major complications— stroke and ...

  14. Risk of atrial fibrillation in diabetes mellitus

    DEFF Research Database (Denmark)

    Pallisgaard, Jannik L.; Schjerning, Anne-Marie; Lindhardt, Tommi B.;

    2016-01-01

    AIM: Diabetes has been associated with atrial fibrillation but the current evidence is conflicting. In particular knowledge regarding young diabetes patients and the risk of developing atrial fibrillation is sparse. The aim of our study was to investigate the risk of atrial fibrillation in patients...... with diabetes compared to the background population in Denmark. METHODS AND RESULTS: Through Danish nationwide registries we included persons above 18 years of age and without prior atrial fibrillation and/or diabetes from 1996 to 2012. The study cohort was divided into a background population without...... diabetes and a diabetes group. The absolute risk of developing atrial fibrillation was calculated and Poisson regression models adjusted for sex, age and comorbidities were used to calculate incidence rate ratios of atrial fibrillation. The total study cohort included 5,081,087 persons, 4,827,713 (95%) in...

  15. Almanac 2015: atrial fibrillation research in Heart.

    Science.gov (United States)

    Jawad-Ul-Qamar, Muhammad; Kirchhof, Paulus

    2016-04-15

    Atrial fibrillation continues to attract interest in the cardiovascular community and inHeart Over 60 original research and review papers published inHeartin 2014-2015 cover various aspects of atrial fibrillation, from associated conditions and precipitating factors to new approaches to management. Here, we provide an overview of articles on atrial fibrillation published inHeartin 2014-2015, highlighting new developments, emerging concepts and novel approaches to treatment. PMID:26791994

  16. Minimally Invasive Surgical Therapies for Atrial Fibrillation

    OpenAIRE

    Chu, Michael W.A.; Yoshitsugu Nakamura; Bob Kiaii

    2012-01-01

    Atrial fibrillation is the most common sustained arrhythmia and is associated with significant risks of thromboembolism, stroke, congestive heart failure, and death. There have been major advances in the management of atrial fibrillation including pharmacologic therapies, antithrombotic therapies, and ablation techniques. Surgery for atrial fibrillation, including both concomitant and stand-alone interventions, is an effective therapy to restore sinus rhythm. Minimally invasive surgical ablat...

  17. Postoperative atrial fibrillation, oxidative stress, and inflammation

    OpenAIRE

    ÖZAYDIN, Mehmet

    2011-01-01

    Postoperative atrial fibrillation is the most common complication of cardiac surgery. It is associated with increased complication rates. Recent trials have suggested that inflammation and oxidative stress have key roles in the pathophysiology of atrial fibrillation. Current evidence evaluating the use of antiinflammatory and antioxidant agents, including statins, corticosteroids, N-acetylcysteine, vitamin C, and fish oil, to prevent postoperative atrial fibrillation is promising. However, la...

  18. Atrial fibrillation: inflammation in disguise?

    Science.gov (United States)

    Lappegård, K T; Hovland, A; Pop, G A M; Mollnes, T E

    2013-08-01

    Atrial fibrillation is highly prevalent, and affected patients are at an increased risk of a number of complications, including heart failure and thrombo-embolism. Over the past years, there has been increasing interest in the role of inflammatory processes in atrial fibrillation, from the first occurrence of the arrhythmia to dreaded complications such as strokes or peripheral emboli. As the standard drug combination which aims at rate control and anticoagulation only offers partial protection against complications, newer agents are needed to optimize treatment. In this paper, we review recent knowledge regarding the impact of inflammation on the occurrence, recurrence, perpetuation and complications of the arrhythmia, as well as the role of anti-inflammatory therapies in the treatment for the disease. PMID:23672430

  19. Nonfluoroscopic Ablation of Atrial Fibrillation Using Cryoballoon

    Directory of Open Access Journals (Sweden)

    Mansour Razminia, M.D., F.A.C.C.; Hany Demo, M.D.; Carlos Arrieta-Garcia, M.D.;

    2014-10-01

    Full Text Available Background: The conventional method of cryoballoon ablation of atrial fibrillation involves the use of fluoroscopy for visual guidance. The use of fluoroscopy is accompanied by significant radiation risks to the patient and the medical staff. Herein, we report our experience in performing successful nonfluoroscopic pulmonary vein isolation using cryoballoon ablation in 5 consecutive patients with paroxysmal atrial fibrillation Methods and Results: Five consecutive patients with paroxysmal atrial fibrillation underwent cryoballoon ablation for pulmonary vein isolation using a nonfluoroscopic approach. Pre-procedural cardiac computed tomography or cardiac magnetic resonance imaging was not performed in any patient. A total of twenty pulmonary veins were identified and successfully isolated (100% with the guidance of intracardiac echocardiography and 3-dimensional electroanatomic mapping. No fluoroscopy was used for the procedures. There were no major procedural adverse events. Conclusion: In an unselected group of patients undergoing cryoballoon ablation, a nonfluoroscopic approach is feasible and can be performed safely and effectively while eliminating the risks associated with radiation to both the patient and the medical staff.

  20. Aspirin Often Wrongly Prescribed for Atrial Fibrillation

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_159459.html Aspirin Often Wrongly Prescribed for Atrial Fibrillation Blood thinners -- not aspirin -- dramatically cut the risk of stroke, researchers say ...

  1. Present treatment options for atrial fibrillation

    OpenAIRE

    Lairikyengbam, S; Anderson, M.,; Davies, A

    2003-01-01

    Atrial fibrillation is the commonest sustained cardiac arrhythmia. It accounts for >35% of all hospital admissions for cardiac arrhythmias in the United States. The presence of atrial fibrillation increases the mortality of a population by up to twofold. The risk of stroke increases from 1.5% in patients with atrial fibrillation from 50–59 years of age to up to 23.5% for such patients aged 80–89 years. Although the diagnosis of atrial fibrillation is usually straightforward, effective treatme...

  2. Mapping Atrial Fibrillation: 2015 Update

    OpenAIRE

    Chirag R. Barbhayia; Saurabh Kumar; Gregory F. Michaud

    2015-01-01

    Atrial fibrillation requires a trigger that initiates the arrhythmia and substrate that favors perpetuation. Cardiac mapping is necessary to locate triggers and substrate so that an ablation strategy can be optimized. The most commonly used cardiac mapping approach is isochronal or activation mapping, which aims to create a spatial model of electrical wavefront propagation. Historically, activation mapping has been successful for mapping point source and single or double wave reentrant arr...

  3. Atrial fibrillation care improvement collaborative

    OpenAIRE

    Robelia, Paul; Kopecky, Stephen; Thacher, Tom

    2015-01-01

    Atrial fibrillation (AF) is an increasingly common cardiac arrhythmia. Many patients with new onset or recurrent AF present to the emergency department and are subsequently admitted to the hospital and seen by cardiology specialists for follow up. In an attempt to address this high utilization of acute health care resources, reduce costs, and improve patient care, our institution instituted a collaborative project between the departments of emergency medicine, cardiology, family medicine, and...

  4. Atrial fibrillation in the elderly

    Institute of Scientific and Technical Information of China (English)

    Roger Kerzner; Michael W. Rich

    2005-01-01

    Atrial fibrillation (AF) is an extremely common condition in the elderly, with increasing prevalence around the world as the population ages. AF may be associated with serious health consequences, including stroke, heart failure, and decreased quality of life, so that careful management of AF by geriatric health care providers is required. With careful attention to anticoagulation therapy, and prudent use of medications and invasive procedures to minimize symptoms, many of the adverse health consequences of AF can be prevented.

  5. Atrial remodeling, fibrosis, and atrial fibrillation.

    Science.gov (United States)

    Jalife, José; Kaur, Kuljeet

    2015-08-01

    The fundamental mechanisms governing the perpetuation of atrial fibrillation (AF), the most common arrhythmia seen in clinical practice, are poorly understood, which explains in part why AF prevention and treatment remain suboptimal. Although some clinical parameters have been identified as predicting a transition from paroxysmal to persistent AF in some patients, the molecular, electrophysiological, and inflammation changes leading to such a progression have not been described in detail. Oxidative stress, atrial dilatation, calcium overload, inflammation, microRNAs, and myofibroblast activation are all thought to be involved in AF-induced atrial remodeling. However, it is unknown to what extent and at which time points such alterations influence the remodeling process that perpetuates AF. Here we postulate a working model that might open new pathways for future investigation into mechanisms of AF perpetuation. We start from the premise that the progression to AF perpetuation is the result of interplay among manifold signaling pathways with differing kinetics. Some such pathways have relatively fast kinetics (e.g., oxidative stress-mediated shortening of refractory period); others likely depend on molecular processes with slower kinetics (e.g., transcriptional changes in myocyte ion channel protein expression mediated through inflammation and fibroblast activation). We stress the need to fully understand the relationships among such pathways should one hope to identify novel, truly effective targets for AF therapy and prevention. PMID:25661032

  6. PAROXYSMAL ATRIAL FIBRILLATION: CHOICE OF CARDIOVERSION THERAPY

    Directory of Open Access Journals (Sweden)

    B. A. Tatarskii

    2015-12-01

    Full Text Available Characteristics and classification of different patterns of paroxysmal atrial fibrillation are presented. Main indications to restoration of sinus rhythm are discussed. The features of main medications used to terminate of atrial fibrillation are given. The choice of antiarrhythmic drug is considerate. Necessity of individual approach to therapy tactics is proved.

  7. Atrial fibrillation after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Nair Suresh

    2010-01-01

    Full Text Available Once considered as nothing more than a nuisance after cardiac surgery, the importance of postoperative atrial fibrillation (POAF has been realized in the last decade, primarily because of the morbidity associated with the condition. Numerous causative factors have been described without any single factor being singled out as the cause of this complication. POAF has been associated with stroke, renal failure and congestive heart failure, although it is difficult to state whether POAF is directly responsible for these complications. Guidelines have been formulated for prevention of POAF. However, very few cardiothoracic centers follow any form of protocol to prevent POAF. Routine use of prophylaxis would subject all patients to the side effects of anti-arrhythmic drugs, while only a minority of the patients do actually develop this problem postoperatively. Withdrawal of beta blockers in the postoperative period has been implicated as one of the major causes of POAF. Amiodarone, calcium channel blockers and a variety of other pharmacological agents have been used for the prevention of POAF. Atrial pacing is a non-pharmacological measure which has gained popularity in the prevention of POAF. There is considerable controversy regarding whether rate control is superior to rhythm control in the treatment of established atrial fibrillation (AF. Amiodarone plays a central role in both rate control and rhythm control in postoperative AF. Newer drugs like dronedarone and ranazoline are likely to come into the market in the coming years.

  8. RELATION BETWEEN LEFT ATRIAL SIZE AND ATRIAL FIBRILLATION IN DIFFERENT DISEASES

    OpenAIRE

    Rajith; Divya

    2014-01-01

    BACKGROUND: Atrial fibrillation is the most common cardiac dysrhythmia and left atrial size is an important factor in the development of atrial fibrillation. In the presence of atrial fibrillation an increase in left atrial size is associated with increased risk of stroke as well as increased morbidity and mortality. In this context, this study entitled “relation between left atrial size and atrial fibrillation in different diseases” was undertaken to study the left atrial size in different d...

  9. Implementation of antithrombotic management in atrial fibrillation

    OpenAIRE

    Lairikyengbam, S; Davies, A; Jones, P.

    2000-01-01

    The aim of the study was to assess the extent to which published recommendations on the antithrombotic management of atrial fibrillation had been adopted into clinical practice in a busy district general hospital, and the impact of clinical audit on subsequent management. In the initial audit, 185 consecutive patients with atrial fibrillation were studied using their case notes to identify any further clinical risk factors for stroke. A management algorithm stratified patients with atrial fib...

  10. Current Issues in Atrial Fibrillation

    OpenAIRE

    Khaykin, Yaariv; Shamiss, Yana

    2012-01-01

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It places an enormous burden on the patients, caregivers, and the society at large. While the main themes in the care of an AF patient have not changed over the years and continue to focus on stroke prevention, control of the ventricular, rate and rhythm maintenance, there have been a number of new developments in each of these realms. This paper will discuss the “hot” topics in AF in 2012 including new and upcoming med...

  11. The preventive effect of statin therapy on new-onset and recurrent atrial fibrillation in patients not undergoing invasive cardiac interventions ☆

    DEFF Research Database (Denmark)

    Bang, Casper Niels Furbo; Greve, Anders M; Abdulla, Jawdat;

    2013-01-01

    BACKGROUND: Previous meta-analyses suggest that pre-procedural use of statin therapy may reduce atrial fibrillation (AF) following invasive cardiac interventions (coronary artery by-pass grafting and percutaneous coronary intervention). However, the current evidence on the benefit of statins unre...

  12. Subclinical Atrial Fibrillation and the Risk of Stroke

    NARCIS (Netherlands)

    Healey, Jeff S.; Connolly, Stuart J.; Gold, Michael R.; Israel, Carsten W.; Van Gelder, Isabelle C.; Capucci, Alessandro; Lau, C. P.; Fain, Eric; Yang, Sean; Bailleul, Christophe; Morillo, Carlos A.; Carlson, Mark; Themeles, Ellison; Kaufman, Elizabeth S.; Hohnloser, Stefan H.

    2012-01-01

    BACKGROUND One quarter of strokes are of unknown cause, and subclinical atrial fibrillation may be a common etiologic factor. Pacemakers can detect subclinical episodes of rapid atrial rate, which correlate with electrocardiographically documented atrial fibrillation. We evaluated whether subclinica

  13. Atrial Fibrosis and the Mechanisms of Atrial Fibrillation

    OpenAIRE

    Everett, Thomas H; Olgin, Jeffrey E.

    2006-01-01

    Atrial fibrillation (AF) is commonly associated with congestive heart failure (CHF), and CHF has been shown to be associated with atrial structural remodeling resulting in fibrosis. This atrial interstitial fibrosis has been seen in patients with CHF and animal models of pacing induced heart failure. With atrial fibrosis, conduction abnormalities result in an increase in AF vulnerability. The mechanism of AF that is associated with CHF is still under debate as both focal and reentrant mechani...

  14. Predictors of left atrial appendage stunning after electrical cardioversion of non-valvular atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    杨沙宁; 黄从新; 胡晓军; 金立军; 李凤翥; 彭水先

    2003-01-01

    Objective To identify predictors of left atrial appendage stunning after the use of electrical cardioversion to restore sinus rhythm in patients with non-valvular atrial fibrillation.Methods A total of 68 consecutive patients (45 men, 23 women, 60.5±8.7 years of age) with non-valvular atrial fibrillation undergoing electrical cardioversion were enlisted in this study. Clinical and echocardiographic variables were analyzed by univariate regression and multivariate logistic regression to investigate the relationship between occurrences of left atrial appendage stunning and these factors. Results Univariate analysis revealed that, in comparing patients without and with left atrial appendage stunning, there were significant differences in the duration of atrial fibrillation > 8 weeks (32.3% vs 75.5%, P 50 mm (29.0% vs 54.1%, P 8 weeks (OR=7.249, 95%CI=1.998-26.304, P 50 mm (OR=3.896, 95%CI=1.105-13.734, P8 weeks, left atrial diameter >50 mm, left ventricular ejection fraction <50%, and cumulative energy of electrical cardioversion are independent predictors of left atrial appendage stunning. Anticoagulation treatment should be individualized for patients undergoing electrical cardioversion to reduce the risk of both cardioversion-related thromboembolic events and hemorrhagic complications caused by warfarin treatment.

  15. Persistent atrial fibrillation in a goat model of chronic left atrial overload.

    NARCIS (Netherlands)

    Remes, J.; Brakel, T.J. van; Bolotin, G.; Garber, C.; Jong, MM de; Veen, FH van der; Maessen, J.G.

    2008-01-01

    OBJECTIVES: Atrial dilatation predisposes to atrial fibrillation. Although several animal models focus on the initiating mechanisms of atrial fibrillation in dilated atria, a model of left atrial overload resulting in persistent atrial fibrillation in nonanesthetized animals has not been presented t

  16. Genetics Home Reference: familial atrial fibrillation

    Science.gov (United States)

    ... or Free article on PubMed Central Roberts R. Mechanisms of disease: Genetic mechanisms of atrial fibrillation. Nat Clin Pract Cardiovasc Med. ... with a qualified healthcare professional . About Genetics Home Reference Site Map Contact Us Selection Criteria for Links ...

  17. Atrial Fibrillation - Multiple Languages: MedlinePlus

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Atrial Fibrillation URL of this page: https://medlineplus.gov/languages/atrialfibrillation.html Other topics A-Z A B ...

  18. Atrial Fibrillation During an Exploration Class Mission

    Science.gov (United States)

    Lipsett, Mark; Hamilton, Douglas; Lemery, Jay; Polk, James

    2011-01-01

    This slide presentation reviews a possible scenario of an astronaut having Atrial Fibrillation during a Mars Mission. In the case review the presentation asks several questions about the alternatives for treatment, medications and the ramifications of the decisions.

  19. Psychosomatic correlations in atrial fibrillations

    Directory of Open Access Journals (Sweden)

    Vladimir Ernstovich Medvedev

    2011-12-01

    Full Text Available Patients with atrial fibrillations (AF and comorbid mental disorders were examined. Two patient groups differing in the structure of psychosomatic ratios were identified. Group 1 comprised patients with AF and signs of reactivity lability that manifested itself as psychopathological reactions to the primary manifestations of AF; Group 2 included those who had developed mental disorders mainly in end-stage cardiovascular disease (predominantly a permanent form of AF in the presence of such events as chronic heart failure (CHF. The results of the study suggest that the patients with AF have frequently anxiety and hypochondriacal disorders, which agrees with the data available in the literature. In addition, end-stage AF is marked by depressive syndromes caused by the severe course of cardiovascular diseases resulting in CHF.

  20. Spontaneous onset of atrial fibrillation

    Science.gov (United States)

    Zemlin, Christian W.; Mitrea, Bogdan G.; Pertsov, Arkady M.

    2009-06-01

    Most commonly, atrial fibrillation is triggered by rapid bursts of electrical impulses originating in the myocardial sleeves of pulmonary veins (PVs). However, the nature of such bursts remains poorly understood. Here, we propose a mechanism of bursting consistent with the extensive empirical information about the electrophysiology of the PVs. The mechanism is essentially non-local and involves the spontaneous initiation of non-sustained spiral waves in the distal end of the muscle sleeves of the PVs. It reproduces the experimentally observed dynamics of the bursts, including their frequency, their intermittent character, and the unusual shape of the electrical signals in the pulmonary veins that are reminiscent of so-called early afterdepolarizations (EADs).

  1. Integrin β1 Participates in Atrial Remodeling in Rapid Atrial Pacing Induced Canine Atrial Fibrillation Model

    Institute of Scientific and Technical Information of China (English)

    Zhang wei; Yang guirong; Zheng zhaotong; Wang sujia; Zhang yun

    2004-01-01

    @@ Objective Integrin β1 regulates cell to cell and cell to extracellualr matrix interaction in heart. however, its pathop hysiological role in atrial fibrillation is unclear. The purpose of t his study was to determine whether atrial structural remodeling during atrial fibrillation is associated with altered integrinβ1.

  2. Predicting new-onset of postoperative atrial fibrillation in patients undergoing cardiac surgery using semi-automatic reading of perioperative electrocardiograms

    DEFF Research Database (Denmark)

    Gu, Jiwei; Graff, Claus; Melgaard, Jacob; Lundbye-Christensen, Søren; Schmidt, Erik Berg; Torp-Pedersen, Christian; Thorsteinsson, Kristinn; Andreasen, Jan Jesper

    2015-01-01

    ECG monitoring. A semi-automatic machine capable of reading differentparameters of digitalized ECG’s was used to read both lead specific (P/QRS/T amplitudes/intervals) and global measurements (P-duration/QRS-duration/PR-interval/QT/Heart Rate/hypertrophy).Results: We divided the patients into two......P10 Predicting new-onset of postoperative atrial fibrillation in patients undergoingcardiac surgery using semi-automatic reading of perioperative electrocardiograms. Jiwei Gu, Claus Graff, Jacob Melgaard, Søren Lundbye-Christensen, Erik Berg Schmidt, Christian Torp-Pedersen, Kristinn Thorsteinsson......, Jan Jesper Andreasen. Aalborg, DenmarkBackground: Postoperative new onset atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery. The aim of this study was to evaluate if semi-automatic readings of perioperative electrocardiograms (ECGs) is of any value in predicting POAF after...

  3. Atrial Fibrillation in Congestive Heart Failure

    OpenAIRE

    Lubitz, Steven A.; Benjamin, Emelia J.; Ellinor, Patrick T.

    2010-01-01

    Atrial fibrillation and congestive heart failure are morbid conditions that share common risk factors and frequently coexist. Each condition predisposes to the other, and the concomitant presence of the two identifies individuals at increased risk for mortality. Recent data have emerged which help elucidate the complex genetic and non-genetic pathophysiological mechanisms that contribute to the development of atrial fibrillation in individuals with congestive heart failure. Clinical trial res...

  4. Hypercoagulability causes atrial fibrosis and promotes atrial fibrillation

    NARCIS (Netherlands)

    Spronk, Henri M H; De Jong, Anne Margreet; Verheule, Sander; De Boer, Hetty C; Maass, Alexander H; Lau, Dennis H; Rienstra, Michiel; van Hunnik, Arne; Kuiper, Marion; Lumeij, Stijn; Zeemering, Stef; Linz, Dominik; Kamphuisen, Pieter Willem; Ten Cate, Hugo; Crijns, Harry J; Van Gelder, Isabelle C; van Zonneveld, Anton Jan; Schotten, Ulrich

    2016-01-01

    AIMS: Atrial fibrillation (AF) produces a hypercoagulable state. Stimulation of protease-activated receptors by coagulation factors provokes pro-fibrotic, pro-hypertrophic, and pro-inflammatory responses in a variety of tissues. We studied the effects of thrombin on atrial fibroblasts and tested the

  5. Left atrial appendage occlusion for stroke prevention in atrial fibrillation

    DEFF Research Database (Denmark)

    Tzikas, Apostolos; Shakir, Samera; Gafoor, Sameer;

    2015-01-01

    Aims: To investigate the safety, feasibility, and efficacy of left atrial appendage occlusion (LAAO) with the AMPLATZER Cardiac Plug (ACP) for stroke prevention in patients with atrial fibrillation (AF). Methods and results: Data from consecutive patients treated in 22 centres were collected. A...

  6. Acute treatment of atrial fibrillation.

    Science.gov (United States)

    Kowey, P R; Marinchak, R A; Rials, S J; Filart, R A

    1998-03-12

    Atrial fibrillation (AFib) is a common clinical entity, responsible for significant morbidity and mortality, but it also accounts for a large percentage of healthcare dollar expenditures. Efforts to treat this arrhythmia in the past have focused on subacute antithrombotic therapy and eventually use of antiarrhythmic drugs for maintenance of sinus rhythm. However, there has been a growing interest in the concept of acute electrical and pharmacologic conversion. This treatment strategy has a number of benefits, including immediate alleviation of patient symptoms, avoidance of antithrombotic therapy, and prevention of electrophysiologic remodeling, which is thought to contribute to the perpetuation of the arrhythmia. There is also increasing evidence that this is a cost-effective strategy in that it may obviate admission to the hospital and the cost of long-term therapy. This article represents a summary of the treatments that may be used acutely to control the ventricular response to AFib, prevent thromboembolic events, and provide for acute conversion either pharmacologically or electrically. It includes information on modalities that are currently available and those that are under active development. We anticipate that an active, acute treatment approach to AFib and atrial flutter will become the therapeutic norm in the next few years, especially as the benefits of these interventions are demonstrated in clinical trials. PMID:9525568

  7. Pulmonary vein orientation assessment: Is it necessary in patients undergoing contact force sensing guided radiofrequency catheter ablation of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Pim Gal

    2015-09-01

    Conclusions: This study shows that in patients undergoing PVI with the CFC ablation system, PV orientation does not affect CF and is not associated with AF free survival. PV orientation assessment does not appear to be necessary in patients undergoing CFC PVI.

  8. Refractory atrial fibrillation effectively treated with ranolazine

    OpenAIRE

    Vaishnav, Aditi; Vaishnav, Avani; Lokhandwala, Yash

    2014-01-01

    Atrial fibrillation is the most common sustained cardiac arrhythmia which is often troublesome to manage. Currently, rhythm and rate control medications are the mainstays of therapy. In 2 amiodarone-refractory highly symptomatic patients, an innovative approach using ranolazine, which selectively acts on Na+ channels and delays atrial depolarization, was tried successfully.

  9. The international normalized ratio (INR as seen in a population of patients with atrial fibrillation and cerebral infarction undergoing long-term treatment with vitamin K antagonists

    Directory of Open Access Journals (Sweden)

    Szczepańska-Szerej Anna

    2015-12-01

    Full Text Available It is estimated that nearly 20% of all cerebral infarctions in the total population are the result of a complication of atrial fibrillation (AF. While oral anticoagulation with vitamin K antagonists (AVKs substantially reduces this risk, this requires regular monitoring of the international normalized ratio (INR in order to achieve therapeutic levels (2,0-3,0. The aim of this study was to evaluate a group at high risk of cerebral infarction, among patients with AF undergoing long-term treatment with VKAs, taking into account the significance of therapeutic INR values. The analysed group consisted of 90 acute ischaemic stroke patients with paroxysmal or chronic “non-valvular” AF, receiving treatment with VKAs. As a result of the study, therapeutic INR values (≥ 2 were seen in thirty-five of these individuals (38,8%, while 55 (61,2% showed non-therapeutic INR values. Moreover, there were no differences in demographics, vascular risk factors, biochemical and morphological blood parameters, mean CHA2DS2-VASc score and TOAST classification between either of the two groups. Furthermore, no additional factor that would increase their risk of cerebral infarction during the adequate treatment with VKAs was found. However, patients with non-therapeutic INR values had a statistically significantly higher frequency of concomitant moderate pathology of the bicuspid valve, p<0.05. Hence, a lack of proper control of INR can proved to be particularly dangerous for this subgroup of patients. Hence, this is a group with an elevated risk of cerebral infarction and therefore requires special oversight of VKA treatment or NOA treatment.

  10. Effect of single intraoperative dose of amiodarone in patients with rheumatic valvular heart disease and atrial fibrillation undergoing valve replacement surgery

    Directory of Open Access Journals (Sweden)

    Selvaraj Thiruvenkadam

    2009-01-01

    Full Text Available Maintenance of sinus rhythm (SR is superior to rate control in atrial fibrillation (AF. In order to achieve SR, we administered single-dose intravenous amiodarone intraoperatively and evaluated its effect on conversion of rheumatic AF to SR in patients undergoing valvular heart surgery. Patients were randomly assigned to amiodarone ( n = 42 or control ( n = 40 group in a double blind manner. The amiodarone group received amiodarone (3 mg/kg intravenously prior to the institution of cardiopulmonary bypass and the control group received the same volume of normal saline. In the amiodarone group, the initial rhythm after the release of aortic cross clamp was noted to be AF in 14.3% ( n = 6 and remained so in 9.5% ( n = 4 of patients till the end of surgery. In the control group, the rhythm soon after the release of aortic cross clamp was AF in 37.5% ( n = 15 ( p = 0.035 and remained so in 32.5% ( n = 13 of patients till the end of surgery ( p = 0.01. At the end of first post-operative day 21.4% ( n = 9 of patients in amiodarone group and 55% ( n = 22 of patients in control group were in AF ( p = 0.002. The requirement of cardioversion/defibrillation was 1.5 (±0.54 in amiodarone group and 2.26 (±0.73 in the control group ( p = 0.014, and the energy needed was 22.5 (±8.86 joules in the amiodarone group and 40.53 (±16.5 in the control group ( p = 0.008. A single intraoperative dose of intravenous amiodarone increased the conversion rate of AF to normal sinus rhythm, reduced the need and energy required for cardioversion/defibrillation and reduced the recurrence of AF within one day.

  11. Effect of age on stroke prevention therapy in patients with atrial fibrillation: the atrial fibrillation investigators

    DEFF Research Database (Denmark)

    van Walraven, Carl; Hart, Robert G; Connolly, Stuart;

    2009-01-01

    BACKGROUND AND PURPOSE: Stroke risk increases with age in patients who have nonvalvular atrial fibrillation. It is uncertain whether the efficacy of stroke prevention therapies in atrial fibrillation changes as patients age. The objective of this study was to determine the effect of age on the...... relative efficacy of oral anticoagulants (OAC) and antiplatelet (AP) therapy (including acetylsalicylic acid and triflusal) on ischemic stroke, serious bleeding, and vascular events in patients with atrial fibrillation. METHODS: This is an analysis of the Atrial Fibrillation Investigators database, which...... contains patient level-data from randomized trials of stroke prevention in atrial fibrillation. We used Cox regression models with age as a continuous variable that controlled for sex, year of randomization, and history of cerebrovascular disease, diabetes, hypertension, and congestive heart failure...

  12. Typical flutter ablation as an adjunct to catheter ablation of atrial fibrillation

    OpenAIRE

    Dipen Shah

    2008-01-01

    Typical atrial flutter and atrial fibrillation are frequently observed to coexist(1) .  In the current context of interventional electrophysiology, curative or at least definitive ablation is available for both arrhythmias. Despite their coexistence, it is not clear whether typical flutter ablation is necessary in all patients undergoing catheter ablation of atrial fibrillation. The following review explores the pathophysiology of both arrhythmias, their interrelationships and the availa...

  13. Typical flutter ablation as an adjunct to catheter ablation of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Dipen Shah

    2008-12-01

    Full Text Available Typical atrial flutter and atrial fibrillation are frequently observed to coexist(1 .  In the current context of interventional electrophysiology, curative or at least definitive ablation is available for both arrhythmias. Despite their coexistence, it is not clear whether typical flutter ablation is necessary in all patients undergoing catheter ablation of atrial fibrillation. The following review explores the pathophysiology of both arrhythmias, their interrelationships and the available data pertaining to this theme.

  14. Risk of atrial fibrillation and stroke in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Lindhardsen, Jesper; Ahlehoff, Ole; Gislason, Gunnar Hilmar;

    2012-01-01

    To determine if patients with rheumatoid arthritis have increased risk of atrial fibrillation and stroke.......To determine if patients with rheumatoid arthritis have increased risk of atrial fibrillation and stroke....

  15. A roadmap to improve the quality of atrial fibrillation management

    DEFF Research Database (Denmark)

    Kirchhof, Paulus; Breithardt, Günter; Bax, Jeroen;

    2016-01-01

    At least 30 million people worldwide carry a diagnosis of atrial fibrillation (AF), and many more suffer from undiagnosed, subclinical, or 'silent' AF. Atrial fibrillation-related cardiovascular mortality and morbidity, including cardiovascular deaths, heart failure, stroke, and hospitalizations,...

  16. Patient's Guide to Antithrombotic Therapy in Atrial Fibrillation

    Science.gov (United States)

    ... to Antithrombotic A Patient’s Guide to AntithromboticTherapy in Atrial Fibrillation AMERICAN COLLEGE OF CHEST PHYSICIANS Therapy in Atrial Fibrillation PATIENT EDUCATION GUIDE AMERICAN COLLEGE OF CHEST PHYSICIANS ...

  17. Who Is at Risk for Atrial Fibrillation (AF or AFib)?

    Science.gov (United States)

    ... living with AFib Atrial Fibrillation • Introduction • What is Atrial Fibrillation? • Why AFib Matters • Understand your Risk for AFib Children • Symptoms of AFib • Treatment & Prevention of AFib Treatment Guidelines of AFib Treatment Options ...

  18. Clinical efficacy and safety of catheter ablation for atrial fibrillation in elderly patients

    Institute of Scientific and Technical Information of China (English)

    董静

    2013-01-01

    Objective To evaluate the clinical efficacy and safty of catheter ablation for atrial fibrillation in elderly patients.Methods From September 2008 to October 2011,a total of 420 consecutive patients undergoing cathete rablation

  19. Optimizing therapy in patients with atrial fibrillation and heart failure

    OpenAIRE

    Mulder, Bart Antonius

    2015-01-01

    Atrial fibrillation is the most common cardiac arrhythmia and the prevalence is expected to increase in the coming years. The same is true for heart failure. Atrial fibrillation may result in heart failure, and vice versa, but they can also exacerbate each other. The combination of atrial fibrillation and heart failure has important therapeutic implications to treat both diseases and create optimal outcomes for these patients. We started with patients with permanent atrial fibrillation. These...

  20. Heart failure and atrial fibrillation: current concepts and controversies

    OpenAIRE

    Berg, van den, T.J.T.P.; Tuinenburg, A. E.; Crijns, H. J. G. M.; Gelder, De; Gosselink, A. T.; Lie, K. I.

    1997-01-01

    Heart failure and atrial fibrillation are very common, particularly in the elderly. Owing to common risk factors both disorders are often present in the same patient. In addition, there is increasing evidence of a complex, reciprocal relation between heart failure and atrial fibrillation. Thus heart failure may cause atrial fibrillation, with electromechanical feedback and neurohumoral activation playing an important mediating role. In addition, atrial fibrillation may promote heart failure; ...

  1. [Antithrombotic management in atrial fibrillation].

    Science.gov (United States)

    Fauchier, Laurent; Taillandier, Sophie; Clementy, Nicolas

    2013-02-01

    There is increasing recognition of the value of oral anticoagulation for stroke prevention in atrial fibrillation (AF), and the availability of new oral anticoagulants that overcome the limitations of vitamin K antagonists (VKA). Stroke risk assessment using the CHA2DS2-Vasc score allows identification of patients who are at truly low risk (score = 0) who should need no antithrombotic therapy, while all others (CHA2DS2-Vasc score > or = 1 with a risk of thromboembolic event > 1% per year) would be considered for oral anticoagulation. The HAS-BLED score has been recently proposed to easily assess bleeding risk in AF patients. A score of > or = 3 indicates "high risk" and some caution and regular review of the patient are needed. It also makes the clinician think of correctable common bleeding risk factors. The direct thrombin inhibitor dabigatran and factor Xa inhibitors rivaroxaban and apixaban are new oral anticoagulants that are at least as efficacious and safe as VKA in non valvular AF. Their advantages are easier use, predictable anticoagulant effects, low propensity for food and drug interactions, and lower rates of intracranial bleeding than with VKA, but they should not be used in patients with kidney disease at the present time. Overall, one may expect that more AF patients will be appropriately treated with oral anticoagulation in the next years. PMID:23513780

  2. Information Learned from Animal Models of Atrial Fibrillation

    OpenAIRE

    Finet, J. Emanuel; Rosenbaum, David S.; Donahue, J. Kevin

    2009-01-01

    Animal models of atrial fibrillation have taught us about mechanisms of this common disease. A variety of animal models exist, including models of lone atrial fibrillation and models of atrial fibrillation in the setting of heart failure, aging or pericardial inflammation. This chapter reviews these various models.

  3. Subclinical Hypothyroidism: An Overlooked Cause of Atrial Fibrillation?

    Directory of Open Access Journals (Sweden)

    Theofilos M. Kolettis, MD

    2012-12-01

    Full Text Available The association between clinical1 or subclinical2 hyperthyroidism and atrial fibrillation is established from large prospective cohort studies, with serum free thyroxin (T4 concentrations correlating with atrial fibrillation rates.3 However, the role of subclinical hypothyroidism as a causal factor for atrial fibrillation has not been elucidated.

  4. Nitric Oxide synthases and atrial fibrillation

    Directory of Open Access Journals (Sweden)

    CynthiaAnnCarnes

    2012-04-01

    Full Text Available Oxidative stress has been implicated in the pathogenesis of atrial fibrillation. There are multiple systems in the myocardium which contribute to redox homeostasis, and loss of homeostasis can result in oxidative stress. Potential sources of oxidants include nitric oxide synthases, which normally produce nitric oxide in the heart. Two nitric oxide synthase isoforms (1 and 3 are normally expressed in the heart. During pathologies such as heart failure, there is induction of nitric oxide synthase 2 in multiple cell types in the myocardium. In certain conditions, the NOS enzymes may become uncoupled, shifting from production of nitric oxide to superoxide anion, a potent free radical and oxidant. Multiple lines of evidence suggest a role for nitric oxide synthases in the pathogenesis of atrial fibrillation. Therapeutic approaches to reduce atrial fibrillation by modulation of nitric oxide synthase activity may be beneficial, although further investigation of this strategy is needed.

  5. Alcohol consumption and risk of atrial fibrillation

    DEFF Research Database (Denmark)

    Tolstrup, Janne Schurmann; Wium-Andersen, Marie Kim; Ørsted, David Dynnes;

    2016-01-01

    BACKGROUND: The aim of this study was to test the hypothesis that alcohol consumption, both observational (self-reported) and estimated by genetic instruments, is associated with a risk of atrial fibrillation and to determine whether people with high cardiovascular risk are more sensitive towards...... alcohol than people with low risk. METHODS: We used data for a total of 88,782 men and women from the Copenhagen City Heart Study 1991-1994 and 2001-2003 and the Copenhagen General Population Study 2003-2010. Information on incident cases of atrial fibrillation was obtained from a validated nationwide...... register. As a measure of alcohol exposure, both self-reported consumption and genetic variations in alcohol metabolizing genes (ADH1B/ADH1C) were used as instrumental variables. The endpoint was admission to hospital for atrial fibrillation as recorded in a validated hospital register. RESULTS: A total...

  6. Antihypertensive treatment and risk of atrial fibrillation

    DEFF Research Database (Denmark)

    Marott, Sarah C W; Nielsen, Sune F; Benn, Marianne;

    2014-01-01

    AIMS: To examine the associations between antihypertensive treatment with angiotensin-converting enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs), β-blockers, diuretics, or calcium-antagonists, and risk of atrial fibrillation. We examined these associations using the entire Danish...... population from 1995 through 2010. METHODS AND RESULTS: Excluding medication used in atrial fibrillation, we matched individuals on ACEi monotherapy 1:1 with individuals on β-blocker (n = 48 658), diuretic (n = 69 630), calcium-antagonist (n = 57 646), and ARB monotherapy (n = 20 158). Likewise, individuals...... on ARB monotherapy were matched 1:1 with individuals on β-blocker (n = 20 566), diuretic (n = 20 832), calcium-antagonist (n = 20 232), and ACEi monotherapy (n = 20 158). All were free of atrial fibrillation and of predisposing diseases like heart failure, ischaemic heart disease, diabetes mellitus...

  7. Incidence and predictive factors of atrial fibrillation after ablation of typical atrial flutter.

    Science.gov (United States)

    Laurent, Valérie; Fauchier, Laurent; Pierre, Bertrand; Grimard, Caroline; Babuty, Dominique

    2009-03-01

    Although cavotricuspid isthmus radiofrequency catheter ablation is considered curative therapy for typical atrial flutter, many patients develop an atrial fibrillation after ablation. The purpose of our study was to determine the incidence and the predictive factors of post-ablation atrial fibrillation. One hundred and forty eight consecutive patients underwent cavotricuspid isthmus ablation for the treatment of typical atrial flutter between January 2004 and December 2005 in our electrophysiological department. Complete cavotricuspid isthmus block was successfully obtained in 96.6% of the patients. At the end of the electrophysiological study a sustained atrial fibrillation was inducible in 20 patients (13.5%). During an average follow-up of 21.3 +/- 8.2 months, atrial fibrillation occurred in 27% of the patients. Univariate analysis identified four parameters correlated with post-ablation atrial fibrillation among the 21 parameters tested: the young age of the patients, a prior history of atrial fibrillation, an inducible atrial fibrillation, and a paroxysmal atrial flutter. Only inducible atrial fibrillation and paroxysmal atrial flutter were independent factors linked to atrial fibrillation after ablation. In our study the incidence of atrial fibrillation after cavotricuspid isthmus radiofrequency catheter ablation is 152 per 1,000 patient-years, i.e. 25 times higher than the incidence of atrial fibrillation in the general population of the same age. Twenty five percent of the patients who had neither prior history of atrial fibrillation nor structural heart disease suffered from atrial fibrillation during a mean follow-up of 21.3 +/- 8.2 months. All these results suggest that atrial flutter and fibrillation could be manifestations of a more general electrophysiologic disease. They emphasize the need for all these patients to benefit from regular, long-term cardiological follow-up after cavotricuspid isthmus ablation because of the high incidence of atrial

  8. Atrial fibrillation and the 4P medicine

    Directory of Open Access Journals (Sweden)

    Federica Censi

    2013-09-01

    Full Text Available Although the paradigm of the 4P medicine - Predictive, Personalized, Preemptive, and Participatory - has been suggested several years ago, its application to atrial fibrillation is still far away. Given the increasing prevalence and incidence of this pathology it is the time to promote preventive strategies, by identifying the risk factors associated to life style and by incentivizing innovative diagnostic technologies. The promotion of the correct life style and of the use of diagnostic devices based on innovative and reliable technologies, represent a first step towards the full realization of the revolution of 4P medicine in atrial fibrillation.

  9. The immediate future for the medical treatment of atrial fibrillation

    DEFF Research Database (Denmark)

    Pedersen, Ole Dyg; Brendorp, Bente; Køber, Lars;

    2002-01-01

    Atrial fibrillation is the most commonly sustained cardiac arrhythmia and a common reason for mortality and morbidity. Atrial fibrillation causes disease for three reasons: i) the ventricular rate is often high, which leads to symptoms ranging from discomfort to life threatening heart failure; ii......) the rhythm causes loss of atrioventricular synchrony, which reduces diastolic filling and may lead to heart failure; and iii) atrial contraction is lost leading to stagnant blood that again may lead to atrial thrombi and peripheral embolism. Thus, the treatment of atrial fibrillation is focused on the...... are in development, but to the author's knowledge only a single thrombin inhibitor is actively being developed for atrial fibrillation....

  10. Atrial Fibrillation and Heart Failure Parallels: Lessons for Atrial Fibrillation Prevention

    OpenAIRE

    McManus, David D.; Shaikh, Amir Y; Abhishek, FNU; Vasan, Ramachandran S.

    2011-01-01

    Heart failure (HF) and atrial fibrillation (AF) are two of the most common cardiovascular diseases encountered in clinical practice, and the prevalence of these diseases continues to grow world-wide with the aging of the global population.

  11. Reduced kidney function is a risk factor for atrial fibrillation.

    Science.gov (United States)

    Laukkanen, Jari A; Zaccardi, Francesco; Karppi, Jouni; Ronkainen, Kimmo; Kurl, Sudhir

    2016-08-01

    There is limited knowledge on the relationship between kidney function and incidence of atrial fibrillation. Thus, this prospective study was designed to evaluate whether various biomarkers of kidney function are associated to the risk of atrial fibrillation. The study population consisted of 1840 subjects (615 women and 1225 men) aged 61-82 years. Cystatin C- and creatinine-based estimation of glomerular filtration rate (eGFRcys and eGRFcreat , respectively) and urinary albumin/creatinine ratio (ACR) were assessed to investigate their relationship with the risk of atrial fibrillation. During a median follow-up of 3.7 years, a total of 159 incident atrial fibrillation cases occurred. After adjustment for potential confounders, the risk of atrial fibrillation was increased (hazard ratio 2.74, 95% confidence interval (CI) 1.56-4.81, P atrial fibrillation (hazard ratio 2.16, CI 1.35-2.82, P atrial fibrillation. PMID:26780558

  12. Management and prognosis of atrial fibrillation in the diabetic patient

    DEFF Research Database (Denmark)

    Pallisgaard, Jannik Langtved; Lindhardt, Tommi Bo; Olesen, Jonas Bjerring;

    2015-01-01

    The global burden of atrial fibrillation and diabetes mellitus (diabetes) is considerable, and prevalence rates are increasing. Diabetes is associated with an increased risk of developing atrial fibrillation; however, diabetes also influences the management and prognosis of atrial fibrillation. In...... the following article, the authors describe the association between diabetes and atrial fibrillation; specifically, the significance of diabetes on the risk of atrial fibrillation, ischemic stroke and bleeding complications associated with anticoagulation. In addition, the authors evaluate the risks...... and outcomes of heart failure and the success rates of both ablation and cardioversion in atrial fibrillation patients with diabetes. Finally, this article describes the association of HbA1c levels with the management and prognosis of atrial fibrillation patients....

  13. An "account" of digitalis and atrial fibrillation

    NARCIS (Netherlands)

    Meijler, F.L.

    1985-01-01

    This review deals with the mechanisms by which digitalis exerts its "opium-Iike" action on the ventricular rate in patients with atrial fibrillation. To understand the effect of digitalis on ventricular rate and rhythm, it is essential to learn more about the basic electrophysiologic principles resp

  14. Attitudes Towards Catheter Ablation for Atrial Fibrillation

    DEFF Research Database (Denmark)

    Vadmann, Henrik; Pedersen, Susanne S; Nielsen, Jens Cosedis;

    2015-01-01

    BACKGROUND: Catheter ablation for atrial fibrillation (AF) is an important but expensive procedure that is the subject of some debate. Physicians´ attitudes towards catheter ablation may influence promotion and patient acceptance. This is the first study to examine the attitudes of Danish...

  15. Spontaneous conversion of first onset atrial fibrillation

    DEFF Research Database (Denmark)

    Lindberg, Søren Østergaard; Hansen, Sidsel; Nielsen, Tonny

    2011-01-01

    Background  We studied all patients admitted to hospital with first onset atrial fibrillation (AF) to determine the probability of spontaneous conversion to sinus rhythm and to identify factors predictive of such a conversion. Methods and Results  We retrospectively reviewed charts of 438...

  16. Genetic aspects of lone atrial fibrillation

    DEFF Research Database (Denmark)

    Andreasen, Laura; Nielsen, Jonas B; Olesen, Morten S

    2015-01-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia. A subgroup of patients presents with AF without traditional risk factors and is diagnosed before the age of 60 years. Such patients are commonly referred as having "lone AF" and comprise 10-20% of all cases. A number of studies have...

  17. A population screening programme for atrial fibrillation

    DEFF Research Database (Denmark)

    Proietti, Marco; Mairesse, Georges H; Goethals, Peter;

    2016-01-01

    AIMS: Despite the increased prevalence of atrial fibrillation (AF), data for the implementation of nationwide screening programmes are limited. The aim of this national screening study was to increase nationwide awareness about AF and stroke risk, to determine the prevalence of AF in Belgian...

  18. Bleeding Risk Assessment in Atrial Fibrillation

    DEFF Research Database (Denmark)

    Lip, Gregory Y H; Lane, Deirdre A

    2016-01-01

    Stroke prevention is central to the management of atrial fibrillation (AF), and effective thromboprophylaxis requires oral anticoagulation (OAC). Even a single stroke risk factor confers excess risk, and the net clinical benefit of treatment is positive for OAC compared to no treatment or aspirin...

  19. Do omega-3 fatty acids decrease the incidence of atrial fibrillation?

    Directory of Open Access Journals (Sweden)

    Peter Ofman, M.D., M.Sc; Adelqui Peralta, M.D.; Peter Hoffmeister, M.D; J. Michael Gaziano, M.D., M.P.H; Luc Djousse, M.D., M.P.H., Sc.D

    2013-06-01

    Full Text Available Although atrial fibrillation is a very common medical problem in general population and has a high incidence in the setting of open heart surgery, currently there are very few therapies to prevent occurrence or recurrence of atrial fibrillation. N-3 polyunsaturated fatty acids have been shown to change basic physiologic properties of the atrial tissue to make it less susceptible to atrial fibrillation. In this review, we first describe basic physiological mechanisms thought to be responsible for these changes and then discuss epidemiological studies evaluating the use n-3 polyunsaturated fatty acids for primary and secondary prevention of atrial fibrillation in the general population, in subjects undergoing open heart surgery, and in special subgroups of patients.

  20. Home Screening for Detecting Subclinical Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Renato Pietro Ricci; Taya V. Glotzer

    2015-12-01

    Full Text Available The advent of cardiac implanted electronic devices with accurate atrial arrhythmia diagnostic capabilities has revealed a large burden of “silent “ atrial fibrillation that is present in the cardiac population. Many studies have been completed, and many more are ongoing, to determine the correct treatment course when these atrial arrhythmias are detected. Alongside the development of accurate atrial diagnostics within the devices, has been the growth an entire network of wireless home monitoring capability. It is now possible to see, over the internet, individual patients’ atrial arrhythmia burden on every day. This capability has tremendous promise for patient care, with the possibility of reducing strokes, decreasing heart failure, preventing cardiomyopathies, and likely substantially reducing health care costs. As this innovative diagnostic capability is generating large amounts of data, protocols for what should be done with the plethora of new information are being developed. In the pages that follow, we will present what is known about home monitoring for silent atrial fibrillation, and present the results of recent studies published in this arena.

  1. Vitamin C in prevention of atrial fibrillation after coronary artery bypass graft: double blind randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Mahmoodreza Sarzaeem

    2014-03-01

    Conclusion: Vitamin C is relatively safe, inexpensive, well tolerated and has a low complication. According to the 44% reduction in the incidence of atrial fibrillation in vitamin C patients undergoing coronary artery bypass grafting surgery, this drug can be prescribed as a prophylaxis for prevention of post-CABG atrial fibrillation.

  2. Anti-thromboembolic strategies in atrial fibrillation.

    Science.gov (United States)

    Cocco, Giuseppe; Amiet, Philpp; Jerie, Paul

    2016-01-01

    Oral anticoagulation (OAC) is highly effective for stroke prevention in high-risk-patients with atrial fibrillation (AF). AF is also a risk for dementia, and effective OAC reduces the risk of dementia. Up to 30% of patients with AF have a coronary artery disease and antiplatelets are used to avoid thrombotic complications. Patients with AF often have an acute coronary syndrome (ACS) and undergo a percutaneous intervention with stent-implantation. These patients require a triple therapy, i.e. the combination of OAC with dual-antiplatelet therapy. It is obvious that OAC may induce bleeding with potentially deleterious effects on mortality. Even the occurrence of minor bleeding is problematic. The review describes available data on used anti-thromboembolic regimens in patients treated with OAC (vitamin K antagonists and non-vitamin K antagonists) who need a triple therapy (i.e. anticoagulation and antiplatelets). Most data are from patients who were treated for an ACS and cannot be directly extrapolated for patients with AF. The impact of used stents and novel P2Y12 antagonist-antiplatelets and duration of triple therapy is discussed. Often some high-risk patients with AF would need anticoagulation but cannot be given this therapy be-cause of excessive bleeding risks or contraindicating comorbidities: in these patients left atrial appendage closure with an occluding device can be used as an alternative to anti-thromboem-bolic therapy. The unavoidable anti-thromboembolic triple therapy carries a strong potential for bleeding events, which increase mortality. We have many data and several recommendations are offered. Nonetheless, we lack solid data on the best anti-thromboembolic regimen in patients with AF who need anticoagulation and antiplatelets. PMID:26779967

  3. To Pace Or Not To Pace! – Prevention Of Atrial Fibrillation After Coronary Artery Bypass Surgery

    OpenAIRE

    Amit Vora

    2005-01-01

    Atrial fibrillation (AF) is a very undesirable, but unfortunately a common arrhythmia following coronary artery bypass graft (CABG) surgery, occurring in up to 40% of patients. There is an increase in hospital stay and adds to the overall cost of the surgery. Atrial fibrillation occurrence may identify a subset of patients with reduced survival. Prevention of AF therefore would have a significant positive impact on patients undergoing CABG surgery. Based on the mechanism of postoperative AF,...

  4. To Pace Or Not To Pace! – Prevention Of Atrial Fibrillation After Coronary Artery Bypass Surgery

    OpenAIRE

    Vora, Amit

    2005-01-01

    Atrial fibrillation (AF) is a very undesirable, but unfortunately a common arrhythmia following coronary artery bypass graft (CABG) surgery, occurring in up to 40% of patients. There is an increase in hospital stay and adds to the overall cost of the surgery. Atrial fibrillation occurrence may identify a subset of patients with reduced survival. Prevention of AF therefore would have a significant positive impact on patients undergoing CABG surgery. Based on the mechanism of postoperative AF, ...

  5. Post-operative Atrial Fibrillation: Pathophysiology, prevention and treatment

    Directory of Open Access Journals (Sweden)

    E Bidar;

    2013-04-01

    Full Text Available Atrial fibrillation occurring after cardiac surgery has been the subject of intensive research over the past decades. However, the incidence remains high, despite numerous preventive and treatment strategies. In addition, several reports show that the impact of post-operative atrial fibrillation (POAF is high. It is an independent risk factor for mortality after several years. These findings make clear that the fact that the pathophysiology of POAF is not fully understood and POAF-associated risks to some extent might be underestimated. On the one hand, excessive triggers during the acute post operative phase after cardiac surgery might initiate AF even in atria with low vulnerability. On the other hand, many patients undergoing surgery have an atrial substrate at the time of operation promoting AF not only in the post-operative phase but also in the days and weeks thereafter. Progress in our understanding of the AF mechanisms in general has provided valuable insights into processes involved in atrial structural remodeling due to advanced age, hypertension, obesity, and congestive heart failure. These patient characteristics strongly contribute to cardiac disease, predict POAF and likely have an impact on the risk of thrombus formation in the weeks and months after cardiac surgery. For a better understanding of the mechanisms involved, it is important to not only recognize the occurrence of POAF by continuous monitoring after surgery, but also to identity the extent of atrial vulnerability to AF in these patients.

  6. Monitoring Atrial Fibrillation After Catheter Ablation

    Directory of Open Access Journals (Sweden)

    Giovanni B Forleo, MD PhD; MAssimo Moltrasio, MD; Michela Casella MD, PhD; Antonio Dello Russo MD, PhD; Getano Fassini, MD; Manfredi Tesauro, MD, PhD; Claudio Tondo, MD, PhD.

    2014-04-01

    Full Text Available Although catheter ablation is an effective treatment for recurrent atrial fibrillation (AF, there is no consensus on the definition of success or follow-up strategies. Symptoms are the major motivation for undergoing catheter ablation in patients with AF, however it is well known that reliance on perception of AF by patients after AF ablation results in an underestimation of recurrence of the arrhythmia. Because symptoms of AF occurrence may be misleading, a reliable assessment of rhythm outcome is essential for the definition of success in both clinical care and research trials. Continuous rhythm monitoring over long periods of time is superior to intermittent recording using external monitors to detect the presence of AF episodes and to quantify the AF burden. Today, new devices implanted subcutaneously using a minimally invasive technique have been developed for continuous AF monitoring. Implantable devices keep detailed information about arrhythmia recurrences and might allow identification of very brief episodes of AF, the significance of which is still uncertain. In particular, it is not known whether there is any critical value of daily AF burden that has a prognostic significance. This issue remains an area of active discussion, debate and investigation. Further investigation is required to determine if continuous AF monitoring with implantable devices is effective in reducing stroke risk and facilitating maintenance of sinus rhythm after AF ablation.

  7. Dronedarone for atrial fibrillation: a new therapeutic agent

    Directory of Open Access Journals (Sweden)

    Pawan D Patel

    2009-08-01

    Full Text Available Pawan D Patel, Rohit Bhuriya, Dipal D Patel, Bhaskar L Arora, Param P Singh, Rohit R AroraDepartment of Cardiology, Chicago Medical School, Chicago, IL, USAAbstract: Atrial fibrillation is the most common of the serious cardiac rhythm disturbances and is responsible for substantial morbidity and mortality. Amiodarone is currently one of the most widely used and most effective antiarrhythmic agents for atrial fibrillation. But during chronic usage amiodarone can cause some serious extra cardiac adverse effects, including effects on the thyroid. Dronedarone is a newer therapeutic agent with a structural resemblance to amiodarone, with two molecular changes, and with a better side effect profile. Dronedarone is a multichannel blocker and, like amiodarone, possesses both a rhythm and a rate control property in atrial fibrillation. The US Food and Drug Administration approved dronedarone for atrial fibrillation on July 2, 2009. In this review, we discuss the role of dronedarone in atrial fibrillation.Keywords: dronedarone, amiodarone, atrial fibrillation

  8. Induction of atrial fibrillation with rapid high voltage ventricular pacing for ventricular fibrillation conversion testing

    OpenAIRE

    Schuchert, A; Kuhl, M; Ruppel, R; Meinertz, T

    2000-01-01

    OBJECTIVE—To assess whether rapid high voltage ventricular pacing can also induce atrial fibrillation, and whether the induction of atrial fibrillation during ventricular fibrillation conversion testing is related to the patient's heart disease.
DESIGN—Prospective study of 50 patients who received the dual chamber implantable cardioverter-defibrillator (ICD) Ventak AV II DR (Guidant) as a first implant. This device can record atrial activity even during a ventricular fibrillation episode and ...

  9. Effects of trimetazidine on atrial structural remodeling and platelet activation in dogs with atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    HAN Wei; LI Wei-min; ZHOU Hong-yan; HUO Hong; WEI Na; DONG Guo; CAO Yong; ZHOU Guo; YANG Shu-sen

    2009-01-01

    @@ Atrial fibrillation (AF) is one of the most common arrhythmias in clinical practice. AF results in electrophysiological alterations which involve increased atrial effective refractory period and atrial effective refractory period dispersion, reduced rate adaptation of atrial effective refractory period, and slowed atrial conduction.

  10. Outcomes after ablation for typical atrial flutter (from the Loire Valley Atrial Fibrillation Project).

    Science.gov (United States)

    Clementy, Nicolas; Desprets, Laurent; Pierre, Bertrand; Lallemand, Bénédicte; Simeon, Edouard; Brunet-Bernard, Anne; Babuty, Dominique; Fauchier, Laurent

    2014-11-01

    Similar predisposing factors are found in most types of atrial arrhythmias. The incidence of atrial fibrillation (AF) among patients with atrial flutter is high, suggesting similar outcomes in patients with those arrhythmias. We sought to investigate the long-term outcomes and prognostic factors of patients with AF and/or atrial flutter with contemporary management using radiofrequency ablation. In an academic institution, we retrospectively examined the clinical course of 8,962 consecutive patients admitted to our department with a diagnosis of AF and/or atrial flutter. After a median follow-up of 934 ± 1,134 days, 1,155 deaths and 715 stroke and/thromboembolic (TE) events were recorded. Patients with atrial flutter undergoing cavotricuspid isthmus ablation (n = 875, 37% with a history of AF) had a better survival rate than other patients (hazard ratio [HR] 0.35, 95% confidence interval [CI] 0.25 to 0.49, p <0.0001). Using Cox proportional hazards model and propensity score model, after adjustment for main other confounders, ablation for atrial flutter was significantly associated with a lower risk of all-cause mortality (HR 0.55, 95% CI 0.36 to 0.84, p = 0.006) and stroke and/or TE events (HR 0.53, 95% CI 0.30 to 0.92, p = 0.02). After ablation, there was no significant difference in the risk of TE between patients with a history of AF and those with atrial flutter alone (HR 0.83, 95% CI 0.41 to 1.67, p = 0.59). In conclusion, in patients with atrial tachyarrhythmias, those with atrial flutter with contemporary management who undergo cavotricuspid isthmus radiofrequency ablation independently have a lower risk of stroke and/or TE events and death of any cause, whether a history of AF is present or not. PMID:25200340

  11. Autonomic and surgical substrate modulation of atrial fibrillation

    OpenAIRE

    Krul, S.P.J.

    2016-01-01

    This thesis focuses on the effects of fibrosis and the autonomic nervous system on conduction in patients with atrial fibrillation and the surgical ablation of the atria and autonomic nervous system as treatment of atrial fibrillation. Atrial fibrillation is the most common arrhythmia and results from multiple pathophysiological mechanisms. Both fibrosis and the autonomic nervous system influence the occurrence and maintenance of AF. Animal and clinical studies have shown that the parasympath...

  12. Preoperative Arrhythmias Such as Atrial Fibrillation: Cardiovascular Surgery Risk Factor

    OpenAIRE

    Diana Anghel; Radu Anghel; Flavia Corciova; Mihail Enache; Grigore Tinica

    2014-01-01

    Atrial fibrillation is still the most common arrhythmia that occurs in heart surgery. However, there is few literature data on the manner in which preoperative atrial fibrillation may influence the postoperative outcome of various heart surgery procedures. The purpose of our research is to assess the effects of preoperative atrial fibrillation on patients having undergone different heart surgery procedures. The results of our research are a review of clinical data which were collected prospec...

  13. Genetics of Atrial Fibrillation and Possible Implications for Ischemic Stroke

    OpenAIRE

    Vincent Thijs; Robin Lemmens; Dieter Nuyens; Sylvia Hermans

    2011-01-01

    Atrial fibrillation is the most common cardiac arrhythmia mainly caused by valvular, ischemic, hypertensive, and myopathic heart disease. Atrial fibrillation can occur in families suggesting a genetic background especially in younger subjects. Additionally recent studies have identified common genetic variants to be associated with atrial fibrillation in the general population. This cardiac arrhythmia has important public health implications because of its main complications: congestive heart...

  14. Stroke and atrial fibrillation: is stroke prevention treatment appropriate beforehand?

    OpenAIRE

    DEPLANQUE, D; Corea, F; Arquizan, C; Parnetti, L.; Mas, J.; Gallai, V.; Leys, D; the, S

    1999-01-01

    OBJECTIVE—To undertake a pilot study before conducting a large European multicentre prospective study, to determine the proportion of patients with atrial fibrillation who were not receiving antithrombotic treatment before stroke onset, and their characteristics.
DESIGN AND PATIENTS—The stroke in atrial fibrillation ensemble (SAFE) I study was an observational study conducted in 213 patients with atrial fibrillation consecutively admitted in 1997 to three European centres for an acute stroke ...

  15. Atrial fibrillation in a primary care practice: prevalence and management

    OpenAIRE

    Upshur Ross E; Ceresne Lance

    2002-01-01

    Abstract Background Atrial fibrillation is a common serious cardiac arrhythmia. Knowing the prevalence of atrial fibrillation and documentation of medical management are important in the provision of primary care. This study sought to determine the prevalence of atrial fibrillation in a primary care population and to identify and quantify the treatments being used for stroke prevention in this group of patients. Methods A prevalence study through chart audit was conducted in the family medici...

  16. The use of warfarin in veterans with atrial fibrillation

    OpenAIRE

    Rosenbeck Karen; Bravata Dawn M; Kancir Sue; Brass Lawrence M

    2004-01-01

    Abstract Background Warfarin therapy is effective for the prevention of stroke in patients with atrial fibrillation. However, warfarin therapy is underutilized even among ideal anticoagulation candidates. The purpose of this study was to examine the use of warfarin in both inpatients and outpatients with atrial fibrillation within a Veterans Affairs (VA) hospital system. Methods This retrospective medical record review included outpatients and inpatients with atrial fibrillation. The outpatie...

  17. Genetika idiopatske atrijske fibrilacije: Genetics of lone atrial fibrillation:

    OpenAIRE

    Antolič, Bor; Petrovič, Danijel; Šinkovec, Matjaž; Žižek, David

    2010-01-01

    Atrial fibrillation is the most common sustained cardiac dysrhythmia leading to an increased risk of heart failure and thromboembolic stroke. It is a multifactorial disease, the incidence of which increases with age and presenceof other comorbidities. Especially in the young it can develop in the absence of known risk factors, and is called idiopathic or ,loneĆ atrial fibrillation, which in a smaller proportion can occur as a familial form. The familial idiopathic atrial fibrillation is a mon...

  18. Clinical experience with apixaban in atrial fibrillation: implications of AVERROES

    OpenAIRE

    De Caterina R.

    2011-01-01

    Raffaele De CaterinaInstitute of Cardiology and Center of Excellence on Aging, G d’Annunzio University, Chieti, G Monasterio Foundation, Pisa, ItalyAbstract: Atrial fibrillation is an extremely common arrhythmia, which substantially increases the risk of stroke and thromboembolism. Prevention of stroke and thromboembolism is therefore an important part of the management of atrial fibrillation. Guidelines until now have recommended that patients with atrial fibrillation receive some ...

  19. Left Atrial Appendage Exclusion for Stroke Prevention in Atrial Fibrillation

    OpenAIRE

    Patel, Taral K.; Yancy, Clyde W; Knight, Bradley P.

    2012-01-01

    The public health burden of atrial fibrillation (AF) and associated thromboembolic stroke continues to grow at alarming rates. AF leads to a fivefold increase in the risk of stroke. Therefore, stroke prevention remains the most critical aspect of AF management. Current standard of care focuses on oral systemic anticoagulation, most commonly with warfarin and now with newer agents such as dabigatran, rivaroxaban, and apixaban. However, the challenges and limitations of oral anticoagulation hav...

  20. Atrial fibrillation due to licorice root syrup.

    Science.gov (United States)

    Erkuş, Musluhittin Emre; Altıparmak, İbrahim Halil; Demirbağ, Recep; Günebakmaz, Özgür

    2016-04-01

    While it is known that consumption of licorice may lead to cardiac arrhythmias, there have been no reports of atrial fibrillation resulting from the consumption of licorice root syrup. A 57-year-old male with no prior history of cardiovascular disease was admitted to the emergency department with palpitation. His electrocardiogram showed atrial fibrillation with a moderate to rapid ventricular rate. In laboratory assessment, potassium was 2.0 mmol/L and plasma renin activity and aldosterone level were suppressed (<300 ng/L/hour, 42 ng/L respectively). Volumes of the heart chambers were within normal range and functions and structures of the heart valves were normal in echocardiographic assessment. The arrhythmia was resolved with propafenone infusion. PMID:27138313

  1. Ablate and pace revisited: long term survival and predictors of permanent atrial fibrillation

    OpenAIRE

    Queiroga, A; Marshall, H J; Clune, M; Gammage, M. D.

    2003-01-01

    Objective: To assess long term mortality and identify factors associated with the development of permanent atrial fibrillation after atrioventricular (AV) node ablation for drug refractory paroxysmal atrial fibrillation.

  2. Do Statins Reduce Atrial Fibrillation After Coronary Artery Bypass Grafting?

    Directory of Open Access Journals (Sweden)

    Anil Paturi MD

    2011-07-01

    Full Text Available Background Atrial Fibrillation (AF is a common postoperative complication after coronary artery bypass grafting. There is contradictory evidence as to whether pre-operative statin use lowers the incidence of postoperative AF. This study aimed to assess whether pre operative statin therapy prevents the post-operative AF. Methods In this retrospective cohort study we used a propensity score–matching analysis to evaluate the effect of preoperative treatment with statins on postoperative atrial fibrillation. There were 427 matched pairs of patients. Primary outcome was the incidence of postoperative AF. Secondary outcomes were 30 day mortality, stroke, myocardial infarction and length of hospital stay Results The incidence of postoperative AF was not different in the statin users compared with the nonusers (123, 28.1%, versus 127, 29.7%, respectively; p = 0.764. The 30 day mortality (6, 1.4%, versus 8, 1.9%; p = 0.590, stroke (10, 2.3%, versus 8, 1.9%; p = 0.634, myocardial infarction (2, 0.5%, versus 0, 0.0%; p = 0.499 and length of hospital stay in days (11.8 ± 9.0, versus 11.9 ± 9.3; p = 0.544 did not differ significantly between the two groups. Conclusions In a propensity-matched cohort of patients undergoing coronary bypass surgery, we could not demonstrate that preoperative statins were protective for the development of post operative atrial fibrillation.

  3. Atrial Fibrillation - Multiple Languages: MedlinePlus

    Science.gov (United States)

    ... Chinese - Simplified (简体中文) Chinese - Traditional (繁體中文) French (français) Hindi (हिन्दी) Japanese (日本語) Korean (한국어) Portuguese (português) ... auriculaire - français (French) Bilingual PDF Health Information Translations Hindi (हिन्दी) Atrial Fibrillation हिन्दी (Hindi) Bilingual ...

  4. Acute atrial fibrillation during dengue hemorrhagic fever

    Directory of Open Access Journals (Sweden)

    Veloso Henrique Horta

    2003-01-01

    Full Text Available Dengue fever is a viral infection transmitted by the mosquito, Aedes aegypti. Cardiac rhythm disorders, such as atrioventricular blocks and ventricular ectopic beats, appear during infection and are attributed to viral myocarditis. However, supraventricular arrhythmias have not been reported. We present a case of acute atrial fibrillation, with a rapid ventricular rate, successfully treated with intravenous amiodarone, in a 62-year-old man with dengue hemorrhagic fever, who had no structural heart disease.

  5. Nitric Oxide Synthases and Atrial Fibrillation

    OpenAIRE

    CynthiaAnnCarnes; ArunSridhar; SandorGyorke

    2012-01-01

    Oxidative stress has been implicated in the pathogenesis of atrial fibrillation. There are multiple systems in the myocardium which contribute to redox homeostasis, and loss of homeostasis can result in oxidative stress. Potential sources of oxidants include nitric oxide synthases, which normally produce nitric oxide in the heart. Two nitric oxide synthase isoforms (1 and 3) are normally expressed in the heart. During pathologies such as heart failure, there is induction of nitric oxide syn...

  6. Changes in plasma atrial natriuretic factor in patients with idiopathic atrial fibrillation

    International Nuclear Information System (INIS)

    To observe the changes in plasma atrial natriuretic factor (AFN) in patients with idiopathic atrial fibrillation and investigate its mechanism, plasma ANF, platelet count and hematocrit were detected in 21 cases with transient idiopathic atrial fibrillation (group A, A1 representing attack, while A2 termination), 28 with persistent idiopathic atrial fibrillation (group B), 27 suffered from rheumatic heart disease with mitral stenosis and persistent atrial fibrillation (group C), 32 with transient supraventricular tachycardia (group D) and 20 normal controls (group E). It was found that the level of ANF was significantly higher in patients with attacking transient idiopathic atrial fibrillation than that in group A2, D and E (P 0.05), while there was significant difference in hematocrit in group A1 compared with group A2, D, E (P < 0.01). It suggested that ANF and hematocrit play an important role in the attack of idiopathic atrial fibrillation

  7. Triple antithrombotic therapy in patients with atrial fibrillation undergoing coronary artery stenting: hovering among bleeding risk, thromboembolic events, and stent thrombosis

    Directory of Open Access Journals (Sweden)

    Menozzi Mila

    2012-10-01

    Full Text Available Abstract Dual antiplatelet treatment with aspirin and clopidogrel is the antithrombotic treatment recommended after an acute coronary syndrome and/or coronary artery stenting. The evidence for optimal antiplatelet therapy for patients, in whom long-term treatment oral anticoagulation is mandatory, is however scarce. To evaluate the safety and efficacy of the various antithrombotic strategies adopted in this population, we reviewed the available evidence on the management of patients receiving oral anticoagulation, such as a vitamin-k-antagonists, referred for coronary artery stenting. Atrial fibrillation is the most frequent indication for oral anticoagulation. The need of starting antiplatelet therapy in this clinical scenario raises concerns about the combination to choose: triple therapy with warfarin, aspirin, and a thienopyridine being the most frequent and advised. The safety of this regimen appeared suboptimal because of an increased risk in hemorrhagic complications. On the other hand, the combination of oral anticoagulation and an antiplatelet agent is suboptimal in preventing thromboembolic events and stent thrombosis; dual antiplatelet therapy may be considered only when a high hemorrhagic risk and low thromboembolic risk are perceived. Indeed, the need for prolonged multiple-drug antithrombotic therapy increases the bleeding risks when drug eluting stents are used. Since current evidence derives mainly from small, single-center and retrospective studies, large-scale prospective multicenter studies are urgently needed.

  8. Bleeding after initiation of multiple antithrombotic drugs, including triple therapy, in atrial fibrillation patients following myocardial infarction and coronary intervention

    DEFF Research Database (Denmark)

    Lamberts, Morten; Olesen, Jonas Bjerring; Ruwald, Martin Huth;

    2012-01-01

    Uncertainty remains over optimal antithrombotic treatment of patients with atrial fibrillation presenting with myocardial infarction and/or undergoing percutaneous coronary intervention. We investigated the risk and time frame for bleeding following myocardial infarction/percutaneous coronary int...

  9. Differential gene expression during atrial structural remodeling in human left and right atrial appendages in atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    Hui Zhu; Wei Zhang; Ming Zhong; Gong Zhang; Yun Zhang

    2011-01-01

    Extracellular matrix (ECM) remodeling increases the vulnerability to atrial fibrillation (AF). Some gene expressions are crucial for the metabolism of ECM. The left atrium plays an important role in maintaining AF.However, most studies investigated only the right atrial tissue. We therefore chose human tissue samples from both the left and right atrial to detect the different gene expressions during structural remodeling in AF. The atrial appendages tissue samples from 24 patients with chronic AF and 12 patients with sinus rhythm were obtained when they were undergoing mitral/aortic valve replacement operation. The mRNA levels of matrix metalloproteinases-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), disintegrin, metalloproteases-15, and integrins β1 were determined by reverse transcriptionpolymerase chain reaction (RT-PCR). in AF group, the level of MMP-9 in left atrial appendage (LAA) was increased (P<0.001), while integrin β1 level was decreased (P< 0.05) compared with those expressed in right atrial appendage (RAA) tissue. The levels of disintegrin, metalloproteinases-15, and TIMP-1 genes in the LAA and RAA had no significant differences. The results demonstrated that the gene expressions in the LAA and RAA are different during AF, which implied that the mechanism of atrial structural remodeling in AF is due to multiple sources and is complicated.

  10. Cardiac Remodeling After Atrial Fibrillation Ablation

    Directory of Open Access Journals (Sweden)

    Li-Wei Lo, MD; Shih-Ann Chen, MD

    2013-06-01

    Full Text Available Radiofrequency catheter ablation procedures are considered a reasonable option for patients with symptomatic, drug refractory atrial fibrillation (AF. Ablation procedures have been reported to effectively restore sinus rhythm and provide long-term relief of symptoms. Both electrical and structural remodeling occurs with AF. A reversal of the electrical remodeling develops within 1 week after restoration to sinus rhythm following the catheter ablation. The recovery rate is faster in the right atrium than the left atrium. Reverse structural remodeling takes longer and is still present 2 to 4 months after restoration of sinus rhythm. The left atrial transport function also improves after successful catheter ablation of AF. Left atrial strain surveys from echocardiography are able to identify patients who respond to catheter ablation with significant reverse remodeling after ablation. Pre-procedural delayed enhancement magnetic resonance imaging is also able to determine the degree of atrial fibrosis and is another tool to predict the reverse remodeling after ablation. The remodeling process is complex if recurrence develops after ablation. Recent evidence shows that a combined reverse electrical and structural remodeling occurs after ablation of chronic AF when recurrence is paroxysmal AF. Progressive electrical remodeling without any structural remodeling develops in those with recurrence involving chronic AF. Whether progressive atrial remodeling is the cause or consequence during the recurrence of AF remains obscure and requires further study.

  11. Pathophysiology of cancer therapy-provoked atrial fibrillation.

    Science.gov (United States)

    Cheng, Wan-Li; Kao, Yu-Hsun; Chen, Shih-Ann; Chen, Yi-Jen

    2016-09-15

    Atrial fibrillation (AF) occurs with increased frequency in cancer patients, especially in patients who undergo surgery or chemotherapy. AF disturbs the prognosis of cancer patients and challenges therapeutic outcomes of cancer treatment. Elucidating the mechanisms of cancer-induced AF would help identify specific strategies for preventing AF occurrence. In addition to concurrent risk factors of cancer and AF, cancer surgery, side effects of anticancer agents, and cancer-associated immune responses play critical roles in the genesis of AF. In this review, we provide succinct potential mechanisms of AF genesis in cancer patients. PMID:27327505

  12. Obesity and Outcomes among Patients with Established Atrial Fibrillation

    OpenAIRE

    Ardestani, Afrooz; Hoffman, Heather J.; Cooper, Howard A

    2010-01-01

    Atrial fibrillation (AF) and obesity have both reached epidemic proportions. The impact of obesity on clinical outcomes in patients with established AF is unknown. We analyzed 2492 patients in the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study. Body mass index (BMI) was evaluated as a categorical variable (normal: 18.5 to

  13. Transient atrial fibrillation precipitated by hypoglycaemia: two case reports.

    OpenAIRE

    Collier, A.; Matthews, D. M.; R. J. Young; Clarke, B F

    1987-01-01

    We describe two insulin-dependent diabetic females who presented with severe hypoglycaemia associated with atrial fibrillation which reverted to sinus rhythm after intravenous dextrose. Atrial fibrillation has not previously been reported as a complication of hypoglycaemia in insulin-dependent diabetic patients.

  14. Dronedarone in high-risk permanent atrial fibrillation

    DEFF Research Database (Denmark)

    Connolly, Stuart J; Camm, A John; Halperin, Jonathan L;

    2011-01-01

    Dronedarone restores sinus rhythm and reduces hospitalization or death in intermittent atrial fibrillation. It also lowers heart rate and blood pressure and has antiadrenergic and potential ventricular antiarrhythmic effects. We hypothesized that dronedarone would reduce major vascular events in...... high-risk permanent atrial fibrillation....

  15. Rising rates of hospital admissions for atrial fibrillation

    DEFF Research Database (Denmark)

    Friberg, Jens; Buch, Nina Pernille Gardshodn; Scharling, Henrik;

    2003-01-01

    Atrial fibrillation is a common arrhythmia associated with excess morbidity and mortality. We studied temporal changes in hospital admission rates for atrial fibrillation using data from a prospective population-based cohort study spanning 2 decades (the Copenhagen City Heart Study)....

  16. Atrial fibrillation: Is ablation the way of the future?

    Institute of Scientific and Technical Information of China (English)

    Brian Olshansky

    2004-01-01

    @@ This issue of the Journal of Geriatric Cardiology features a manuscript entitled "A three-pulmonary vein isolation approach to treat paroxysmal atrial fibrillation".Dr. Lexin Wang addresses an important issue, and is to be congratulated for taking a new look at an approach to ablate atrial fibrillation.

  17. Association between familial atrial fibrillation and risk of new-onset atrial fibrillation

    NARCIS (Netherlands)

    Lubitz, Steven A.; Yin, Xiaoyan; Fontes, Joao D.; Magnani, Jared W.; Rienstra, Michel; Pai, Manju; Villalon, Mark L.; Vasan, Ramachandran S.; Pencina, Michael J.; Levy, Daniel; Larson, Martin G.; Ellinor, Patrick T.; Benjamin, Emelia J.

    2010-01-01

    CONTEXT: Although the heritability of atrial fibrillation (AF) is established, the contribution of familial AF to predicting new-onset AF remains unknown. OBJECTIVE: To determine whether familial occurrence of AF is associated with new-onset AF beyond established risk factors. DESIGN, SETTING, AND P

  18. What have we learned of ablation procedures for atrial fibrillation?

    Science.gov (United States)

    Maurer, T; Lundqvist, C B; Tilz, R; Mont, L; Chierchia, G-B; Malmborg, H; Metzner, A; Kuck, K-H

    2016-05-01

    Atrial fibrillation is a widespread disease of growing clinical, economic and social importance. Interventional therapy for atrial fibrillation offers encouraging results, with pulmonary vein isolation (PVI) as the established cornerstone. Yet, the challenge to create durable transmural lesions remains, leading to recurrence of atrial fibrillation in long-term follow-up even after multiple ablation procedures in 20% of patients with paroxysmal atrial fibrillation and approximately 50% with persistent atrial fibrillation. To overcome these limitations, innovative tools such as the cryoballoon and contact force catheters have been introduced and have demonstrated their potential for safe and effective PVI. Furthermore, advanced pharmacological and pacing manoeuvres enhance evaluation of conduction block in PVI. PMID:26940476

  19. Determinants of development and preservation of atrial fibrillation at thyrotoxicosis

    Directory of Open Access Journals (Sweden)

    A Yu Babenko

    2013-03-01

    Full Text Available Atrial fibrillation is a frequent violation of a heart rhythm at thyrotoxicosis and it can determine serious complica tions (tromboembolia, stroke and death. The study of factors increasing risk development of atrial fibrillation at thy rotoxicosis is investigating many years but the occurrence of new diagnostic methods and mathematic analysis allows to reveal new determinants of development of atrial fibrillation and its persistence after restoration of euthyreosis. In our research we’ve studied the Echocardiography parameters in 254 normotensive patients with a thyrotoxicosis Graves’ disease without any CVD and 110 patients with a subclinical thyrotoxicosis. We detected new factors of risk of atrial fibrillation: the duration of thyrotoxicosis and the left ventricular concentric hypertrophy. The contribution of different factors in development of atrial fibrillation is defined.

  20. Genetics of Atrial Fibrillation and Possible Implications for Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Robin Lemmens

    2011-01-01

    Full Text Available Atrial fibrillation is the most common cardiac arrhythmia mainly caused by valvular, ischemic, hypertensive, and myopathic heart disease. Atrial fibrillation can occur in families suggesting a genetic background especially in younger subjects. Additionally recent studies have identified common genetic variants to be associated with atrial fibrillation in the general population. This cardiac arrhythmia has important public health implications because of its main complications: congestive heart failure and ischemic stroke. Since atrial fibrillation can result in ischemic stroke, one might assume that genetic determinants of this cardiac arrhythmia are also implicated in cerebrovascular disease. Ischemic stroke is a multifactorial, complex disease where multiple environmental and genetic factors interact. Whether genetic variants associated with a risk factor for ischemic stroke also increase the risk of a particular vascular endpoint still needs to be confirmed in many cases. Here we review the current knowledge on the genetic background of atrial fibrillation and the consequences for cerebrovascular disease.

  1. Atrial Fibrillation: When the heart is not in rhythm | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Atrial Fibrillation Atrial Fibrillation: When the heart is not in rhythm Past ... show, Deal With It . Photo: TBS/Deal Understanding Atrial Fibrillation Atrial fibrillation (AFib) is the most common type ...

  2. Epicardial adipose tissue and atrial fibrillation.

    Science.gov (United States)

    Hatem, Stéphane N; Sanders, Prashanthan

    2014-05-01

    Atrial fibrillation (AF) is the most frequent cardiac arrhythmia in clinical practice. AF is often associated with profound functional and structural alterations of the atrial myocardium that compose its substrate. Recently, a relationship between the thickness of epicardial adipose tissue (EAT) and the incidence and severity of AF has been reported. Adipose tissue is a biologically active organ regulating the metabolism of neighbouring organs. It is also a major source of cytokines. In the heart, EAT is contiguous with the myocardium without fascia boundaries resulting in paracrine effects through the release of adipokines. Indeed, Activin A, which is produced in abundance by EAT during heart failure or diabetes, shows a marked fibrotic effect on the atrial myocardium. The infiltration of adipocytes into the atrial myocardium could also disorganize the depolarization wave front favouring micro re-entry circuits and local conduction block. Finally, EAT contains progenitor cells in abundance and therefore could be a source of myofibroblasts producing extracellular matrix. The study on the role played by adipose tissue in the pathogenesis of AF is just starting and is highly likely to uncover new biomarkers and therapeutic targets for AF. PMID:24648445

  3. A Patient With an Asymptomatic Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Ewa Majos, MD; Rafal Dabrowski MD, PhD

    2015-02-01

    Full Text Available Atrial fibrillation (AF is a common and refractory arrhythmia. Prevalence of AF increases with age. Asymptomatic AF is a state of asymptomatic episodes of arrhythmia and its exact prevalence remains unknown. Ablation and therapy with antiarrhythmic agents may predispose to asymptomatic AF. Detection of silent AF is crucial for prevention of ischaemic stroke. Progress in continuous ECG monitoring by Holter ECG, telemetry methods or implantable devices can provide a useful tools for identifying silent AF. Simple screening procedures like pulse examination and ambulatory ECG may be helpful in arrhythmia detection and logically – ischemic stroke prevention.

  4. Current approaches in atrial fibrillation treatment

    Directory of Open Access Journals (Sweden)

    Cenk Sarı

    2014-09-01

    Full Text Available Atrial fibrillation (AF is the most common sustained arrhythmia encountered in clinical practice. Its incidence increases with age. AF is classified into subtypes according to the duration and/or able to provide sinus rhytym. İnitially, patients should be evaluated for rhythm or rate control for appropriate treatment. Second stage of strategy aimed to investigate the feasibility of anticoagulation therapy. Recently, due to the progress made in treatment with rhythm control and anticoagulation therapy, either American or European guidelines have been renovated. These developments have taken place in the newly published guide. In this article, the current change in the management of AF is discussed.

  5. NASA's First Atrial Fibrillation Case - Deke Slayton

    Science.gov (United States)

    Tarver, William J.

    2010-01-01

    Concerns about heart dysrhythmia have been present since the earliest days of the US manned space program. While information about an astronaut's health is general kept private, one of the original seven American astronaut's health status was played out in a very public forum. Donald "Deke" Slayton was removed from the second manned space flight when it was discovered he had idiopathic atrial fibrillation. Referencing the original medical documents, details of how this was discovered and managed from the medical perspective will be reviewed. This is NASA's first heart dysrhythmia case in an astronaut and it proves quite interesting when placed in historic perspective.

  6. Atrial fibrillation in China: a brief review

    Institute of Scientific and Technical Information of China (English)

    MA Chang-sheng; DU Xin; JIANG Chen-xi

    2009-01-01

    @@ Atrial fibrillation (AF) is the most common heart rhythm disturbance encountered in clinical practice.It affects at least ten million Chinese, constituting a major public health epidemic. For the shortness of resource in the initial stage of new China and the chaos during the culture revolution, there was a scarcity of AF data on the Chinese population. However, Chinese physicians had never stopped exploring in this field, which has provided a solid foundation for today's flourishing development in the research of AF. This paper aims to review the major achievements in dealing with AF in the past 60 years in China, especially in the latest 15 years.

  7. Atrioventricular Junction Ablation for Atrial Fibrillation.

    Science.gov (United States)

    Patel, Dilesh; Daoud, Emile G

    2016-04-01

    Atrioventricular junction (AVJ) ablation is an effective therapy in patients with symptomatic atrial fibrillation who are intolerant to or unsuccessfully managed with rhythm control or medical rate control strategies. A drawback is that the procedure mandates a pacing system. Overall, the safety and efficacy of AVJ ablation is high with a majority of the patients reporting significant improvement in symptoms and quality-of-life measures. Risk of sudden cardiac death after device implantation is low, especially with an appropriate postprocedure pacing rate. Mortality benefit with AVJ ablation has been shown in patients with heart failure and cardiac resynchronization therapy devices. PMID:26968669

  8. Apixaban and atrial fibrillation: no clear advantage.

    Science.gov (United States)

    2014-02-01

    For the prevention of thromboembolic events in patients with atrial fibrillation and a high thrombotic risk, the standard treatment is warfarin, an anticoagulant. Dabigatran, a thrombin inhibitor, is the alternative when warfarin fails to maintain the INR within the therapeutic range. Patients with a moderate thrombotic risk may receive either warfarin or low-dose aspirin. Apixaban, a factor Xa inhibitor anticoagulant, has been authorised in the European Union for use in patients with non-valvular atrial fibrillation and a moderate or high risk of thrombosis. In a double-blind, randomised non-inferiority trial versus warfarin in 18 201 patients, the incidence of stroke or systemic embolism was lower in the apixaban group (average 1.3 versus 1.6 events per 100 patient-years; p = 0.01). This difference was mainly due to a lower incidence of haemorrhagic stroke and did not result in a clear decline in mortality. In addition, these results are undermined by multiple methodological flaws. Clinical evaluation included no trials comparing apixaban with dabigatran; any indirect comparison would be risky given the poor quality of the clinical assessment of both drugs in atrial fibrillation. A double-blind, randomised trial including 5598 patients compared apixaban with aspirin but provided little information on these options in patients with a moderate risk of thrombosis, as most patients were at high risk. In clinical trials, major bleeding events were less frequent with apixaban than with warfarin (average 2.1 versus 3.1 events per 100 patient-years), but they were more frequent with apixaban than with aspirin (1.4 versus 0.9 events per 100 patient-years). In 2013, there is no way of monitoring the anticoagulant activity of apixaban in routine clinical practice, and there is no antidote in case of overdose; the same is true for dabigatran. Apixaban is a substrate for various cytochrome P450 isoenzymes and for P-glycoprotein, creating a risk of multiple drug

  9. 78 FR 11207 - Clinical Study Designs for Surgical Ablation Devices for Treatment of Atrial Fibrillation...

    Science.gov (United States)

    2013-02-15

    ... Treatment of Atrial Fibrillation; Guidance for Industry and Food and Drug Administration Staff; Availability... Ablation Devices for Treatment of Atrial Fibrillation.'' This guidance provides FDA's recommendations on clinical trial designs for surgical ablation devices intended for the treatment of atrial...

  10. Graves disease and atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Bello-Espinosa Ariel

    2010-06-01

    Full Text Available A clinical case of am 26 year old male is presented, with a diagnosis of hypothyroidism 2 years before admission. The patient consulted because he presented the following clinical symptoms: palpitation, exhaustion, fatigue, loss of weight, and trembling. The physical exam reveals ocular proptosis and a notable mass in the anterolateral region of the neck, besides classical symptomatology of Graves’ disease. After the realization of different labs (TSH, Electrocardiogram, a Graves’ disease and auricular paroxystic fibrillation are diagnosed. The patient is treated with Metimazol, Propranolol, and Hidrocortisona. Following that, the patient improves his clinical condition, for which he is discharged. Additionally, in concord with current bibliography, clinical and epidemiological aspects of Graves’ disease are presented and physiopathological mechanisms that trigger this disease are illustrated with the aim to show the medical community about a pathology infrequently presented in young males.RESUMENSe presenta el caso clínico de un paciente masculino de 26 años de edad condiagnóstico de base de hipertiroidismo dos años previos al ingreso que consulta por cuadro clínico de palpitaciones, cansancio excesivo, fatiga, pérdida de peso y temblor generalizado. El examen físico revela protrusión ocular y masa notable en región antero - lateral del cuello, además de la presentación de signos clásicos de enfermedad de Graves. Después de la realización de diferentes estudios, entre ellos análisis de hormonas tiroideas y electrocardiograma, se diagnostica enfermedad de Graves y fibrilación auricular paroxística. El paciente es tratado con Metimazol, Propranolol e hidrocortisona, presentando mejoría clínica por lo que es dado de alta. Adicionalmente, en concordancia con la bibliografía se señalan no solo los aspecto clínicos y epidemiológicos más relevantes de la enfermedad de Graves, sino que también se expone con claridad los

  11. Reversal of pulmonary vein remodeling after catheter ablation of atrial fibrillation

    OpenAIRE

    Wu, Jia-hui; Li, Hung-Kei; Couri, Daniel M; Araoz, Philip A; Lee, Ying-Hsiang; Ma, Chang-Sheng; Packer, Douglas L.; Cha, Yong-Mei

    2016-01-01

    Background Pulmonary veins (PV) and the atria undergo electrical and structural remodeling in atrial fibrillation (AF). This study aimed to determine PV and left atrial (LA) reverse remodeling after catheter ablation for AF assessed by chest computed tomography (CT). Methods PV electrophysiologic studies and catheter ablation were performed in 63 patients (68% male; mean ± SD age: 56 ± 10 years) with symptomatic AF (49% paroxysmal, 51% persistent). Chest CT was performed before and 3 months a...

  12. Review of Dominant Frequency Analysis in Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Rakesh Latchamsetty

    2009-10-01

    Full Text Available Significant advancements have been made in the technology and approach to catheter ablation of atrial fibrillation (AF. Pulmonary vein isolation has emerged as the dominant strategy in this procedure and has fueled innovations in catheter design as well as various mapping and navigation systems. Mapping and targeting of complex fractionated atrial electrograms has also emerged as an additional or alternate strategy employed by some ablationists. Recently, attention is being drawn to a new approach targeting atrial sites with high dominant frequencies (DF derived from their electrograms. This article is a review of the basic concepts of DF, the relevant literature behind DF analysis in AF, and the potential clinical applicability of DF analysis for catheter ablation. Key Words : Dominant Frequency, Atrial Fibrillation, Ablation Abbreviations : AF - atrial fibrillation; CFAE - complex fractionated atrial electrogram; DF - dominant frequency

  13. Minimally invasive surgery for atrial fibrillation.

    Science.gov (United States)

    Zembala, Michael O; Suwalski, Piotr

    2013-11-01

    Atrial fibrillation (AF) remains the most common cardiac arrhythmia, affecting nearly 2% of the general population worldwide. Minimally invasive surgical ablation remains one of the most dynamically evolving fields of modern cardiac surgery. While there are more than a dozen issues driving this development, two seem to play the most important role: first, there is lack of evidence supporting percutaneous catheter based approach to treat patients with persistent and long-standing persistent AF. Paucity of this data offers surgical community unparalleled opportunity to challenge guidelines and change indications for surgical intervention. Large, multicenter prospective clinical studies are therefore of utmost importance, as well as honest, clear data reporting. Second, a collaborative methodology started a long-awaited debate on a Heart Team approach to AF, similar to the debate on coronary artery disease and transcatheter valves. Appropriate patient selection and tailored treatment options will most certainly result in better outcomes and patient satisfaction, coupled with appropriate use of always-limited institutional resources. The aim of this review, unlike other reviews of minimally invasive surgical ablation, is to present medical professionals with two distinctly different, approaches. The first one is purely surgical, Standalone surgical isolation of the pulmonary veins using bipolar energy source with concomitant amputation of the left atrial appendage-a method of choice in one of the most important clinical trials on AF-The Atrial Fibrillation Catheter Ablation Versus Surgical Ablation Treatment (FAST) Trial. The second one represents the most complex approach to this problem: a multidisciplinary, combined effort of a cardiac surgeon and electrophysiologist. The Convergent Procedure, which includes both endocardial and epicardial unipolar ablation bonds together minimally invasive endoscopic surgery with electroanatomical mapping, to deliver best of the

  14. Clinical characteristics, management, and control of permanent vs. nonpermanent atrial fibrillation: insights from the RealiseAF survey.

    LENUS (Irish Health Repository)

    Murin, Jan

    2014-01-01

    Atrial fibrillation can be categorized into nonpermanent and permanent atrial fibrillation. There is less information on permanent than on nonpermanent atrial fibrillation patients. This analysis aimed to describe the characteristics and current management, including the proportion of patients with successful atrial fibrillation control, of these atrial fibrillation subsets in a large, geographically diverse contemporary sample.

  15. Atrial Cardiopathy: A Broadened Concept of Left Atrial Thromboembolism Beyond Atrial Fibrillation

    Science.gov (United States)

    Kamel, Hooman; Okin, Peter M.; Longstreth, W. T.; Elkind, Mitchell S.V.; Soliman, Elsayed Z.

    2016-01-01

    Atrial fibrillation (AF) has long been associated with a heightened risk of ischemic stroke and systemic thromboembolism, but recent data require a re-evaluation of our understanding of the nature of this relationship. New findings about the temporal connection between AF and stroke, alongside evidence linking markers of left atrial abnormalities with stroke in the absence of apparent AF, suggest that left atrial thromboembolism may occur even without AF. These observations undermine the hypothesis that the dysrhythmia that defines AF is necessary and sufficient to cause thromboembolism. In this commentary, we instead suggest that the substrate for thromboembolism may often be the anatomic and physiological atrial derangements associated with AF. Therefore, our understanding of cardioembolic stroke may be more complete if we shift our representation of its origin from AF to the concept of atrial cardiopathy. PMID:26021638

  16. Raised plasma concentrations of atrial natriuretic peptide are independent of left atrial dimensions in patients with chronic atrial fibrillation.

    OpenAIRE

    Berglund, H; Boukter, S; Theodorsson, E; Vallin, H; Edhag, O

    1990-01-01

    The aim of the present study was to determine whether left atrial size--a likely indicator of atrial stretching--correlates with the plasma concentration of atrial natriuretic peptide and whether this relation is different in patients in sinus rhythm and in those with atrial fibrillation. Arterial plasma concentrations of immunoreactive atrial natriuretic peptide (ir-ANP), adrenaline, noradrenaline, aldosterone, and vasopressin were measured in 13 patients in sinus rhythm without apparent hea...

  17. No incremental benefit of multisite atrial pacing compared with right atrial pacing in patients with drug refractory paroxysmal atrial fibrillation

    OpenAIRE

    Levy, T; Walker, S; Rex, S; Rochelle, J; Paul, V.

    2001-01-01

    OBJECTIVE—To evaluate the incremental antifibrillatory effect of multisite atrial pacing compared with right atrial pacing in patients with drug refractory paroxysmal atrial fibrillation paced for arrhythmia prevention alone.
METHODS—In 20 of these patients (mean (SD) age 64 (8) years; 14 female, six male), a single blinded randomised crossover study was performed to investigate the incremental benefit of one month of multisite atrial pacing compared with one month of right atrial pacing. Out...

  18. Left atrial dimension and atrial fibrillation in surgical heart disease patients

    Institute of Scientific and Technical Information of China (English)

    Kaihu Shi; Peisheng Liu; David Shek; Hongwei Shi; Ying Yu; Fei Ye; Xinwei Mu; Youxiang Zhang; Leiyang Zhang; Junjie Shao; Rui Wang

    2008-01-01

    Objective The effect of left atrial (LA) dimension on the occurrence of atrial fibrillation (AF) has been examined in some small studies.Less is known about the relationship of LA dimension,hemodynamic with AF during echocardiographic evaluation,especially,the flow dynamics in LA poorly described.The objective of this study was to investigate the relationship between LA dimension and the occurrence of AE Methods Two hundred and forty-five consecutive patients with heart disease scheduled to undergo open heart surgery were prospectively enrolled in the study.Patients were divided into 2 groups according to atrial fibrillation:AF group (n=148,99 men and 49 women,with a mean age 59.3+8.4 years),and no-AF group (n= 97,60 men and 37 womem).Echocardiography was performed before surgery.All measurements were performed following the American Society of Echocardiography recommendations.Results There were more patients with congestive heart failure in AF group than in no-AF group (45.9% vs 39.1%,P <0.05).The mean LA volume was 49.2±12.2 ml/m2 in AF group and 33.1±10.8 ml/m2 in no-AF group.There were also significant differences between two groups in left atrial end systolic dimension (LAESD) (50±13mm vs 27±14mm),left atrial end diastolic dimension (LAEDD) (79±17mm vs 53±13mm),PA pressure ( 41.3+11.6 mmHg vs 37.5±10.4 mmHg),and ratio of mitral E velocity and septal mitral annulus motion velocity (E/E') .The percentage of abnormal diastolic function grades (DGF) was also higher in AF than in no-AF group (89.9% versus 59.8% );.Conclusion Atrial fibrillation is associated more frequently with an increased LA dimension and more severe atrial hemodynamics disorder.(J Geriatr Cardiol 2008;5:11-4)

  19. [Obesity as a risk factor for atrial fibrillation].

    Science.gov (United States)

    Duraj, Iwona; Broncel, Marlena

    2016-01-01

    Atrial fibrillation (AF) and obesity is a growing problem of public health both in Poland and in the whole world. AF risk factors may be summarized as elderliness, male sex, smoking, hypertension, diabetes, obesity, coronary heart disease, heart failure, valvular heart disease, cardiac surgery. Once obesity is an independent, potentially modifiable risk factor for AF. The connection between obesity and atrial fibrillation is very up-to-date because of incremental prevalence, almost epidemic of obesity in the whole world. The probability of AF among obese patients increases with concomitant obstructive sleep apnea. Regardless many researches it hasn't been assessed yet how obesity itself predisposes to AF. It could be an effect of change in the atrial anatomy, the rise of atrial pressure, mechanical stretch, interstitial atrial fibrosis and disruption of atrial electric integrity. A great role is ascribed to inflammation, especially proinflammatory cytokines increased by adipocites of left atrial epicardial adiposity. PMID:26891428

  20. Dronedarone in high-risk permanent atrial fibrillation

    DEFF Research Database (Denmark)

    Connolly, Stuart J; Camm, A John; Halperin, Jonathan L;

    2011-01-01

    Dronedarone restores sinus rhythm and reduces hospitalization or death in intermittent atrial fibrillation. It also lowers heart rate and blood pressure and has antiadrenergic and potential ventricular antiarrhythmic effects. We hypothesized that dronedarone would reduce major vascular events in...

  1. Interrupting Anticoagulation in Patients With Nonvalvular Atrial Fibrillation

    OpenAIRE

    Yates, Scott W

    2014-01-01

    No agents are approved to reverse the effects of newer anticoagulants used to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. This review focuses on ways to monitor, interrupt, and reverse such anticoagulation.

  2. Women Sex Importance in Stroke Patients with Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Cemile Handan Mısırlı

    2014-08-01

    Full Text Available OBJECTIVE: It was shown the differences in age, risk factors and treatment between women and men in stroke patients with atrial fibrillation METHODS: The stroke patients with atrial fibrillation who were hospitalized in our department at the last 2 years were seperated into 2 groups of aged above 75 and below 75, investigated with CHADS2 and CHA2DS2VASc scores and looked at the sex differences of women and men. RESULTS: Stroke ratio according to sex was statistically meaningful especially in women above the age of 75. Risc factors also were founded in elderly women and CHA2DS2VASc scores were higher in women than men so more anticoagulan treatment were begun. No differences were shown between sexes at lone atrial fibrillation and no treatment were begun. CONCLUSION: Women with atrial fibrillation had more risk factors, higher stroke rate and higher anticoagulation treatment.

  3. Atrial fibrillation in the dog: a review of eight cases

    International Nuclear Information System (INIS)

    Eight cases of canine atrial fibrillation encountered in small animal practice are reported. Details are included of age, sex and breed, history and clinical signs, thoracic radiography, electrocardiography, clinical pathology, treatment and survival periods

  4. YKL-40 levels and atrial fibrillation in the general population

    DEFF Research Database (Denmark)

    Marott, Sarah C W; Benn, Marianne; Johansen, Julia S;

    2013-01-01

    BACKGROUND: Atrial fibrillation is associated with inflammation. In contrast to inflammatory markers like C-reactive protein (CRP) and fibrinogen produced in the liver, YKL-40 is produced at the site of inflammation including in the myocardium. We hypothesized that elevated plasma YKL-40 levels...... associate with increased risk of atrial fibrillation. METHOD AND RESULTS: We measured plasma YKL-40 in 8731 participants from the prospective Copenhagen City Heart Study including 896 individuals who developed atrial fibrillation during up to 18years of follow-up. Additionally, we measured YKL-40 in 6621...... individuals from the cross-sectional Copenhagen General Population Study including 337 cases with atrial fibrillation. A YKL-40 level >95% percentile (>204μg/L) versus 95% percentile versus...

  5. CHRONIC KIDNEY DISEASE AND CARDIOVASCULAR DISEASES: FOCUS ON ATRIAL FIBRILLATION

    OpenAIRE

    V N Shishkova

    2015-01-01

    The question of mutual influence of risk factors for cardiovascular and renal diseases with a focus on atrial fibrillation is considered. Modern approaches to the prevention of major macrovascular events in patients with comorbidity are evaluated.

  6. CHRONIC KIDNEY DISEASE AND CARDIOVASCULAR DISEASES: FOCUS ON ATRIAL FIBRILLATION

    Directory of Open Access Journals (Sweden)

    V. N. Shishkova

    2015-09-01

    Full Text Available The question of mutual influence of risk factors for cardiovascular and renal diseases with a focus on atrial fibrillation is considered. Modern approaches to the prevention of major macrovascular events in patients with comorbidity are evaluated.

  7. Treatment Guidelines of Atrial Fibrillation (AFib or AF)

    Science.gov (United States)

    ... Pressure Symptoms, Diagnosis & Monitoring of High Blood Pressure Prevention & Treatment of High Blood Pressure High Blood Pressure Tools & Resources Stroke More Treatment Guidelines of Atrial Fibrillation (AFib or AF) Updated:Jun 23,2016 What ...

  8. New Technologies in Atrial Fibrillation Ablation

    Directory of Open Access Journals (Sweden)

    John Rickard, MD, MPH; Saman Nazarian MD, PhD

    2014-08-01

    Full Text Available Atrial fibrillation (AF is a major public health issue worldwide the incidence of which is likely to continue to rise. With the birth of pulmonary vein isolation(PVI, cardiac ablation has emerged as key strategy for the treatment of AF. PVI using traditional point by point radiofrequency ablation is time consuming and technically challenging. Refining patient selection for PVI also remains an important goal. New ablative strategies using catheter-based balloon technologies, such as cryothermy and laser-based systems, may simplify PVI. In addition, new MRI-based techniques offer the hope of refining patient selection prior to ablation. Lastly, FIRM mapping represents an entirely new approach to AF ablation via the targeting of mechanisms that perpetuate AF rather than simply targeting triggers alone.

  9. Endurance Sport Practice and Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Naiara Calvo

    2010-10-01

    Full Text Available Atrial fibrillation (AF is the most common cardiac rhythm disorder in clinical practice, with an estimated prevalence of 0.4% to 1% in the general population, increasing with age to 8% in those older than 80 years. The recognized risk factors for developing AF include age, hypertension, structural heart disease, diabetes mellitus, and hyperthyroidism. However, the etiology remains unclear in a significant number of patients younger than age 60 in whom no cardiovascular disease or any other known causal factor is present. This condition is termed lone AF, and may be responsible for as many as 30% of patients with paroxysmal AF seeking medical attention. Although regular physical activity clearly reduces cardiovascular morbidity risk, in recent years long-term endurance sport practice has been recognized as a risk factor for AF. However, the underlying mechanism explaining this association is unclear.

  10. Surgical ablation devices for atrial fibrillation.

    Science.gov (United States)

    Lall, Shelly C; Damiano, Ralph J

    2007-12-01

    The introduction of ablation technology has revolutionized the surgical treatment of atrial fibrillation (AF). It has greatly simplified surgical approaches and has significantly increased the number of procedures being performed. Various energy sources have been used clinically, including cryoablation, radiofrequency, microwave, laser, and high-frequency ultrasound. The goal of these devices is to create conduction block to either block activation wavefronts or to isolate the triggers of AF. All present devices have been shown to have clinical efficacy in some patients. The devices each have their unique advantages and disadvantages. It is important that surgeons develop accurate dose-response curves for new devices in clinically relevant models on both the arrested and beating heart. This will allow the appropriate use of technology to facilitate AF surgery. PMID:18175210

  11. Advances in Imaging for Atrial Fibrillation Ablation

    International Nuclear Information System (INIS)

    Over the last fifteen years, our understanding of the pathophysiology of atrial fibrillation (AF) has paved the way for ablation to be utilized as an effective treatment option. With the aim of gaining more detailed anatomical representation, advances have been made using various imaging modalities, both before and during the ablation procedure, in planning and execution. Options have flourished from procedural fluoroscopy, electro anatomic mapping systems, pre procedural computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and combinations of these technologies. Exciting work is underway in an effort to allow the electro physiologist to assess scar formation in real time. One advantage would be to lessen the learning curve for what are very complex procedures. The hope of these developments is to improve the likelihood of a successful ablation procedure and to allow more patients access to this treatment

  12. Managing atrial fibrillation in the elderly: critical appraisal of dronedarone

    OpenAIRE

    Trigo P; Fischer GW

    2011-01-01

    Paula Trigo, Gregory W FischerDepartment of Anesthesiology, Mount Sinai School of Medicine, New York, NY, USAAbstract: Atrial fibrillation is the most commonly seen arrhythmia in the geriatric population and is associated with increased cardiovascular morbidity and mortality. Treatment of the elderly with atrial fibrillation remains challenging for physicians, because this unique subpopulation is characterized by multiple comorbidities requiring chronic use of numerous medications, which can ...

  13. Management of Atrial Fibrillation in Patients with Heart Failure

    OpenAIRE

    Dr. Andrew E. Darby

    2014-01-01

    Atrial fibrillation (AF) and heart failure (HF) are common conditions that frequently coexist. Both conditions share risk factors, are associated with increased morbidity and mortality, and may worsen the other. The presence of heart failure and symptoms associated with it may influence both the approach to management (i.e., rate versus rhythm control) and the treatment options available for AF patients. The presence of HF increases the stroke risk with atrial fibrillation, and thromboembo...

  14. Cognitive function in patients with atrial fibrillation (review

    Directory of Open Access Journals (Sweden)

    Demenko T.N.

    2015-12-01

    Full Text Available A lot of attention is paid to the problem of cognitive impairment in cardiovascular diseases now. Contribution of atrial fibrillation (AF to the cognitive decline is very large. The relevance of the topic is caused by a prevalence of cognitive impairment in AF, which may cause disability and reduced quality of life of these patients. The diagnosis of mild cognitive impairment is important. It would allow to identify a group of patients with an increased risk of cerebral complications timely, especially among working-age cohort of patients. Reduction of cerebral perfusion, 'silent' heart attacks, neurodegenerative changes in the brain may cause cognitive impairment. The relationship of cognitive impairment and atrial fibrillation is confirmed in large-scale multicenter trials. We searched PubMed, Medline, e-library and Cochrane databases on the terms 'atrial fibrillation' and 'cognitive impairment' in reports published from 2010 to 2014. Cognitive status is lower in patients with AF versus patients with sinus rhythm. All parameters of cognitive functions were reduced in patients with atrial fibrillation. The dynamics of cognitive impairment in various forms of atrial fibrillation is poorly studied yet. However, there are data of increased risk of ischemic stroke or systemic embolism in subclinical atrial fibrillation. Neuroimaging techniques allow to confirm asymptomatic embolization of cerebral vessels. The risk of dementia is more than 2 times higher in patients with the signs of 'silent' strokes on MRI versus patients with clinical stroke. In addition, neuropsychological tests can detect cognitive impairment in early, preclinical stages of dementia. Anxiety and depressive disorders in atrial fibrillation can mask cognitive impairment. Detection and correction of anxiety and depressive disorders will allow to avoid false-positive results in psychological testing on cognitive impairment. In general, identification of the cognitive impairment in

  15. Stroke and bleeding in atrial fibrillation with chronic kidney disease

    DEFF Research Database (Denmark)

    Olesen, Jonas Bjerring; Lip, Gregory Y.H.; Kamper, Anne-Lise;

    2012-01-01

    Both atrial fibrillation and chronic kidney disease increase the risk of stroke and systemic thromboembolism. However, these risks, and the effects of antithrombotic treatment, have not been thoroughly investigated in patients with both conditions.......Both atrial fibrillation and chronic kidney disease increase the risk of stroke and systemic thromboembolism. However, these risks, and the effects of antithrombotic treatment, have not been thoroughly investigated in patients with both conditions....

  16. Stroke Prevention in Atrial Fibrillation: Concepts and Controversies

    OpenAIRE

    Ahmad, Yousif; Lip, Gregory YH

    2012-01-01

    Atrial fibrillation (AF) is the commonest cardiac rhythm disorder worldwide, affecting 1% of the general population. It is estimated that up to 16 million people in the US will suffer from the arrhythmia by 2050. AF is an independent stroke risk factor and associated with more severe strokes. For six decades, warfarin has been the only truly effective therapy to protect against stroke for patients with atrial fibrillation. Despite the proven worth of warfarin, its limitations have seen reluct...

  17. Pharmacological Management of Atrial Fibrillation: One, None, One Hundred Thousand

    OpenAIRE

    Jos Maessen; Gian Franco Gensini; Benedetto Daniela; Roberto Lorusso; Rocco Carella; Ludovico Vasquez; Orlando Parise; Carmelo Massimiliano Rao; Mark La Meir; Fabiana Lucà; Sandro Gelsomino

    2011-01-01

    Abstract atrial fibrillation (AF) is associated with a significant burden of morbidity and increased risk of mortality. Antiarrhythmic drug therapy remains a cornerstone to restore and maintain sinus rhythm for patients with paroxysmal and persistent AF based on current guidelines. However, conventional drugs have limited efficacy, present problematic risks of proarrhythmia and cause significant noncardiac organ toxicity. Thus, inadequacies in current therapies for atrial fibrillation have ma...

  18. Atrial Fibrillation Predictors: Importance of the Electrocardiogram.

    Science.gov (United States)

    German, David M; Kabir, Muammar M; Dewland, Thomas A; Henrikson, Charles A; Tereshchenko, Larisa G

    2016-01-01

    Atrial fibrillation (AF) is the most common arrhythmia in adults and is associated with significant morbidity and mortality. Substantial interest has developed in the primary prevention of AF, and thus the identification of individuals at risk for developing AF. The electrocardiogram (ECG) provides a wealth of information, which is of value in predicting incident AF. The PR interval and P wave indices (including P wave duration, P wave terminal force, P wave axis, and other measures of P wave morphology) are discussed with regard to their ability to predict and characterize AF risk in the general population. The predictive value of the QT interval, ECG criteria for left ventricular hypertrophy, and findings of atrial and ventricular ectopy are also discussed. Efforts are underway to develop models that predict AF incidence in the general population; however, at present, little information from the ECG is included in these models. The ECG provides a great deal of information on AF risk and has the potential to contribute substantially to AF risk estimation, but more research is needed. PMID:26523405

  19. Bolus injection of acetylcholine terminates atrial fibrillation in rats.

    Science.gov (United States)

    Fleidervish, Ilya A; Goldberg, Yuri; Ovsyshcher, I Eli

    2008-01-28

    It is well established that a tonic increase in the availability of the atrial muscarinic K(+) channels, either by enhanced vagal tone or by steady infusion of a low-dose of cholinergic or adenosine receptor agonists, promotes the genesis of atrial fibrillation. Here, we aimed to test the hypothesis that bolus administration of a muscarinic receptor agonist would destabilize and terminate atrial arrhythmia by uniformly and transiently activating K(+) channels throughout the atria, and that if the agonist was rapidly hydrolysable, it would dissipate before the more tonic, pro-arrhythmic effects could take hold. The episodes of untreated atrial fibrillation, induced in anesthetized rats by programmed electrical stimulation via trans-esophageal bipolar catheter, lasted on average 8.6+/-2.2 min (n=32). Intravenous injection of a model hydrolysable muscarinic agonist, acetylcholine (0.2 mg/kg body weight), converted atrial fibrillation into sinus rhythm within 8.4+/-1.9 s (n=10, Ppre-atrial fibrillation values within 10-20 s of injection. In conclusion, our evidence indicates that bolus administration of rapidly hydrolysable muscarinic agonist could be an effective way to pharmacologically terminate atrial fibrillation and restore sinus rhythm. PMID:18078927

  20. Atrial fibrillation and its determinants after radiofrequency ablation of chronic common atrial flutter

    OpenAIRE

    2005-01-01

    Aim. Atrial fibrillation (AFib) is a major clinical issue and its occurrence is the main problem after catheter ablation of atrial flutter. The long-term occurrence of AFib after common atrial flutter ablation is still matter of debate as it may influence the therapeutic approach. So, the aim of our study was to analyze the determinants and the time course of AFib after radiofrequency catheter ablation of chronic common atrial flutter. Methods and Results. 89 consecutive patients (67.5 ± ...

  1. Vascular disease and stroke risk in atrial fibrillation

    DEFF Research Database (Denmark)

    Olesen, Jonas Bjerring; Lip, Gregory Y.H.; Lane, Deirdre A;

    2012-01-01

    Vascular disease (including myocardial infarction and peripheral artery disease) has been proposed as a less well-validated risk factor for stroke in patients with atrial fibrillation. We investigated whether vascular disease is an independent risk factor of stroke/thromboembolism in atrial fibri...

  2. KCNE3 R53H substitution in familial atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    ZHANG Dai-fu; LIANG Bo; LIN Jie; LIU Ban; ZHOU Qin-shu; YANG Yi-qing

    2005-01-01

    @@ Atrial fibrillation (AF) is the most common cardiac arrhythmia with debilitating compli-cations of stroke. Multiple-wavelet re-entry and focal activation from pulmonary vein foci are two dominant electrophysiological theories of AF. Atrial electrical remodeling plays a role in the maintenance of AF. However, molecular mechanisms of the arrhythmia are still poorly understood.

  3. Atrioverter: An implantable device for the treatment of atrial fibrillation

    OpenAIRE

    Wellens, HJJ; Lau, CP; Lüderitz, B; Akhtar, M.; Waldo, AL; Camm, AJ; C. Timmermans; Tse, HF; Jung, W.; Jordaens, L.; Ayers, G

    1998-01-01

    Background - During atrial fibrillation, electrophysiological changes occur in atrial tissue that favor the maintenance of the arrhythmia and facilitate recurrence after conversion to sinus rhythm. An implantable defibrillator connected to right atrial and coronary sinus defibrillation leads allows prompt restoration of sinus rhythm by a low-energy shock. The safety and efficacy of this system, called the Atrioverter, were evaluated in a prospective, multicenter study. Methods and Results - T...

  4. Cardiac ion channels and mechanisms for protection against atrial fibrillation

    DEFF Research Database (Denmark)

    Grunnet, Morten; Bentzen, Bo Hjorth; Sørensen, Ulrik S;

    2011-01-01

    Atrial fibrillation (AF) is recognised as the most common sustained cardiac arrhythmia in clinical practice. Ongoing drug development is aiming at obtaining atrial specific effects in order to prevent pro-arrhythmic, devastating ventricular effects. In principle, this is possible due to a different...... the recent discovery that Ca(2+)-activated small conductance K(+) channels (SK channels) are important for the repolarisation of atrial action potentials. Finally, an overview of current pharmacological treatment of AF is included....

  5. Freedom from atrial fibrillation after cox maze III ablation during follow-up

    OpenAIRE

    Fariborz Akbarzadeh; Rezayat Parvizi; Naser Safaie; Mohammad-Mahdi Karbalaei; Bita Hazhir-Karzar; Babak Bagheri

    2015-01-01

    Background: Nearly 60% of patients undergoing mitral valve (MV) operations are affected by atrial fibrillation (AF). Cox Maze III ablation is one of the effective ways for restoring sinus rhythm for patients undergoing open heart surgery. The aim of present study was to evaluate efficacy of Maze III ablation procedure for restoring sinus rhythm among patients who had underwent open heart surgery. Materials and Methods: During present descriptive-analytic prospective study 114 patients with ch...

  6. Collateral damage from Catheter Ablation of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Wanwarang Wongcharoen, MD

    2013-04-01

    Full Text Available Atrial fibrillation (AF is the most common sustained arrhythmia, contributing to a significant morbidity and mortality. Catheter ablation of the pulmonary veins (PVs and left atrium (LA has been shown to be an effective strategy for the treatment of symptomatic AF. Regardless of technological advances and technique improvement, catheter ablation for AF remains a highly complex procedure and the risk of procedural complications is not negligible. The major complications have been reported to occur in up to 5.2% of procedures. A systematic investigation among 32,569 patients undergoing catheter ablation for AF has demonstrated that mortality is around 0.1%. Nevertheless, the true prevalence of complications is possibly underestimated in retrospective surveys because of recollection bias and other factors. This article will focus on the management of serious complications of catheter AF ablation including PV stenosis, atrioesophageal fistula, cardiac tamponade, stroke and thromboembolic complication

  7. Altered Excitation-Contraction Coupling in Human Chronic Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Eleonora Grandi

    2012-04-01

    Full Text Available This review focuses on the (maladaptive processes in atrial excitation-contraction coupling occurring in patients with chronic atrial fibrillation. Cellular remodeling includes shortening of the atrial action potential duration and effective refractory period, depressed intracellular Ca2+ transient, and reduced myocyte contractility. Here we summarize the current knowledge of the ionic bases underlying these changes. Understanding the molecular mechanisms of excitation-contraction-coupling remodeling in the fibrillating human atria is important to identify new potential targets for AF therapy.

  8. The totally thoracoscopic left atrial maze procedure for the treatment of atrial fibrillation.

    Science.gov (United States)

    van Laar, Charlotte; Geuzebroek, Guillaume S C; Hofman, Frederik N; Van Putte, Bart P

    2016-01-01

    The totally thoracoscopic left atrial maze (TT-maze) is a recent, minimally invasive surgical procedure for the treatment of atrial fibrillation, with promising results in terms of freedom from atrial fibrillation. The TT-maze consists of a bilateral, epicardial pulmonary vein isolation with the creation of a box using radiofrequency and exclusion of the left atrial appendage (LAA). In addition, the box is connected with the base of the LAA and furthermore with the mitral annulus with the so-called trigonum line. In this report, we describe our surgical approach and short-term results. PMID:26993056

  9. The Relation of Atrial Fibrillation and Inflammation Do Inflammation Imply the Pathogenesis of Atrial Fibrillation?

    Institute of Scientific and Technical Information of China (English)

    Ruibin Fu; Pingsheng Wu; Shulin Wu

    2008-01-01

    @@ Atrial fibrillation (AF),the most commonly encountered arrhythmia in clinical practice,is associated with a 2-fold increase in total cardiovascular mortality[1],as well as the potential for substantial morbidity,including stroke,congestive heart failure,and cardiomyopathy.Its incidence and prevalence are increasing,and it represents a growing clinical and economic burden.Owing to relative inefficacy and side effects of current pharmacological and non-pharmacological therapy for AF,it remains a great challenge to improve primary and secondary AF prevention strategies to reduce this potentially enormous health burden.

  10. Impaired endothelial function in lone atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Polovina Marija

    2013-01-01

    Full Text Available Background/Aim. Impaired endothelial function has been previously documented in patients with atrial fibrillation (AF and underlying comorbidities or older patients with idiopathic AF. The aim of this study was to evaluate systemic endothelial function in younger AF patients (less than 7 days lone AF. The second group comprised of 28 healthy controls in sinus rhythm (the mean age 43 ± 13, 53% male, matched by age, gender and atherosclerotic risk factors. All the participants underwent physical examination, laboratory analysis [including determination of C-reactive protein (CRP], standard echocardiography and exercise-stress testing. Brachial artery FMD and endothelium independent dilation (NMD were assessed with a high-resolution ultrasound probe and arterial diameters taken from 5 consecutive cardiac cycles were averaged for each measurement to accommodate to beat-to-beat flow variations in AF. Results. There were no differences between the 2 groups regarding age, gender and most clinical, laboratory and echocardiographic characteristics (all p > 0.05, apart from the increased heart rate (p = 0.018, body mass index (p = 0.027, CRP levels (p = 0.007 and left atrial anteroposterior dimension (p 0.05. In the multivariate analysis, the independent FMD determinants in our study population were the presence of AF, smoking and total cholesterol levels (all p < 0.001. In patients with AF, the strongest independent FMD determinant was arrhythmia duration (p < 0.001, followed by smoking (p = 0.013 and total cholesterol levels (p = 0.045. Conclusions. Our findings confirm that sustained AF is associated with systemic endothelial dysfunction even in relatively young patients with no cardiovascular disorders or risk factors. AF is an independent contributor to lower FMD and a prolonged arrhythmia duration may confer the risk for more profound endothelial damage.

  11. Excessive supraventricular ectopic activity and increased risk of atrial fibrillation and stroke

    DEFF Research Database (Denmark)

    Binici, Zeynep; Intzilakis, Theodoros; Wendelboe Nielsen, Olav;

    2010-01-01

    Prediction of stroke and atrial fibrillation in healthy individuals is challenging. We examined whether excessive supraventricular ectopic activity (ESVEA) correlates with risk of stroke, death, and atrial fibrillation in subjects without previous stroke or heart disease....

  12. Prevalence and risk factors of atrial fibrillation in hospitalized patients with chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    王骄

    2013-01-01

    Objective Atrial fibrillation (AF) is the most common sustained tachyarrhythmia in the general population.AF and Chronic Kidney Disease (CKD) share several common risk factors.We investigated the association between chronic kidney disease and risk of atrial fibrillation

  13. Risk of atrial fibrillation as a function of the electrocardiographic PR interval

    DEFF Research Database (Denmark)

    Nielsen, Jonas Bille; Pietersen, Adrian; Graff, Claus;

    2013-01-01

    Prolongation of the PR interval has been associated with an increased risk of incident atrial fibrillation (AF).......Prolongation of the PR interval has been associated with an increased risk of incident atrial fibrillation (AF)....

  14. Cardiovascular and non-cardiovascular hospital admissions associated with atrial fibrillation

    DEFF Research Database (Denmark)

    Christiansen, Christine Benn; Olesen, Jonas Bjerring; Gislason, Gunnar;

    2013-01-01

    To examine the excess risk of hospitalisation in patients with incident atrial fibrillation (AF).......To examine the excess risk of hospitalisation in patients with incident atrial fibrillation (AF)....

  15. Concomitant surgical removal of left atrial myxoma and ablation of paroxysmal atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Revishvili A. Sh.

    2013-03-01

    Full Text Available This article describes a clinical case of a patient with left atrial myxoma combined with paroxysmal atrial fibrillation. General practitioner considered symptoms of left ventricular insufficiency (shortness of breath, cough, palpitation, dizziness, blood spitting as lung pathology. When paroxysms of atrial fibrillation became more frequent the patient was send to cardiologist. Transthoracic echocardiography revealed a tumor (55 × 52 mm arising from the middle third of interatrial septum, floating and partially obstructing left atrioventricular orifice. Patient underwent Maze IV procedure combined with tumor resection. Histological study of the tumor showed typical for heart myxoma structure and cells. This case shows on-time diagnostics and successful surgical treatment of the patient with left atrial myxoma combined with paroxysmal atrial fibrillation.

  16. Entropy measurements in paroxysmal and persistent atrial fibrillation

    International Nuclear Information System (INIS)

    Recent studies on atrial fibrillation (AF) have identified different activation patterns in paroxysmal and persistent AF. In this study, bipolar intra-atrial registers from 28 patients (14 paroxysmal AF and 14 persistent AF) were analyzed in order to find out regional differences in the organization in both types of arrhythmias. The organization of atrial electrical activity was assessed in terms of nonlinear parameters, such as entropy measurements. Results showed differences between the atrial chambers with a higher disorganization in the left atrium in paroxysmal AF patients and a more homogenous behavior along the atria in persistent AF patients

  17. Embolic Risk in Atrial Fibrillation that Arises from Hyperthyroidism: Review of the Medical Literature

    OpenAIRE

    Traube, Elie; Coplan, Neil L.

    2011-01-01

    Atrial fibrillation, the most common cardiac complication of hyperthyroidism, occurs in an estimated 10% to 25% of overtly hyperthyroid patients. The prevalence of atrial fibrillation increases with age in the general population and in thyrotoxic patients. Other risk factors for atrial fibrillation in thyrotoxic patients include male sex, ischemic or valvular heart disease, and congestive heart failure. The incidence of arterial embolism or stroke in thyrotoxic atrial fibrillation is less cle...

  18. Age as Risk Factor for Stroke in Atrial Fibrillation Patients:Implications for Thromboprophylaxis

    OpenAIRE

    Konstantina Mitrousi; Gregory Y H Lip; Stavros Apostolakis

    2013-01-01

    Atrial fibrillation is associated with significant morbidity and mortality. There is a strong relationship between atrial fibrillation and aging, thromboembolism, stroke, congestive heart failure and hypertension. On the other hand, advanced age confers a powerful risk factor for stroke and thromboembolism in patients with atrial fibrillation. For many years, vitamin K antagonists were the only approved anticoagulants for the management of atrial fibrillation. Lately new anticoagulants ma...

  19. Atrial fibrillation in the elderly: Is ablation ready for prime time?

    Institute of Scientific and Technical Information of China (English)

    Allen J. Solomon

    2005-01-01

    @@ Atrial fibrillation is the most common sustained arrhythmia and results in significant morbidity, especially in the elderly. The prevalence of atrial fibrillation increases dramatically with advancing age to almost 6% in individuals older than 65 years. In fact, 84% of people with atrial fibrillation are over 65 years of age.1 Additionally, the risk of stroke increases with advancing age, such that one-third of strokes in patients over the age of 65 are caused by atrial fibrillation.

  20. Atrial fibrillation and risk of stroke

    DEFF Research Database (Denmark)

    Christiansen, Christine Benn; Gerds, Thomas A; Olesen, Jonas Bjerring;

    2016-01-01

    AIM: Although the relation between stroke risk factors and stroke in patients with atrial fibrillation (AF) has been extensively examined, only few studies have explored the association of AF and the risk of ischaemic stroke/systemic thromboembolism/transient ischaemic attack (stroke/TE/TIA) in the...... presence of concomitant stroke risk factors. METHODS AND RESULTS: From nationwide registries, all persons who turned 50, 60, 70, or 80 from 1997 to 2011 were identified. Persons receiving warfarin were excluded. The absolute risk of stroke/TE/TIA was reported for a 5-year period, as was the absolute risk...... ratios for AF vs. no AF according to prior stroke and the number of additional risk factors. The study cohort comprised of 3 076 355 persons without AF and 48 189 with AF. For men aged 50 years, with no risk factors, the 5-year risk of stroke was 1.1% (95% confidence interval 1.1-1.1); with AF alone 2...

  1. Comorbidity of atrial fibrillation and heart failure.

    Science.gov (United States)

    Ling, Liang-Han; Kistler, Peter M; Kalman, Jonathan M; Schilling, Richard J; Hunter, Ross J

    2016-03-01

    Atrial fibrillation (AF) and heart failure (HF) are evolving epidemics, together responsible for substantial human suffering and health-care expenditure. Ageing, improved cardiovascular survival, and epidemiological transition form the basis for their increasing global prevalence. Although we now have a clear picture of how HF promotes AF, gaps remain in our knowledge of how AF exacerbates or even causes HF, and how the development of HF affects the outcome of patients with AF. New data regarding HF with preserved ejection fraction and its unique relationship with AF suggest a possible role for AF in its aetiology, possibly as a trigger for ventricular fibrosis. Deciding on optimal treatment strategies for patients with both AF and HF is increasingly difficult, given that results from trials of pharmacological rhythm control are arguably obsolete in the age of catheter ablation. Restoring sinus rhythm by catheter ablation seems successful in the medium term and improves HF symptoms, functional capacity, and left ventricular function. Long-term studies to examine the effect on rates of stroke and death are ongoing. Guidelines continue to evolve to keep pace with this rapidly changing field. PMID:26658575

  2. Imaging in percutaneous ablation for atrial fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Maksimovic, Ruzica [Erasmus Medical Center, Department of Radiology, GD Rotterdam (Netherlands); Institute for Cardiovascular Diseases of the University Medical Center, Belgrade (Czechoslovakia); Dill, Thorsten [Kerckhoff-Heart Center, Department of Cardiology, Bad Nauheim (Germany); Ristic, Arsen D.; Seferovic, Petar M. [Institute for Cardiovascular Diseases of the University Medical Center, Belgrade (Czechoslovakia)

    2006-11-15

    Percutaneous ablation for electrical disconnection of the arrhythmogenic foci using various forms of energy has become a well-established technique for treating atrial fibrillation (AF). Success rate in preventing recurrence of AF episodes is high although associated with a significant incidence of pulmonary vein (PV) stenosis and other rare complications. Clinical workup of AF patients includes imaging before and after ablative treatment using different noninvasive and invasive techniques such as conventional angiography, transoesophageal and intracardiac echocardiography, computed tomography (CT) and magnetic resonance imaging (MRI), which offer different information with variable diagnostic accuracy. Evaluation before percutaneous ablation involves assessment of PVs (PV pattern, branching pattern, orientation and ostial size) to facilitate position and size of catheters and reduce procedure time as well as examining the left atrium (presence of thrombi, dimensions and volumes). Imaging after the percutaneous ablation is important for assessment of overall success of the procedure and revealing potential complications. Therefore, imaging methods enable depiction of PVs and the anatomy of surrounding structures essential for preprocedural management and early detection of PV stenosis and other ablation-related procedures, as well as long-term follow-up of these patients. (orig.)

  3. Imaging in percutaneous ablation for atrial fibrillation

    International Nuclear Information System (INIS)

    Percutaneous ablation for electrical disconnection of the arrhythmogenic foci using various forms of energy has become a well-established technique for treating atrial fibrillation (AF). Success rate in preventing recurrence of AF episodes is high although associated with a significant incidence of pulmonary vein (PV) stenosis and other rare complications. Clinical workup of AF patients includes imaging before and after ablative treatment using different noninvasive and invasive techniques such as conventional angiography, transoesophageal and intracardiac echocardiography, computed tomography (CT) and magnetic resonance imaging (MRI), which offer different information with variable diagnostic accuracy. Evaluation before percutaneous ablation involves assessment of PVs (PV pattern, branching pattern, orientation and ostial size) to facilitate position and size of catheters and reduce procedure time as well as examining the left atrium (presence of thrombi, dimensions and volumes). Imaging after the percutaneous ablation is important for assessment of overall success of the procedure and revealing potential complications. Therefore, imaging methods enable depiction of PVs and the anatomy of surrounding structures essential for preprocedural management and early detection of PV stenosis and other ablation-related procedures, as well as long-term follow-up of these patients. (orig.)

  4. Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants versus Vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Radiofrequency Catheter Ablation of Atrial Fibrillation: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Giuseppe Santarpia

    Full Text Available Use of the non-vitamin K antagonist oral anticoagulants (NOACs is endorsed by current guidelines for stroke prevention in patients with atrial fibrillation (AF. However efficacy and safety of NOACs in patients undergoing catheter ablation (RFCA of AF has not been well established yet.To perform a meta-analysis of all studies comparing NOACs and vitamin K antagonist oral anticoagulants (VKAs in patients undergoing RFCA.Studies were searched for in PubMed and Google Scholar databases.Studies were considered eligible if: they evaluated the clinical impact of NOACs versus VKAs; they specifically analyzed the use of anticoagulants during periprocedural phase of RFCA; they reported clinical outcome data.25 studies were selected, including 9881 cases. The summary measure used was the risk ratio (RR with 95% confidence interval (CI. The random-effects or the fixed effect model were used to synthesize results from the selected studies.There was no significant difference in thromboembolic complications (RR 1.39; p=0.13. Bleeding complications were significantly lower in the NOACs-treated arm as compared to VKAs (RR=0.67, p<0.001. Interestingly, a larger number of thromboembolic events was found in the VKAs-treated arm in those studies where VKAs had been interrupted during the periprocedural phase (RR=0.68; p=ns. In this same subgroup a significantly higher incidence of both minor (RR=0.54; p=0.002 and major bleeding (RR=0.41; p=0.01 events was recorded. Conversely, the incidence of thromboembolic events in the VKAs-treated arm was significantly lower in those studies with uninterrupted periprocedural anticoagulation treatment (RR=1.89; p=0.02.As with every meta-analysis, no patients-level data were available.The use of NOACs in patients undergoing RFCA is safe, given the lower incidence of bleedings observed with NOACs. On the other side, periprocedural interruption of VKAs and bridging with heparin is associated with a higher bleeding rate with no

  5. 77 FR 11121 - Scientific Information Request on Treatment of Atrial Fibrillation

    Science.gov (United States)

    2012-02-24

    ... Atrial Fibrillation AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION: Request for... scientific information submissions from manufacturers of atrial fibrillation medical devices. Scientific... effectiveness review of the evidence for the treatment of atrial fibrillation. The EHC Program is dedicated...

  6. Inflammation and C-Reactive Protein in Atrial Fibrillation: Cause or Effect?

    OpenAIRE

    Galea, Roberto; Cardillo, Maria Teresa; Caroli, Annalisa; Marini, Maria Giulia; Sonnino, Chiara; Narducci, Maria L.; Luigi M. Biasucci

    2014-01-01

    Atrial fibrillation is associated with substantial morbidity and mortality rates. The incompletely understood pathogenesis of this cardiac dysrhythmia makes it difficult to improve approaches to primary and secondary prevention. Evidence has accumulated in regard to a relationship between inflammation and atrial fibrillation. Investigators have correlated the dysrhythmia with myocarditis, pericardiotomy, and C-reactive protein levels, suggesting that inflammation causes atrial fibrillation or...

  7. Left Atrial Sphericity Index Predicts Early Recurrence of Atrial Fibrillation After Direct-Current Cardioversion

    DEFF Research Database (Denmark)

    Osmanagic, Armin; Möller, Sören; Osmanagic, Azra;

    2016-01-01

    BACKGROUND: Attempts to achieve rhythm control using direct-current cardioversion (DCC) are common in those with persistent atrial fibrillation (AF). Although often successful, AF recurs within 1 month in as many as 57% of patients. The aim of this study was to assess whether a baseline left atrial...

  8. Robotic atrial septal defect repair and endoscopic treatment of atrial fibrillation.

    Science.gov (United States)

    Argenziano, Michael; Williams, Mathew R

    2003-04-01

    Computer (robotic) enhancement has emerged as a facilitator of minimally invasive cardiac surgery and has been used to perform portions of intracardiac procedures via thoracotomy incisions. This report describes the use of the da Vinci surgical system in two totally endoscopic ("closed chest") cardiac operations: atrial septal defect closure and pulmonary vein isolation of atrial fibrillation. ASD closure: Fifteen patients underwent repair of a secundum-type atrial septal defect or patent foramen ovale by a totally endoscopic approach, utilizing the da Vinci robotic system. Cardiopulmonary bypass (CPB) was achieved peripherally. Cardioplegia was administered via the distal port of the arterial cannula after endoballoon inflation. Via three port incisions in the right chest, the entire operation including pericardiotomy; bicaval occlusion; atriotomy; atrial septopexy; and atrial closure was performed by a surgeon seated at a computer console. A fourth 15 mm port was utilized for suction and suture passage by a patient-side assistant. In one case, a recurrent shunt was identified and repaired on POD 5. Median ICU length of stay (LOS) was 20 hours, and median hospital LOS was 4 days. Atrial fibrillation surgery: This report also describes the pathway that we have pursued in the development of a totally endoscopic operation for atrial fibrillation. Beginning with animal models, we tested various ablative energy sources; methods of ablation; and minimally invasive approaches. This work has led to the development of a variety of minimally invasive surgical approaches including a totally endoscopic, robotically assisted beating heart procedure for the treatment of atrial fibrillation. PMID:12838483

  9. Intra-atrial endothelial lesion resulting from transseptal puncture for catheter ablation of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Samir M. Said

    2012-06-01

    Full Text Available Thromboembolic events are known complications of left atrial ablation therapy. We describe a complication which may also lead to systemic thromboembolism that has not been reported so far: the formation of a moving structure attached to the fossa ovalis after an attempted transseptal puncture in a 66-year old patient with symptomatic paroxysmal atrial fibrillation.

  10. Percutaneous atrial appendage occlusion for stroke prevention in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Munkholm-Larsen, Stine; Cao, Christopher; Yan, Tristan D;

    2012-01-01

    This review aims to evaluate systematically the safety and efficacy of percutaneous left atrial appendage occlusion (PLAAO) in stroke prevention for patients with atrial fibrillation (AF). A systematic review of peer-reviewed journals on PLAAO before June 2011 was performed on three electronic...

  11. Extracellular Matrix Remodeling in Atrial Fibrosis: Mechanisms and Implications in Atrial Fibrillation

    OpenAIRE

    Pellman, Jason; Lyon, Robert C.; Sheikh, Farah

    2009-01-01

    Atrial fibrosis has been strongly associated with the presence of heart diseases/arrhythmias, including congestive heart failure (CHF) and atrial fibrillation (AF). Inducibility of AF as a result of atrial fibrosis has been the subject of intense recent investigation, since it is the most commonly encountered arrhythmia in adults and can substantially increase the risk of premature death. Rhythm and rate control drugs as well as surgical interventions are used as therapies for AF; however, in...

  12. Impact of dronedarone in atrial fibrillation and flutter on stroke reduction

    DEFF Research Database (Denmark)

    Christiansen, Christine Benn; Torp-Pedersen, Christian; Køber, Lars

    2010-01-01

    Dronedarone has been developed for treatment of atrial fibrillation (AF) or atrial flutter (AFL). It is an amiodarone analogue but noniodinized and without the same adverse effects as amiodarone.......Dronedarone has been developed for treatment of atrial fibrillation (AF) or atrial flutter (AFL). It is an amiodarone analogue but noniodinized and without the same adverse effects as amiodarone....

  13. Left atrial appendage thrombus with resulting stroke post-RF ablation for atrial fibrillation in a patient on dabigatran.

    LENUS (Irish Health Repository)

    Lobo, R

    2015-11-01

    Dabigatran etexilate is licensed for use in prevention of deep venous thromboembolism and in prevention of stroke and systemic embolism in nonvalvular atrial fibrillation (AF). It has also been used in patients for other indications as a substitute for warfarin therapy because it requires no monitoring; one group being patients undergoing radiofrequency (RF), ablation for AF, although there have been no consensus guidelines with regards to dosage and timing of dose. We report the case of a patient with documentary evidence of left atrial appendage (LAA) thrombus formation and neurological sequelae post-RF ablation despite being on dabigatran. This case highlights the concern that periprocedural dabigatran may not provide adequate protection from development of LAA thrombus and that a standardised protocol will need to be developed and undergo large multicentre trials before dabigatran can be safely used for patients undergoing RF-ablation.

  14. Automatic Detection of Atrial Fibrillation for Mobile Devices

    Science.gov (United States)

    Kaiser, Stefanie; Kirst, Malte; Kunze, Christophe

    Two versions of a new detector for automatic real-time detection of atrial fibrillation in non-invasive ECG signals are introduced. The methods are based on beat to beat variability, tachogram analysis and simple signal filtering. The implementation on mobile devices is made possible due to the low demand on computing power of the employed analysis procedures. The proposed algorithms correctly identified 436 of 440 five minute episodes of atrial fibrillation or flutter and also correctly identified up to 302 of 342 episodes of no atrial fibrillation, including normal sinus rhythm as well as other cardiac arrhythmias. These numbers correspond to a sensitivity of 99.1 % and a specificity of 88.3%.

  15. Time of Occurrence and Duration of Atrial Fibrillation Following Coronary Artery Bypass Grafting

    Science.gov (United States)

    Avdic, Sevleta; Osmanovic, Enes; Kadric, Nedzad; Mujanovic, Emir; Ibisevic, Merima; Avdic, Azra

    2016-01-01

    Introduction: Dilatation of the left atrium and left ventricular diastolic dysfunction (DDLV) according to recent studies has significance in the occurrence of postoperative atrial fibrillation (AF), stroke and death. Authors of some studies found no relationship between these parameters and atrial fibrillation. Objective: this study is to determine the time of occurrence and duration of atrial fibrillation in patients after surgical revascularization (CABG) due to the presence of left ventricular diastolic dysfunction and left atrium dilatation and identify the most significant predictors of incident AF. Methods: Prospective study included 116 patients undergoing surgical myocardial revascularization followed from admission to discharge. The study was conducted at the Special Hospital “Heart Center BH” Tuzla for a period of one year (March 2011/2012 g.). For all patients was performed preoperative ultrasound examination, especially parameters of diastolic function of the left ventricle and left atrium volume index (LAVi), as the best parameter sized left atrium, and the postoperative occurrence of certain AF and day occurrence, duration in hours, the number of attacks. To assess whether an event occurred or not was used logistic regression, and the effect of time on the event of interest is analyzed by Cox ‘s regression hazard parallel. Results: 75.9 % of patients had DDLV, and 91.4 % were hypertensives, 12.9 % from the previous stroke (ICV) and 42.2 % diabetics (DM), 14 % with COPD. The average age of patients was 61.41 ± 4.69 years. In both groups was 32.8 % women and 67.2 % men. LAVi preoperative values were significantly higher as DDLV greater degree. In patients with DDLV and higher values LAVi risk of AF is higher, the greater the length of AF and significantly higher number of attacks FA. Early occurrence of atrial fibrillation and its longer duration in function with increasing LAVi a marked increase in the value LAVi have the greatest hazard for

  16. The Role of Intracardiac Echocardiography in Atrial Fibrillation Ablation

    Directory of Open Access Journals (Sweden)

    Elad Anter, MD

    2009-10-01

    Full Text Available Radiofrequency catheter ablation of pulmonary veins has emerged as an effective therapy for patients with symptomatic atrial fibrillation. Advances in real-time intracardiac echocardiography with 2D and Doppler color flow imaging have led to it integration in atrial fibrillation ablation procedures. It allows imaging of the left atrium and pulmonary veins, including identification of anatomic variations. It has an important role in guiding transseptal catheterization, imaging the pulmonary vein ostia, assisting in accurate placement of mapping and ablation catheters, monitoring lesion morphology and flow changes in the ablated pulmonary veins, hence allowing titration of energy delivery. Importantly, it allows instant detection of procedural complications.

  17. The Role of Intracardiac Echocardiography in Atrial Fibrillation Ablation

    Directory of Open Access Journals (Sweden)

    Elad Anter

    2009-10-01

    Full Text Available Radiofrequency catheter ablation of pulmonary veins has emerged as an effective therapy for patients with symptomatic atrial fibrillation. Advances in real-time intracardiac echocardiography with 2D and Doppler color flow imaging have led to its integration in atrial fibrillation ablation procedures. It allows imaging of the left atrium and pulmonary veins, including identification of anatomic variations. It has an important role in guiding transseptal catheterization, imaging the pulmonary vein ostia, assisting in accurate placement of mapping and ablation catheters, monitoring lesion morphology and flow changes in the ablated pulmonary veins, hence allowing titration of energy delivery. Importantly, it allows instant detection of procedural complications.

  18. Managing atrial fibrillation in the elderly: critical appraisal of dronedarone

    Directory of Open Access Journals (Sweden)

    Trigo P

    2011-12-01

    Full Text Available Paula Trigo, Gregory W FischerDepartment of Anesthesiology, Mount Sinai School of Medicine, New York, NY, USAAbstract: Atrial fibrillation is the most commonly seen arrhythmia in the geriatric population and is associated with increased cardiovascular morbidity and mortality. Treatment of the elderly with atrial fibrillation remains challenging for physicians, because this unique subpopulation is characterized by multiple comorbidities requiring chronic use of numerous medications, which can potentially lead to severe drug interactions. Furthermore, age-related changes in the cardiovascular system as well as other physiological changes result in altered drug pharmacokinetics. Dronedarone is a new drug recently approved for the treatment of arrhythmias, such as atrial fibrillation and/or atrial flutter. Dronedarone is a benzofuran amiodarone analog which lacks the iodine moiety and contains a methane sulfonyl group that decreases its lipophilicity. These differences in chemical structure are responsible for making dronedarone less toxic than amiodarone which, in turn, results in fewer side effects. Adverse events for dronedarone include gastrointestinal side effects and rash. No dosage adjustments are required for patients with renal impairment. However, the use of dronedarone is contraindicated in the presence of severe hepatic dysfunction.Keywords: atrial fibrillation, elderly, antiarrhythmic agents, amiodarone, dronedarone

  19. Age as a Risk factor for Atrial Fibrillation and Flutter after Coronary Artery Bypass Grafting

    Directory of Open Access Journals (Sweden)

    Prashant Bhave MD

    2012-02-01

    Full Text Available Atrial fibrillation affects approximately 3 million people in the United States and creates a huge burden on the health care system, both in terms of morbidity, mortality, and cost.1 The prevalence of atrial fibrillation rises sharply with increases in age. It is estimated that 8% of people above 70 years of age have atrial fibrillation.2-4 Atrial fibrillation has long been recognized as a powerful risk factor for stroke,5 heart failure,6 and mortality.7 Advancing age amplifies the risk of all of these sequelae of atrial fibrillation.

  20. Analysis of brain natriuretic peptide in 30 patients with atrial fibrillation

    International Nuclear Information System (INIS)

    To investigate the relationship between atrial fibrillation and brain natriuretic peptide (BNP), plasma levels of BNP in 30 patients with atrial fibrillation and 30 health controls were assayed and compared. The results showed that plasma levels of BNP in patients with atrial fibrillation were significantly higher than those of health controls (P<0.05). When the patients with atrial fibrillation were restored sinus rhythm, the concentration of BNP decreased significantly (P<0.05). BNP was a sensitive marker of cardiac dysfunction, and BNP was positively correlated with atrial fibrillation. (authors)

  1. Outcome of Cox Maze procedure concomitant with mitral valve operation in treatment of atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    ZHANG Sai; CHEN Ru-kun; DONG Ai-qiang; WANG Yong-qin; CHEN Suo-cheng; LI Zhi-jun

    2006-01-01

    @@ Atrial fibrillation (AF) is fairly common in patients with chronic mitral valve disease and a markedly dilated left atrium. These patients rarely return to sinus rhythm spontaneously, even after a successful mitral valve operation. The Maze procedure,developed by Cox and associates,1-5 has been used in patients undergoing a mitral valve operation.Restoration of normal sinus rhythm and atrial contraction in such patients have been reported by some groups. This study will summarize retrospectively a group of patients who underwent the Cox Maze procedure for the treatment of AF associated with rheumatic mitral valve disease in China.

  2. Stroke in Atrial Fibrillation – Long-term Follow-up of Cardiovascular Events

    OpenAIRE

    Chao, Tze-Fan; Chiang, Chern-En; Chen, Shih-Ann

    2013-01-01

    The incidence of atrial fibrillation (AF) was around 1.5 per 1000 person-years in Taiwan. Systemic thromboembolism is the most severe complication of AF. Risk stratification and adequate thromboembolism prophylaxis is the cornerstone of treatment in AF patients. The CHA2DS2-VASc score is powerful in selecting “truly low-risk” patients who are not necessary to receive anticoagulation therapies. It is also useful in predicting thromboembolic events and mortality for patients undergoing AF ablat...

  3. Fish Oil and Atrial Fibrillation after Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

    OpenAIRE

    Xin, Wei; Wei, Wei; Lin, Zhiqin; Zhang, Xiaoxia; Yang, Hongxia; Zhang, Tao; Li, Bin; Mi, Shuhua

    2013-01-01

    Background Influence of fish oil supplementation on postoperative atrial fibrillation (POAF) was inconsistent according to published clinical trials. The aim of the meta-analysis was to evaluate the effects of perioperative fish oil supplementation on the incidence of POAF after cardiac surgery. Methods Pubmed, Embase and the Cochrane Library databases were searched. Randomized controlled trials (RCTs) assessing perioperative fish oil supplementation for patients undergoing cardiac surgery we...

  4. Circadian variation in dominant atrial fibrillation frequency in persistent atrial fibrillation

    International Nuclear Information System (INIS)

    Circadian variation in atrial fibrillation (AF) frequency is explored in this paper by employing recent advances in signal processing. Once the AF frequency has been estimated and tracked by a hidden Markov model approach, the resulting trend is analyzed for the purpose of detecting and characterizing the presence of circadian variation. With cosinor analysis, the results show that the short-term variations in the AF frequency exceed the variation that may be attributed to circadian. Using the autocorrelation method, circadian variation was found in 13 of 18 ambulatory ECG recordings (Holter) acquired from patients with long-standing persistent AF. Using the ensemble correlation method, the highest AF frequency usually occurred during the afternoon, whereas the lowest usually occurred during late night. It is concluded that circadian variation is present in most patients with long-standing persistent AF though the short-term variation in the AF frequency is considerable and should be taken into account

  5. Clinical Characteristics, Management, and Control of Permanent vs. Nonpermanent Atrial Fibrillation: Insights from the RealiseAF Survey

    OpenAIRE

    Jan Murin; Lisa Naditch-Brûlé; Sandrine Brette; Chern-En Chiang; James O'Neill; P Gabriel Steg

    2014-01-01

    BACKGROUND: Atrial fibrillation can be categorized into nonpermanent and permanent atrial fibrillation. There is less information on permanent than on nonpermanent atrial fibrillation patients. This analysis aimed to describe the characteristics and current management, including the proportion of patients with successful atrial fibrillation control, of these atrial fibrillation subsets in a large, geographically diverse contemporary sample. METHODS AND RESULTS: Data from RealiseAF, an interna...

  6. Atrial Fibrillation: A Review of Recent Studies with a Focus on Those from the Duke Clinical Research Institute

    OpenAIRE

    Rao, Meena P.; Pokorney, Sean D; Christopher B Granger

    2014-01-01

    Atrial fibrillation is the most common arrhythmia and accounts for one-third of hospitalizations for rhythm disorders in the United States. The prevalence of atrial fibrillation averages 1% and increases with age. With the aging of the population, the number of patients with atrial fibrillation is expected to increase 150% by 2050, with more than 50% of atrial fibrillation patients being over the age of 80. This increasing burden of atrial fibrillation will lead to a higher incidence of strok...

  7. Clinical application of low energy intracardiac cardioversion of atrial fibrillation

    International Nuclear Information System (INIS)

    Objective: To evaluate the efficacy and safety of low energy intracardiac cardioversion in persistent atria fibrillation. Methods: Low energy intracardiac cardioversion was performed by delivering R wave-synchronized biphasic shocks in 7 patients (4 men, 3 women) with persistent atrial fibrillation. Prior to the procedure, all patients underwent transesophageal echocardiographic examinations to rule out the presence of intracardiac thrombus and received subcutaneous injection of low molecular weight heparin for 3-5 days. Two custom-made 6 Fr catheters (Rhythm Technologies of Getz, USA) were used for de-fibrillation shock delivery. One catheter was positioned in the lower right atrium so that the majority of the catheter electrodes had firm contact with the right atrial free wall. The second catheter was placed randomly either in coronary sinus through right internal jugular vein or in the left pulmonary artery through femoral vein. In addition, a standard diagnostic 6-F quadrupolar catheter was placed at the right ventricular apex for ventricular synchronization and postshock ventricular pacing. Shocks were delivered by Implant Support Device (Model 4510, Teleceronics). After conversion, all patients were treated with intravenous amiodarone in the first 24 hours followed by oral administration. Results: In all 7 patients cardioversion of atrial fibrillation to sinus rhythm was successfully obtained. A mean of 2 ± 1 shocks per patient has been delivered with a total amount of 13 shocks. The average delivered energy was 7.8 ± 2.2 Joules. No complication occurred. At a mean follow-up of 18 ± 9 months, 4 of the 7 patients treated successfully showed sinus rhythm there after. Atrial fibrillation recurred in 3 patients at the second, fifth day and eighth month after cardioversion. Conclusions: Low energy intracardiac cardioversion is effective and safe, and can be easily performed in patients without general anesthesia. It offers a new option for restoring sinus

  8. Ventricular rhythm in atrial fibrillation under anaesthetic infusion with propofol

    International Nuclear Information System (INIS)

    Changes in patients' autonomic tone and specific pharmacologic interventions may modify the ventricular response (actual heart rate) during atrial fibrillation (AF). Hypnotic agents such as propofol may modify autonomic balance as they promote a sedative state. It has been shown that propofol slightly slows atrial fibrillatory activity, but the net global effect on the ventricular response remains unknown. We aimed to evaluate in patients in AF the effect of a propofol bolus on the ventricular rate and regularity at ECG. We analysed the possible relation with local atrial fibrillatory activities, as ratios between atrial and ventricular rates (AVRs), analysing atrial activity from intracardiac electrograms at the free wall of the right and left atria and at the interatrial septum. We compared data at the baseline and after complete hypnosis. Propofol was associated with a more homogeneous ventricular response and lower AVR values at the interatrial septum

  9. P-wave duration and the risk of atrial fibrillation

    DEFF Research Database (Denmark)

    Nielsen, Jonas B.; Kühl, Jørgen T.; Pietersen, Adrian;

    2015-01-01

    BACKGROUND: Results on the association between P-wave duration and the risk of atrial fibrillation (AF) are conflicting. OBJECTIVE: The purpose of this study was to obtain a detailed description of the relationship between P-wave duration and the risk of AF. METHODS: Using computerized analysis o...

  10. Familial aggregation of atrial fibrillation: a study in Danish twins

    DEFF Research Database (Denmark)

    Christophersen, Ingrid Elisabeth; Ravn, Lasse Steen; Budtz-Joergensen, Esben; Skytthe, Axel; Haunsoe, Stig; Svendsen, Jesper Hastrup; Christensen, Kaare

    2009-01-01

    BACKGROUND: Heritability may play a role in nonfamilial atrial fibrillation (AF). We hypothesized that a monozygotic (MZ) twin whose co-twin was diagnosed with AF would have an increased risk of the disease compared with a dizygotic (DZ) twin in the same situation. METHODS AND RESULTS: A sample o...

  11. Management of atrial fibrillation in patients with heart failure

    NARCIS (Netherlands)

    Neuberger, Hans-Ruprecht; Mewis, Christian; van Veldhuisen, Dirk J.; Schotten, Ulrich; van Gelder, Isabelle C.; Allessie, Maurits A.; Boehm, Michael

    2007-01-01

    Atrial. fibrillation (AF) and chronic heart failure (CHF) are two major and even growing cardiovascular conditions that often coexist. However, few data are available to guide treatment of AF in patients with CHF. This review summarizes current literature concerning the following topics: (i) prognos

  12. Risk factors for atrial fibrillation incidence and progression

    NARCIS (Netherlands)

    Vermond, Robert Aldo

    2016-01-01

    During atrial fibrillation (AF) irregular activation of the hearts atria occur, causing an irregular heart rate and altered blood flow. AF is the most common heart rhythm disorder, causing stroke, heart failure, dementia, reduced quality of life and high health care expences. AF is diagnosed increas

  13. Ranolazine for atrial fibrillation: buy one get three beneficial mechanisms!

    OpenAIRE

    Maier, Lars S

    2012-01-01

    This editorial refers to ‘Further insights into the underlying electrophysiological mechanisms for reduction of atrial fibrillation by ranolazine in an experimental model of chronic heart failure’, by G. Frommeyer et al., published in this issue on pages 1322–1331

  14. Mechanisms of ranolazine's dual protection against atrial and ventricular fibrillation

    OpenAIRE

    Verrier, Richard L.; Kumar, Kapil; Nieminen, Tuomo; Belardinelli, Luiz

    2012-01-01

    Coronary artery disease and heart failure carry concurrent risk for atrial fibrillation and life-threatening ventricular arrhythmias. We review evidence indicating that at therapeutic concentrations, ranolazine has potential for dual suppression of these arrhythmias. Mechanisms and clinical implications are discussed.

  15. Cardiovascular Risk Factors and Atrial Fibrillation: What is the Link?

    OpenAIRE

    Yaariv Khaykin

    2009-01-01

    Atrial fibrillation is a common cardiac arrhythmia. It is well known to occur in older patients with comorbid conditions such congestive heart failure and ischemic heart disease.1-3 In these otherwise sick individuals it is associated with higher long term morbidity and mortality.

  16. Edoxaban versus warfarin in patients with atrial fibrillation

    NARCIS (Netherlands)

    Giugliano, R.P.; Ruff, C.T.; Braunwald, E.; Murphy, S.A.; Wiviott, S.D.; Halperin, J.L.; Waldo, A.L.; Ezekowitz, M.D.; Weitz, J.I.; Spinar, J.; Ruzyllo, W.; Ruda, M.; Koretsune, Y.; Betcher, J.; Shi, M.; Grip, L.T.; Patel, S.P.; Patel, I.; Hanyok, J.J.; Mercuri, M.; Antman, E.M.; Verheugt, F.W.A.

    2013-01-01

    BACKGROUND: Edoxaban is a direct oral factor Xa inhibitor with proven antithrombotic effects. The long-term efficacy and safety of edoxaban as compared with warfarin in patients with atrial fibrillation is not known. METHODS: We conducted a randomized, double-blind, double-dummy trial comparing two

  17. Pattern of atrial fibrillation and risk of outcomes

    DEFF Research Database (Denmark)

    Banerjee, Amitava; Taillandier, Sophie; Olesen, Jonas Bjerring; Lane, Deirdre A; Lallemand, Benedicte; Lip, Gregory Y.H.; Fauchier, Laurent

    2012-01-01

    BACKGROUND: Risk of stroke and thromboembolism (TE) in patients with non-valvular atrial fibrillation (NVAF) is categorised in stroke risk stratification scores. The role of pattern of NVAF in risk prediction is unclear in contemporary 'real world' cohorts. METHODS AND RESULTS: Patients with NVAF...

  18. Atrial fibrillation and vascular disease-a bad combination

    DEFF Research Database (Denmark)

    Bjerring Olesen, Jonas; Gislason, Gunnar Hilmar; Torp-Pedersen, Christian; Lip, Gregory Y H

    management in patients with atrial fibrillation, several stroke and bleeding risk prediction schemes have been developed. Clin. Cardiol. 2012 DOI: 10.1002/clc.20955 Dr. Olesen received an honorarium through an educational grant from Sanofi Aventis for time and expertise spent writing this article. Dr Lip has...

  19. Brugada syndrome risk loci seem protective against atrial fibrillation

    DEFF Research Database (Denmark)

    Andreasen, Laura; Nielsen, Jonas B; Darkner, Stine;

    2014-01-01

    Several studies have shown an overlap between genes involved in the pathophysiological mechanisms of atrial fibrillation (AF) and Brugada Syndrome (BrS). We investigated whether three single-nucleotide polymorphisms (SNPs) (rs11708996; G>C located intronic to SCN5A, rs10428132; T>G located in SCN10...

  20. Use of Oral Anticoagulation Therapy in Atrial Fibrillation after Stroke

    DEFF Research Database (Denmark)

    Jespersen, Stine Funder; Christensen, Louisa M; Christensen, Anders;

    2013-01-01

    Background. The knowledge is still sparse about patient related factors, influencing oral anticoagulation therapy (OAC) rates, in stroke patients with atrial fibrillation (AF). Aims. To assess the use of OAC in ischemic stroke patients diagnosed with AF and to identify patient related factors...

  1. Familial Aggregation of Lone Atrial Fibrillation in Young Persons

    DEFF Research Database (Denmark)

    Oyen, Nina; Ranthe, Mattis F; Carstensen, Lisbeth;

    2012-01-01

    OBJECTIVES: We investigated whether an individual's risk of developing lone atrial fibrillation (AF) before age 60 years is associated with lone AF in relatives. BACKGROUND: Genetic factors may play a role in the development of lone AF. METHODS: Using Danish national registers, a cohort was...

  2. Paroxysmal Atrial Fibrillation in a Mission-Assigned Astronaut

    Science.gov (United States)

    Bauer, Peter A.; Polk, J. D.

    2010-01-01

    This presentation will explore the clinical and administrative conundrums faced by the flight surgeon upon discovering asymptomatic paroxysmal atrial fibrillation seven months prior to scheduled long duration spaceflight. The presenter will discuss the decision-making process as well as the clinical and operational outcomes.

  3. Increased plasma aldosterone during atrial fibrillation declines following cardioversion

    DEFF Research Database (Denmark)

    Soeby-Land, C; Dixen, U; Therkelsen, S K;

    2011-01-01

    The renin-angiotensin-aldosterone system (RAAS) may be activated during atrial fibrillation (AF); our aim was to evaluate the level of aldosterone in patients with either permanent AF, persistent AF scheduled for cardioversion or patients in sinus rhythm (SR). We hypothesized that an increased...

  4. Clinical considerations of anticoagulation therapy for patients with atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    Shu ZHANG

    2012-01-01

    Atrial fibrillation (AF) increases the risk of stroke.New anticoagulation agents have recently provided alternative and promising approaches.This paper reviews the current state of anticoagulation therapy in AF patients,focusing on various clinical scenarios and on comparisons,where possible,between western and eastern populations.

  5. Anticoagulant treatment in patients with atrial fibrillation and ischemic stroke

    DEFF Research Database (Denmark)

    Brunner-Frandsen, Nicole; Dammann Andersen, Andreas; Ashournia, Hamoun;

    2015-01-01

    BACKGROUND: Atrial fibrillation (AF) is the most common cardiac dysrhythmia, with a lifetime risk of 25%, and it is a well-known independent risk factor for ischemic stroke. Over the last 15 years, efforts have been made to initiate relevant treatment in patients with AF. A retrospective study was...

  6. Clinical experience with apixaban in atrial fibrillation: implications of AVERROES

    Directory of Open Access Journals (Sweden)

    De Caterina R

    2011-07-01

    Full Text Available Raffaele De CaterinaInstitute of Cardiology and Center of Excellence on Aging, G d’Annunzio University, Chieti, G Monasterio Foundation, Pisa, ItalyAbstract: Atrial fibrillation is an extremely common arrhythmia, which substantially increases the risk of stroke and thromboembolism. Prevention of stroke and thromboembolism is therefore an important part of the management of atrial fibrillation. Guidelines until now have recommended that patients with atrial fibrillation receive some form of antithrombotic therapy, ie, a vitamin K antagonist or aspirin, with a preference for anticoagulants in most cases. However, current treatments are suboptimal, and despite the recommendations, many patients do not receive adequate thromboprophylaxis, because they are considered, for various reasons, “unsuitable” to receive a vitamin K antagonist. In this patient population, apixaban, a new oral anticoagulant inhibiting activated coagulation factor X, administered in fixed doses and without anticoagulation monitoring, has undergone testing against aspirin in the recently published AVERROES trial. This paper addresses the strengths and limitations of this trial and the practical relevance of the new clinical information it provides.Keywords: atrial fibrillation, apixaban, thromboprophylaxis 

  7. How to define valvular atrial fibrillation?

    Science.gov (United States)

    Fauchier, Laurent; Philippart, Raphael; Clementy, Nicolas; Bourguignon, Thierry; Angoulvant, Denis; Ivanes, Fabrice; Babuty, Dominique; Bernard, Anne

    2015-10-01

    Atrial fibrillation (AF) confers a substantial risk of stroke. Recent trials comparing vitamin K antagonists (VKAs) with non-vitamin K antagonist oral anticoagulants (NOACs) in AF were performed among patients with so-called "non-valvular" AF. The distinction between "valvular" and "non-valvular" AF remains a matter of debate. Currently, "valvular AF" refers to patients with mitral stenosis or artificial heart valves (and valve repair in North American guidelines only), and should be treated with VKAs. Valvular heart diseases, such as mitral regurgitation, aortic stenosis (AS) and aortic insufficiency, do not result in conditions of low flow in the left atrium, and do not apparently increase the risk of thromboembolism brought by AF. Post-hoc analyses suggest that these conditions probably do not make the thromboembolic risk less responsive to NOACs compared with most forms of "non-valvular" AF. The pathogenesis of thrombosis is probably different for blood coming into contact with a mechanical prosthetic valve compared with what occurs in most other forms of AF. This may explain the results of the only trial performed with a NOAC in patients with a mechanical prosthetic valve (only a few of whom had AF), where warfarin was more effective and safer than dabigatran. By contrast, AF in the presence of a bioprosthetic heart valve or after valve repair appears to have a risk of thromboembolism that is not markedly different from other forms of "non-valvular" AF. Obviously, we should no longer consider the classification of AF as "valvular" (or not) for the purpose of defining the aetiology of the arrhythmia, but for the determination of a different risk of thromboembolic events and the need for a specific antithrombotic strategy. As long as there is no better new term or widely accepted definition, "valvular AF" refers to patients with mitral stenosis or artificial heart valves. Patients with "non-valvular AF" may have other types of valvular heart disease. One should

  8. The Connexin40A96S mutation from a patient with atrial fibrillation causes decreased atrial conduction velocities and sustained episodes of induced atrial fibrillation in mice.

    Science.gov (United States)

    Lübkemeier, Indra; Andrié, René; Lickfett, Lars; Bosen, Felicitas; Stöckigt, Florian; Dobrowolski, Radoslaw; Draffehn, Astrid M; Fregeac, Julien; Schultze, Joachim L; Bukauskas, Feliksas F; Schrickel, Jan Wilko; Willecke, Klaus

    2013-12-01

    Atrial fibrillation (AF) is the most common type of cardiac arrhythmia and a major cause of stroke. In the mammalian heart the gap junction proteins connexin40 (Cx40) and connexin43 (Cx43) are strongly expressed in the atrial myocardium mediating effective propagation of electrical impulses. Different heterozygous mutations in the coding region for Cx40 were identified in patients with AF. We have generated transgenic Cx40A96S mice harboring one of these mutations, the loss-of-function Cx40A96S mutation, as a model for atrial fibrillation. Cx40A96S mice were characterized by immunochemical and electrophysiological analyses. Significantly reduced atrial conduction velocities and strongly prolonged episodes of atrial fibrillation were found after induction in Cx40A96S mice. Analyses of the gating properties of Cx40A96S channels in cultured HeLa cells also revealed significantly lower junctional conductance and enhanced sensitivity voltage gating of Cx40A96S in comparison to Cx40 wild-type gap junctions. This is caused by reduced open probabilities of Cx40A96S gap junction channels, while single channel conductance remained the same. Similar to the corresponding patient, heterozygous Cx40A96S mice revealed normal expression levels and localization of the Cx40 protein. We conclude that heterozygous Cx40A96S mice exhibit prolonged episodes of induced atrial fibrillation and severely reduced atrial conduction velocities similar to the corresponding human patient. PMID:24060583

  9. Improving outpatient warfarin use for hospitalized patients with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Touchette DR,

    2008-03-01

    Full Text Available Atrial fibrillation affects an estimated 5 million Americans and accounts for approximately 15% of all strokes. Few studies have successfully addressed patient screening, assessment, and introduction of appropriate antithrombotic therapy in patients with atrial fibrillation. Objective: To assess whether an intervention improved planned antithrombotic prescribing at the time of discharge in hospitalized patients. Methods: The study was a prospectively designed, retrospectively evaluated, non-blinded, historical control study of a pharmacist-initiated intervention. The intervention, consisting of pharmacist review and assessment of antithrombotic prescribing in patients with non-valvular atrial fibrillation, was conducted in an urban teaching hospital. Results: Although antithrombotic prescribing was not significantly higher at discharge in the 252 enrolled subjects (control 67.3% vs. intervention 70.8%; p = 0.58, a significantly greater number of patients had a written discharge plan for antithrombotic therapy (control 73.5% vs. intervention 88.3%; p < 0.01. The adjusted odds ratio that the study group was associated with an improvement in planned or actual warfarin use was 2.46 (95% CI 1.63-3.74. In addition, clinicians adhered to guidelines for antithrombotic therapy in patients with atrial fibrillation more frequently in the intervention group (control 70.4% vs. intervention 88.2%; p < 0.01. Conclusion: A program designed to identify hospitalized patients with non-valvular atrial fibrillation, assess their need for stroke prophylaxis, and initiate appropriate antithrombotic therapy led to an increase in planned antithrombotic, and most importantly, warfarin use upon discharge from the hospital. Confirmation that an increase in planned antithrombotic use upon discharge results in an actual increase in use after discharge is needed to determine the true effectiveness of this intervention.

  10. Renal sympathetic denervation provides ventricular rate control but does not prevent atrial electrical remodeling during atrial fibrillation.

    Science.gov (United States)

    Linz, Dominik; Mahfoud, Felix; Schotten, Ulrich; Ukena, Christian; Hohl, Mathias; Neuberger, Hans-Ruprecht; Wirth, Klaus; Böhm, Michael

    2013-01-01

    Renal denervation (RDN) reduces renal efferent and afferent sympathetic activity thereby lowering blood pressure in resistant hypertension. The effect of modulation of the autonomic nervous system by RDN on atrial electrophysiology and ventricular rate control during atrial fibrillation (AF) is unknown. Here we report a reduction of ventricular heart rate in a patient with permanent AF undergoing RDN. Subsequently, we investigated the effect of RDN on AF-induced shortening of atrial effective refractory period, AF inducibility, and ventricular rate control during AF maintained by rapid atrial pacing in 12 pigs undergoing RDN (n=7) or sham procedure (n=5). During sinus rhythm, RDN reduced heart rate (RR-interval, 708±12 versus 577±19 ms; P=0.0021) and increased atrioventricular node conduction time (PQ-interval, 112±12 versus 88±9 ms; P=0.0001). Atrial tachypacing for 30 minutes increased AF inducibility and decreased AF cycle length. This was not influenced by RDN. RDN reduced ventricular rate during AF episodes by ≈24% (119±9 versus 158±19 bpm; P=0.0001). AF episodes were shorter after RDN compared with sham (12±3 versus 34±4 s; P=0.0091), but atrial effective refractory period was not modified by RDN. RDN reduced heart rate and reduced atrioventricular node conduction time during sinus rhythm and provided rate control during AF. AF-induced atrial electrical remodeling, AF inducibility, and AF cycle length were not modified, but duration of AF episodes was shorter after RDN. Modulation of the autonomic nervous system by RDN might provide rate control and reduce susceptibility to AF. Whether RDN may provide rate control in a larger number of patients with AF deserves further clinical studies. PMID:23150501

  11. Personalized management of atrial fibrillation : Proceedings from the fourth Atrial Fibrillation competence NETwork/European Heart Rhythm Association consensus conference

    NARCIS (Netherlands)

    Kirchhof, Paulus; Breithardt, Guenter; Aliot, Etienne; Al Khatib, Sana; Apostolakis, Stavros; Auricchio, Angelo; Bailleul, Christophe; Bax, Jeroen; Benninger, Gerlinde; Blomstrom-Lundqvist, Carina; Boersma, Lucas; Boriani, Giuseppe; Brandes, Axel; Brown, Helen; Brueckmann, Martina; Calkins, Hugh; Casadei, Barbara; Clemens, Andreas; Crijns, Harry; Derwand, Roland; Dobrev, Dobromir; Ezekowitz, Michael; Fetsch, Thomas; Gerth, Andrea; Gillis, Anne; Gulizia, Michele; Hack, Guido; Haegeli, Laurent; Hatem, Stephane; Haeusler, Karl Georg; Heidbuechel, Hein; Hernandez-Brichis, Jessica; Jais, Pierre; Kappenberger, Lukas; Kautzner, Joseph; Kim, Steven; Kuck, Karl-Heinz; Lane, Deirdre; Leute, Angelika; Lewalter, Thorsten; Meyer, Ralf; Mont, Lluis; Moses, Gregory; Mueller, Markus; Muenzel, Felix; Naebauer, Michael; Nielsen, Jens Cosedis; Oeff, Michael; Oto, Ali; Pieske, Burkert; Pisters, Ron; Potpara, Tatjana; Rasmussen, Lars; Ravens, Ursula; Reiffel, James; Richard-Lordereau, Isabelle; Schaefer, Herbert; Schotten, Ulrich; Stegink, Wim; Stein, Kenneth; Steinbeck, Gerhard; Szumowski, Lukasz; Tavazzi, Luigi; Themistoclakis, Sakis; Thomitzek, Karen; Van Gelder, Isabelle C.; von Stritzky, Berndt; Vincent, Alphons; Werring, David; Willems, Stephan; Lip, Gregory Y. H.; Camm, A. John

    2013-01-01

    The management of atrial fibrillation (AF) has seen marked changes in past years, with the introduction of new oral anticoagulants, new antiarrhythmic drugs, and the emergence of catheter ablation as a common intervention for rhythm control. Furthermore, new technologies enhance our ability to detec

  12. Probucol attenuates atrial autonomic remodeling in a canine model of atrial fibrillation produced by prolonged atrial pacing

    Institute of Scientific and Technical Information of China (English)

    GONG Yong-tai; LI Wei-min; LI Yue; YANG Shu-sen; SHENG Li; YANG Ning; SHAN Hong-bo; XUE Hong-jie; LIU Wei; YANG Bao-feng; DONG De-li; LI Bao-xin

    2009-01-01

    Background We hypothesize that increased atrial oxidative stress and inflammation may play an important role in atrial nerve sprouting and heterogeneous sympathetic hyperinnervation during atrial fibrillation (AF). To test the hypothesis, we examined whether the antioxidant and anti-inflammatory treatment with probucol attenuates atrial autonomic remodeling in a canine model of AF produced by prolonged rapid right atrial pacing. Methods Twenty-one dogs were divided into a sham-operated group, a control group and a probucol group. Dogs in the control group and probucol group underwent right atrial pacing at 400 beats per minute for 6 weeks, and those in the probucol group received probucol 1 week before rapid atrial pacing until pacing stopped. After 6-week rapid atrial pacing, general properties including left atrial structure and function, atrial hemodynamics and the inducibility and duration of AF were measured in all the groups. Atrial oxidative stress markers and serum C-reactive protein (CRP) concentration were estimated. The degree of nerve sprouting and sympathetic innervation at the right atrial anterior wall (RAAW) and the left atrial anterior wall (LAAW) were quantified by immunohistochemistry, atdal norepinephrine contents were also detected. Atrial beta-nerve growth factor (beta-NGF) mRNA and protein expression at the RAAW and LAAW were assessed by real-time quantitative RT-PCR and Western blotting respectively. Results Atrial tachypacing induced significant nerve sprouting and heterogeneous sympathetic hyperinnervation, and the magnitude of nerve sprouting and hyperinnervation was higher in the RAAW than in the LAAW. Atrial beta-NGF mRNA and protein levels were significantly increased at the RAAW and LAAW, and the upregulation of beta-NGF expression was greater at the RAAW than at the LAAW in the control group. The beta-NGF protein level was positively correlated with the density of sympathetic nerves in all groups. Probucol decreased the increase of

  13. Amiodarone cost effectiveness in preventing atrial fibrillation after coronary artery bypass graft surgery

    DEFF Research Database (Denmark)

    Zebis, Lars R; Christensen, Thomas D; Hjortdal, Vibeke E;

    2008-01-01

    BACKGROUND: The purpose of this study was to estimate the costs and health benefits of routinely administered postoperative amiodarone as prevention of atrial fibrillation for patients undergoing coronary artery bypass grafting (CABG) for stable angina. METHODS: This cost-effectiveness study was...... patients were included to receive either 300 mg amiodarone or placebo (5% aqueous dextrose solution) administered intravenously over 20 minutes followed by 600 mg amiodarone/placebo orally twice a day (8 am and 8 pm) for the first 5 postoperative days. RESULTS: In the amiodarone group, there were 14 cases...... of atrial fibrillation compared with 32 in the control group (p < 0.01) whereas there were no differences in the length of stay. The mean total cost per patient was 7,639 euros in the amiodarone group and 7,814 euros in the placebo group (p < 0.01). CONCLUSIONS: Routine use of postoperative...

  14. Amiodarone is a cost-neutral way of preventing atrial fibrillation after surgery for lung cancer

    DEFF Research Database (Denmark)

    Riber, Lars P; Christensen, Thomas D; Pilegaard, Hans K

    2013-01-01

    OBJECTIVES: Our aim was to estimate the costs and health benefits of routinely administered postoperative amiodarone as a prophylactic agent in reducing the risk of atrial fibrillation in patients undergoing surgery for lung cancer. METHODS: This was a cost-effectiveness study, based on the......, Denmark, were included and randomized to receive either 300 mg of amiodarone or placebo (5% aqueous dextrose solution), administered intravenously over 20 min immediately after surgery, followed by 600 mg of amiodarone/placebo orally twice per day (8 a. m. and 6 p. m.) for the first five postoperative...... days. RESULTS: In the amiodarone group there were 11 cases of atrial fibrillation, compared with 38 in the control group (P <0.001). There were no differences in the length of hospital stay or resources used. The mean total costs per patient were equal and amounted to (sic)7288 per patient (P = 0...

  15. Frequent periodic leg movement during sleep is an unrecognized risk factor for progression of atrial fibrillation.

    Directory of Open Access Journals (Sweden)

    Mahek Mirza

    Full Text Available Sleep apnea has been recognized as a factor predisposing to atrial fibrillation recurrence and progression. The effect of other sleep-disturbing conditions on atrial fibrillation progression is not known. We sought to determine whether frequent periodic leg movement during sleep is a risk factor for progression of atrial fibrillation. In this retrospective study, patients with atrial fibrillation and a clinical suspicion of restless legs syndrome who were referred for polysomnography were divided into two groups based on severity of periodic leg movement during sleep: frequent (periodic movement index >35/h and infrequent (≤35/h. Progression of atrial fibrillation to persistent or permanent forms between the two groups was compared using Wilcoxon rank-sum test, chi-square tests and logistic regression analysis. Of 373 patients with atrial fibrillation (77% paroxysmal, 23% persistent, 108 (29% progressed to persistent or permanent atrial fibrillation during follow-up (median, 33 months; interquartile range, 16-50. Compared to patients with infrequent periodic leg movement during sleep (n=168, patients with frequent periodic leg movement during sleep (n=205 had a higher rate of atrial fibrillation progression (23% vs. 34%; p=0.01. Patients with frequent periodic leg movement during sleep were older and predominantly male; however, there were no significant differences at baseline in clinical factors that promote atrial fibrillation progression between both groups. On multivariate analysis, independent predictors of atrial fibrillation progression were persistent atrial fibrillation at baseline, female gender, hypertension and frequent periodic leg movement during sleep. In patients with frequent periodic leg movement during sleep, dopaminergic therapy for control of leg movements in patients with restless legs syndrome reduced risk of atrial fibrillation progression. Frequent leg movement during sleep in patients with restless legs syndrome is

  16. Percutaneous Left Atrial Appendage Ligation for Stroke Prevention in Atrial Fibrillation.

    Science.gov (United States)

    Valderrábano, Miguel; Price, Matthew J

    2015-01-01

    Prevention of thromboembolic complications in atrial fibrillation remains a tremendous clinical challenge. Knowledge that the left atrial appendage (LAA) is the most common anatomical origin of cardioembolic strokes1 has been the main motivation to develop clinical and procedural strategies to exclude the LAA from the circulation, either surgically or percutaneously. This review discusses the rationale behind these strategies, their relative merits, and future prospects for LAA exclusion strategies. PMID:26306126

  17. Dronedarone for the treatment of atrial fibrillation and atrial flutter: approval and efficacy

    OpenAIRE

    Deborah Wolbrette, Deborah

    2010-01-01

    Deborah Wolbrette, Mario Gonzalez, Soraya Samii, Javier Banchs, Erica Penny-Peterson, Gerald NaccarelliPenn State Heart and Vascular Institute, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USAAbstract: Dronedarone, a new Class III antiarrhythmic agent, has now been approved by the US Food and Drug Administration for use in patients with atrial fibrillation or atrial flutter. Approval came in March 2009 due to the positive results of the ATHENA trial showing significant r...

  18. Left Atrial Appendage Closure for Stroke Prevention in Patients with Atrial Fibrillation and Hereditary Hemorrhagic Telangiectasia

    OpenAIRE

    Sebastiaan Velthuis; Swaans, Martin J.; Mager, Johannes J.; Rensing, Benno J. W. M.; Lucas V. A. Boersma; Post, Martijn C.

    2012-01-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting millions of individuals worldwide, and a major risk factor for disabling cerebral embolic stroke. Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant inherited disorder, characterized by vascular abnormalities with high-bleeding tendency and therefore intolerance for oral anticoagulation. We report a case of percutaneous closure of the left atrial appendage, which might be a good alternative strategy in...

  19. Percutaneous Left Atrial Appendage Ligation for Stroke Prevention in Atrial Fibrillation

    OpenAIRE

    Valderrábano, Miguel; Price, Matthew J.

    2015-01-01

    Prevention of thromboembolic complications in atrial fibrillation remains a tremendous clinical challenge. Knowledge that the left atrial appendage (LAA) is the most common anatomical origin of cardioembolic strokes1 has been the main motivation to develop clinical and procedural strategies to exclude the LAA from the circulation, either surgically or percutaneously. This review discusses the rationale behind these strategies, their relative merits, and future prospects for LAA exclusion stra...

  20. Calpain I Inhibition prevents atrial structural remodeling in a canine model with atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    XUE Hong-jie; SHAN Hong-bo; LIU Jie; LI Wei-min; LI Yue; GONG Yong-tai; YANG Bao-feng; JIN Cheng-luo; SHENG Li; CHU Shan; ZHANG Li

    2008-01-01

    Background Atrial fibrillation (AF) is accompanied by atrial structural remodeling. Calpain activity is induced during AR To lest a causal relationship between calpain activation and atrial structural changes, N-acetyl-Leu-Leu-Met (ALLM), a calpain inhibitor, was utilized in a canine AF model.Methods Fifteen dogs were randomly divided into 3 groups: sham-operated group, control group and calpain inhibitor group; each with 5 dogs. Sustained AF was induced by rapid right atrium pacing at 600 beats per minute for 3 weeks. ALLM was administered at a dosage of 1.0 mg-kg-1·d-1 in the calpain inhibitor group. Three weeks later, the proteolysis, protein expression of TnT and myosin, calpain l localization and expression and structural changes were examined in left atrial free walls, right atrial free walls and the interatrial septum respectively. Atrial size and contractile function were also measured by echocardiography.Results Long-term rapid atrial pacing induced marked structural changes such as enlarged atrial volume, myolysis, degradation of TnT and myosin, accumulation of glycogen and changes in mitochondrial shape and size, which were paralleled by an increase in calpain activity. The positive correlation between calpain activity and the degree of myolysis (rs=0.90 961, P<0.0001) was demonstrated. In addition to structural abnormalities, pacing-induced atrial contractile dysfunction was observed in this study. The pacing-induced atrial structural alterations and loss of contractility were partially prevented by the calpain inhibitor ALLM.Conclusions Activation of calpain represents key features in the progression towards overt structural remodeling. Calpain inhibitor, ALLM, suppressed the increased calpain activity and reversed structural remodeling caused by sustained atrial fibrillation in the present model. Calpain Inhibition may therefore provide a possibility for therapeutic Intervention in AF.

  1. Laser Ablation Of Atrial Fibrillation: Mid-term Clinical Experience

    Directory of Open Access Journals (Sweden)

    Li Poa, MD

    2009-08-01

    Full Text Available Background: Atrial Fibrillation is known to account for one third of all the strokes caused in the US in the population above the age of 70. Patients treated with the surgical Cox MAZE operation have been shown to have a 150 fold decrease in the incidence of stroke over an 18 year period. However, the original Cox MAZE although extremely successful in treating atrial fibrillation and decreasing the incidence of strokes was not performed widely because of complexity and invasiveness of the procedure. A variety of alternative energy based curative ablation strategies are now available for more minimally invasive therapeutic management of atrial fibrillation (AF. In this communication, we report our clinical experience in AF therapy utilizing laser energy ablation technology. Methods: Fifty two consecutive AF patients underwent concomitant or isolated ablation prior to any coexisting cardiac procedures that included CABG (coronary artery bypass surgery, MV (mitral valve or AV (aortic valve repairs. All patients had an epicardially based ablation pattern with basic lesions being en bloc box type pulmonary vein isolation which included the antral surface of the left atrium, directed ganglionectomies of the the right anterior and inferior ganglions, posteriomedial ablation of the IVC ( inferior vena cava, and a right isthmus ablation. Twenty seven patients had ligation of their left atrial appendage, 14 patients had resection of the ligament of Marshall, and three patients had endocardial placed lesions of a mitral annular connecting type lesion. In order to maintain the patients in normal sinus rhythm (NSR, electrical cardioversion and anti-arrhythmic drugs were employed as required. Results: At a median follow-up of 250 days, 44 of the total 52 patients (84.6% exhibited NSR.. No complications or mortality were reported due to the laser procedure. Conclusion: Laser ablation was successfully and safely used for endocardial and epicardial AF ablation

  2. Study on Effect of Compound Salvia Pellet in Preventing Atrial Fibrillation with Left Atrial Thrombosis

    Institute of Scientific and Technical Information of China (English)

    连耀植; 李玉光; 张汉灵; 张元春; 闫纯英; 林建才; 许端敏; 张钰; 郑宝群; 麦芒

    2004-01-01

    @@ Atrial fibrillation (AF) is a kind of common arrhythmia, which, besides affecting cardiac function, has another serious outcome, that is, it is easy to form atrial thrombosis and induce thrombus/embolus, especially cerebral embolus.The incidence of left atrial thrombosis (LAT)could reach 25%-30%(1), the incidence of embolic complication per year could reach 2. 98%-6.30%, even 20% or more(2,3). To prevent thrombosis so as to lower the incidence of cerebral stroke and other embolic complications has been so far the focal point of AF treatment.

  3. Recurrence of arrhythmia following short-term oral AMIOdarone after CATheter ablation for atrial fibrillation

    DEFF Research Database (Denmark)

    Darkner, Stine; Chen, Xu; Hansen, Jim;

    2014-01-01

    AIMS: Patients undergoing catheter ablation for atrial fibrillation (AF) often experience recurrent arrhythmias within the first few months post-ablation. We aimed to investigate whether short-term use of amiodarone to prevent early arrhythmias following radiofrequency ablation for AF could reduce...... history of previous ablation], 206 patients were available for analysis of the primary end-point which was any documented atrial tachyarrhythmia lasting >30 s following a blanking period of 3 months. This was observed in 42/107 (39%) in the amiodarone group vs. 48/99 (48%) in the placebo group (P = 0.......18). Among the secondary end-points, the amiodarone group showed significantly lower rate of atrial tachyarrhythmia-related hospitalizations [rate ratio = 0.43; 95% confidence interval (CI) = 0.23-0.77, P = 0.006] and cardioversions (rate ratio = 0.36; 95% CI = 0.20-0.62, P = 0.0004) within the blanking...

  4. Body Mass Index, Quality of Life, and Catheter Ablation in Patients with Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Ethan R. Ellis, M.D

    2012-12-01

    Full Text Available Atrial fibrillation and obesity are interlinked epidemics and both impair quality of life. As the prevalence of both conditions in the US continues to rise, so will the number of obese patients with atrial fibrillation referred for catheter ablation. Catheter ablation has already been shown to significantly improve quality of life in patients with atrial fibrillation. Until recently, there has been little attention to the effects of catheter ablation on quality of life specifically in obese patients with atrial fibrillation. This paper will review what is known about the effects of atrial fibrillation and obesity on quality of life and how quality of life is affected by catheter ablation for atrial fibrillation in obese patients.

  5. Clinical Differences between Subtypes of Atrial Fibrillation and Flutter: Cross-Sectional Registry of 407 Patients

    Directory of Open Access Journals (Sweden)

    Eduardo Dytz Almeida

    2015-01-01

    Full Text Available Introduction: Atrial fibrillation and atrial flutter account for one third of hospitalizations due to arrhythmias, determining great social and economic impacts. In Brazil, data on hospital care of these patients is scarce. Objective: To investigate the arrhythmia subtype of atrial fibrillation and flutter patients in the emergency setting and compare the clinical profile, thromboembolic risk and anticoagulants use. Methods: Cross-sectional retrospective study, with data collection from medical records of every patient treated for atrial fibrillation and flutter in the emergency department of Instituto de Cardiologia do Rio Grande do Sul during the first trimester of 2012. Results: We included 407 patients (356 had atrial fibrillation and 51 had flutter. Patients with paroxysmal atrial fibrillation were in average 5 years younger than those with persistent atrial fibrillation. Compared to paroxysmal atrial fibrillation patients, those with persistent atrial fibrillation and flutter had larger atrial diameter (48.6 ± 7.2 vs. 47.2 ± 6.2 vs. 42.3 ± 6.4; p < 0.01 and lower left ventricular ejection fraction (66.8 ± 11 vs. 53.9 ± 17 vs. 57.4 ± 16; p < 0.01. The prevalence of stroke and heart failure was higher in persistent atrial fibrillation and flutter patients. Those with paroxysmal atrial fibrillation and flutter had higher prevalence of CHADS2 score of zero when compared to those with persistent atrial fibrillation (27.8% vs. 18% vs. 4.9%; p < 0.01. The prevalence of anticoagulation in patients with CHA2DS2-Vasc ≤ 2 was 40%. Conclusions: The population in our registry was similar in its comorbidities and demographic profile to those of North American and European registries. Despite the high thromboembolic risk, the use of anticoagulants was low, revealing difficulties for incorporating guideline recommendations. Public health strategies should be adopted in order to improve these rates.

  6. Atrial Fibrillation in the Wolff-Parkinson-White Syndrome

    Directory of Open Access Journals (Sweden)

    Osmar Antonio Centurion MD, PhD, FACC

    2011-05-01

    Full Text Available Since the advent of catheter ablation for atrial fibrillation (AF aiming the pulmonary veins a few years ago, there has been an overwhelming interest and a dramatic increase in AF investigation. AF has a different dimension in the context of the Wolff-Parkinson-White (WPW syndrome. Indeed, AF may be a nightmare in a young person that has an accessory pathway (AP with fast anterograde conduction. It may be life-threatening if an extremely rapid ventricular response develops degenerating into ventricular fibrillation. Therefore, it is very important to know the mechanisms involved in the development of AF in the WPW syndrome. There are several possible mechanisms that may be involved in the development of AF in the WPW syndrome, namely, spontaneous degeneration of atrioventricular reciprocating tachycardia into AF, the electrophysiological properties of the AP, the effects of AP on atrial architecture, and intrinsic atrial muscle vulnerability. Focal activity, multiple reentrant wavelets, and macroreentry have all been implicated in AF, perhaps under the further influence of the autonomic nervous system. AF can also be initiated by ectopic beats originating from the pulmonary veins, and elsewhere. Several studies demonstrated a decrease incidence of AF after successful elimination of the AP, suggesting that the AP itself may play an important role in the initiation of AF. However, since AF still occurs in some patients with the WPW syndrome even after successful ablation of the AP, there should be other mechanisms responsible for the development of AF in the WPW syndrome. There is a clear evidence of an underlying atrial muscle disease in patients with the WPW syndrome. Atrial myocardial vulnerability has been studied performing an atrial endocardial catheter mapping during sinus rhythm, and analizing the recorded abnormal atrial electrograms. This review analizes the available data on this singular setting since AF has a reserved prognostic

  7. Atrial fibrillation in heart failure: new directions in diagnosis, risk assessment and risk reduction.

    OpenAIRE

    Dr Richard Till; Prof artin Cowie

    2014-01-01

    Heart failure and atrial fibrillation are common conditions which frequently co-exist. In patients with established systolic and diastolic dysfunction, atrial fibrillation increases the risk of stroke, mortality and reduces quality of life. Recent advances in implantable device technology have improved the detection of atrial fibrillation and reduced the time to intervention. Rate control remains the mainstay of treatment to improve symptoms in patients with heart failure. Currently evidence ...

  8. Increased susceptibility to atrial fibrillation secondary to atrial fibrosis in transgenic goats expressing transforming growth factor - B1

    Science.gov (United States)

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in people with significant morbidity and mortality. There is a strong association between atrial fibrosis and AF. Transforming growth factor B1 (TGF-B1) is an essential mediator of atrial fibrosis in animal models and human pat...

  9. Atrial fibrillation management: evaluating rate vs rhythm control.

    Science.gov (United States)

    Nguyen, Tuan; Jolly, Umjeet; Sidhu, Kiran; Yee, Raymond; Leong-Sit, Peter

    2016-06-01

    Atrial fibrillation (AF) is an increasing global issue leading to increased hospitalizations, adverse health related events and mortality. This review focuses on the management of atrial fibrillation, in particular in the past decade, comparing two major strategies, rate or rhythm control. We evaluate the evidence for each strategy, pharmacological options and the increasing utilization of invasive techniques, in particular catheter ablation and use of implantable cardiac pacing devices. Pharmacological comparative trials evaluating both strategies have shown rate control being non-inferior to rhythm control for clinical outcomes of mortality and other cardiovascular events (including stroke). Catheter ablation techniques, involving radiofrequency ablation and recently cryoablation, have shown promising results in particular with paroxysmal AF. However, persistent AF provides ongoing challenges and will be a particular focus of continued research. PMID:26960034

  10. Atrial fibrillation in fracture patients treated with oral bisphosphonates

    DEFF Research Database (Denmark)

    Abrahamsen, B; Eiken, P; Brixen, K

    2009-01-01

    OBJECTIVES: To determine if patients receiving oral bisphosphonates are at excess risk of atrial fibrillation (AF), stroke and myocardial infarction. DESIGN: Register-based restricted cohort study. SETTING: National Hospital Discharge Register and National Prescriptions Database (1995-2005). SUBJ......OBJECTIVES: To determine if patients receiving oral bisphosphonates are at excess risk of atrial fibrillation (AF), stroke and myocardial infarction. DESIGN: Register-based restricted cohort study. SETTING: National Hospital Discharge Register and National Prescriptions Database (1995...... proportional to adherence. There was no increased risk of ischaemic stroke and an increased risk of myocardial infarction was not significant after adjustment for comorbidity. CONCLUSIONS: The increased occurrence of AF in fracture patients who are users of oral bisphosphonates should be attributed to...

  11. Age as a Risk factor for Atrial Fibrillation and Flutter after Coronary Artery Bypass Grafting

    OpenAIRE

    Prashant Bhave MD; Rod Passman MD, MSCE

    2012-01-01

    Atrial fibrillation affects approximately 3 million people in the United States and creates a huge burden on the health care system, both in terms of morbidity, mortality, and cost.1 The prevalence of atrial fibrillation rises sharply with increases in age. It is estimated that 8% of people above 70 years of age have atrial fibrillation.2-4 Atrial fibrillation has long been recognized as a powerful risk factor for stroke,5 heart failure,6 and mortality.7 Advancing age amplifies the risk of al...

  12. MODERN APPROACHES TO ANTICOAGULANT THERAPY DURING CATHETER ABLATION TREATMENT OF NON-VALVULAR ATRIAL FIBRILLATION

    OpenAIRE

    E. A. Belikov; K. V. Davtyan; O. N. Tkacheva

    2015-01-01

    Prevention of thromboembolic complications in patients with atrial fibrillation during catheter pulmonary veins isolation is discussed. This subject review is presented with special consideration to new anticoagulants.

  13. Left Atrial Linear Ablation of Paroxysmal Atrial Fibrillation Guided by Three-dimensional Electroanatomical System

    DEFF Research Database (Denmark)

    Zhang, Dai-Fu; Li, Ying; Qi, Wei-Gang;

    2005-01-01

    Objective To investigate the safety and efficacy of Left atrial linear ablation of paroxysmal atrial fibrillation guided by three-dimensional electroanatomical system. Methods 29 patients with paroxysmal atrial fibrillation in this study. A nonfluoroscopic mapping system was used to generate a 3D...... electroanatomic LA mapping, and all pulmonary vein ostia were marked under the help of pulmonary veins angiography on the 3D map. Radiofrequency (RF) energy was delivered to create continuous linear lesions encircling the pulmonary veins, it was delivered with a target temperature of 43¿, a maximal power limit of...... 30W and applied for =20 seconds until the maximal local electrogram amplitude decreased by =50%. The ablation was completed by finishing the circular line. Results The mean procedure duration was 180±18 minutes, with mean fluoroscopy time of 80±20 minutes. The average number of RE pulses was 120...

  14. Risk factors for atrial fibrillation incidence and progression

    OpenAIRE

    Vermond, Robert Aldo

    2016-01-01

    During atrial fibrillation (AF) irregular activation of the hearts atria occur, causing an irregular heart rate and altered blood flow. AF is the most common heart rhythm disorder, causing stroke, heart failure, dementia, reduced quality of life and high health care expences. AF is diagnosed increasingly frequent, at increasingly young age. Treatment requires knowledge on factors that may cause AF, which may help prevent occurence of AF and AF progression. AF progression is the proces by whic...

  15. Alternative therapies in the treatment of atrial fibrillation

    OpenAIRE

    Federico Lombardi, MD, FESC; Sebastiano Belletti, MD; Alberto Lomuscio, MD.

    2013-01-01

    Atrial fibrillation (AF) is the most common clinical arrhythmia and represents a major social and economic problem. The number of subjects with AF is constantly increasing as a result of aging and improved survival in several cardiac and non-cardiac diseases. Patients with AF are often symptomatic, have a reduced physical capacity and are at high risk for thromboembolic events. Moreover, AF is associated with increased mortality and independently of the management based either on rhythm o...

  16. Obesity, Diabetes and Atrial Fibrillation; Epidemiology, Mechanisms and Interventions

    OpenAIRE

    Asghar, O; Alam, U; Hayat, SA; Aghamohammadzadeh, R; Heagerty, AM; Malik, RA

    2012-01-01

    The last few decades have witnessed a global rise in adult obesity of epidemic proportions. The potential impact of this is emphasized when one considers that body mass index (BMI) is a powerful predictor of death, type 2 diabetes (T2DM) and cardiovascular (CV) morbidity and mortality [1, 2]. Similarly we have witnessed a parallel rise in the incidence of atrial fibrillation (AF), the commonest sustained cardiac arrhythmia, which is also a significant cause of cardiovascular morbidity and mor...

  17. Diabetes, Obesity and Atrial Fibrillation; Epidemiology, Mechanisms and Interventions

    OpenAIRE

    Asghar O; Alam U; Hayat SA; Aghamohammadzadeh R; Heagerty AM; Malik RA

    2013-01-01

    Body mass index (BMI) is a powerful predictor of death, type 2 diabetes (T2DM) and cardiovascular (CV) morbidity and mortality [1, 2]. Over the last few decades, we have witnessed a global rise in adult obesity of epidemic proportions. Similarly ,there has been a parallel increase in the incidence of atrial fibrillation (AF), itself a significant cause of cardiovascular morbidity and mortality. This may be partly attributable to advances in the treatment of coronary heart disease (CHD) and he...

  18. Management Options in Atrial Fibrillation – The Role of Vernakalant

    OpenAIRE

    Hohnloser, Stefan H.; Sami A. Omar

    2012-01-01

    Atrial Fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice and is associated with significant mortality and morbidity mainly due to thromboembolic complications and heart failure. Furthermore, it is an important contributor to the increasing costs of healthcare. This article provides a short summary of our current knowledge related to some important aspects of AF. Particular emphasis is given to chemical restoration of sinus rhythm by means of intravenous ...

  19. Inflammation in the genesis and perpetuation of atrial fibrillation

    DEFF Research Database (Denmark)

    Engelmann, Mads D M; Svendsen, Jesper Hastrup

    2005-01-01

    The prevalence and persistence of atrial fibrillation (AF) and the relative inefficacy of the currently available pharmacotherapy requires development of new treatment strategies. Recent findings have suggested a mechanistic link between inflammatory processes and the development of AF. Epidemiol...... through anti-inflammatory activity. This article reviews what is known about inflammation in genesis and perpetuation of AF, the putative underlying mechanisms, and possible therapeutic implications for the inhibition of inflammation as an evolving treatment modality for AF....

  20. Atrial fibrillation and heart failure in seven nursing homes

    OpenAIRE

    Krüger, Kjell; Sandli, Marie; Geitung, Jonn Terje; Eide, Geir Egil; Grimsmo, Anders

    2012-01-01

    Objectives: Previous research suggests that blood-thinning treatment for patients with atrial fibrillation as well as treatment for patients with heart failure is not adequate among the elderly. We tested this among long-term patients in nursing homes. Methods: Information about the patients (n = 513) was collected during the period March-April 2008. Data collection consisted of electrocardiography, particulars of any stroke suffered and copying medication records. A standardized set of blood...

  1. Primary Prevention of Atrial Fibrillation where are we in 2012?

    OpenAIRE

    Massimo Imazio MD

    2012-01-01

    Drugs to alter or delay myocardial remodelling associated with heart failure, hypertension, or inflammation in the post-operative setting, may prevent the development of atrial fibrillation. Current experimental and clinical evidences support specific treatments for defined patient population (i.e. ACE-inhibitors and ARB for chronic heart failure and hypertension expecially with LV hypertrophy; statins, corticosteroids and possibly colchicine after cardiac surgery).

  2. Atrial fibrillation in heart failure: The sword of Damocles revisited.

    OpenAIRE

    Khan, Muhammad A.; Ahmed, Fozia; Neyses, Ludwig; Mamas, Mamas A.

    2013-01-01

    Heart failure (HF) and atrial fibrillation (AF) frequently coexist and have emerged as major cardiovascular epidemics. There is growing evidence that AF is an independent prognostic marker in HF and affects patients with both reduced as well as preserved LV systolic function. There has been a general move in clinical practice from a rhythm control to a rate control strategy in HF patients with AF, although recent data suggests that rhythm control strategies may provide better outcomes in sele...

  3. Does obstructive sleep apnea associate with atrial fibrillation?

    Institute of Scientific and Technical Information of China (English)

    TAO Hai-long; LONG De-yong; DONG Jian-zeng; MA Chang-sheng

    2008-01-01

    @@ Obstructive sleep apnea(OSA)is a disorder in which transient obstruction fcomplete or partiall of the airway during sleep causes loud snoring,oxyhemoglobin desaturation and frequent arousal.1-4 OSA has been identified to relate to many cardiovascular diseases such as hypertension,coronary heart disease,heart failure,and cardiac arrhythmia.In this article,we attempt to discuss the association between OSA and atrial fibrillation (AF) while reviewing the recent data on OSA and AF.

  4. Relation between epicardial fat tissue and atrial fibrillation

    OpenAIRE

    Enbiya Aksakal; İbrahim Halil Tanboğa; Mustafa Kurt; Süleyman Karakoyun

    2012-01-01

    Objectives: The objective of the study was to evaluatethe relationship of epicardial fat thickness (EFT) assessedby echocardiography with atrial fibrillation (AF) ina clinical setting.Materials and methods: The study consisted of 58 AFpatients who underwent echocardiography and a controlgroup of 22 participants. The EFT thickness was measuredon the free wall of the right ventricle from the parasternallong-axis view. The association between EFT andAF was studied by adjusting the risk factors f...

  5. The definition of success in atrial fibrillation ablation surgery

    OpenAIRE

    Hunter, Steven

    2014-01-01

    In spite of recent attempts to define and clarify the treatment endpoints in atrial fibrillation (AF) ablation surgery, the definition of success has remained blurred. It is of importance to address the burden of AF in the non-symptomatic population. Thromboembolic events invariably blight the outcomes, therefore freedom from stroke must be incorporated into any definition of success and guidelines. It is essential to meticulously study the long-term outcomes of an unsuccessful treatment as a...

  6. Ranolazine versus amiodarone for prevention of postoperative atrial fibrillation

    OpenAIRE

    Burashnikov, Alexander; Antzelevitch, Charles

    2011-01-01

    Postoperative atrial fibrillation (AF) is a major complication of cardiothoracic surgery, leading to significant consequences, including a higher rate of stroke, longer hospital stays and increased costs. Amiodarone is among the most widely used agents for prevention of postoperative AF. Ranolazine, a US FDA-approved antianginal agent, has been shown to effectively, safely prevent and terminate nonpostoperative AF in both experimental and clinical studies. In a recent publication, Miles and c...

  7. Ablation of atrial fibrillation using CT image integration

    International Nuclear Information System (INIS)

    In our case report we describe a catheter ablation in a patient with symptomatic, drug-refractory atrial fibrillation using the new CT image integrating mapping technology. Using image integration an arrhythmogenic right inferior pulmonary vein was revealed which was not found during conventional 3-dimensional mapping. Thereby we want to demonstrate potential impacts on safety and effectiveness of ablation strategies using an image integration technology, especially in cases of difficult anatomic variations. (author)

  8. Emerging Tools for Stroke Prevention in Atrial Fibrillation

    OpenAIRE

    Christos Voukalis; Lip, Gregory Y. H.; Eduard Shantsila

    2016-01-01

    Ischaemic strokes resulting from atrial fibrillation (AF) constitute a devastating condition for patients and their carers with huge burden on health care systems. Prophylactic treatment against systemic embolization and ischaemic strokes is the cornerstone for the management of AF. Effective stroke prevention requires the use of the vitamin K antagonists or non-vitamin K oral anticoagulants (NOACs). This article summarises the latest developments in the field of stroke prevention in AF and a...

  9. Atrial fibrillation and its influence on stroke risk

    OpenAIRE

    Prisco, Domenico

    2015-01-01

    Domenico Prisco,1,2 Caterina Cenci,1 Elena Silvestri,1,2 Lucia Ciucciarelli,1,2 Benedetta Tomberli,2 Carlo Tamburini2 1Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; 2Patologia Medica Unit, Careggi University Hospital, Florence, Italy Abstract: Atrial fibrillation (AF) is the most common cardiac arrhythmia in the clinical setting. AF increases both the risk and severity of stroke, and is associated with substantial morbidity and mortality. Decision...

  10. Stroke Prevention in Atrial Fibrillation: Where are We Now?

    OpenAIRE

    Yousif Ahmad; Lip, Gregory Y. H.

    2012-01-01

    Atrial fibrillation is the commonest arrhythmia worldwide and is a growing problem. AF is responsible for 25% of all strokes, and these patients suffer greater mortality and disability. Warfarin has traditionally been the only successful therapy for stroke prevention, but its limitations have resulted in underutilisation. Major progress has been made in AF research, leading to improved management strategies. Better risk stratification permits identification of truly low-risk patients who do n...

  11. Novel Anticoagulants in Atrial Fibrillation: Monitoring, Reversal and Perioperative Management

    OpenAIRE

    Fadi Shamoun; Hiba Obeid; Harish Ramakrishna

    2015-01-01

    Atrial fibrillation continues to be a significant source of morbidity and mortality worldwide. Effective anticoagulation remains the cornerstone of outpatient and inpatient treatment. The use of the new generation of anticoagulants (NOACs) continues to grow. Recently published data indicate their cost-effectiveness and overall safety in stroke prevention; compared to vitamin K antagonists, they can be prescribed in fixed doses for long-term therapy without the need for coagulation monitoring....

  12. Epidemiology, diagnosis, and management of atrial fibrillation in women

    OpenAIRE

    Poli, Daniela; Antonucci, Emilia

    2015-01-01

    Atrial fibrillation (AF) is the most common arrhythmia and has become a serious public health problem. Moreover, epidemiological data demonstrate that incidence and prevalence of AF are increasing. Several differences in epidemiological patterns, clinical manifestations, and incidence of stroke have been reported between AF in women and in men, particularly in elderly women. Elderly women have higher blood pressure than men and a higher prevalence of heart failure with preserved ejection frac...

  13. Artificial Intelligence Methods Applied to Parameter Detection of Atrial Fibrillation

    Science.gov (United States)

    Arotaritei, D.; Rotariu, C.

    2015-09-01

    In this paper we present a novel method to develop an atrial fibrillation (AF) based on statistical descriptors and hybrid neuro-fuzzy and crisp system. The inference of system produce rules of type if-then-else that care extracted to construct a binary decision system: normal of atrial fibrillation. We use TPR (Turning Point Ratio), SE (Shannon Entropy) and RMSSD (Root Mean Square of Successive Differences) along with a new descriptor, Teager- Kaiser energy, in order to improve the accuracy of detection. The descriptors are calculated over a sliding window that produce very large number of vectors (massive dataset) used by classifier. The length of window is a crisp descriptor meanwhile the rest of descriptors are interval-valued type. The parameters of hybrid system are adapted using Genetic Algorithm (GA) algorithm with fitness single objective target: highest values for sensibility and sensitivity. The rules are extracted and they are part of the decision system. The proposed method was tested using the Physionet MIT-BIH Atrial Fibrillation Database and the experimental results revealed a good accuracy of AF detection in terms of sensitivity and specificity (above 90%).

  14. A Simple Porcine Model of Inducible Sustained Atrial Fibrillation.

    Science.gov (United States)

    Lee, Anson M; Miller, Jacob R; Voeller, Rochus K; Zierer, Andreas; Lall, Shelly C; Schuessler, Richard B; Damiano, Ralph J; Melby, Spencer J

    2016-01-01

    The surgical management of atrial fibrillation (AF) is an evolving field with a history of testing various lesion sets and ablation technologies. Previous animal models of AF require a chronic intervention to make AF reliably inducible. Our objective was to create an acute, reliable, and reproducible porcine model of sustained AF. To accomplish this, 21 adult domestic pigs underwent median sternotomy. Methods to induce AF were then performed sequentially: manual stimulation, rapid pacing (200 beats per minute), and then rapid pacing of 8 beats with a cycle length of 300 milliseconds, followed by an extra stimulus at decreasing cycle lengths. If AF was not induced, burst pacing was performed at a cycle length of 90 milliseconds for 30 seconds. If AF was still not induced, intravenous neostigmine was administered, and the process was repeated. Atrial fibrillation was considered sustained after 1 minute. Attempts at AF induction were successful in 18 (86%) of 21. Atrial fibrillation was induced during manual stimulation in four (19%), during rapid pacing in five (24%), during burst pacing in five (24%), and after the administration of neostigmine in four (19%). Mean (SD) duration of AF was 3.6 (2.6) minutes. Of the 18, 14 (78%) reverted to sinus rhythm spontaneously and 4 (22%) required an antiarrhythmic. This technique of inducing AF can easily be used to evaluate new technologies and lesion sets without the need for creating a chronic animal model. PMID:26889882

  15. Left atrial appendage closure devices for cardiovascular risk reduction in atrial fibrillation patients

    Directory of Open Access Journals (Sweden)

    Cruz-Gonzalez I

    2015-05-01

    Full Text Available Ignacio Cruz-Gonzalez,* Juan Carlos Rama-Merchan,* Javier Rodriguez-Collado, Javier Martin-Moreiras, Alejandro Diego-Nieto, Antonio Arribas-Jimenez, Pedro Luís SanchezDepartment of Cardiology, University Hospital of Cardiology and IBSAL, Salamanca, Spain *Ignacio Cruz-Gonzalez and Juan Carlos Rama-Merchan have contributed equally to this work and should be considered co-first authors Abstract: Atrial fibrillation (AF is the most common sustained arrhythmia in clinical practice. AF is associated with a 4–5-fold increased risk of stroke and systemic embolism. Oral anticoagulant is the first-line therapy for this purpose, but it has various limitations and is often contraindicated or underutilized. Autopsy and surgical data have suggested that 90% of atrial thrombi in nonvalvular AF patients originate from the left atrial appendage, leading to the development of percutaneous closure for thromboembolic prevention. This paper examines the current evidence on left atrial appendage closure devices for cardiovascular risk reduction in AF patients. Keywords: atrial fibrillation, left atrial appendage, stroke, oral anticoagulant, percutaneous closure, thromboembolic prevention

  16. Review of Dominant Frequency Analysis in Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Rakesh Latchamsetty, MD

    2009-10-01

    Full Text Available Significant advancements have been made in the technology and approach to catheter ablation of atrial fibrillation (AF. Pulmonary vein isolation has emerged as the dominant strategy in this procedure and has fueled innovations in catheter design as well as various mapping and navigation systems. Mapping and targeting of complex fractionated atrial electrograms has also emerged as an additional or alternate strategy employed by some ablationists. Recently, attention is being drawn to a new approach targeting atrial sites with high dominant frequencies (DF derived from their electrograms. This article is a review of the basic concepts of DF, the relevant literature behind DF analysis in AF, and the potential clinical applicability of DF analysis for catheter ablation.

  17. Paroxysmal atrial fibrillation occurs often in cryptogenic ischaemic stroke

    DEFF Research Database (Denmark)

    Christensen, L M; Krieger, D W; Højberg, S; Pedersen, O D; Karlsen, F M; Jacobsen, M D; Worck, R; Nielsen, H; Aegidius, K; Jeppesen, L L; Rosenbaum, S; Marstrand, J; Christensen, H

    2014-01-01

    BACKGROUND AND PURPOSE: Atrial fibrillation (AF) increases the risk of stroke fourfold and is associated with a poor clinical outcome. Despite work-up in compliance with guidelines, up to one-third of patients have cryptogenic stroke (CS). The prevalence of asymptomatic paroxysmal atrial fibrilla...... of implantable cardiac monitors after stroke and determine the potential therapeutic benefit of OAC treatment of patients with PAF.......BACKGROUND AND PURPOSE: Atrial fibrillation (AF) increases the risk of stroke fourfold and is associated with a poor clinical outcome. Despite work-up in compliance with guidelines, up to one-third of patients have cryptogenic stroke (CS). The prevalence of asymptomatic paroxysmal atrial...... patients (16.1%). In three patients PAF was detected by other methods before or after monitoring and was undiscovered due to device sensitivity in one case. The first event of PAF was documented at a mean of 109 days (SD ±48) after stroke onset. PAF was asymptomatic in all cases and occurred in episodes...

  18. [Atrial fibrillation. New views on an old disease].

    Science.gov (United States)

    Asensio-Lafuente, E; Alvarez-Mosquera, J B; Lozano-Díaz, J E; Farías-Vega, A; Narváez-David, R; Dorantes-García, J; Orea-Tejeda, A; Rebollar-González, V; Portos-Silva, J M; Oseguera-Moguel, J

    2001-01-01

    Atrial fibrillation (Afib) is clinically the most common arrhythmia. Its main complications are recurrent embolic events and a variable deterioration of functional class. Atrial fibrillation induces changes in cellular ionic channels that self-perpetuate the arrhythmia. The pharmacologic treatment of Afib is directed toward correction of those changes and return to sinus rhythm. It is also intended to maintain adequate heart rates and prevent embolic events through anticoagulation or platelet antiagregation. There are presently several class IC or class III antiarrhythmics available for attempting a return to sinus rhythm. The success rates are irregular, the best achieved with flecainide or propafenone among patients without structural heart disease. Amiodarone is the best choice when there is such a problem. The combination possibilities are huge, so that each case must be individualized. The new class III antiarrhythmics are very effective, but have a relatively high rate of side effects including torsade de pointes. Anticoagulation should be the preferred treatment among the majority of patients, but each case should be individually evaluated. New therapies such as focal or linear catheter ablation techniques, atrial or biatrial programmed stimulation, and atrial cardioverter-defibrillator need longer follow-up and experience to be objectively evaluated, although there are reasons to be optimistic in the future, even if patients need antiarrhythmic support at present. Surgery has high morbi-mortality rates, so it is not the preferred approach. PMID:11692812

  19. Increasing rate of atrial fibrillation from 2003 to 2011 in patients with ischaemic stroke

    DEFF Research Database (Denmark)

    Jespersen, S F; Christensen, Thomas; Christensen, A;

    2015-01-01

    BACKGROUND AND PURPOSE: The general awareness of atrial fibrillation is increasing. The key to prevent atrial fibrillation related stroke is oral anticoagulation therapy; however, it has often been proposed that oral anticoagulation therapy is under-utilized despite indication. The aim of the study...... was to examine the trends in atrial fibrillation rate in patients after acute ischaemic stroke and to determine whether the use of oral anticoagulation therapy increased from 2003 to 2011. METHODS: In the nationwide Danish Stroke Registry 55 551 patients (≥18 years) admitted with acute ischaemic...... stroke were identified. Frequency analysis and linear regression were used to assess trends in atrial fibrillation diagnosis and oral anticoagulation therapy prescription. RESULTS: A total of 17.1% (n = 9482) of ischaemic stroke patients had atrial fibrillation. The relative frequency of atrial...

  20. Atrial Tachycardias Occurring After Atrial Fibrillation Ablation: Strategies for Mapping and Ablation

    Directory of Open Access Journals (Sweden)

    Stavros Mountantonakis, MD

    2010-10-01

    Full Text Available The occurrence of left atrial tachycardias (AT after catheter ablation for atrial fibrillation (AF is common, especially after more extensive ablation of persistent AF. These AT are invariably symptomatic and often do not respond to medical therapy. The initial strategy involves ventricular rate control, cardioversion, and observation as some tachycardias may resolve with time. For persistent ATs, effective management frequently requires catheter intervention. Careful characterization of the tachycardia mechanism is essential in designing an effective ablation strategy that would also avoid further creation of pro-arrhythmic substrate. With this review, we summarize the incidence, mechanism, diagnosis and treatment of ATs occurring after AF ablation.

  1. Atrial-Selective Sodium Channel Block Strategy to Suppress Atrial Fibrillation: Ranolazine versus Propafenone

    OpenAIRE

    Burashnikov, Alexander; Belardinelli, Luiz; Antzelevitch, Charles

    2012-01-01

    Ranolazine has been shown to produce atrial-selective depression of sodium channel-dependent parameters and suppress atrial fibrillation (AF) in a variety of experimental models. The present study contrasts the effects of ranolazine and those of a clinically used anti-AF class IC agent, propafenone. Electrophysiological and anti-AF effects of propafenone and ranolazine were compared at clinically relevant concentrations (i.e., 0.3–1.5 and 1–10 μM, respectively) in canine isolated coronary-per...

  2. Study on Effect of Compound Salvia Pellet in Preventing Atrial Fibrillation with Left Atrial Thrombosis

    Institute of Scientific and Technical Information of China (English)

    连耀植; 李玉光; 张汉灵; 张元春; 闫纯英; 林建才; 许瑞敏; 张钰; 郑宝群; 麦芒

    2004-01-01

    Atrialarrhythmia,fibrillation (AF) is a kind of common arrhythmia which, besides affecting cardiac function, has another serious outcome, that is, it is easy to form atrial thrombosis and induce thrombus/embolus, especially cerebral embolus. The incidence of left atrial thrombosis (LAT) could reach 25%—30%, the incidence of embolic complication per year could reach 2. 98%-6.30%, even 20% or more. To prevent thrombosis so as to lower the incidence of cerebral stroke and other embolic complications has been so far the focal point of AF treatment.

  3. Left atrial appendage occlusion for stroke prevention in atrial fibrillation in Europe

    DEFF Research Database (Denmark)

    Lip, Gregory Y.H.; Dagres, Nikolaos; Proclemer, Alessandro;

    2013-01-01

    The purpose of this EP wire survey was to assess clinical practice in relation to the use of left atrial appendage occlusion (LAAO) devices for stroke prevention in atrial fibrillation (AF) among members of the European Heart Rhythm Association research network. The average number of performed LAAO...... was 10.6 per year and most (73%) centres performed ≤10 procedures per year. We found that LAAO was being performed for stroke prevention in AF, for the most common indication being 'the patient has absolute contraindication to long term oral anticoagulants'. Among survey respondents, LAAO procedures...

  4. Left Atrial Appendage Closure in Atrial Fibrillation: A World without Anticoagulation?

    OpenAIRE

    Tahmeed Contractor; Atul Khasnis

    2011-01-01

    Atrial Fibrillation (AF) is a common arrhythmia with an incidence that is as high as 10% in the elderly population. Given the large proportion of strokes caused by AF as well as the associated morbidity and mortality, reducing stroke burden is the most important part of AF management. While warfarin significantly reduces the risk of AF-related stroke, perceived bleeding risks and compliance limit its widespread use in the high-risk AF population. The left atrial appendage is believed to be th...

  5. Lessons from comparative studies of atrial fibrillation in dog, man and horse

    NARCIS (Netherlands)

    Meijler, F.L.; Tweel, I. van der; Herbschleb, J.N.; Heethaar, R.M.; Borst, C.

    1985-01-01

    Since its first description in 1903 by Hering, the irregularity of the heart beat has been the most striking characteristic of atrial fibrillation and has been subject of many studies. To quote Selzer, "Atrial fibrillation is the grandfather of cardiac arrhythmias." It is an arrhythmia that 1) often

  6. Diffusion of Innovation and the Survival of Cardiovascular Surgeons: the Impact of Atrial Fibrillation Procedures

    Directory of Open Access Journals (Sweden)

    Hebert K.

    2014-12-01

    Full Text Available As cardiovascular disease prevalence continues to decrease in the United States as does cardiovascular surgical procedures, the aging of the population brings an increase in the prevalence of heart failure and atrial fibrillation. A new hybrid procedure for the treatment of atrial fibrillation shows great promise. More randomized clinical trials are needed.

  7. An analysis of risk factors for stroke in atrial fibrillation and hypertension patients

    Institute of Scientific and Technical Information of China (English)

    王娟

    2014-01-01

    Objective To explore the independent risk factors for the 1 year stroke event in Chinese patients with atrial fibrillation(AF)and hypertension(HT).Methods Data of AF and HT patients in the Chinese Emergency Atrial Fibrillation Registry Study were retrospectively analyzed.The eligible patients were divided into the stroke group

  8. Angiotensinogen and ACE gene polymorphisms and risk of atrial fibrillation in the general population

    DEFF Research Database (Denmark)

    Ravn, Lasse S; Benn, Marianne; Nordestgaard, Børge G;

    2008-01-01

    OBJECTIVES: The renin-angiotensin system may play a role in the pathogenesis of atrial fibrillation, and renin-angiotensin system blockers reduce the risk of atrial fibrillation. We hypothesized that polymorphisms in the angiotensinogen and angiotensin-converting enzyme (ACE) genes encoding prote...

  9. Diffusion of Innovation and the Survival of Cardiovascular Surgeons: the Impact of Atrial Fibrillation Procedures

    OpenAIRE

    Hebert K.; McKinnie J.

    2014-01-01

    As cardiovascular disease prevalence continues to decrease in the United States as does cardiovascular surgical procedures, the aging of the population brings an increase in the prevalence of heart failure and atrial fibrillation. A new hybrid procedure for the treatment of atrial fibrillation shows great promise. More randomized clinical trials are needed.

  10. Paroxysmal atrial fibrillation is uncommon in outpatients with chronic heart failure

    DEFF Research Database (Denmark)

    Corell, Pernille; Gustafsson, Finn; Mehlsen, Jesper;

    2008-01-01

    The objective was to evaluate the prevalence of paroxysmal atrial fibrillation (PAF) in patients with heart failure (HF) due to systolic dysfunction.......The objective was to evaluate the prevalence of paroxysmal atrial fibrillation (PAF) in patients with heart failure (HF) due to systolic dysfunction....

  11. J-shaped association between QTc interval duration and the risk of atrial fibrillation

    DEFF Research Database (Denmark)

    Nielsen, Jonas Bille; Graff, Claus; Pietersen, Adrian;

    2013-01-01

    The aim of this study was to investigate whether the heart rate-corrected QT (QTc) interval on the electrocardiogram (ECG) is associated with the onset of atrial fibrillation (AF).......The aim of this study was to investigate whether the heart rate-corrected QT (QTc) interval on the electrocardiogram (ECG) is associated with the onset of atrial fibrillation (AF)....

  12. Atrial fibrillation pharmacotherapy after hospital discharge between 1995 and 2004: a shift towards beta-blockers

    DEFF Research Database (Denmark)

    Hansen, Morten Lock; Gadsbøll, Niels; Gislason, Gunnar H;

    2008-01-01

    AIMS: To study evolvement in pharmacotherapy of atrial fibrillation from 1995 to 2004. METHODS AND RESULTS: All Danish patients were discharged following first-time atrial fibrillation and their pharmacotherapy was identified by individual-level-linkage of nationwide registers of hospitalization...

  13. Alcohol consumption and risk of atrial fibrillation in men and women: the Copenhagen City Heart Study

    DEFF Research Database (Denmark)

    Mukamal, Kenneth J; Tolstrup, Janne S; Friberg, Jens;

    2005-01-01

    incident atrial fibrillation among 16,415 women and men enrolled in the Copenhagen City Heart Study. We ascertained use of beer, wine, and spirits individually at up to 3 study visits with a structured questionnaire. We identified cases of atrial fibrillation by routine study ECGs and a validated...

  14. Risk factors for prethrombotic state in elderly patients with chronic atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    王会玖

    2013-01-01

    Objective To explore the correlation between prethrombotic state (PTS) and chronic atrial fibrillation in elderly patients,and to analyze the risk factors.Methods A total of 142 elderly patients with chronic atrial fibrillation from May 2009 to May 2011 were selected.Patients were divided into the PTS group (n=90) and

  15. The Contribution of Nonlinear Methods in the Understanding of Atrial Fibrillation

    OpenAIRE

    Alcaraz, Raúl; Rieta, José Joaquín

    2013-01-01

    Alcaraz Martínez, R.; Rieta Ibañez, JJ. (2013). The Contribution of Nonlinear Methods in the Understanding of Atrial Fibrillation. En Atrial Fibrillation - Mechanisms and Treatment. InTech. 181-204. doi:10.5772/53407.

  16. Warfarin for the prevention of systemic embolism in patients with non-valvular atrial fibrillation

    DEFF Research Database (Denmark)

    Andersen, L V; Vestergaard, P; Deichgraeber, P;

    2008-01-01

    Warfarin for stroke prevention in patients with atrial fibrillation (AF) is well documented. However, it has not been examined in the prevention of systemic embolism.......Warfarin for stroke prevention in patients with atrial fibrillation (AF) is well documented. However, it has not been examined in the prevention of systemic embolism....

  17. Assessment of left atrial volume and function in patients with permanent atrial fibrillation

    DEFF Research Database (Denmark)

    Agner, Bue F Ross; Kühl, Jørgen Tobias; Linde, Jesper James;

    2014-01-01

    Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with substantial morbidity and mortality. AF is associated with enlargement of the left atrium (LA), and the LA volume has important prognostic implications for the disease. The objective of the study was to determine how ...... measurements of LA volume and function obtained by transthoracic echocardiography (TTE), cardiac magnetic resonance (CMR), and 320-slice multi-detector computed tomography (MDCT) correlate in patients with permanent AF.......Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with substantial morbidity and mortality. AF is associated with enlargement of the left atrium (LA), and the LA volume has important prognostic implications for the disease. The objective of the study was to determine how...

  18. Atrial ectopy predicts late recurrence of atrial fibrillation after pulmonary vein isolation

    DEFF Research Database (Denmark)

    Gang, Uffe J O; Nalliah, Chrishan J; Lim, Toon Wei;

    2015-01-01

    BACKGROUND: Late recurrence of atrial fibrillation (AF) after radiofrequency ablation remains significant. Asymptomatic recurrence poses a difficult clinical problem as it is associated with an equally increased risk of stroke and death compared with symptomatic AF events. Meta-analyses reveal th...... associated with a significantly increased risk of late AF recurrence. These results could have important clinical implications for the design of post-PVI follow-up. CLINICAL TRIAL REGISTRATION: URL: http://www.anzctr.org.au. Unique identifier: ACRTN12606000467538....

  19. Assessment of atrial fibrosis for the rhythm control of atrial fibrillation.

    Science.gov (United States)

    Begg, Gordon A; Holden, Arun V; Lip, Gregory Y H; Plein, Sven; Tayebjee, Muzahir H

    2016-10-01

    Rhythm control of atrial fibrillation (AF) remains challenging, with modest long-term success rates. Atrial fibrosis has been associated with AF, but the clinical utility of assessment of this fibrosis has yet to be fully elucidated. In this paper we review the current state of understanding of the pathophysiology of atrial fibrosis in AF, and its impact upon the instigation and propagation of the arrhythmia. Fibrosis causes an increase in volume of dysfunctional extracellular matrix, and is associated with cellular alterations such as hypertrophy, apoptosis and membrane dysfunction within the atrial myocardium. In turn, these cause pathological alterations to atrial conduction, such as increased anisotropy, conduction block and re-entry, which can lead to AF. We review current methods of assessing atrial fibrosis and their impact upon the prediction of success of interventional rhythm control strategies such as ablation and cardioversion. We focus particularly on circulating biomarkers of fibrosis and scar formation; their role in the fibrotic process, and their value in the prediction of rhythm control success. We also review imaging and invasive electrocardiographic mapping techniques that may identify fibrosis, and again assess their potential predictive value. In this area there exist many unanswered questions, but further work will help to refine techniques to reliably identify and treat those patients who are most likely to benefit from rhythm control treatment strategies. PMID:27389440

  20. Atrial fibrillation is associated with a lower exercise capacity in male chronic heart failure patients

    OpenAIRE

    Pardaens, K; Van Cleemput, J.; Vanhaecke, J.; Fagard, R.

    1997-01-01

    Objective—To study the influence of atrial fibrillation on peak oxygen uptake (peak V̇O2) in chronic heart failure. An unfavourable effect of atrial fibrillation has been shown in several patient populations, but the results have not been consistent in chronic heart failure.
Methods—Data were analysed from male heart transplant candidates who were able to perform graded bicycle ergometry until exhaustion with respiratory gas analysis and measurement of heart rate. Patients in atrial fibrillat...

  1. Clinical Differences between Subtypes of Atrial Fibrillation and Flutter: Cross-Sectional Registry of 407 Patients

    OpenAIRE

    Eduardo Dytz Almeida; Raphael Boesche Guimarães; Laura Siga Stephan; Alexandre Kreling Medeiros; Katia Foltz; Roberto Tofani Santanna; Leonardo Martins Pires; Marcelo Lapa Kruse; Gustavo Glotz de Lima; Tiago Luiz Luz Leiria

    2015-01-01

    Introduction: Atrial fibrillation and atrial flutter account for one third of hospitalizations due to arrhythmias, determining great social and economic impacts. In Brazil, data on hospital care of these patients is scarce. Objective: To investigate the arrhythmia subtype of atrial fibrillation and flutter patients in the emergency setting and compare the clinical profile, thromboembolic risk and anticoagulants use. Methods: Cross-sectional retrospective study, with data collection from medic...

  2. Inducibility of human atrial fibrillation in an in silico model reflecting local acetylcholine distribution and concentration

    OpenAIRE

    Hwang, Minki; Lee, Hyun-Seung; Pak, Hui-Nam; Shim, Eun Bo

    2015-01-01

    Vagal nerve activity has been known to play a crucial role in the induction and maintenance of atrial fibrillation (AF). However, it is unclear how the distribution and concentration of local acetylcholine (ACh) promotes AF. In this study, we investigated the effect of the spatial distribution and concentration of ACh on fibrillation patterns in an in silico human atrial model. A human atrial action potential model with an ACh-dependent K+ current (IKAch) was used to examine the effect of vag...

  3. HALT & REVERSE: Hsf1 activators lower cardiomyocyt damage; towards a novel approach to REVERSE atrial fibrillation

    OpenAIRE

    Lanters, Eva A. H.; van Marion, Denise M. S.; Kik, Charles; Steen, Herman; Bogers, Ad J.J.C.; Allessie, Maurits A.; Brundel, Bianca J. J. M.; de Groot, Natasja M. S.

    2015-01-01

    BACKGROUND: Atrial fibrillation is a progressive arrhythmia, the exact mechanism underlying the progressive nature of recurrent AF episodes is still unknown. Recently, it was found that key players of the protein quality control system of the cardiomyocyte, i.e. Heat Shock Proteins, protect against atrial fibrillation progression by attenuating atrial electrical and structural remodeling (electropathology). HALT & REVERSE aims to investigate the correlation between electropathology, as define...

  4. Stroke prevention in atrial fibrillation: Commentary regarding the AAN's evidence-based guideline update

    OpenAIRE

    Hart, Robert G.; Eikelboom, John W.

    2014-01-01

    Atrial fibrillation is a common, potentially preventable cause of disabling stroke in the elderly, particularly in elderly women, resulting from embolism of stasis-precipitated thrombi formed in the left atrial appendage. In 1989, the first randomized clinical trial of anticoagulant therapy in atrial fibrillation showed that warfarin produced a large reduction in ischemic stroke.1 In the ensuing 25 years, more than 40 additional randomized trials have permitted stroke prophylaxis to be import...

  5. Current State of the Surgical Treatment of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Elena Sandoval

    2011-01-01

    Full Text Available Surgery of atrial fibrillation (AF was first described in 1991 by James Cox in what was named the Cox-Maze procedure, and over the years it has been considered the gold-standard treatment, with best results in maintaining sinus rhythm in the long term. Nevertheless, the complexity and aggressivity of the first techniques of cut-and-sew limited the application of this procedure, and few centers were dedicated to AF surgery. In the past years, however, new devices able to ablate atrial tissue with cryotherapy, radiofrequency, or ultrasounds have facilitated this operation. In the mid-term, other energy devices with laser or microwave have been abandoned due to a lack of consistency in getting transmural lesions in a consistent and reproducible manner. Additionally, better knowledge of the physiopathology of AF, with the importance of triggering zones around the pulmonary veins, has started new minimally invasive techniques to approach paroxysmal and persistent AF patients through thoracoscopy.

  6. Strategies in the Surgical Management of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Leanne Harling

    2011-01-01

    Full Text Available Atrial fibrillation (AF is associated with substantial morbidity, mortality, and economic burden and confers a lifetime risk of up to 25%. Current medical management involves thromboembolism prevention, rate, and rhythm control. An increased understanding of AF pathophysiology has led to enhanced pharmacological and medical therapies; however this is often limited by toxicity, variable symptom control, and inability to modulate the atrial substrate. Surgical AF ablation has been available since the original description of the Cox Maze procedure, either as a standalone or concomitant intervention. Advances in novel energy delivery systems have allowed the development of less technically demanding procedures potentially eliminating the need for median sternotomy and cardiopulmonary bypass. Variations in the definition, duration, and reporting of AF have produced methodological limitations impacting on the validity of interstudy comparisons. Standardization of these parameters may, in future, allow us to further evaluate clinical endpoints and establish the efficacy of these techniques.

  7. The relationship between gap junctional remodeling and human atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    李大强; 冯义柏; 张会琴

    2004-01-01

    @@ Atrial fibrillation (AF) is currently the most common cardiac tachyarrhythmia in clinical practice. AF has a tendency to become more persistent over time. Progression of an underlying disease is one explanation. Another possible explanation is electrical, structural, and gap junctional remodeling of the atrium by repetitive induction of AF.1 The expression level and distribution of it have close relation with the conduction velocity of electrical activation in the atrium. The aim of the present study was to investigate the alternations of the expression and distribution of (connexin 40, Cx 40) and (connexin 43, Cx 43) in the right atrial appendages of the patients with AF by laser confocal scanning microscopy and Western blot technique.

  8. Personalized management of atrial fibrillation: Proceedings from the fourth Atrial Fibrillation competence NETwork/European Heart Rhythm Association consensus conference.

    Science.gov (United States)

    Kirchhof, Paulus; Breithardt, Günter; Aliot, Etienne; Al Khatib, Sana; Apostolakis, Stavros; Auricchio, Angelo; Bailleul, Christophe; Bax, Jeroen; Benninger, Gerlinde; Blomstrom-Lundqvist, Carina; Boersma, Lucas; Boriani, Giuseppe; Brandes, Axel; Brown, Helen; Brueckmann, Martina; Calkins, Hugh; Casadei, Barbara; Clemens, Andreas; Crijns, Harry; Derwand, Roland; Dobrev, Dobromir; Ezekowitz, Michael; Fetsch, Thomas; Gerth, Andrea; Gillis, Anne; Gulizia, Michele; Hack, Guido; Haegeli, Laurent; Hatem, Stephane; Häusler, Karl Georg; Heidbüchel, Hein; Hernandez-Brichis, Jessica; Jais, Pierre; Kappenberger, Lukas; Kautzner, Joseph; Kim, Steven; Kuck, Karl-Heinz; Lane, Deirdre; Leute, Angelika; Lewalter, Thorsten; Meyer, Ralf; Mont, Lluis; Moses, Gregory; Mueller, Markus; Münzel, Felix; Näbauer, Michael; Nielsen, Jens Cosedis; Oeff, Michael; Oto, Ali; Pieske, Burkert; Pisters, Ron; Potpara, Tatjana; Rasmussen, Lars; Ravens, Ursula; Reiffel, James; Richard-Lordereau, Isabelle; Schäfer, Herbert; Schotten, Ulrich; Stegink, Wim; Stein, Kenneth; Steinbeck, Gerhard; Szumowski, Lukasz; Tavazzi, Luigi; Themistoclakis, Sakis; Thomitzek, Karen; Van Gelder, Isabelle C; von Stritzky, Berndt; Vincent, Alphons; Werring, David; Willems, Stephan; Lip, Gregory Y H; Camm, A John

    2013-11-01

    The management of atrial fibrillation (AF) has seen marked changes in past years, with the introduction of new oral anticoagulants, new antiarrhythmic drugs, and the emergence of catheter ablation as a common intervention for rhythm control. Furthermore, new technologies enhance our ability to detect AF. Most clinical management decisions in AF patients can be based on validated parameters that encompass type of presentation, clinical factors, electrocardiogram analysis, and cardiac imaging. Despite these advances, patients with AF are still at increased risk for death, stroke, heart failure, and hospitalizations. During the fourth Atrial Fibrillation competence NETwork/European Heart Rhythm Association (AFNET/EHRA) consensus conference, we identified the following opportunities to personalize management of AF in a better manner with a view to improve outcomes by integrating atrial morphology and damage, brain imaging, information on genetic predisposition, systemic or local inflammation, and markers for cardiac strain. Each of these promising avenues requires validation in the context of existing risk factors in patients. More importantly, a new taxonomy of AF may be needed based on the pathophysiological type of AF to allow personalized management of AF to come to full fruition. Continued translational research efforts are needed to personalize management of this prevalent disease in a better manner. All the efforts are expected to improve the management of patients with AF based on personalized therapy. PMID:23981824

  9. Atrium-atrioventricular node block: an unusual complication during catheter ablation of persistent atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    MIAO Cheng-long; SANG Cai-hua; DONG Jian-zeng; MA Chang-sheng

    2011-01-01

    Ablation of persistent atrial fibrillation is still a challenge for the ablationist. Extensive ablation is required under some conditions and could lead to some unintended complications. Here we report a case of atrium-atrioventricular node block complicating multiple catheter ablation procedures for persistent atrial fibrillation. After extensive ablation, including circumferential pulmonary vein ablation, linear ablation at the left atrial roof, mitral isthmus, atrial septum, cavotricuspid isthmus, and complex fractionated atrial electrogram ablation, conduction obstacle was found, and sinus impulse could not travel from the right atrium, atrial septum and left atrium to atrioventricular node. The case indicated that intensive ablation at some key sites, especially the interatrial septum, should be careful during ablation of atrial fibrillation.

  10. Mechanisms of Atrial Fibrillation: Rotors, Ionic Determinants, and Excitation Frequency.

    Science.gov (United States)

    Berenfeld, Omer; Jalife, José

    2016-04-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia; however, therapy is suboptimal. We review recent data on dynamics of wave propagation during AF and its mechanistic link to the substrate. Data show that the dominant frequency (DF) increase during transition to persistent AF may be explained by rotor acceleration. We discuss how translation of experimentally derived understanding of the rotors may find its way into the clinic, focusing on studies analyzing spatial distribution of DF in the atria of patients with paroxysmal versus persistent AF, and how that knowledge might contribute to improve the outcome of AF ablation procedures. PMID:26968663

  11. Targeting histone deacetylases: A novel therapeutic strategy for atrial fibrillation.

    Science.gov (United States)

    Lkhagva, Baigalmaa; Kao, Yu-Hsun; Chen, Yao-Chang; Chao, Tze-Fan; Chen, Shih-Ann; Chen, Yi-Jen

    2016-06-15

    Atrial fibrillation (AF) is a common cardiac arrhythmia associated with high mortality and morbidity. Current treatments of AF have limited efficacy and considerable side effects. Histone deacetylases (HDACs) play critical roles in the pathophysiology of cardiovascular diseases and contribute to the genesis of AF. Therefore, HDAC inhibition may prove a novel therapeutic strategy for AF through upstream therapy and modifications of AF electrical and structural remodeling. In this review, we provide an update of the knowledge of the effects of HDACs and HDAC inhibitors on AF, and dissect potential underlying mechanisms. PMID:27089819

  12. Selective Versus Total Pulmonary Vein Isolation in Atrial Fibrillation Ablation

    Directory of Open Access Journals (Sweden)

    Sonia Ammar, MD; Tilko Reents, MD; Stephanie Fichtner, MD; Gabriele Hessling, MD; Isabel Deisenhofer, MD

    2014-06-01

    Full Text Available One of the greatest discoveries in cardiac electrophysiology was the recognition of the crucial role of pulmonary vein (PV myocardial sleeves for atrial fibrillation (AF initiation. Based on this concept, catheter ablation of paroxysmal AF by pulmonary vein isolation (PVI has become a routine approach for this arrhythmia. An attractive concept implies the selective isolation of the arrhythmogenic PVs only. Based on the most important studies regarding this approach, we describe pros and cons of a selective PVI compared to a complete PVI and try to illustrate why selective PVI did not find widespread acceptance in the electrophysiologic community.

  13. Ectopic Triggers of Superior Vena Cava in Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Jayasree Pillarisetti MD

    2009-04-01

    Full Text Available Superior vena cava (SVC triggers constitute 6- 8% of non-pulmonary vein (PV foci that initiate atrial fibrillation (AF.1 Since SVC cardiomyocytes originate from the right sinus horn they possess enhanced automacity and after-depolarization leading to arrhythmogenicity.2 In a recent study by Arruda et al. 12% of patients had SVC triggers and empiric adjunctive isolation of SVC-right atrium along with PVisolation resulted in higher long term success rate than the group that underwent PVI alone. They demonstrated that adjunctive isolation of SVC along with PV isolation (PVI is a safe and feasible strategy for ablation of AF.

  14. Periablative Anticoagulation Strategies in Patients with Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Eduardo B. Saad

    2008-12-01

    Full Text Available Atrial fibrillation is associated with thromboembolic events that may cause important impairment on quality of life. Pulmonary vein isolation is the treatment of choice in cases that are refractory to medical therapy. Once sheaths and catheters are manipulated inside the left atrium, anticoagulation with heparin must be used during the procedure to protect patients from thromboembolic phenomena. Different strategies of anticoagulation are used at different centers. This review summarizes the pathophysiology of thrombus formation in the left atrium, defines which patients are under high risk and describes the main strategies used for anticoagulation.

  15. Phrenic Nerve Injury After Catheter Ablation of Atrial Fibrillation

    OpenAIRE

    2007-01-01

    Phrenic Nerve Injury (PNI) has been well studied by cardiac surgeons. More recently it has been recognized as a potential complication of catheter ablation with a prevalence of 0.11 to 0.48 % after atrial fibrillation (AF) ablation. This review will focus on PNI after AF ablation Anatomical studies have shown a close relationship between the right phrenic nerve and it's proximity to the superior vena cava (SVC), and the antero-inferior part of the right superior pulmonary vein (RSPV). In addi...

  16. Atrial Fibrillation in Athletes - The Story Behind The Running Hearts

    Directory of Open Access Journals (Sweden)

    Sunny S. Po

    2010-03-01

    Full Text Available Atrial fibrillation (AF is the most commonly encountered arrhythmia in clinical practice but the mechanisms underlying the initiation and maintenance of AF are yet to be clarified. It is well-known that regular exercise is beneficial to health and reduces the risks of cardiovascular diseases. However, recent studies suggest that long-term endurance exercise, including running [1], swimming, rowing [2] and cycling [3], or vigorous competitive sports may increase the incidence of AF in these athletes. This review article is intended to provide a summary of the possible links between exercise and AF.

  17. Ogilvie’s Syndrome following Cardioversion for Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Moh’d Al-Halawani

    2014-01-01

    Full Text Available Acute colonic pseudoobstruction, also known as Ogilvie’s syndrome, is characterized by distension of the colon in the absence of a mechanical obstruction as evident by abdominal radiography. This syndrome is usually treated conservatively; however, medical or surgical therapies can be employed in refractory cases. Ogilvie’s syndrome has been reported following cardiac events, such as myocardial infarction, heart failure, and cardiac bypass surgeries. We report the first case of Ogilvie’s syndrome following synchronized electric cardioversion for atrial fibrillation.

  18. The importance of interactions between atrial fibrillation and heart failure.

    Science.gov (United States)

    Khan, Muhammad A; Satchithananda, Duwarakan K; Mamas, Mamas A

    2016-06-01

    Heart failure (HF) and atrial fibrillation (AF) are among the commonest cardiovascular conditions encountered in clinical practice and frequently coexist. Over the last decade, they have evolved into global cardiovascular epidemics. This, in turn, has huge clinical and economic implications. There is ample evidence that AF and HF have a mutually deleterious effect on each other. AF is not only a marker of HF severity but also affects HF prognosis independently. This article presents the close pathophysiological relationship between AF and HF and the adverse prognostic consequences of this bidirectional interaction. The scope of various therapeutic modalities and their potential impacts are discussed briefly. PMID:27251919

  19. Atrial Fibrillation and Stroke – Increasing Stroke Risk With Intervention

    Directory of Open Access Journals (Sweden)

    Christopher V. DeSimone; Malini Madhavan; Elisa Ebrille; Alejandro A. Rabinstein; Paul A. Friedman; Samuel J. Asirvatham

    2013-12-01

    Full Text Available In this review, we focus on the important newly recognized appreciation for the paradoxical increase in stroke and TIA as a result of intervention meant to treat atrial fibrillation (AF with the hope of decreasing stroke risk in the long term. The impact of silent cerebral lesions recently appreciated as a potentially major limitation and risk with AF ablation is explained. We categorize our present understanding of how we can minimize risk and provide a platform for what will undoubtedly be newer study, changes in the way procedures are done today, and possibly vascular-based stroke-reduction strategies.

  20. CT imaging of complications of catheter ablation for atrial fibrillation

    International Nuclear Information System (INIS)

    The complication rate following radiofrequency catheter ablation for atrial fibrillation is low (<5%). Complications include pericardial effusion, cardiac tamponade, pulmonary vein stenosis, oesophageal ulceration or perforation, atrio-oesophageal fistula formation, stroke/transient ischaemic attack, phrenic nerve injury, haematoma at the puncture site, and femoral arteriovenous fistula. Among available imaging tools, computed tomography (CT) can be very useful in diagnosing complications of the procedure, particularly in the subacute and delayed stages after ablation. This review illustrates CT imaging of several of the common and uncommon complications of radiofrequency catheter ablation

  1. Combined Catheter Ablation for Atrial Fibrillation and Watchman® Left Atrial Appendage Occlusion Procedures: A Single Centre Experience

    Directory of Open Access Journals (Sweden)

    Daniel T. Walker B. App Sci

    2012-10-01

    Full Text Available Background Patients with atrial fibrillation (AF may be interested in undergoing concomitant interventions of left atrial catheter ablation and device occlusion of the left atrial appendage (LAA. We report on the feasibility and outcome of combined procedures in a single centre case series. Methods Twenty-six patients underwent either first time or redo pulmonary vein isolation (PVI procedures followed by successful implant of a Watchman? device. Results All procedures were uncomplicated with a mean case time of 233 ? 38 minutes. Maximal LAA orifice dimension was smaller in 3 of 26 patients post PVI (range 1mm than on the pre-procedural transoesophageal echocardiogram (TOE. A new peri-device leak of maximum 3mm was noted in 5 of 26 patients at 6 week follow-up TOE, but resolved in 4 by the 6 month follow-up. Conclusion Combined procedures for catheter ablation for AF and Watchman? LAA implant appear to be feasible and safe with satisfactory occlusion of the LAA maintained at follow-up.

  2. New Procedure for Treatment of Atrial Fibrillation in Patients with Valvular Heart Disease

    Directory of Open Access Journals (Sweden)

    Naser Safaie

    2010-10-01

    Full Text Available Patients with valvular heart disease suffer from atrial fibrillation for more than 12 months after valve surgery and have a low probability of remaining in sinus rhythm. We performed an intra-operative procedure similar to surgical maze ІІІ procedure for conversion of this arrhythmia to sinus rhythm. We did this study to evaluate the efficacy of this procedure to restore the sinus rhythm in patients with valvular heart disease. 28 patients with valvular heart disease and chronic persistent atrial fibrillation underwent different combinations of valve surgery and concomitant reduction of left and right atrial size and resection of both atrial auricles in Shahid Madani cardiothoracic center from September 2004 to October 2008. The procedure for atrial fibrillation treatment was performed with cardiopulmonary bypass and after mitral valve replacement. There was one in-hospital death postoperatively because of respiratory failure, but no other complication till 6 months after the operation. Out of 28 patients, 23 were in sinus rhythm one week after the operation, one patient had junctional rhythm after the operation that restored to sinus rhythm and 4 patients had persistent atrial fibrillation. During the 12-month follow up, atrial fibrillation was corrected in 82.14%. Doppler echocardiography in these patients with sinus rhythm demonstrated good atrial contractility. This procedure on both atria is effective and less invasive than the original maze procedure to eliminate the atrial fibrillation, and can be performed in patients with valvular heart disease without increasing the risk of operation.

  3. New Procedure for Treatment of Atrial Fibrillation in Patients with Valvular Heart Disease

    Directory of Open Access Journals (Sweden)

    Naser Safaie

    2010-09-01

    Full Text Available "nPatients with valvular heart disease suffer from atrial fibrillation for more than 12 months after valve surgery and have a low probability of remaining in sinus rhythm. We performed an intra-operative procedure similar to surgical maze ІІІ procedure for conversion of this arrhythmia to sinus rhythm. We did this study to evaluate the efficacy of this procedure to restore the sinus rhythm in patients with valvular heart disease. 28 patients with valvular heart disease and chronic persistent atrial fibrillation underwent different combinations of valve surgery and concomitant reduction of left and right atrial size and resection of both atrial auricles in Shahid Madani cardiothoracic center from September 2004 to October 2008. The procedure for atrial fibrillation treatment was performed with cardiopulmonary bypass and after mitral valve replacement. There was one in-hospital death postoperatively because of respiratory failure, but no other complication till 6 months after the operation. Out of 28 patients, 23 were in sinus rhythm one week after the operation, one patient had junctional rhythm after the operation that restored to sinus rhythm and 4 patients had persistent atrial fibrillation. During the 12-month follow up, atrial fibrillation was corrected in 82.14%. Doppler echocardiography in these patients with sinus rhythm demonstrated good atrial contractility. This procedure on both atria is effective and less invasive than the original maze procedure to eliminate the atrial fibrillation, and can be performed in patients with valvular heart disease without increasing the risk of operation.

  4. Valsartan Reduced Atrial Fibrillation Susceptibility by Inhibiting Atrial Parasympathetic Remodeling through MAPKs/Neurturin Pathway

    Directory of Open Access Journals (Sweden)

    Lei Liu

    2015-07-01

    Full Text Available Background/Aims: Angiotensin II receptor blockers (ARBs have been proved to be effective in preventing atrial structural and electrical remodelinq in atrial fibrillation (AF. Previous studies have shown that parasympathetic remodeling plays an important role in AF. However, the effects of ARBs on atrial parasympathetic remodeling in AF and the underlying mechanisms are still unknown. Methods: Canines were divided into sham-operated, pacing and valsartan + pacing groups. Rats and HL-1 cardiomyocytes were divided into control, angiotensin II (Ang II and Ang II + valsartan groups, respectively. Atrial parasympathetic remodeling was quantified by immunocytochemical staining with anti-choline acetyltransferase (ChAT antibody. Western blot was used to analysis the protein expression of neurturin. Results: Both inducibility and duration were increased in chronic atrial rapid-pacing canine model, which was significantly inhibited by the treatment with valsartan. The density of ChAT-positive nerves and the protein level of neurturin in the atria of pacing canines were both increased than those in sham-operated canines. Ang II treatment not only induced atrial parasympathetic remodeling in rats, but also up-regulated the protein expression of neurturin. Valsartan significantly prevented atrial parasympathetic remodeling, and suppressed the protein expression of neurturin. Meanwhile, valsartan inhibited Ang II -induced up-regulation of neurturin and MAPKs in cultured cardiac myocytes. Inhibition of MAPKs dramatically attenuated neurturin up-regulation induced by Ang II. Conclusion: Parasympathetic remodeling was present in animals subjected to rapid pacing or Ang II infusion, which was mediated by MAPKs/neurturin pathway. Valsartan is able to prevent atrial parasympathetic remodeling and the occurrence of AF via inhibiting MAPKs/neurturin pathway.

  5. Signal averaged P wave compared with standard electrocardiography or echocardiography for prediction of atrial fibrillation after coronary bypass grafting.

    OpenAIRE

    Stafford, P. J.; Kolvekar, S.; Cooper, J; Fothergill, J.; Schlindwein, F.; deBono, D. P.; Spyt, T J; Garratt, C. J.

    1997-01-01

    OBJECTIVE: To define the clinical value of the signal averaged P wave (SAPW) and to compare it with the standard electrocardiogram (ECG), echocardiogram, and clinical assessment for the prediction of atrial fibrillation after coronary bypass grafting (CABG). DESIGN: Prospective validation cohort study. SETTING: Regional cardiothoracic centre. PATIENTS: 201 unselected patients undergoing first elective CABG were recruited over six months. Patients requiring concomitant valve surgery were exclu...

  6. Skin Burn at the Site of Indifferent Electrode after Radiofrequency Catheter Ablation of AV Node for Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Subba Reddy Vanga, MBBS

    2008-07-01

    Full Text Available Radiofrequency Ablation of AV node with permanent pacemaker has been used to achieve rate control in persistent symptomatic atrial fibrillation. Although RF Ablation is safe, complications may occur in up to 3% of the procedures. A rare complication of 2nd degree skin burn at indifferent electrode site has been described here. This report highlights the rare but possible complication in patients undergoing such a procedure and help in preventing by taking appropriate measures.

  7. Skin Burn at the Site of Indifferent Electrode after Radiofrequency Catheter Ablation of AV Node for Atrial Fibrillation.

    Directory of Open Access Journals (Sweden)

    Dhanunjaya R Lakkireddy

    2008-07-01

    Full Text Available Radiofrequency Ablation of AV node with permanent pacemaker has been used to achieve rate control in persistent symptomatic atrial fibrillation. Although RF Ablation is safe, complications may occur in up to 3% of the procedures. A rare complication of 2nd degree skin burn at indifferent electrode site has been described here. This report highlights the rare but possible complication in patients undergoing such a procedure and help in preventing by taking appropriate measures.

  8. New Oral Anticoagulants vs Vitamin K Antagonists: Benefits for Health-Related Quality of Life in Patients with Atrial Fibrillation

    OpenAIRE

    Alegret, Josep M; Viñolas, Xavier; Arias, Miguel A.; Martínez-Rubio, Antoni; Rebollo, Pablo; Ràfols, Carles; Martínez-Sande, José L.

    2014-01-01

    New oral anticoagulants (NOAC) have demonstrated their efficacy as an alternative to vitamin K antagonists (VKA) in the prophylaxis of cardioembolic events in patients with atrial fibrillation (AF). However, evidence on the benefits of NOAC in health-related quality of life (HRQoL) is lacking.We evaluated changes in HRQoL related to oral anticoagulation therapy employing a specific questionnaire in a cohort of 416 patients with AF undergoing electrical cardioversion. In terms of HRQoL, we obs...

  9. Contact Force and Atrial Fibrillation Ablation

    Directory of Open Access Journals (Sweden)

    Waqas Ullah; Richard Schilling; Tom Wong

    2016-02-01

    Full Text Available Catheters able to measure the force and vector of contact between the catheter tip and myocardium are now available. Pre-clinical work has established that the degree of contact between the radiofrequency ablation catheter and myocardium correlates with the size of the delivered lesion. Excess contact is associated with steam pops and perforation. Catheter contact varies within the left atrium secondary to factors including respiration, location, atrial rhythm and the trans-septal catheter delivery technology used. Compared with procedures performed without contact force (CF-sensing, the use of this technology has, in some studies, been found to improve complication rates, procedure and fluoroscopy times, and success rates. However, for each of these parameters there are also studies suggesting a lack of difference from the availability of CF data. Nevertheless, CF-sensing technology has been adopted as a standard of care in many institutions. It is likely that use of CF-sensing technology will allow for the optimization of each individual radiofrequency application to maximize efficacy and procedural safety. Recent work has attempted to define what these optimal targets should be, and approaches to do this include assessing for sites of pulmonary vein reconnection after ablation, or comparing the impedance response to ablation. Based on such work, it is apparent that factors including mean CF, force time integral (the area under the force-time curve and contact stability are important determinants of ablation efficacy. Multicenter prospective randomized data are lacking in this field and required to define the CF parameters required to produce optimal ablation.

  10. Effect of mmPs/TIMPs on Atrial Structural Remodeling in A Chronic Canine Atrial Fibrillation Model

    Institute of Scientific and Technical Information of China (English)

    Yang guirong; Zhang wei; Li li; Wang sujia; Zhu hui; Zhang yun

    2004-01-01

    @@ Objective Atrial fibrillation (AF) is commonly associatedwith atrial dilation and fibrosis, but the mechanism underlying these abnormalities remains unclear. The purpose of this study is to investigate the effect of matrix metalloproteinase-9 (mmP-9)and tissue in hibitor metalloproteinase -1 (TIMP-1) on extracellular matrix of atrium.

  11. Atrial Size Independently Correlates with the Development of Paroxysmal Atrial Fibrillation in Patients with Sick Sinus Syndrome

    Directory of Open Access Journals (Sweden)

    Yu-Sheng Lin

    2010-12-01

    Full Text Available Background: Atrial fibrillation arises in 20-30% of patients with sick sinus syndrome,increasing the risk of systemic embolization and mortality. The aim of thisstudy was to examine the clinical determinants of development of paroxysmalatrial fibrillation in sick sinus syndrome patients before implantation of apacemaker.Methods: This case-control survey involved 144 patients (mean age

  12. Pharmacological exploration of the resting membrane potential reserve: Impact on atrial fibrillation.

    Science.gov (United States)

    van der Heyden, Marcel A G; Jespersen, Thomas

    2016-01-15

    The cardiac action potential arises and spreads throughout the myocardium as a consequence of highly organized spatial and temporal expression of ion channels conducting Na(+), Ca(2+) or K(+) currents. The cardiac Na(+) current is responsible for the initiation and progression of the action potential. Altered Na(+) current has been found implicated in a number of different arrhythmias, including atrial fibrillation. In the atrium, the resting membrane potential is more depolarized than in the ventricles, and as cardiac Na(+) channels undergo voltage-dependent inactivation close to this potential, minor changes in the membrane potential have a relatively large impact on the atrial Na(+) current. The atrial resting membrane potential is established following ionic currents through the inwardly rectifying K(+) currents IK1, IK,ACh and IK,Ca and to a lesser extent by other ion channels as well as by exchangers and pumps. This review will focus on the relative and regulated contribution of IK1, IK,ACh and IK,Ca, and on pharmacological modification of the channels underlying these currents in respect to the resting membrane potential, Na(+) channel availability and atrial electrophysiology in health and disease. PMID:26601803

  13. The Atrial Neural Network and the Metastatic Progression of Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Shen X; Scherlag BJ; He B; Sun J; Mei G; Po SS

    2013-08-01

    Full Text Available With the advent of catheter ablation of atrial fibrillation (AF there has been acceleration in our understanding of the mechanisms underlying the etiology of this common clinical arrhythmia. In this regard, the role of the intrinsic cardiac autonomic nervous system in the initiation and maintenance of AF began to receive attention in numerous experimental and clinical investigations. Up to now, the focus has been on the large ganglionated plexi (GP which are located in the posterior left atrium mainly at the pulmonary vein-atrial junctions. As long term outcomes have been reported and single procedures have indicated diminished success rates particularly for persistent/long standing persistent AF, emphasis has begun to shift away from the pulmonary vein isolation (PVI alone as well as GP ablation with or without PVI. An understanding of the atrial substrate represented by the extensions of the intrinsic cardiac autonomic system constituting the atrial neural network is beginning to evolve. In this review, the contribution of the intrinsic cardiac autonomic nervous system to the etiology of AF is addressed, particularly in regard to the greater prevalence of AF in the elderly. In addition, we emphasize the involvement of the atrial neural network in the pathological progression of paroxysmal to persistent and long standing persistent forms of AF.

  14. Anticoagulation Management in Patients with Pacemaker-Detected Atrial Fibrillation

    Science.gov (United States)

    Poposka, Lidija; Boskov, Vladimir; Risteski, Dejan; Taleski, Jane; Georgievska-Ismail, Ljubica

    2016-01-01

    INTRODUCTION: In patients with an implanted pacemaker, asymptomatic atrial fibrillation (AF) is associated with an increased risk of thrombo-embolic complications. There is still no consensus which duration of episodes of atrial fibrillation should be taken as an indicator for inclusion of oral anticoagulation therapy (OAC). MATERIAL AND METHODS: A total of 104 patients who had no AF episodes in the past and have an indication for permanent pacing were included in the study. RESULTS: During an average follow-up of 18 months, 33 of the patients developed episodes of AF. Inclusion of OAC was performed in 17 patients, in whom AF was recorded, although in all patients CHA2DS2-VASc score was ≥ 1. The inclusion of OAC showed a statistically significant correlation with increasing duration of episodes of AF (r = 0.502, p = 0.003). During the follow-up period none of the patients developed thrombo-embolic complication. CONCLUSION: Considering that our group of patients had no thrombo-embolic events, we could conclude that dividing the AF episodes in less than 1% in 24 hours and longer than 1% within 24 hours could be an indicator for decision-making to include OAK if the CHA2DS2-VASc score is ≥ 1. PMID:27335594

  15. FIBRILACIÓN AURICULAR ISQUÉMICA / Ischemic atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Jose R. Ruiz Arroyo

    2013-07-01

    Full Text Available Resumen: La fibrilación auricular es la arritmia más frecuente en el período peri-infarto agudo de miocardio, aunque su presencia asociada tan solo a la fase de isquemia aguda y su inmediato cese tras una revascularización precoz y efectiva es testimonial en la literatura, con la consiguiente falta de evidencia para su posterior tratamiento. Se presenta un caso clínico en el que el intervencionismo coronario precoz consiguió la cardioversión a ritmo sinusal de una fibrilación auricular en el curso de un infarto agudo de miocardio, posteriormente se discute la estrategia a seguir en torno a la arritmia en un paciente con buena evolución clínica tras el suceso. / Abstract: Atrial fibrillation is the most common arrhythmia in the periacute myocardial infarc-tion period, although its presence associated only to the acute phase of ischemia and its immediate cessation after early and effective revascularization is anecdotal in the literature, with a consequent lack of evidence for further treatment. A clinical case in which early coronary intervention managed to achieve a cardioversion of atrial fibrillation to sinus rhythm during an acute myocardial infarction is reported. Subsequently, it is discussed the strategy that must be followed with regard to arrhythmia in a patient with good clinical outcome after the event.

  16. What patients want and need to know about atrial fibrillation

    Directory of Open Access Journals (Sweden)

    McCabe PJ

    2011-11-01

    Full Text Available Pamela J McCabe Saint Mary's Hospital, Mayo Clinic, Rochester, MN, USA Abstract: Clinicians in a variety of settings are called upon to care for patients diagnosed with atrial fibrillation (AF, a common chronic condition that affects up to 3 million people in the USA. Evidence-based guidelines provide clinicians with direction for treatment of AF, but recommended content for educating patients and counseling about self-management of AF is not included in published guidelines. When patients believe they have a good understanding of AF they report fewer symptoms, perceive greater control over AF, and attribute less emotional distress to AF. Thus, providing patients with information about AF and how to manage it is important for promoting positive outcomes. The purpose of this article is to offer evidence-based recommendations for content to include in self-management education and counseling for patients with AF. Approaches for educating and counseling patients related to AF pathophysiology, the nature of AF (its cause, consequences, and trajectory, treatments, action plans, and symptom management, and managing the psychosocial challenges of living with AF, are discussed. Keywords: atrial fibrillation, patient education, self-management education, counseling

  17. Resveratrol and derivatives for the treatment of atrial fibrillation.

    Science.gov (United States)

    Baczkó, István; Light, Peter E

    2015-08-01

    Resveratrol is a bioactive polyphenol, found in grapes, red wine, and peanuts, and has recently garnered much media and scientific attention for its diverse beneficial health effects as a nutritional supplement or nutraceutical. Of particular interest are the well-documented cardioprotective effects of resveratrol that are mediated by diverse mechanisms, including its antioxidant and vascular effects. However, it is now becoming clear that resveratrol may also exhibit direct effects on cardiac function and rhythm through modulation of signaling pathways that regulate cardiac remodeling and ion channel activity that controls cardiac excitability. Resveratrol may therefore possess antiarrhythmic properties that contribute to the cardiovascular benefits of resveratrol. Atrial fibrillation (AF) is the most common cardiac arrhythmia, although current therapies are suboptimal. Our laboratory has been studying resveratrol's effects on cardiac ion channels and remodeling pathways, and we initiated a drug development program aimed at generating novel resveratrol derivatives with improved efficacy against AF when compared to currently available therapeutics. This review therefore focuses on the effects of resveratrol and new derivatives on a variety of cardiac ion channels and molecular pathways that contribute to the development and maintenance of atrial fibrillation. PMID:26205342

  18. Role of Intracardiac echocardiography in Atrial Fibrillation Ablation

    Directory of Open Access Journals (Sweden)

    Antonio Dello Russo, MD PhD

    2013-04-01

    Full Text Available In the recent years, several new evidences support catheter-based ablation as a treatment modality of atrial fibrillation (AF. Based on a plenty of different applications, intracardiac echocardiography (ICE is now a well-established technology in complex electrophysiological procedures, in particular in AF ablation. ICE contributes to improve the efficacy and safety of such procedures defining the anatomical structures involved in ablation procedures and monitoring in real time possible complications. In particular ICE allows: a correct identification of the endocardial structures; a guidance of transseptal puncture; an assessment of accurate placement of the circular mapping catheter; an indirect evaluation of evolving lesions during radiofrequency (RF energy delivery via visualization of micro and macrobubbles tissue heating; assessment of catheter contact with cardiac tissues. Recently, also the feasibility of the integration of electroanatomical mapping (EAM and intracardiac echocardiography has been demonstrated, combining accurate real time anatomical information with electroanatomical data. As a matter of fact, different techniques and ablation strategies have been developed throughout the years. In the setting of balloon-based ablation systems, recently adopted by an increasing number of centers, ICE might have a role in the choice of appropriate balloon size and to confirm accurate occlusion of pulmonary veins. Furthermore, in the era of minimally fluoroscopic ablation, ICE has successfully provided a contribute in reducing fluoroscopy time. The purpose of this review is to summarize the current applications of ICE in catheter based ablation strategies of atrial fibrillation, focusing-on electronically phased-array ICE.

  19. Mitral regurgitationin patients with atrial fibrillation. Current state ofthe problem, approaches to diagnosis and complex surgical treatment

    OpenAIRE

    Bockeria L. A.; Klimchuk I.Ya.

    2015-01-01

    Atrial fibrillation is the most common supraventricular arrhythmia with the stroke being the most feared complication. Dysfunction of atrial conduction system may be associated with organic heart disease, and a complication of various systemic diseases. A long-term atrial fibrillation is associated with hypertension, diabetes mellitus and also combined with heart failure. Arrhythmogenic cardiomyopathy may occur in patients with atrial fibrillation tahiform, and not always requires a long hist...

  20. Atrium-Atrioventricular Node Conduction Block during Catheter Ablation of Persistent Atrial Fibrillation

    OpenAIRE

    Yoshihide Takahashi, MD

    2011-01-01

    Previous studies have suggested that fibrillatory substrates are widely distributed in both atria in patients with persistent atrial fibrillation. Extensive bi-atrial ablation has been increasingly performed to improve the clinical outcomes; however, this may adversely affect the intra-atrial conduction during sinus rhythm. The worst con- sequence of an intra-atrial conduction disturbance is conduction block between the atrium and atrioventricular node. There have been a few case reports on t...

  1. DRUG THERAPY OF PAROXYSMAL ATRIAL FIBRILLATION IN THE ELDERLY OVER 75 YEARS OLD

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective To investigate the effectiveness and safety of various agents on paroxysmal atrial fibrillation in the elderly over 75 years old.Methods Totally 264 in-patients (75-91 years old, 185 males and 79 females) with atrial fibrillation history of less than 7 days were enrolled in this study. A total of 611 atrial fibrillation episodes were recorded, but 130 episodes (22. 3% ) of atrial fibrillation were auto-converted to sinus rhythm. The rest 481 episodes of atrial fibrillation were divided into six groups based on the drug used. Results The cardioversion ratio of atrial fibrillation were 9. 5%, 46.9%, 71.7%, 55.9%, 32.7%, and73.6%in control, cedilanid, amiodarone, propafenone, verapamil, and quinidine groups, respectively. Ventricular rate control were 5.4%, 83.6%, 84. 9%, 77.9%, 78.8%, and 11.3% in those groups, respectively. The total effective rates of amiodarone and cedilanid groups were the highest. When the ventricular rate was controlled to below 90 bpm, the patients would almost complain of no discomfort. No severe side-effect was observed in each group. Conclusion Amiodarone and cedilanid may be the proper drugs for the treatment of paroxysmal atrial fibrillation in the elderly. The above antiarrhythmics in each therapeutic group were relatively safe and effective.

  2. Pulmonary vein isolation in the treatment of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Kumar S

    2016-05-01

    Full Text Available Saurabh Kumar, Gregory F Michaud Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA Abstract: Atrial fibrillation (AF is the commonest arrhythmia in humans and is associated with marked reduction in quality of life and an elevated thromboembolic risk. Paroxysmal, persistent, and permanent forms of AF have been recognized. Whilst antiarrhythmic drugs are considered as first-line therapy, the role of catheter ablation is increasing due to its superior efficacy in terms of quality of life and reduction in AF burden. The central paradigm for catheter ablation of AF is that triggers for AF are located near and within the pulmonary veins (PVs, and electrical isolation of the PVs from the left atrium forms the cornerstone of most catheter ablation strategies. Whilst paroxysmal form is generally trigger dependent, persistent and permanent forms are associated with variable interaction between triggers and "substrate" comprised of atrial and PV electrical and structural remodeling. Nevertheless, isolation of the PVs still forms a critical component of catheter ablation strategies, regardless of AF type. Procedural efficacy, however, is limited by PV conduction recovery. This is likely due to deficiencies in ablation tools or limitations of intraprocedural assessment of lesion efficacy. Careful attention to surrogates of tissue heating, such as impedance decrease and electrogram morphology changes, along with advances in catheter technology like contact force catheters may improve rates of durable PV isolation and single-procedural success. This review discusses the mechanism of paroxysmal AF with particular focus on the role of the PVs in AF initiation and PV isolation in the management of AF. Keywords: contact force, lesion transmurality, radiofrequency catheter ablation, paroxysmal atrial fibrillation, electrophysiology, AF

  3. Role of Platelets in Thromboembolism in Patients with Atrial Fibrillation.

    Science.gov (United States)

    Gosk-Bierska, Izabela; Wasilewska, Marta; Wysokiński, Waldemar

    2016-01-01

    Thromboembolic complications of atrial fibrillation (AF) are a major cause of morbidity and mortality but the mechanism of its process remain poorly understood. There are many as yet unanswered questions surrounding the increased thrombotic tendency in AF. One of the crucial questions is what determines the fact that a thrombus remains in the left atrium in situ in some patients, while in others it breaks off and leads to embolic complications. Recent studies indicated an important role of platelets in the left atrial's thrombus formation and suggest that the embolic potential of left atrial thromboses depends on the involvement of platelets in the process of fibrin stabilization rather than aggregation. New methods for investigating platelets function, such as the analysis of transcription activity of RNA coming from platelets contained in thrombi formed in AF, creates an opportunity for studying populations of platelets that are directly involved in homeostatic clot formation. In this paper we present current opinions on the participation of platelets in the pathogenesis of thromboembolism in patients with AF. PMID:26935511

  4. Catheter ablation of atrial fibrillation in the elderly

    Institute of Scientific and Technical Information of China (English)

    Louiza Lioni; Konstantinos P Letsas; Michael Efremidis; Konstantinos Vlachos; Georgios Giannopoulos; Vasileios Kareliotis; Spyridon Deftereos; Antonios Sideris

    2014-01-01

    Background Atrial fibrillation (AF) catheter ablation has emerged as a promising treatment strategy for AF, but has not been widely adopted in the elderly population. The present study aimed to determine the safety and efficacy of AF catheter ablation in the elderly popula-tion. Methods and Results The study population consisted of 316 patients with paroxysmal AF who underwent left atrial ablation. Ninety-five patients were≥65 years (48 males, mean age 68.9 ± 3.0 years old) and 221 patients were<65 years old (130 males, mean age 52.5 ± 10.4 years old). After a mean follow-up period of 34.0 ± 15.1 months, 55 (57.9%) patients in the elderly group were free from ar-rhythmia recurrence compared with 149 (67.4%) patients in the younger group (P=0.169). Procedural complications were uncommon in both study groups. In logistic regression analysis, left atrial diameter (P=0.003), hypertension (P=0.001), dyslipidemia (P=0.039), and coronary artery disease (P=0.018) were independent predictors of AF recurrence in the elderly population. Conclusions Catheter ablation of AF is safe and effective in older patients. Invasive strategies should be considered as an alternative choice in symptomatic elderly patients with AF.

  5. Noninvasive characterization of atrioventricular conduction in patients with atrial fibrillation.

    Science.gov (United States)

    Corino, Valentina D A; Sandberg, Frida; Mainardi, Luca T; Platonov, Pyotr G; Sörnmo, Leif

    2015-01-01

    The atrioventricular (AV) node plays a fundamental role in patients with atrial fibrillation (AF), acting as a filter to the numerous irregular atrial impulses which bombard the node. A phenomenological approach to better understand AV nodal electrophysiology is to analyze the ventricular response with respect to irregularity. In different cohorts of AF patients, such analysis has been performed with the aim to evaluate the association between ventricular response characteristics and long-term clinical outcome and to determine whether irregularity is affected by rate-control drugs. Another approach to studying AV nodal characteristics is to employ a mathematical model which accounts for the refractory periods of the two AV nodal pathways. With atrial fibrillatory rate and RR intervals as input, the model has been considered for analyzing data during (i) rest and head-up tilt test, (ii) tecadenoson and esmolol, and (iii) rate-control drugs. The present paper provides an overview of our recent work on the characterization and assessment of AV nodal conduction using these two approaches. PMID:26324177

  6. Effects of Persistent Atrial Fibrillation-Induced Electrical Remodeling on Atrial Electro-Mechanics – Insights from a 3D Model of the Human Atria

    OpenAIRE

    Adeniran, Ismail; Maclver, David H.; Garratt, Clifford J.; Ye, Jianqiao; Hancox, Jules C.; Zhang, Henggui

    2015-01-01

    Aims Atrial stunning, a loss of atrial mechanical contraction, can occur following a successful cardioversion. It is hypothesized that persistent atrial fibrillation-induced electrical remodeling (AFER) on atrial electrophysiology may be responsible for such impaired atrial mechanics. This simulation study aimed to investigate the effects of AFER on atrial electro-mechanics. Methods and Results A 3D electromechanical model of the human atria was developed to investigate the effects of AFER on...

  7. Combined percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation for rheumatic mitral stenosis and atrial fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Murdoch, Dale, E-mail: dale_murdoch@health.qld.gov.au [The Prince Charles Hospital, Brisbane (Australia); The University of Queensland, Brisbane (Australia); McAulay, Laura [The Prince Charles Hospital, Brisbane (Australia); Walters, Darren L. [The Prince Charles Hospital, Brisbane (Australia); The University of Queensland, Brisbane (Australia)

    2014-11-15

    Rheumatic heart disease is a common cause of cardiovascular morbidity and mortality worldwide, mostly in developing countries. Mitral stenosis and atrial fibrillation often coexist, related to both structural and inflammatory changes of the mitral valve and left atrium. Both predispose to left atrial thrombus formation, commonly involving the left atrial appendage. Thromboembolism can occur, with devastating consequences. We report the case of a 62 year old woman with rheumatic heart disease resulting in mitral stenosis and atrial fibrillation. Previous treatment with warfarin resulted in life-threatening gastrointestinal bleeding and she refused further anticoagulant therapy. A combined procedure was performed, including percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation with the Atritech® Watchman® device. No thromboembolic or bleeding complications were encountered at one year follow-up. Long-term follow-up in a cohort of patients will be required to evaluate the safety and efficacy of this strategy.

  8. Combined percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation for rheumatic mitral stenosis and atrial fibrillation

    International Nuclear Information System (INIS)

    Rheumatic heart disease is a common cause of cardiovascular morbidity and mortality worldwide, mostly in developing countries. Mitral stenosis and atrial fibrillation often coexist, related to both structural and inflammatory changes of the mitral valve and left atrium. Both predispose to left atrial thrombus formation, commonly involving the left atrial appendage. Thromboembolism can occur, with devastating consequences. We report the case of a 62 year old woman with rheumatic heart disease resulting in mitral stenosis and atrial fibrillation. Previous treatment with warfarin resulted in life-threatening gastrointestinal bleeding and she refused further anticoagulant therapy. A combined procedure was performed, including percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation with the Atritech® Watchman® device. No thromboembolic or bleeding complications were encountered at one year follow-up. Long-term follow-up in a cohort of patients will be required to evaluate the safety and efficacy of this strategy

  9. Connexin40 abnormalities and atrial fibrillation in the human heart

    Science.gov (United States)

    Gemel, Joanna; Levy, Andrew E.; Simon, Adria R.; Bennett, Katherine B.; Ai, Xun; Akhter, Shahab; Beyer, Eric C.

    2014-01-01

    Normal atrial conduction requires similar abundances and homogeneous/overlapping distributions of two connexins (Cx40 and Cx43). The remodeling of myocyte connections and altered electrical conduction associated with atrial fibrillation (AF) likely involves perturbations of these connexins. We conducted a comprehensive series of experiments to examine the abundances and distributions of Cx40 and Cx43 in the atria of AF patients. Atrial appendage tissues were obtained from patients with lone AF (paroxysmal or chronic) or normal controls. Connexins were localized by double label immunofluorescence confocal microscopy, and their overlap was quantified. Connexin proteins and mRNAs were quantified by immunoblotting and qRT-PCR. PCR amplified genomic DNA was sequenced to screen for connexin gene mutations or polymorphisms. Immunoblotting showed reductions of Cx40 protein (to 77% or 49% of control values in samples from patients with paroxysmal and chronic AF, respectively), but no significant changes of Cx43 protein levels in samples from AF patients. The extent of Cx43 immunostaining and its distribution relative to N-cadherin were preserved in the AF patient samples. Although there was variability of Cx40 staining among paroxysmal AF patients, all had some fields with substantial Cx40 heterogeneity and reduced overlap with Cx43. Cx40 immunostaining was severely reduced in all chronic AF patients. qRT-PCR showed no change in Cx43 mRNA levels, but reductions in total Cx40 mRNA (to <50%) and Cx40 transcripts A (to ~50%) and B (to <25%) as compared to controls. No Cx40 coding region mutations were identified. The frequency of promoter polymorphisms did not differ between AF patient samples and controls. Our data suggest that reduced Cx40 levels and heterogeneity of its distribution (relative to Cx43) are common in AF. Multiple mechanisms likely lead to reductions of functional Cx40 in atrial gap junctions and contribute to the pathogenesis of AF in different patients. PMID

  10. Atrial Fibrillation Ablation in Systolic Dysfunction: Clinical and Echocardiographic Outcomes

    Directory of Open Access Journals (Sweden)

    Tasso Julio Lobo

    2015-01-01

    Full Text Available Background: Heart failure and atrial fibrillation (AF often coexist in a deleterious cycle. Objective: To evaluate the clinical and echocardiographic outcomes of patients with ventricular systolic dysfunction and AF treated with radiofrequency (RF ablation. Methods: Patients with ventricular systolic dysfunction [ejection fraction (EF <50%] and AF refractory to drug therapy underwent stepwise RF ablation in the same session with pulmonary vein isolation, ablation of AF nests and of residual atrial tachycardia, named "background tachycardia". Clinical (NYHA functional class and echocardiographic (EF, left atrial diameter data were compared (McNemar test and t test before and after ablation. Results: 31 patients (6 women, 25 men, aged 37 to 77 years (mean, 59.8±10.6, underwent RF ablation. The etiology was mainly idiopathic (19 p, 61%. During a mean follow-up of 20.3±17 months, 24 patients (77% were in sinus rhythm, 11 (35% being on amiodarone. Eight patients (26% underwent more than one procedure (6 underwent 2 procedures, and 2 underwent 3 procedures. Significant NYHA functional class improvement was observed (pre-ablation: 2.23±0.56; postablation: 1.13±0.35; p<0.0001. The echocardiographic outcome also showed significant ventricular function improvement (EF pre: 44.68%±6.02%, post: 59%±13.2%, p=0.0005 and a significant left atrial diameter reduction (pre: 46.61±7.3 mm; post: 43.59±6.6 mm; p=0.026. No major complications occurred. Conclusion: Our findings suggest that AF ablation in patients with ventricular systolic dysfunction is a safe and highly effective procedure. Arrhythmia control has a great impact on ventricular function recovery and functional class improvement.

  11. Left Atrial Appendage Closure in Atrial Fibrillation: A World without Anticoagulation?

    Directory of Open Access Journals (Sweden)

    Tahmeed Contractor

    2011-01-01

    Full Text Available Atrial Fibrillation (AF is a common arrhythmia with an incidence that is as high as 10% in the elderly population. Given the large proportion of strokes caused by AF as well as the associated morbidity and mortality, reducing stroke burden is the most important part of AF management. While warfarin significantly reduces the risk of AF-related stroke, perceived bleeding risks and compliance limit its widespread use in the high-risk AF population. The left atrial appendage is believed to be the “culprit” for thrombogenesis in nonvalvular AF and is a new therapeutic target for stroke prevention. The purpose of this review is to explore the evolving field of percutaneous LAA occlusion. After briefly highlighting the risk of stroke with AF, problems with warfarin, and the role of the LAA in clot formation, this article discusses the feasibility and efficacy of various devices which have been developed for percutaneous LAA occlusion.

  12. Assessment of the dynamics of atrial signals and local atrial period series during atrial fibrillation: effects of isoproterenol administration

    Directory of Open Access Journals (Sweden)

    Mantica Massimo

    2004-10-01

    Full Text Available Abstract Background The autonomic nervous system (ANS plays an important role in the genesis and maintenance of atrial fibrillation (AF, but quantification of its electrophysiologic effects is extremely complex and difficult. Aim of the study was to evaluate the capability of linear and non-linear indexes to capture the fine changing dynamics of atrial signals and local atrial period (LAP series during adrenergic activation induced by isoproterenol (a sympathomimetic drug infusion. Methods Nine patients with paroxysmal or persistent AF (aged 60 ± 6 underwent electrophysiological study in which isoproterenol was administered to patients. Atrial electrograms were acquired during i sinus rhythm (SR; ii sinus rhythm during isoproterenol (SRISO administration; iii atrial fibrillation (AF and iv atrial fibrillation during isoproterenol (AFISO administration. The level of organization between two electrograms was assessed by the synchronization index (S, whereas the degree of recurrence of a pattern in a signal was defined by the regularity index (R. In addition, the level of predictability (LP and regularity of LAP series were computed. Results LAP series analysis shows a reduction of both LP and R index during isoproterenol infusion in SR and AF (RSR = 0.75 ± 0.07 RSRISO = 0.69 ± 0.10, p AF = 0.31 ± 0.08 RAFISO = 0.26 ± 0.09, p SR = 99.99 ± 0.001 LPSRISO = 99.97 ± 0.03, p AF = 69.46 ± 21.55 LPAFISO = 55 ± 24.75; p SR = 0.49 ± 0.08 RSRISO = 0.46 ± 0.09 p AF = 0.29 ± 0.09 RAFISO = 0.28 ± 0.08 n.s.. Conclusions The proposed parameters succeeded in discriminating the subtle changes due to isoproterenol infusion during both the rhythms especially when considering LAP series analysis. The reduced value of analyzed parameters after isoproterenol administration could reflect an important pro-arrhythmic influence of adrenergic activation on favoring maintenance of AF.

  13. Right versus left atrial pacing in patients with sick sinus syndrome and paroxysmal atrial fibrillation (Riverleft study): study protocol for randomized controlled trial

    OpenAIRE

    Ramdjan, Tanwier TTK; van der Does, Lisette JME; Knops, Paul; Res, Jan CJ; de Groot, Natasja MS

    2014-01-01

    Background The incidence of sick sinus syndrome will increase due to population ageing. Consequently, this will result in an increase in the number of pacemaker implantations. The atrial lead is usually implanted in the right atrial appendage, but this position may be ineffective for prevention of atrial fibrillation. It has been suggested that pacing distally in the coronary sinus might be more successful in preventing atrial fibrillation episodes. The aim of this trial is to study the effic...

  14. Safety of atrial fibrillation ablation with novel multi-electrode array catheters on uninterrupted anticoagulation-a single-center experience.

    LENUS (Irish Health Repository)

    Hayes, Christopher Ruslan

    2012-02-01

    INTRODUCTION: A recent single-center report indicated that the performance of atrial fibrillation ablation in patients on uninterrupted warfarin using a conventional deflectable tip electrode ablation catheter may be as safe as periprocedural discontinuation of warfarin and bridging with heparin. Novel multi-electrode array catheters for atrial fibrillation ablation are currently undergoing clinical evaluation. While offering the possibility of more rapid atrial fibrillation ablation, they are stiffer and necessitate the deployment of larger deflectable transseptal sheaths, and it remains to be determined if they increase the risk of cardiac perforation and vascular injury. Such potential risks would have implications for a strategy of uninterrupted periprocedural anticoagulation. METHOD AND RESULTS: We audited the safety outcomes of our atrial fibrillation ablation procedures using multi-electrode array ablation catheters in patients on uninterrupted warfarin (CHADS2 score>or=2) and in patients not on warfarin (uninterrupted aspirin). Two bleeding complications occurred in 49 patients on uninterrupted warfarin, both of which were managed successfully without longterm sequelae, and no bleeding complication occurred in 32 patients not on warfarin (uninterrupted aspirin). There were no thromboembolic events or other complication with either anticoagulant regimen. CONCLUSION: Despite the larger diameter and increased stiffness of multi-electrode array catheters and their deflectable transseptal sheaths, their use for catheter ablation in patients with atrial fibrillation on uninterrupted warfarin in this single-center experience does not appear to be unsafe, and thus, an adequately powered multicenter prospective randomized controlled trial should be considered.

  15. Lack of prevention of heart failure by serial electrical cardioversion in patients with persistent atrial fibrillation

    NARCIS (Netherlands)

    Tuinenburg, AE; Van Gelder, IC; Van Den Berg, MP; Brugemann, J; De Kam, PJ; Crijns, HJGM

    1999-01-01

    Objective-To investigate the occurrence of heart failure complications, and to identify variables that predict heart failure in patients with (recurrent) persistent atrial fibrillation, treated aggressively with serial electrical cardioversion and antiarrhythmic drugs to maintain sinus rhythm. Desig

  16. Oral Anticoagulants and Atrial Fibrillation: An Update for the Clinical Nurse.

    Science.gov (United States)

    Spivak, Inna E

    2015-01-01

    Anticoagulation is an important strategy for the prevention of stroke associated with atrial fibrillation. Development of new oral agents has created a need to educate nurses to administer these medications and provide patient education. PMID:26306367

  17. Expression of connexins 40 and 43 in human left atrium in atrial fibrillation of different aetiologies

    OpenAIRE

    Wetzel, U; Boldt, A; Lauschke, J; Weigl, J; Schirdewahn, P; Dorszewski, A; Doll, N; Hindricks, G; Dhein, S; Kottkamp, H

    2005-01-01

    Objective: To test the hypothesis that atrial fibrillation (AF) is associated with changes in the expression of connexins 40 and 43 in the left atrium with more pronounced changes in mitral valve disease than in lone AF.

  18. Alcohol consumption and risk of atrial fibrillation in men and women: the Copenhagen City Heart Study

    DEFF Research Database (Denmark)

    Mukamal, KJ; Tolstrup, JS; Friberg, J;

    2005-01-01

    hazard ratio of 1.45 (95% CI 1.02 to 2.04); few women consumed this amount of alcohol. Approximately 5% of cases of atrial fibrillation among men were attributable to heavy alcohol use. Further adjustment for blood pressure and incident coronary heart disease and congestive heart failure did not...... incident atrial fibrillation among 16,415 women and men enrolled in the Copenhagen City Heart Study. We ascertained use of beer, wine, and spirits individually at up to 3 study visits with a structured questionnaire. We identified cases of atrial fibrillation by routine study ECGs and a validated...... attenuate the association (hazard ratio 1.63; 95% CI 1.15 to 2.31). CONCLUSIONS: Heavy alcohol consumption is associated with a higher risk of atrial fibrillation, at least among men. This relationship does not appear to be related to the adverse effects of heavy drinking on coronary heart disease or blood...

  19. Improved late survival and disability after stroke with therapeutic anticoagulation for atrial fibrillation: a population study.

    LENUS (Irish Health Repository)

    Hannon, Niamh

    2011-09-01

    Although therapeutic anticoagulation improves early (within 1 month) outcomes after ischemic stroke in hospital-admitted patients with atrial fibrillation, no information exists on late outcomes in unselected population-based studies, including patients with all stroke (ischemic and hemorrhagic).

  20. Genetic Modifier of the QTc Interval Associated With Early-Onset Atrial Fibrillation

    DEFF Research Database (Denmark)

    Andreasen, Laura; Nielsen, Jonas B; Christophersen, Ingrid E;

    2013-01-01

    Both shortening and prolongation of the QTc interval have been associated with atrial fibrillation (AF). We investigated whether 8 single nucleotide polymorphisms (SNPs) at loci previously shown to affect QTc interval duration were associated with lone AF....

  1. Inflammatory single nucleotide polymorphisms and the risk of atrial fibrillation: a case control study

    DEFF Research Database (Denmark)

    Henningsen, Kristoffer M; Olesen, Morten S; Ravn, Lasse S; Dixen, Ulrik; Haunsoe, Stig; Bruunsgaard, Helle; Svendsen, Jesper H

    2011-01-01

    Systemic inflammation is associated with atrial fibrillation (AF) and inflammatory processes are involved in the pathophysiology of AF. We hypothesized that genetic polymorphisms, which determine the rate of inflammatory cytokines, are associated with increased risk of AF....

  2. Effects of cilazapril on endothelial cell function and fibrinolysis system in atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    HAN Wei; LI Wei-min; XIE Bao-dong; LI Yue; ZHAO Ji-yi; HUANG Yong-lin

    2005-01-01

    @@ Recently, it has been found that atrial fibrillation (AF) is associated with renin angiotensin aldosterone system (RAAS) activation and that angiotensin converting enzyme inhibition (ACEI) reduces incidence of AF in hypertensive patients.

  3. ANTITHROMBOTIC THERAPY AT AN ATRIAL FIBRILLATION: OLD PROBLEMS AND NEW SOLUTIONS

    OpenAIRE

    M. Yu. Gilyarov; V. A. Sulimov

    2016-01-01

    The problem of antiplatelet drug choice in patients with atrial fibrillation is discussed. Authors give special attention to new alternative drugs for prevention of thrombotic complications apart from old known antiplatelet drugs.

  4. Dental Procedures in Patients with Atrial Fibrillation and New Oral Anticoagulants

    OpenAIRE

    Tsolka, Pepie

    2014-01-01

    This review discusses the basic pharmacology of new oral anticoagulants that are used for prevention of thromboembolism in patients with atrial fibrillation. It presents available evidence, and provides recommendations for the management of patients requiring invasive procedures in dental practice.

  5. Effects of magnesium on atrial fibrillation after cardiac surgery: a meta-analysis

    OpenAIRE

    Miller, S.; Crystal, E; Garfinkle, M; Lau, C; Lashevsky, I; Connolly, S J

    2005-01-01

    Objectives: To assess the efficacy of the administration of magnesium as a method for the prevention of postoperative atrial fibrillation (AF) and to evaluate its influence on hospital length of stay (LOS) and mortality.

  6. Is treatment of atrial fibrillation in primary care based on thromboembolic risk assessment?

    NARCIS (Netherlands)

    Rutten, Frans H; Hak, Eelko; Stalman, Wim A B; Verheij, Theo J M; Hoes, Arno W

    2003-01-01

    BACKGROUND: Antithrombotic treatment in atrial fibrillation should be guided by the risk of thromboembolic events. Although practice studies have shown underutilization of antithrombotics, it is not clear whether physicians make use of thromboembolic risk stratification in their treatment decisions,

  7. Extraction of Desired Signal Based on AR Model with Its Application to Atrial Activity Estimation in Atrial Fibrillation

    Science.gov (United States)

    Wang, Gang; Rao, Ni-ni; Shepherd, Simon J.; Beggs, Clive B.

    2008-12-01

    The use of electrocardiograms (ECGs) to diagnose and analyse atrial fibrillation (AF) has received much attention recently. When studying AF, it is important to isolate the atrial activity (AA) component of the ECG plot. We present a new autoregressive (AR) model for semiblind source extraction of the AA signal. Previous researchers showed that one could extract a signal with the smallest normalized mean square prediction error (MSPE) as the first output from linear mixtures by minimizing the MSPE. However the extracted signal will be not always the desired one even if the AR model parameters of one source signal are known. We introduce a new cost function, which caters for the specific AR model parameters, to extract the desired source. Through theoretical analysis and simulation we demonstrate that this algorithm can extract any desired signal from mixtures provided that its AR parameters are first obtained. We use this approach to extract the AA signal from 12-lead surface ECG signals for hearts undergoing AF. In our methodology we roughly estimated the AR parameters from the fibrillatory wave segment in the V1 lead, and then used this algorithm to extract the AA signal. We validate our approach using real-world ECG data.

  8. Beverages of Daily Life: Impact of Caffeine on Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Dr. Anna Vittoria Mattioli

    2014-08-01

    Full Text Available In recent years, clinical and observational studies reported that caffeine consumption was associated with cardiac arrhythmias, affected heart rate variability, and subsequently increased cardiovascular risk. The analysis of these paper shows that data are controversial and strongly depends on methodology. Moderate intake of caffeine seems to have protective effects on arrhythmias, on contrary high intake of caffeine seems to be associated with increased risk of atrial fibrillation. There is a deep difference when we analysed intake of caffeine from coffee compared to other sources. In very recent time an increase in caffeinated beverages, namely energy drinks, has been reported in young people and several arrhythmic complications has been observed. A review of literature is presented

  9. A Simple Model for Identifying Critical Structures in Atrial Fibrillation

    CERN Document Server

    Christensen, Kim; Peters, Nicholas S

    2014-01-01

    Atrial fibrillation (AF) is the most common abnormal heart rhythm and the single biggest cause of stroke. Ablation, destroying regions of the atria, is applied largely empirically and can be curative but with a disappointing clinical success rate. We design a simple model of activation wavefront propagation on a structure mimicking the branching network architecture of heart muscle and show how AF emerges spontaneously as age-related parameters change. We identify regions responsible for the initiation and maintenance of AF, the ablation of which terminates AF. The simplicity of the model allows us to calculate analytically the risk of arrhythmia. This analytical result allows us to locate the transition in parameter space and highlights that the transition from regular to fibrillatory behaviour is a finite-size effect present in systems of any size. These clinically testable predictions might inform ablation therapies and arrhythmic risk assessment.

  10. Risk factors predictive of atrial fibrillation after lung cancer surgery.

    Science.gov (United States)

    Iwata, Takekazu; Nagato, Kaoru; Nakajima, Takahiro; Suzuki, Hidemi; Yoshida, Shigetoshi; Yoshino, Ichiro

    2016-08-01

    Postoperative atrial fibrillation (POAF), the most frequent arrhythmia after pulmonary resection, is a cause of both morbidity and mortality. Being able to predict the risk of POAF before surgery would help us evaluate the surgical risk and plan prophylaxis. We investigated the reported preoperative risk factors associated with the incidence of POAF and found that the recommended predictive factors were quite variable. Therefore, we evaluated the previously reported preoperative risk factors for POAF using our institutional data. We discuss our findings in this short review. Male gender, resected lung volume, brain natriuretic peptide (BNP), and left ventricular early transmitral velocity/mitral annular early diastolic velocity (E/e') calculated by echocardiography were suggested as independent predictors for POAF, but the predictive values of each individual parameter were not high. The lack of definitive predictors for POAF warrants further investigations by gathering the reported knowledge, to establish an effective preoperative examination strategy. PMID:26471506

  11. Current practice for diagnosis and management of silent atrial fibrillation

    DEFF Research Database (Denmark)

    Dobreanu, Dan; Svendsen, Jesper Hastrup; Lewalter, Thorsten;

    2013-01-01

    Although it is well known that silent atrial fibrillation (AF) is associated with morbidity and mortality rates similar to those of symptomatic AF, no specific strategy for screening and management of this form of AF has been advocated. The purpose of this survey was to identify current practices...... for the diagnosis and management of silent AF. This survey is based on an electronic questionnaire sent to the European Heart Rhythm Association Research Network partners. Responses were received from 33 centres in 16 countries. The preferred screening methods for silent AF in patients with rhythm...... approach for such patients. Most responders preferred rate control over rhythm control in patients with silent AF, although some favoured pulmonary vein isolation in young patients. However, oral anticoagulant therapy in patients at high thromboembolic risk was considered mandatory by most, provided that...

  12. Risk of atrial fibrillation associated with coffee intake

    DEFF Research Database (Denmark)

    Mostofsky, Elizabeth; Johansen, Martin Berg; Lundbye-Christensen, Søren; Tjønneland, Anne; Mittleman, Murray A; Overvad, Kim

    2016-01-01

    BACKGROUND: There have been discrepant findings on whether coffee consumption is associated with the rate of developing atrial fibrillation (AF). METHODS AND RESULTS: We used data on 57,053 participants (27,178 men and 29,875 women) aged 50-64 years in the Danish Diet, Cancer and Health study. All...... participants provided information on coffee intake via food-frequency questionnaires at baseline. Incident AF was identified using nationwide registries. During a median follow-up of 13.5 years, 3415 AF events occurred. Compared with no intake, coffee consumption was inversely associated with AF incidence......% CI 0.63-1.00) for >7 cups/day (p-linear trend = 0.02). CONCLUSIONS: In this large population-based cohort study, higher levels of coffee consumption were associated with a lower rate of incident AF....

  13. Hospitalisation patterns change over time in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Fristrup Qvist, Janne; Høgh Sørensen, Pernille; Dixen, Ulrik

    2014-01-01

    INTRODUCTION: Atrial fibrillation (AF) is a cardiac epidemic. In this study, we aimed to describe the causes of hospital-isation in an AF population over time and to study how different AF treatment strategies affected hospitalization. MATERIAL AND METHODS: This was an observational study in which...... hospitalisations were evaluated. RESULTS: The causes of hospitalisation shifted over time. We observed a lower proportion of admissions due to AF in OP2 (63%) than in OP1 (87%) and a higher proportion of admissions due to congestive heart failure (16% versus 3%) and of days of inpatient care due to ischaemic...... causes of hospitalisation in an AF population shifted from AF relapse to the most frequent complications of AF, ischaemic stroke and congestive heart failure. In this observational study, patients treated with rhythm control were more frequently hospitalised than patients treated with rate control...

  14. CT findings of cerebrovascular diseases in patients with atrial fibrillation

    International Nuclear Information System (INIS)

    CT findings of cerebrovascular diseases were studied in 111 patients with atrial fibrillation (Af). One of these patients had cerebral hemorrhage, and another, subarachnoid hemorrhage, while the others all had cerebral infarctions. CT revealed 122 lesions with a low-density area (LDA) in 105 patients. Based on the cerebral artery territory, the 122 CT lesions were classified into the following 8 types: 10 hemispheric, 43 superficial, 23 deep, 28 superficial+deep, 1 anterior cerebral artery, 6 posterior cerebral artery, 10 watershed, and 1 vertebrobasilar. Therefore, infarctions of the internal carotid artery (ICA) system, including 94 infarctions of the middle cerebral artery territory, were most frequent, accounting for 94% of all lesions. The ratio of the left to the right infarctions of the ICA system was 1.1:1. However, it should be noted that non-embolic infarctions can occur even patients with Af. (author)

  15. Stroke Prevention in Atrial Fibrillation: Latest Clinical Trials and Guidelines

    Directory of Open Access Journals (Sweden)

    Luciana Armaganijan

    2012-04-01

    Full Text Available Atrial Fibrillation (AF is the most common sustained arrhythmia and 1/6 strokes is attributed to AF. The cornerstone of treatment remains maintaining sinus rhythm or appropriate ventricular rate control in addition to prevention of stroke. Oral anticoagulation therapy (OAC with vitamin K antagonists (VKAs has been the gold standard for almost 50 years and a significant reduction in the risk of stroke in patients with AF has been demonstrated. Nonetheless, only 50% of patients with guideline recommendations for OAC treatment actually receive VKAs and half of these will discontinue therapy within 3 to 5 years with only another half achieving therapeutic ranges more than 50% of the time. The aforementioned limitations in addition with frequent blood monitoring have prompted the development of a series of new OAC therapies. The present review focuses on the current pharmacological management for stroke prevention in patients with AF based on current and emerging evidence.

  16. Apixaban versus edoxaban for stroke prevention in nonvalvular atrial fibrillation.

    Science.gov (United States)

    Xiong, Qinmei; Lau, Yee C; Lip, Gregory Y H

    2015-08-01

    Oral anticoagulation therapy is the mainstay of stroke prevention in nonvalvular atrial fibrillation patients. Vitamin K antagonists (such as warfarin) have been effective conventional oral anticoagulants for several decades. However, due to their limitations in clinical use, several nonvitamin K antagonist oral anticoagulants (NOACs, including dabigatran, rivaroxaban, apixaban and edoxaban) have been developed. Nonetheless, no head to head trials have been performed to directly compare these NOACs in patient cohorts. In this review article, two direct factor Xa inhibitors, apixaban and edoxaban, are briefly described with focus on their pharmacokinetic and pharmacodynamic profiles, plus drug interactions. Moreover, both efficacy and safety will be discussed based on the available data from the large Phase III clinical trials and indirect comparison studies. PMID:26274798

  17. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation

    DEFF Research Database (Denmark)

    Walfridsson, H; Walfridsson, U; Nielsen, J Cosedis;

    2015-01-01

    AIMS: The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) trial assessed the long-term efficacy of an initial strategy of radiofrequency ablation (RFA) vs. antiarrhythmic drug therapy (AAD) as first-line treatment for patients with PAF. In...... made on an intention-to-treat basis. Both randomization groups showed significant improvements in assessments with both SF-36 and EQ-5D, at 24 months. Patients randomized to RFA showed significantly greater improvement in four physically related scales of the SF-36. The three most frequently reported...... improvement of HRQoL and symptom burden in patients with PAF. Patients randomized to RFA showed greater improvement in physical scales (SF-36) and the EQ-visual analogue scale. CLINICAL TRIAL REGISTRATION: URL http://www.clinicaltrials.gov. Unique identifier: NCT00133211....

  18. Alternative therapies in the treatment of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Federico Lombardi, MD, FESC; Sebastiano Belletti, MD; Alberto Lomuscio, MD.

    2013-04-01

    Full Text Available Atrial fibrillation (AF is the most common clinical arrhythmia and represents a major social and economic problem. The number of subjects with AF is constantly increasing as a result of aging and improved survival in several cardiac and non-cardiac diseases. Patients with AF are often symptomatic, have a reduced physical capacity and are at high risk for thromboembolic events. Moreover, AF is associated with increased mortality and independently of the management based either on rhythm or rate control strategy, whereas the safety and efficacy of most anti-arrhythmic drugs are questionable. Increasing attention has therefore been addressed to evaluate the possible therapeutic and/or preventive effects of forms of treatment coming from ancient medical traditions of Far East, like acupuncture and yoga. In traditional Chinese medicine, acupuncture has been found effective in managing patients with paroxysmal supraventricular tachycardia. Recently, also in the Western literature, reports have been published supporting the clinical efficacy of acupuncture to treat arterial hypertension and to reduce chest pain. Other studies have evaluated the effects of acupuncture and other methods of Eastern Medicine, i.e., Qigong, Tai Chi Chuan and Yoga, in the treatment of cardiac illnesses associated with supraventricular arrhythmias. Two reports on the effects of acupuncture in preventing or reducing the rate of AF recurrences in patients with persistent or paroxysmal AF have been recently reported . Another ancient traditional eastern form of therapy and prevention, i.e., yoga, has been recently shown to reduce episodes of atrial fibrillation and improve the symptoms of anxiety and depression often associated with this arrhythmia. Growing evidence indicates that acupuncture and yoga are safe, without any pro-arrhythmic effect and with limited cost. All these factors should be considered when evalu­ating the efficacy of therapeutic intervention for an epi

  19. New classification scheme for atrial fibrillation symptom severity and burden.

    Science.gov (United States)

    Koci, Florian; Forbes, Peter; Mansour, Moussa C; Heist, E Kevin; Singh, Jagmeet P; Ellinor, Patrick T; Ruskin, Jeremy N

    2014-07-15

    Although atrial fibrillation (AF) symptom severity is used to guide clinical care, a simple, standardized assessment tool is not available for routine clinical use. We sought to develop and validate a patient-generated score and classification scheme for AF-related symptom severity and burden. Atrial Fibrillation Symptom and Burden, a simple 2-part questionnaire, was designed to assess (1) AF symptom severity using 8 questions to determine how symptoms affect daily life and (2) AF burden using 6 questions to measure AF frequency, duration, and health-care utilization. The resulting score was used to classify patients into 4 classes of symptom and burden severity. Patients were asked to complete the questionnaire, a survey evaluating the questionnaire, and an Short Form-12v2 generic health-related quality-of-life form. Validation of the questionnaire included assessments of its reliability and construct and known groups validity. The strength of interrater agreement between patient-generated and blinded provider-generated classifications of AF symptom severity was also assessed. The survey had good internal consistency (Cronbach α>0.82) and reproducibility (intraclass correlation coefficient=0.93). There was a good linear correlation with health-related quality-of-life aggregates measured by Pearson correlation coefficient (r=0.62 and 0.42 vs physical component summary and mental component summary, respectively). Compared with physical and mental component summary scores, the patient-generated symptom severity classification scheme showed robust discrimination between mild and moderate severity (pcorrelated with standardized quality-of-life measures. PMID:24878121

  20. Low prevalence of connexin-40 gene variants in atrial tissues and blood from atrial fibrillation subjects

    Directory of Open Access Journals (Sweden)

    Tchou Gregory D

    2012-11-01

    Full Text Available Abstract Background The atrial gap junction protein connexin-40 (Cx40 has been implicated to play an important role in atrial conduction and development of atrial fibrillation (AF. However, the frequency of Cx40 mutations in AF populations and their impact on Cx40 expression remains unclear. In this study, we sought to identify polymorphisms in the Cx40 gene GJA5, investigate the potential functional role of these polymorphisms, and determine their allelic frequencies. The prevalence of nonsynonymous Cx40 mutations in blood and atrial tissue was also compared to mutation frequencies reported in prior studies. Methods We conducted direct sequencing of the GJA5 coding and 3′ UTR regions in blood samples from 91 lone AF subjects and 67 atrial tissue-derived samples from a lone cohort, a mixed AF cohort, and several transplant donors. Reporter gene transfection and tissue allelic expression imbalance assays were used to assess the effects of a common insertion/deletion polymorphism on Cx40 mRNA stability and expression. Results We identified one novel synonymous SNP in blood-derived DNA from a lone AF subject. In atrial tissue-derived DNA from lone and mixed AF subjects, we observed one novel nonsynonymous SNP, one rare previously reported synonymous SNP, and one novel 3′ UTR SNP. A previously noted 25 bp insertion/deletion polymorphism in the 3′ UTR was found to be common (minor allele frequency = 0.45 but had no effect on Cx40 mRNA stability and expression. The observed prevalence of nonsynonymous Cx40 mutations in atrial tissues derived from lone AF subjects differed significantly (p = 0.03 from a prior atrial tissue study reporting a high mutation frequency in a group of highly selected young lone AF subjects. Conclusions Our results suggest that Cx40 coding SNPs are uncommon in AF populations, although rare mutations in this gene may certainly lead to AF pathogenesis. Furthermore, a common insertion/deletion polymorphism in the Cx40 3

  1. Surgical Radiofrequency MAZE III Ablation for Treatment of Atrial Fibrillation During Open Heart Surgery

    OpenAIRE

    Fariborz Akbarzadeh; Rezayat Parvizi

    2006-01-01

    Background: Atrial fibrillation is a common arrhythmia in patients with rheumatic mitral and other valve diseases who are candidates for valve repair surgeries. Conversion of rhythm to sinus has positive effects on quality of life and lower use of medications. The aim of this clinical study was to evaluate the effectiveness of the radiofrequency ablation Maze III procedure in the treatment of atrial fibrillation associated with rheumatic heart valve disease. Methods: We applied a modified Cox...

  2. Incidence and prognostic significance of atrial fibrillation in acute myocardial infarction: the GISSI-3 data

    OpenAIRE

    Pizzetti, F; Turazza, F; Franzosi, M.; Barlera, S; Ledda, A; Maggioni, A; Santoro, L; Tognoni, G

    2001-01-01

    BACKGROUND—Atrial fibrillation is the most common supraventricular arrhythmia in patients with acute myocardial infarction. Recent advances in pharmacological treatment of myocardial infarction may have changed the impact of this arrhythmia.
OBJECTIVE—To assess the incidence and prognosis of atrial fibrillation complicating myocardial infarction in a large population of patients receiving optimal treatment, including angiotensin converting enzyme (ACE) inhibitors.
METHODS—Data were derived fr...

  3. Dronedarone: evidence supporting its therapeutic use in the treatment of atrial fibrillation

    OpenAIRE

    Sullivan, Renee M; Brian Olshansky

    2010-01-01

    Renee M Sullivan, Brian OlshanskyDivision of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAIntroduction: Dronedarone, a benzofuran derivative with a structure similar to amiodarone, has been developed as a potential therapy for patients with atrial fibrillation.Aim: To review the published evidence regarding the efficacy and safety of dronedarone use in patients with atrial fibrillation.Evidence review: Available evidence suggests that dronedarone 400 ...

  4. Left ventricular beat to beat performance in atrial fibrillation: dependence on contractility, preload, and afterload

    OpenAIRE

    Muntinga, H; Gosselink, A; Blanksma, P; De Kam, P J; van der Wall, E; Crijns, H.

    1999-01-01

    OBJECTIVE—To assess independent determinants of beat to beat variation in left ventricular performance during atrial fibrillation.
DESIGN—Prospective study.
SETTING—University hospital.
PATIENTS—Seven patients with chronic non-valvar atrial fibrillation.
INTERVENTIONS—Invasive and non-invasive haemodynamic variables were assessed using a non-imaging computerised nuclear probe, a balloon tipped flow directed catheter, and a non-invasive fingertip blood pressure measurement system linked to a p...

  5. ATRIAL FIBRILLATION: CURRENT PROBLEMS AND PROSPECTS OF MEDICAL CARE, TREATMENT AND PREVENTION

    OpenAIRE

    Ju. P. Skirdenko; A. V. Shustov; V. V. Zherebilov; N. A. Nikolaev

    2016-01-01

    Modern approaches to antiarrhythmic anti-relapse therapy of atrial fibrillation are considered. Advantages and disadvantages of the main therapeutic strategies are discussed from the standpoint of evidence-based medicine. The value of strategies of rhythm control, heart rate control and «upstream therapy» in the management of patients with atrial fibrillation is specified. Results of clinical studies on the efficacy and safety of anti-arrhythmic drugs, the search for such new drugs are presen...

  6. The Unexpected Pitter Patter: New-Onset Atrial Fibrillation in Pregnancy

    OpenAIRE

    Sarah White; Janna Welch; Brown, Lawrence H

    2015-01-01

    Background. Atrial fibrillation is a relatively uncommon but dangerous complication of pregnancy. Emergency physicians must know how to treat both stable and unstable tachycardias in late pregnancy. In this case, a 40-year-old female with a cerclage due to incompetent cervix and previous preterm deliveries presents in new-onset atrial fibrillation. Case Report. A previously healthy 40-year-old African American G2 P1 female with a 23-week twin gestation complicated by an incompetent cervix r...

  7. Lumbar Discectomy of a Patient of Mitral Stenosis with Chronic Atrial Fibrillation Under Epidural Anaesthesia

    Directory of Open Access Journals (Sweden)

    Vinaya R Kulkarni

    2008-01-01

    Full Text Available A 60-year-old female patient posted for discectomy of lumbar region L 3 -L 4 was accidently diagnosed to have chronic atrial fibrillation of rheumatic aetiology.This is a case report of this patient of critical mitral stenosis with mild mitral regurgitation with chronic atrial fibrillation managed successfully under lower thoracic epidural anaesthesia,in prone position without any compli-cation.

  8. SECONDARY PREVENTION OF STROKE IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION: THE CLINICIANS’ VIEWPOINT

    Directory of Open Access Journals (Sweden)

    E. A. Drozdova

    2015-09-01

    Full Text Available Atrial fibrillation is one of the main risk factor of ischemic stroke. Current problems of the management of patients with stroke due to non-valvular atrial fibrillation and secondary stroke prevention in these patients are considered. Data of own author’s observation for patients of this type during 6 months after discharge from the hospital are presented. The problems which patients faced with are analyzed. Comparative assessment of warfarin and dabigatran therapies is given.

  9. Risk assessment in contemporary outpatients with non-valvular atrial fibrillation recently on vitamin K antagonists

    OpenAIRE

    Abumuaileq, Rami Riziq Yousef

    2016-01-01

    Atrial Fibrillation increases the risk of embolic stroke by five fold. Vitamin K antagonists (VKAs) are still the most used oral anticoagulants in patients with nonvalvular atrial fibrillation (NVAF) and are highly effective for the prevention of thromboembolic (TE) complications in these patients. However, achieving the best benefit and safety from VKAs in the clinical practice remains a major challenge mainly because of their unpredictable anticoagulant response. In this thes...

  10. The diagnostic accuracy of the MyDiagnostick to detect atrial fibrillation in primary care

    OpenAIRE

    Vaes, Bert; Stalpaert, Silke; Tavernier, Karen; Thaels, Britt; Lapeire, Daphne; Mullens, Wilfried; Degryse, Jean-Marie

    2014-01-01

    Background: Atrial fibrillation is very common in people aged 65 or older. This condition increases the risk of death, congestive heart failure and thromboembolic conditions. Many patients with atrial fibrillation are asymptomatic and a cerebrovascular accident (CVA) is often the first clinical presentation. Guidelines concerning the prevention of CVA recommend monitoring the heart rate in patients aged 65 or older. Recently, the MyDiagnostick (Applied Biomedical Systems BV, Maastricht, The N...

  11. Effect of lipid lowering on new-onset atrial fibrillation in patients with asymptomatic aortic stenosis

    DEFF Research Database (Denmark)

    Bang, Casper N; Greve, Anders; Boman, Kurt;

    2012-01-01

    Lipid-lowering drugs, particularly statins, have anti-inflammatory and antioxidant properties that may prevent atrial fibrillation (AF). This effect has not been investigated on new-onset AF in asymptomatic patients with aortic stenosis (AS).......Lipid-lowering drugs, particularly statins, have anti-inflammatory and antioxidant properties that may prevent atrial fibrillation (AF). This effect has not been investigated on new-onset AF in asymptomatic patients with aortic stenosis (AS)....

  12. Prevention of atrial fibrillation by Renin-Angiotensin system inhibition a meta-analysis

    DEFF Research Database (Denmark)

    Schneider, Markus; Hua, Tsushung A; Böhm, Michael;

    2010-01-01

    The authors reviewed published clinical trial data on the effects of renin-angiotensin system (RAS) inhibition for the prevention of atrial fibrillation (AF), aiming to define when RAS inhibition is most effective.......The authors reviewed published clinical trial data on the effects of renin-angiotensin system (RAS) inhibition for the prevention of atrial fibrillation (AF), aiming to define when RAS inhibition is most effective....

  13. Reducing Ionizing Radiation Associated with Atrial Fibrillation Ablation: An Ultrasound-Guided Approach

    Directory of Open Access Journals (Sweden)

    Nisha L. Bhatia, MD

    2010-12-01

    Full Text Available Radiation exposure with cardiac interventional procedures is an emerging concern. Patients receiving radiofrequency ablation for atrial fibrillation (AF still routinely undergo pre-ablation computed tomography (CT scans for definition of left atrial and pulmonary vein anatomy, as well as creation of a surrogate geometry. In an effort to decrease ionizing radiation associated with AF ablation, an ultrasound-guided surrogate geometry approach is proposed as an alternative to routine CT imaging. Ten patients underwent AF ablation using intracardiac ultrasound for the creation of a surrogate left atrial geometry (CartoSound, Biosense Webster, CA; and ten control-cases who had conventional CT-guided imaging (CartoMerge, Biosense Webster, CA were matched for age, gender, and type of catheter ablation. Sources of radiation included 1 intraprocedural fluoroscopy (CartoSound: 151 ± 43 mGray*cm^2, CartoMerge: 174 ± 130 mGray*cm^2; p=0.6 and 2 CT ionizing radiation (CartoSound: 0 mSv, CartoMerge 9.4 ± 2.3 mSv/CT scan. When comparing clinical success rates after a trial of previously ineffective anti-arrhythmic drugs, ultrasound-guided AF ablation was non-inferior to a CT-guided approach. This potentially obviates the need for CT-guided imaging, therefore reducing doses of ionizing radiation by nearly 10 mSv per AF catheter ablation.

  14. Effect of atrial preference pacing on reducing long-term burden of atrial fibrillation:a clinical study

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical effect of atrial preference pacing (APP) on the prevention of paroxysmal atrial fibrillation. Methods: Based on the type of implanted pacemaker, 46 patients with sick sinus syndrome and paroxysmal atrial fibrillation were divided into two groups. Dual-chamber pacemaker equipped with APP function was implanted in patients of group APP (n=21), while conventional dual-chamber pacemaker was implanted in patients of control group (n=25). The patients were followed up for six months, the maximum P wave duration (Pmax), the P wave dispersion (Pd), the structure of heart chambers, the data of automatic mode switch (AMS) and the total burden of atrial fibrillation were estimated,and the results were statistically analyzed and compared between two groups. Results: The basic clinical characteristics of two groups were comparable. After six months pacing, the difference in Pmax between two groups was of no significance (115.0 ± 10.1 ms vs 122.0 ± 11.0 ms, P > 0.05), while the increase of Pd in control group was more obvious than that in group APP (32.7 ± 4.2 ms vs 20.1 ± 5.3 ms, P 0.05), and also no remarkable difference in the left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF) could be found (P > 0.05). Moreover, no significant difference existed between two groups (P > 0.05). After six months pacing,in group APP the frequencies of AMS decreased more sharply (145 ± 37 times vs 327 ± 13 times, P < 0.05), the duration of AMS shortened more apparently (73 ± 15 hours vs 139 ± 28 hours, P < 0.05) and the total burden of atrial fibrillation was alleviated more obviously (13 ± 5% vs 28 ± 6%, P < 0.05) when compared to those in control group. Conclusion: Atrial preference pacing can coordinate the anisotropy of double atrial depolarization, reduce the frequencies of long-term paroxysmal atrial fibrillation, shorten the duration of atrial fibrillation

  15. Hyperuricemia and Risk for Atrial Fibrillation Yuansheng Liu

    Directory of Open Access Journals (Sweden)

    Dr. Yuansheng Liu

    2014-02-01

    Full Text Available Atrial fibrillation (AF is a clinically common arrhythmia and preferentially afflicts elderly persons[1]. The main risk factors for AF are complicated and multifactorial. Several clinical risk factors for the development of AF have been confirmed, including old age, male gender, rheumatic heart disease, hypertension, congestive heart failure, hyperthyroidism, chronic kidney disease and diabetes mellitus. Although the pathophysiology of AF remains incompletely understood, accumulative evidences indicated that oxidative stress and inflammation were involved in the process of atrial remodeling which predisposed patients to AF [2,3]. In addition, a consistent relationship between elevated serum uric acid (SUA levels and circulating inflammatory markers has been reported.The association between SUA levels and AF is currently poorly known. In our previous study, the results also showed that low serum albumin and hyperuricemia were independently correlated with the presence of AF compared with the non-AF group[4]. Previous studies support the hypothesis that hyperuricemia causes vascular disease via endothelial dysfunction. It is clear that further studies are needed to determine whether the SUA level increases the risk of AF directly or indirectly[4,5].

  16. Obesity, diabetes and atrial fibrillation; epidemiology, mechanisms and interventions.

    Science.gov (United States)

    Asghar, O; Alam, U; Hayat, S A; Aghamohammadzadeh, R; Heagerty, A M; Malik, R A

    2012-11-01

    The last few decades have witnessed a global rise in adult obesity of epidemic proportions. The potential impact of this is emphasized when one considers that body mass index (BMI) is a powerful predictor of death, type 2 diabetes (T2DM) and cardiovascular (CV) morbidity and mortality [1, 2]. Similarly we have witnessed a parallel rise in the incidence of atrial fibrillation (AF), the commonest sustained cardiac arrhythmia, which is also a significant cause of cardiovascular morbidity and mortality. Part of this increase is attributable to advances in the treatment of coronary heart disease (CHD) and heart failure (HF) improving life expectancy and consequently the prevalence of AF. However, epidemiological studies have demonstrated an independent association between obesity and AF, possibly reflecting common pathophysiology and risk factors for both conditions. Indeed, weight gain and obesity are associated with structural and functional changes of the cardiovascular system including left atrial and ventricular remodeling, haemodynamic alterations, autonomic dysfunction, and diastolic dysfunction. Moreover, diabetic cardiomyopathy is characterized by an adverse structural and functional cardiac phenotype which may predispose to the development of AF [3]. In this review, we discuss the pathophysiological and mechanistic relationships between obesity, diabetes and AF, and the challenges posed in the management of this high-risk group of individuals. PMID:22920475

  17. Extraatrial Disease in Patients with �Lone� Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Jason Confino, MD

    2008-12-01

    Full Text Available Aims: Lone atrial fibrillation (LAF is considered by some to be a primary atrial electrophysiologic disorder. However, we have frequently observed evidence of “extraatrial” diseases - atherosclerosis and associated metabolic disorders - in our LAF patients. We sought to characterize and quantify extraatrial disease burden in LAF patients, and to correlate this burden with features of the arrhythmia including pattern (paroxysmal versus persistent and response to catheter ablation. Methods and Results: Forty-six consecutive patients with non-familial LAF underwent assessment for evidence of atherosclerosis (computed tomographic vascular calcification and elevated arterial pulse wave velocity and associated metabolic diseases (dyslipidemia, insulin resistance and inflammation, and then catheter ablation. The cohort had a significant incidence of atherosclerosis (57% and metabolic (70% diseases. Patients with persistent AF tended to have a greater extraatrial disease burden than those with paroxysmal AF. A significant inverse relationship between the rate of ablation success and extraatrial disease burden was demonstrated. Conclusions: Extraatrial disease was common in this LAF cohort. Correlations between extraatrial disease burden and features of the arrhythmia would, if verified, challenge the notion that LAF is a “primary” electrophysiologic disorder.

  18. Extraatrial Disease in Patients with "Lone" Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Christopher R. Deible

    2008-12-01

    Full Text Available Aims: Lone atrial fibrillation (LAF is considered by some to be a primary atrial electrophysiologic disorder. However, we have frequently observed evidence of "extraatrial" diseases - atherosclerosis and associated metabolic disorders - in our LAF patients. We sought to characterize and quantify extraatrial disease burden in LAF patients, and to correlate this burden with features of the arrhythmia including pattern (paroxysmal versus persistent and response to catheter ablation.           Methods and Results: Forty-six consecutive patients with non-familial LAF underwent assessment for evidence of atherosclerosis (computed tomographic vascular calcification and elevated arterial pulse wave velocity and associated metabolic diseases (dyslipidemia, insulin resistance and inflammation, and then catheter ablation.   The cohort had a significant incidence of atherosclerosis (57% and metabolic (70% diseases. Patients with persistent AF tended to have a greater extraatrial disease burden than those with paroxysmal AF. A significant inverse relationship between the rate of ablation success and extraatrial disease burden was demonstrated. Conclusions: Extraatrial disease was common in this LAF cohort. Correlations between extraatrial disease burden and features of the arrhythmia would, if verified, challenge the notion that LAF is a "primary" electrophysiologic disorder.     

  19. Management of Atrial Fibrillation in Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Mattia Arrigo

    2014-01-01

    Full Text Available Atrial fibrillation (AF is common in ICU patients and is associated with a two- to fivefold increase in mortality. This paper provides a reappraisal of the management of AF with a special focus on critically ill patients with haemodynamic instability. AF can cause hypotension and heart failure with subsequent organ dysfunction. The underlying mechanisms are the loss of atrial contraction and the high ventricular rate. In unstable patients, sinus rhythm must be rapidly restored by synchronised electrical cardioversion (ECV. If pharmacological treatment is indicated, clinicians can choose between the rate control and the rhythm control strategy. The optimal substance should be selected depending on its potential adverse effects. A beta-1 antagonist with a very short half-life (e.g., esmolol is an advantage for ICU patients because the effect of beta-blockade on cardiovascular stability is unpredictable in those patients. Amiodarone is commonly used in the ICU setting but has potentially severe cardiac and noncardiac side effects. Digoxin controls the ventricular response at rest, but its benefit decreases in the presence of adrenergic stress. Vernakalant converts new-onset AF to sinus rhythm in approximately 50% of patients, but data on its efficacy and safety in critically ill patients are lacking.

  20. Current controversies in determining the main mechanisms of atrial fibrillation.

    Science.gov (United States)

    Schotten, U; Dobrev, D; Platonov, P G; Kottkamp, H; Hindricks, G

    2016-05-01

    Despite considerable basic research into the mechanisms of atrial fibrillation (AF), not much progress has been made in the prognosis of patients with AF. With the exception of anticoagulant therapy, current treatments for AF still do not improve major cardiovascular outcomes. This may be due partly to the diverse aetiology of AF with increasingly more factors found to contribute to the arrhythmia. In addition, a strong increase has been seen in the technological complexity of the methods used to quantify the main pathophysiological alterations underlying the initiation and progression of AF. Because of the lack of standardization of the technological approaches currently used, the perception of basic mechanisms of AF varies widely in the scientific community. Areas of debate include the role of Ca(2+) -handling alterations associated with AF, the contribution and noninvasive assessment of the degree of atrial fibrosis, and the best techniques to identify electrophysiological drivers of AF. In this review, we will summarize the state of the art of these controversial topics and describe the diverse approaches to investigating and the scientific opinions on leading AF mechanisms. Finally, we will highlight the need for transparency in scientific reporting and standardization of terminology, assumptions, algorithms and experimental conditions used for the development of better AF therapies. PMID:26991914

  1. New technologies in treatment of atrial fibrillation in cardiosurgical patients

    Science.gov (United States)

    Evtushenko, A. V.; Evtushenko, V. V.; Bykov, A. N.; Sergeev, V. S.; Syryamkin, V. I.; Kistenev, Yu. V.; Anfinogenova, Ya. D.; Smyshlyaev, K. A.; Kurlov, I. O.

    2015-11-01

    The article is devoted to the evaluation of the results of clinical application of penetrating radiofrequency ablation techniques on atrial myocardium. Total operated on 241 patients with valvular heart disease and coronary heart disease complicated with atrial fibrillation. All operations were performed under cardiopulmonary bypass and cardioplegia. The main group consists of 141 patients which were operated using penetrating technique radiofrequency exposure. The control group consisted of 100 patients who underwent surgery with the use of "classical" monopolar RF-ablation technique. Both groups were not significantly different on all counts before surgery. Patients with previous heart surgery were excluded during the selection of candidates for the procedure, due to the presence of adhesions in the pericardium, that do not allow good visualization of left atrium, sufficient to perform this procedure. Penetrating technique has significantly higher efficiency compared to the "classic" technique in the early and long-term postoperative periods. In the early postoperative period, its efficiency is 93%, and in the long term is 88%. The efficacy of "classical" monopolar procedure is below: 86% and 68% respectively.

  2. Ionic Remodeling and Direct Effects of Valsartan on Ionic Currentsin Human Atrial Myocytes with Atrial Fibrillation

    Institute of Scientific and Technical Information of China (English)

    Xue Yumei; Wu Shulin; Deng Chunyu; Qian Weimin; Chen Chunbo

    2004-01-01

    Objectives Previous studies demonstrated that angiotensin receptor antagonists had effects on some potassium channels in guinea pig myocytes and cloned channels that expressed in human cardiac myocytes. This study determined the direct effects of Valsartan on I caL, INa, IKur, IK1 and Ito1 in isolated human atrial myocytes. Methods and Results Specimens of right atrial appendage tissue were obtained from 39 patients with coronary artery and valvular heart diseases during cardiopulmonary bypass procedure. Pre- operation cardiac rhythm was sinus (SR)in 19 patients and was atrial fibrillation (AF) in the others. Single atrial myocyte was isolated by enzymatic dissociation with the chunk method. The ionic currents were recorded using the whole cell coffiguration of the voltage clamp technique. ICaL and Ito1 densities in AF patients were significantly lower than those in SR patients by 74% and 60%, respectively, while IK1density was significantly higher by 34% at command potential of - 120 mV. With 10 μmol/L Valsartan, INa density was significantly decreased by 59% in SR patients and by 66% in AF patients. IKur and IKl density were significantly decreased in only AF patients by 31% and23%, respectively. Conclusions Conclusions Decreased IcaL and Itol and increased IKl at hyperpolarizing potentials in AF patients' atrial myocytes may result from the electrophysiological remodeling by AF. Valsartan significantly decreases INa, IK1 and IKur current densities in AF patients' myocyte, but decreases only INa in SR patients' myocyte, suggesting that Valsartan may be beneficial to the recovering of remolded atria.

  3. Assessment of non-invasive time and frequency atrial fibrillation organization markers with unipolar atrial electrograms

    International Nuclear Information System (INIS)

    The standard electrocardiogram (ECG) is the most common non-invasive way to study atrial fibrillation (AF). In this respect, previous works have shown that the surface lead V1 reflects mainly the dominant atrial frequency (DAF) of the right atrium (RA), which has been widely used to study AF. In a similar way, AF organization and fibrillatory (f) wave amplitude are two recently proposed non-invasive AF markers. These markers need to be validated with invasive recordings in order to assess their capability to reliably reflect the internal fibrillatory activity dynamics. In this work, these two non-invasive metrics have been compared with similar measures recorded from two unipolar atrial electrograms (AEGs). For both ECG and AEG signals, AF organization has been computed by applying a nonlinear regularity index, such as sample entropy (SampEn), to the atrial activity (AA) and to its fundamental waveform, defined as the main atrial wave (MAW). The surface and epicardial f wave amplitude has been estimated through their mean power. Results obtained for 38 patients showed statistically significant correlations between the values measured from surface and invasive recordings, thus corroborating the usefulness of the aforesaid markers in the non-invasive study of AF. Precisely, for AF organization computed from the MAW, the correlation coefficients between surface and both AEGs were R = 0.926 (p < 0.001) and R = 0.932 (p < 0.001). For f wave amplitude, slightly lower significant relationships were noticed, the correlation coefficients being R = 0.765 (p < 0.001) and R = 0.842 (p < 0.001). These outcomes together with interesting linear relationships found among the parameters suggest that AF regularity estimated via SampEn and f wave amplitude can non-invasively characterize the epicardial activity related to AF

  4. Surgical Radiofrequency MAZE III Ablation for Treatment of Atrial Fibrillation During Open Heart Surgery

    Directory of Open Access Journals (Sweden)

    Fariborz Akbarzadeh

    2006-05-01

    Full Text Available Background: Atrial fibrillation is a common arrhythmia in patients with rheumatic mitral and other valve diseases who are candidates for valve repair surgeries. Conversion of rhythm to sinus has positive effects on quality of life and lower use of medications. The aim of this clinical study was to evaluate the effectiveness of the radiofrequency ablation Maze III procedure in the treatment of atrial fibrillation associated with rheumatic heart valve disease. Methods: We applied a modified Cox III Maze procedure using radiofrequency ablation in the treatment of atrial fibrillation associated with rheumatic heart valve disease and evaluated the outcome of 20 patients of atrial fibrillation associated rheumatic valve disease who underwent radiofrequency ablation Maze III procedure plus heart valve surgery. Demographic, echocardiographic, Electrocardiographic and Doppler study data were calculated before surgery, six month and one year after surgery.. Results: No perioperative deaths occurred in the study group. Duration of additional time for doing radiofrequency ablation was about 22 minutes. Freedom from atrial fibrillation was 85% and 75% at six months and one year follow-up respectively... Conclusions: The addition of the radiofrequency ablation Maze procedure to heart valve surgery is safe and effective in the treatment of atrial fibrillation associated with rheumatic heart valve disease.

  5. CMR findings in patients with hypertrophic cardiomyopathy and atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Dinter Dietmar

    2009-09-01

    Full Text Available Abstract Objectives We sought to evaluate the relation between atrial fibrillation (AF and the extent of myocardial scarring together with left ventricular (LV and atrial parameters assessed by late gadolinium-enhancement (LGE cardiovascular magnetic resonance (CMR in patients with hypertrophic cardiomyopathy (HCM. Background AF is the most common arrhythmia in HCM. Myocardial scarring is also identified frequently in HCM. However, the impact of myocardial scarring assessed by LGE CMR on the presence of AF has not been evaluated yet. Methods 87 HCM patients underwent LGE CMR, echocardiography and regular ECG recordings. LV function, volumes, myocardial thickness, left atrial (LA volume and the extent of LGE, were assessed using CMR and correlated to AF. Additionally, the presence of diastolic dysfunction and mitral regurgitation were obtained by echocardiography and also correlated to AF. Results Episodes of AF were documented in 37 patients (42%. Indexed LV volumes and mass were comparable between HCM patients with and without AF. However, indexed LA volume was significantly higher in HCM patients with AF than in HCM patients without AF (68 ± 24 ml·m-2 versus 46 ± 18 ml·m-2, p = 0.0002, respectively. The mean extent of LGE was higher in HCM patients with AF than those without AF (12.4 ± 14.5% versus 6.0 ± 8.6%, p = 0.02. When adjusting for age, gender and LV mass, LGE and indexed LA volume significantly correlated to AF (r = 0.34, p = 0.02 and r = 0.42, p Conclusion HCM patients with AF display significantly more LGE than HCM patients without AF. However, the extent of LGE is inferior to the LA size for predicting AF prevalence. LA dilation is the strongest determinant of AF in HCM patients, and is related to the extent of LGE in the LV, irrespective of LV mass.

  6. Phase synchrony reveals organization in human atrial fibrillation.

    Science.gov (United States)

    Vidmar, David; Narayan, Sanjiv M; Rappel, Wouter-Jan

    2015-12-15

    It remains unclear if human atrial fibrillation (AF) is spatially nonhierarchical or exhibits a hierarchy of organization sustained by sources. We utilize activation times obtained at discrete locations during AF to compute the phase synchrony between tissue regions, to examine underlying spatial dynamics throughout both atria. We construct a binary synchronization network and show that this network can accurately define regions of coherence in coarse-grained in silico data. Specifically, domains controlled by spiral waves exhibit regions of high phase synchrony. We then apply this analysis to clinical data from patients experiencing cardiac arrhythmias using multielectrode catheters to simultaneously record from a majority of both atria. We show that pharmaceutical intervention with ibutilide organizes activation by increasing the size of the synchronized domain in AF and quantify the increase in temporal organization when arrhythmia changes from fibrillation to tachycardia. Finally, in recordings from 24 patients in AF we show that the level of synchrony is spatially broad with some patients showing large spatially contiguous regions of synchronization, while in others synchrony is localized to small pockets. Using computer simulations, we show that this distribution is inconsistent with distributions obtained from simulations that mimic multiwavelet reentry but is consistent with mechanisms in which one or more spatially conserved spiral waves is surrounded by tissue in which activation is disorganized. PMID:26475585

  7. Transesophageal cardioversion of atrial flutter and atrial fibrillation using an electric balloon electrode system

    Institute of Scientific and Technical Information of China (English)

    郑方胜; 祁学文; 刘海峰; 康宁宁

    2003-01-01

    Objective To determine the feasibility and efficiency of terminating atrial flutter (AFL) and atrial fibrillation (AF) using synchronous low-energy shocks delivered through a novel transesophageal electric balloon electrode system.Methods By using a novel electric balloon electrode system, we attempted 91 transesophageal cardioversions in 52 patients, to treat 53 episodes of AFL and 38 episodes of AF.Results Of the 40 patients of AFL that failed to respond to drug therapy, 37 (92.5%) were successfully countershocked to sinus rhythm by transesophageal cardioversion, with a mean energy of (22.70±4.50) J (20-30 J). Of the 19 patients in AF, transesophageal cardioversion was successful in 16 (84.2%) cases, requiring a mean delivered energy of (17.38±8.58) J (3-30 J). There were no complications such as heart block or ventricular fibrillation, and no evidence of esophageal injury. Conclusions Transesophageal cardioversion using an electric balloon electrode system is an effective and feasible method for the treatment of AFL and AF. It requires low energy and no anesthesia, leads to less trauma, and shows a high cardioversion success rate that may prove valuable in the management of tachyarrhythmias.

  8. Risk analysis on postoperative recurrence of atrial fibrillation after bipolar radiofrequency ablation undergoing open heart procedures%心内直视房颤射频消融术前危险因素与术后转律关系

    Institute of Scientific and Technical Information of China (English)

    韦俊; 张大发; 刘志勇; 陆启同; 刘德森

    2012-01-01

    Objective Surgical radiofrequency (RF) ablation has recently been one of the most effective means to treat chronic atrial fibrillation(AF).However,about 20% to 30% patients have shown recurrence of AF during the follow-up period.This study retrospectively analyzed AF recurrence rate in those patients who underwent valve replacement procedures combined with RF ablation to treat AF in our department during the last three years.We compared the information and clinical date in the sinus rhythm(SR) group with in the AF recurrence group to analyze the relationship between various preoperative risk factors and operation failure.The aim of this study is to provide evidences to select patients who can benefit most from this type of surgery and to reduce their surgical risk and hospital charges.Methods From June 2006 to June 2009,52 patients with rheumatic heart disease (RHD) and chronic AF underwent RF ablation concomitant with valve replacement in our department by a same surgeon with the same method.Preoperative and intraoperative data was retrospectively collected and all patients were followed up longer than six months to determine the type of heart rhythm.Operation failure was defined as showing any rhythm except normal sinus rhythm by electrocardiogram.We divided all patients to the SR grope and AF grope.Univariate and multivariate statistical analysis was used to compare the data between the two groups in pre-,intra- and postoperative period.Results There was only one case in-hospital mortality ( 1.9% ).None mortality,re-exploration for bleeding and pacemaker implantation for malignant arrhythmia was shown during the mean follow-up period of 14 months (9-35 months).At the last follow-up,sinus rhythm was shown in 71.2% (37/52) patients.In univariaye analysis,the left atrial diameter,AF duration,left ventricular end diastolic volume and aortic cross-clamp were predictors of recurrence of AF.Age,left ventricular ejection factor,cardiopulmonary bypass time showed

  9. Dual-chamber implantable cardioverter-defibrillator. Is it useful in patient with permanent atrial fibrillation?

    Science.gov (United States)

    Porres-Aracama, José M; Cerezuela, José Luis; García-Urra, Francisco; Luque-Lezcano, Oscar; Herrero, Vicente

    2016-08-01

    In patients with permanent atrial fibrillation (AF) and implantable cardioverter-defibrillator (ICD) implant indication, a single-chamber device is the choice because AF does not provide interesting information for the treatment. It is very unusual to find patients with permanent AF that coexist with atrial tachycardia with various degree of Atrioventricular block. PMID:27525075

  10. Detection of occult atrial fibrillation in patients with embolic stroke of uncertain source: a work in progress

    OpenAIRE

    Andrade, Jason G; Field, Thalia; Khairy, Paul

    2015-01-01

    Atrial fibrillation accounts for a substantial proportion of ischemic strokes of known etiology and may be responsible for an additional subset of the 25–40% of strokes of unknown cause (so-called cryptogenic). Oral anticoagulation is significantly more effective than antiplatelet therapy in the secondary prevention of atrial fibrillation-related strokes, providing justification for developing more sensitive approaches to detecting occult paroxysms of atrial fibrillation. In this article, we ...

  11. A biophysical model of atrial fibrillation and electrograms: formulation, validation and applications

    OpenAIRE

    Jacquemet, Vincent

    2004-01-01

    Atrial arrhythmias are the most frequent rhythm disorders in humans and often lead to severe complications such as heart failure and stroke. While different mapping techniques have provided significant information on the electrophysiological processes associated with atrial fibrillation (AF), the mechanisms underlying AF initiation and maintenance remain unclear. Hence the treatment of atrial arrhythmias is still based on empirical considerations. To assist the study of the complex spatio-tem...

  12. Pre-Procedural Imaging to Direct Catheter Ablation of Atrial Fibrillation: Anatomy and Ablation Strategy.

    OpenAIRE

    Moussa Mansour; Ruskin, Jeremy N; Suhny Abbara; Godtfred Holmvang; E. Kevin Heist

    2008-01-01

    Successful catheter ablation of atrial fibrillation (AF) requires a detailed understanding of left atrial anatomy in order to maximize the safety and efficacy of the procedure. Common and rare variants of left atrial and pulmonary venous anatomy have been described which can affect the optimal ablation strategy for each individual patient. These variants include the presence of a right or left middle pulmonary vein, a left or right common pulmonary vein, a common inferior pulmonary vein, a ri...

  13. Pre-Procedural Imaging to Direct Catheter Ablation of Atrial Fibrillation: Anatomy and Ablation Strategy

    OpenAIRE

    E. Kevin Heist MD PhD; Godtfred Holmvang MD; Suhny Abbara MD; Jeremy N. Ruskin MD; Moussa Mansour MD

    2008-01-01

    Successful catheter ablation of atrial fibrillation (AF) requires a detailed understanding of left atrial anatomy in order to maximize the safety and efficacy of the procedure. Common and rare variants of left atrial and pulmonary venous anatomy have been described which can affect the optimal ablation strategy for each individual patient. These variants include the presence of a right or left middle pulmonary vein, a left or right common pulmonary vein, a common inferior pulmonary vein, a ri...

  14. Angiotensin II receptor blockers in the prevention of complications from atrial fibrillation

    OpenAIRE

    Gerald V. Naccarelli; Peacock, Frank

    2009-01-01

    Atrial fibrillation (AF) is the most common form of cardiac arrhythmia and is associated with an increased risk of cardiovascular morbidity and mortality, especially due to ischemic stroke. The occurrence of AF leads to atrial electrical and structural remodeling. The renin-angiotensin system appears to play a role in the development of atrial arrhythmias by its involvement in both of these processes. Large-scale hypertension trials and heart failure trials have indicated the potential value ...

  15. Results of Atrial Fibrillation Ablation in Patients With or Without a History of Atrial Flutter

    Institute of Scientific and Technical Information of China (English)

    Lu chunshan; Liu Xingpeng; Dong Jianzeng; Ma Changsheng

    2006-01-01

    Objectives There are two kind of atrial flutter during circumferential ablation for atrial fibrillation (AF): new onset left atrial flutter (LAFL), with a history of atrial flutter (AFL). What is the relationship of AFL and AF? Whether there are some differences in clinical course and mechanism between the new onset LAFL and the with a history of AFL remained unclear. The aim of this study was to assess the impacts of circumferential ablation on the occurrence of arrhythmias in follow-up in 2 groups:( 1 ) patients with a history of AFL and AF, and (2)patients with new onset LAFL. Methods Data from 465 patients who had circumferential pulmonary vein ablation (CPVA) or segmental pulmonary vein ablation (SPVA) were analyzed. Patients with a history of AFL ablation and patients who had concomitant AFL ablation were included from analysis. Forty-one patients constituted the history of AFL group (group 1, aged 57±13 years, 7 females) and twenty-eight patients constituted the new onset LAFL group (group 2, aged 55±12 years, 6 females). bipolar recordings were obtained from the tricuspid annulus, coronary sinus,interatrial septum and left atrium. Target sites were identified by early, fragmented or double potentials and by concealed entrainment. Linear lesions were created between target sites and nearby anatomical barriers (1) typical atrial flutter (cycle length, 242±39 ms). cavotricuspid isthmus ablation was performed.(2) new onset LAFL (cycle length, 282±153 ms). 20 episodes of AAFs were documented in 20/28 (71.4%)patients. Target sites were identified around pulmonary veins (n=10), gap in linear lesion (n=7), left atrial roof lines (1 case). For those cases the ablation line between PV and mitral annulus was performed.Patients in Group 2 had larger left atria, higher incidence of AFL pre-CPVA, and lower ejection fraction. Results There was no significant difference in post-CPVA AF recurrence between Groups 1 and 2, but AFL incidence after CPVA was higher in Group

  16. Mechanisms of atrial fibrillation: from ideas and hypotheses to effective understanding of the problem

    Directory of Open Access Journals (Sweden)

    Bockeria L.A.

    2014-03-01

    Full Text Available Atrial fibrillation (AF is one of the most common and dangerous arrhythmias and one of the main problems of medicine all over the world. The disease is characterised with rapid and disordered atrial depolarization, which leads to the disorganized contraction of atrial myocardium. The article deals with the mechanisms of AF from the first ideas to the modern data. AF is a complex pathology with several etiopathogenetic mechanisms. Many investigations show that this arrhythmia needs a trigger for its induction and anatomical or electrophysiological changes for its preservation. Fist G. Mines in 1914 advanced the theory of wave reentry and much more later a group of scientists headed by М. Haissaguerre found trigger activity of pulmonary veins orifices, which may contribute to the formation of one or several macro-reentry circuits in one or both atriums and launch arrhythmia. After that many articles were dedicated to the anatomical and electrophysiological characteristics of pulmonary veins orifices. An important aspect of understanding of the mechanisms of persistence of AF is electrical remodeling. During this process, the cells involved into the of macro-reentrant circuits undergo changes in the characteristics of their repolarization, manifested as shortening of the action potential duration and consequently shortening of the refractoryness period. These changes contribute to the preservation of reentry circles. That means the more atrium is fibrillating, the more it tends to support fibrillation due to processes of electrical remodeling. Thus, AF becomes persistent, when the macro-reentry circles are able to support themselves without the participation of the triggers. Later other focuses of ectopic activity were found. Among them were sites of myocardium near superior vena cava, coronary sinus, posterior wall of left atrium, interatrial septum and left atrial appendage. Also the role of genes, which can take part in AF genesis in some cases

  17. Pharmacotherapy for atrial fibrillation in elderly hospitalized patients with comorbid congestive heart failure in australia: A retrospective study

    OpenAIRE

    Wang, Lexin; Curran, Shane; Ball, Patrick; White, Fiona

    2008-01-01

    Background: Despite the proven effectiveness of antiplatelet and anticoagulation treatment for atrial fibrillation (AF), their use has been suboptimal in practice, particularly in rural areas of Australia.

  18. Physician stated atrial fibrillation management in light of treatment guidelines: data from an international, observational prospective survey

    DEFF Research Database (Denmark)

    Kowey, Peter R; Breithardt, Günter; Camm, John;

    2010-01-01

    The Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation (RecordAF) study is the first worldwide, prospective, survey of real-life management of atrial fibrillation (AF) in recently diagnosed patients (n = 5604) with a 1-year follow-up.......The Registry on Cardiac Rhythm Disorders Assessing the Control of Atrial Fibrillation (RecordAF) study is the first worldwide, prospective, survey of real-life management of atrial fibrillation (AF) in recently diagnosed patients (n = 5604) with a 1-year follow-up....

  19. Impact of dronedarone on hospitalization burden in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Torp-Pedersen, Christian; Crijns, Harry J G M; Gaudin, Christophe;

    2011-01-01

    Hospitalization or death from any cause in patiENTs with Atrial fibrillation/atrial flutter (ATHENA), a composite of first CV hospitalization or death from any cause, was significantly reduced by dronedarone. This post hoc analysis evaluated the secondary endpoint of CV hospitalization and the clinical benefit of...... dronedarone on the number and duration of CV hospitalizations in patients with atrial fibrillation (AF).......Cardiovascular (CV) hospitalization is a predictor of CV mortality and has a negative impact on patients' quality of life. The primary endpoint of A placebo-controlled, double-blind, parallel-arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular...

  20. Angiotensin II blockade, YKL-40 and maintenance of sinus rhythm after electrical cardioversion for atrial fibrillation

    DEFF Research Database (Denmark)

    Tveit, Arnljot; Seljeflot, Ingebjørg; Smith, Pal;

    2013-01-01

    cardioversion (ECV) for persistent AF and serum levels of YKL-40. A secondary point of interest was a potential effect of the angiotensin receptor blocker candesartan on YKL-40 levels. In the Candesartan in the Prevention of Relapsing Atrial Fibrillation (CAPRAF) study, 171 patients with persistent AF were......High levels of the novel inflammatory marker YKL-40 have been demonstrated in inflammatory environments and in remodeling of the extracellular matrix. Both are key components in atrial wall remodeling in atrial fibrillation (AF). We studied the relation between rhythm outcome after electrical...

  1. Freedom from atrial fibrillation after cox maze III ablation during follow-up

    Directory of Open Access Journals (Sweden)

    Fariborz Akbarzadeh

    2015-01-01

    Full Text Available Background: Nearly 60% of patients undergoing mitral valve (MV operations are affected by atrial fibrillation (AF. Cox Maze III ablation is one of the effective ways for restoring sinus rhythm for patients undergoing open heart surgery. The aim of present study was to evaluate efficacy of Maze III ablation procedure for restoring sinus rhythm among patients who had underwent open heart surgery. Materials and Methods: During present descriptive-analytic prospective study 114 patients with chronic AF had undergone open heart surgery for their valvular or coronary artery diseases in Educational-Medical centres of Tabriz University of Medical Sciences (Tabriz, Iran 2006-2012, were included in the study. For all patients Maze III ablation was done. Patients were evaluated by 12 lead electrocardiography (ECG and 24 hours ambulatory ECG monitoring after 3-6 years (mean 4.8 of follow-up. Result : Patients′ rhythm before Cox Maze III surgery was chronic AF in all patients. All patients were discharged from operating room with sinus rhythm. During intensive care unit (ICU hospitalization, rhythm of 34 patients changed to AF and 80 patients had sinus rhythm. Sixteen patients had undergone electrical cardioversion for restoring sinus rhythm which was successful in 12 patients. Ninety-two patients had sinus rhythm when discharged from the hospital. After termination of follow-up, freedom from atrial fibrillation was 51%. Patients with AF during follow-up on surface ECG didn′t have episodes of sinus rhythm in their ambulatory monitoring. One patient implanted cardiac pacemaker due to persistent sinus bradycardia. Conclusion: Based on the results of this study, Cox Maze III ablation procedure is an effective and safe way for restoring sinus rhythm among patients who are candidate for open heart surgery, while no significant complication was seen among patients.

  2. Integration of cardiac computed tomography into pulmonary vein isolation in patients with paroxysmal atrial fibrillation

    International Nuclear Information System (INIS)

    Purpose: Detailed anatomic information of the left atrium is necessary for securely performing radiofrequency ablation of atrial fibrillation-triggering ectopies in the pulmonary vein ostia. In this study the impact of a preinterventionally acquired cardiac computed tomography (CT) on pulmonary vein isolation (PVI) was assessed. Materials and methods: Examinations of 54 patients with paroxysmal atrial fibrillation undergoing PVI were analyzed. In 27 patients a supplementary cardiac CT was obtained prior to PVI (CT group, 12 women, 15 men, 59.7 ± 9.9 years of age): 16 x 1.5 mm collimation, 0.2 pitch, 120 kV tube voltage, 400 effective mAs. The fluoroscopy time, effective dose and quantity of radiofrequency (RF) pulses of the following catheter ablation were compared to 27 patients undergoing stand-alone PVI (11 women, 16 men, 62.0 ± 9.9 years of age). Mann-Whitney tests served for statistical comparison. Results: CT datasets were successfully integrated into the ablation procedure of each patient in the CT group. The mean quantity of RF pulses was significantly lower in the CT group (22.1 ± 8.0 vs. 29.1 ± 11.9, p = 0.030), and a significant reduction of fluoroscopy time was found (41.8 ± 12.0 min vs. 51.2 ± 16.0 min, p = 0.005). Effective doses of the catheter ablation differed in an equivalent dimension but altogether not significantly (14.9 ± 10.0 mSv vs. 20.0 ± 16.0 mSv, p = 0.203). The mean additive effective dose of the cardiac CT was 85 ± 0.3 mSv. (orig.)

  3. Effect of Omega-3 Polyunsaturated Fatty Acid Supplementation in Patients with Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Sanjay Kumar MD, FASH

    2012-08-01

    Full Text Available Atrial fibrillation (AF is the most common sustained atrial arrhythmia conferring a higher morbidity and mortality. Despite the increasing incidence of AF; available therapies are far from perfect. Dietary fish oils, containing omega 3 fatty acids, also called polyunsaturated fatty acid [PUFA] have demonstrated beneficial electrophysiological, autonomic and anti-inflammatory effects on both atrial and ventricular tissue. Multiple clinical trials, focusing on various subsets of patients with AF, have studied the role of PUFA and their potential role in reducing the incidence of this common arrhythmia. While PUFA appears to have a beneficial effect in the primary prevention of AF in the elderly with structural heart disease, this benefit has not been universally observed. In the secondary prevention of AF, PUFA seems to have a greater impact in the reducing AF in patients with paroxysmal or persistent AF, stages of AF associated with less atrial fibrosis and negative structural remodeling. However, AF suppression has not been consistently demonstrated in clinical trials. In patients undergoing heart surgery, increasing PUFA intake has yielded mixed results in terms of AF prevention post-operatively; however, increased PUFA has been associated with a reduction in hospital stay. Therefore recommending the use of PUFA for the purpose of AF reduction remains controversial. This is in part attributable to the complexity of AF. Other conflicting variables include: heterogeneous patient populations studied; variable dosing; duration of follow-up; comorbidities; and, concomitant pharmacotherapy. This review article reviews in detail available basic and clinical research studies of fish oil in the treatment of AF, and its role in the treatment of this common disorder.

  4. Fibrilación atrial en los adultos mayores Atrial Fibrillation in the Elderly

    Directory of Open Access Journals (Sweden)

    Jorge Brizuela-Torres

    2009-09-01

    Full Text Available La fibrilación atrial es la taquiarritmia más prevalente en los adultos mayores. La frecuencia de dicha arritmia aumenta con la edad, presentándose en un 1.5% de los 50 a 59 años a 10% de los 80 a 89 años. La fibrilación atrial no valvular incrementa el riesgo de sufrir un evento cerebrovascular isquémico cardioembólico en 5 veces y causa el 15% de todos los accidentes cerebrovasculares isquémicos en Estados Unidos de América. El manejo de la fibrilación atrial se enfoca, principalmente, en la prevención de los fenómenos tromboembólicos y en el control de la frecuencia y ritmo cardiaco. La anticoagulación, cuando está indicada, ha demostrado ser la principal herramienta en la prevención de dichos eventos. Sin embargo, aunque las complicaciones hemorrágicas son más frecuentes, en esta población, y aumentan con la edad, sobrepasa por mucho, el beneficio al riesgo. El control de la frecuencia cardiaca ha demostrado ser igual o mejor que el control del ritmo en cuanto a prevención de eventos cerebrovasculares y mortalidad en estos pacientes. La edad cronológica por sí sola, no es contraindicación alguna para ofrecer una terapia óptima. Debe tomarse en cuenta el estado funcional, cognitivo y social, así como aspectos fisiológicos del envejecimiento con respecto a la prescripción de medicamentos. Cuando, a pesar del tratamiento adecuado, la sintomatología persiste, las estrategias invasivas han demostrado ser beneficiosas, pero faltan estudios que involucren a individuos mayores.Atrial fibrillation is the most prevalent arrhythmia in the elderly. Its frequency increases with age, being 1.5% from 50 to 59 years old and 10% from 80 to 89 years old. Non valvular atrial fibrillation increases 5 fold the risk of suffering an stroke and causes 15% of strokes in the USA. Atrial fibrillation management focuses in the prevention of thromboembolic phenomena and heart rate and rhythm control. Anticoagulation, when indicated, has

  5. Atrial and ventricular volume and function in persistent and permanent atrial fibrillation, a magnetic resonance imaging study

    DEFF Research Database (Denmark)

    Therkelsen, Susette Krohn; Groenning, Bjoern Aaris; Svendsen, Jesper Hastrup;

    2005-01-01

    Left atrial size is independently related to cardiovascular morbidity and mortality, and atrial fibrillation (AF) is strongly associated with atrial size. Our aims were to report atrial and ventricular dimensions in patients with AF evaluated with magnetic resonance imaging (MRI), and to assess the...... inter-study reproducibility of the measurements. Nineteen healthy volunteers, 19 patients with permanent AF, and 58 patients with persistent AF had cardiac dimensions evaluated by 6-mm cinematographic breath-hold MRI scans using a 1.5 Tesla Siemens Vision Magnetom scanner with a phased array chest coil....... Intraobserver variability and inter-study reproducibility of the cardiac volumes and ejection fractions (EF) gave acceptable Bland-Altman plots, good correlations (R2: 0.80-0.99), and low reproducibility coefficients. The mean atrial volumes were similar in the two groups with AF [systolic vol. index (SVI): 75...

  6. Prevalence and risk factors of atrial fibrillation in preterminal inpatients aged 60 years and over

    Institute of Scientific and Technical Information of China (English)

    YANG Jie-fu; LIU Bing; LIU Dong-ge; LUO Yao; FANG Fang

    2008-01-01

    Background Atrial fibrillation is a common arrhythmia and a major risk factor for ischaemic stroke. We investigated the prevalence of atrial fibrillation and its relation to age, gender and underlying heart disease in patients aged 60 years and over who died during hospitalization.Methods Between 1955 and 2005, 1519 autopsies of in-hospital deaths in Beijing Hospital were performed. Among them, 540 cases met criteria of age ≥60 years and full clinical history including electrocardiogram, echocardiogram, myocardial perfusion images and detailed cardiac pathology records from autopsy.Results Atrial fibrillation occurred in 193 of 540 patients and prevalence increased with age (10.5% in patients younger than 60 years, 39.6% (80-89 years) and 54.8% (≥90 years)) being higher in patients with underlying heart disease than without heart disease (P<0.0001). Coronary artery disease (CAD), congestive heart failure, cardiac valve dysfunction and chronic renal failure were associated with a higher prevalence of atrial fibrillation (P<0.001). CAD with anterior myocardial infarction or left anterior descending artery disease was also associated with an increased prevalence of atrial fibrillation (P <0.05). Following autopsy, clinical misdiagnosis of CAD increased with age and missed clinical diagnosis of CAD decreased with age. Multivariate Logistic regression analysis revealed independent predictors of atrial fibrillation: age (OR=1.335, 95% Cl: 1.114-1.600, P<0.0001), underlying heart disease (OR=2.019, 95% CI: 1.244-3.278, P <0.005), chronic heart failure (OR=1.873, 95% CI: 1.272-2.757, P <0.005), mitral regurgitation (OR=2.163, 95% Cl: 1.093-4.278, P<0.05) and mitral stenosis (OR=33.575, 95% CI: 2.852-395.357, P<0.05). Conclusions A high prevalence of atrial fibrillation was found in Chinese patients

  7. The Left Atrial Appendage: Target for Stroke Reduction in Atrial Fibrillation.

    Science.gov (United States)

    Ramlawi, Basel; Abu Saleh, Walid K; Edgerton, James

    2015-01-01

    A patient with atrial fibrillation (AF) has a greater than 5% annual risk of major stroke, a 5-fold increase compared to the general population. While anticoagulation remains the standard stroke prevention strategy, the nature of lifelong anticoagulation inevitably carries an increased risk of bleeding, increased stroke during periods of interruption, increased cost, and significant lifestyle modification. Many patients with atrial fibrillation have had their left atrial appendage (LAA) ligated or excised by surgeons during cardiac surgery, a decision based largely on intuition and with no clear evidence of efficacy in stroke risk reduction. The observation that 90% of the thrombi found in nonvalvular AF patients and 57% found in valvular AF are in the LAA, triggered significant interest in the LAA as a potential therapeutic target. Until recently, the results were inconsistent, and high rates of incomplete occlusions precluded the medical community from confirming a definite relationship between LAA and stroke. As a result, anticoagulation is still the recommended first-line stroke risk reduction in AF, and the American College of Cardiology/American Heart Association guidelines recommend LAA exclusion only with surgical ablation of AF or in the context of concomitant mitral valve surgery. A handful of devices have been developed for LAA exclusion. This includes percutaneous options such as WATCHMAN™ Left Atrial Appendage Closure Device (Boston Scientific Corporation, Marlborough, MA), hybrid epicardial devices such as the LARIAT Suture Delivery Device (SentreHEART, Inc., Redwood City, CA), and epicardial surgical devices such as AtriClip® LAA Occlusion System (AtriCure, Inc., West Chester, OH). Studies of the Watchman device have shown noninferiority to Warfarin in stroke prevention and this device has recently gained approval from the U.S. Food and Drug Administration (FDA) following lengthy delays due to safety concerns. The Lariat device, which received 510

  8. Paroxysmal atrial fibrillation prediction method with shorter HRV sequences.

    Science.gov (United States)

    Boon, K H; Khalil-Hani, M; Malarvili, M B; Sia, C W

    2016-10-01

    This paper proposes a method that predicts the onset of paroxysmal atrial fibrillation (PAF), using heart rate variability (HRV) segments that are shorter than those applied in existing methods, while maintaining good prediction accuracy. PAF is a common cardiac arrhythmia that increases the health risk of a patient, and the development of an accurate predictor of the onset of PAF is clinical important because it increases the possibility to stabilize (electrically) and prevent the onset of atrial arrhythmias with different pacing techniques. We investigate the effect of HRV features extracted from different lengths of HRV segments prior to PAF onset with the proposed PAF prediction method. The pre-processing stage of the predictor includes QRS detection, HRV quantification and ectopic beat correction. Time-domain, frequency-domain, non-linear and bispectrum features are then extracted from the quantified HRV. In the feature selection, the HRV feature set and classifier parameters are optimized simultaneously using an optimization procedure based on genetic algorithm (GA). Both full feature set and statistically significant feature subset are optimized by GA respectively. For the statistically significant feature subset, Mann-Whitney U test is used to filter non-statistical significance features that cannot pass the statistical test at 20% significant level. The final stage of our predictor is the classifier that is based on support vector machine (SVM). A 10-fold cross-validation is applied in performance evaluation, and the proposed method achieves 79.3% prediction accuracy using 15-minutes HRV segment. This accuracy is comparable to that achieved by existing methods that use 30-minutes HRV segments, most of which achieves accuracy of around 80%. More importantly, our method significantly outperforms those that applied segments shorter than 30 minutes. PMID:27480743

  9. Efficacy of catheter ablation of atrial fibrillation beyond HATCH score

    Institute of Scientific and Technical Information of China (English)

    TANG Ri-bo; DONG Jian-zeng; LONG De-yong; YU Rong-hui; NING Man; JIANG Chen-xi; SANG Cai-hua; LIU Xiao-hui; MA Chang-sheng

    2012-01-01

    Background HATCH score is an established predictor of progression from paroxysmal to persistent atrial fibrillation (AF).The purpose of this study was to determine if HATCH score could predict recurrence after catheter ablation of AF.Methods The data of 488 consecutive paroxysmal AF patients who underwent an index circumferential pulmonary veins (PV) ablation were retrospectively analyzed.Of these patients,250 (51.2%) patients had HATCH score=0,185(37.9%) patients had HATCH score=1,and 53 (10.9%) patients had HATCH score >2 (28 patients had HATCH score=2,23 patients had HATCH score=3,and 2 patients had HATCH score=4).Results The patients with HATCH score >2 had significantly larger left atrium size,the largest left ventricular end systolic diameter,and the lowest ejection fraction.After a mean follow-up of (823±532) days,the recurrence rates were 36.4%,37.8% and 28.3% from the HATCH score=0,HATCH score=1 to HATCH score >2 categories (P=0.498).Univariate analysis revealed that left atrium size,body mass index,and failure of PV isolation were predictors of AF recurrence.After adjustment for body mass index,left atrial size and PV isolation,the HATCH score was not an independent predictor of recurrence (HR=0.92,95% confidence interval=0.76-1.12,P=0.406) in multivariate analysis.Conclusion HATCH score has no value in prediction of AF recurrence after catheter ablation.

  10. Management of atrial fibrillation: focus on the role of dronedarone

    Directory of Open Access Journals (Sweden)

    Cheng JW

    2011-09-01

    Full Text Available Judy WM Cheng1,2 1Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA; 2Brigham and Women's Hospital, Boston, MA, USA Background: Dronedarone is an amiodarone derivative that was approved in the US in July 2009 to reduce the risk of cardiovascular hospitalization in patients with paroxysmal or persistent atrial fibrillation (AF, who are in sinus rhythm (SR, or who will be cardioverted. Objective: This article reviews the pharmacology, adverse effects, and clinical evidence available to date on the use of dronedarone in the management of AF and its potential role in the emergency department setting. Results: In the EURIDIS and ADONIS studies evaluating the efficacy of dronedarone in maintaining SR, dronedarone significantly reduced the risk of recurrence of AF compared to placebo, by 22% and 27%, respectively. The ERATO study examined the ability of dronedarone to control ventricular rate in permanent AF. The DIONYSOS study demonstrated that recurrences of AF were more frequent with dronedarone. However, discontinuation of therapy due to intolerance was more frequent with amiodarone. Furthermore, the ATHENA study demonstrated that dronedarone reduced mortality and cardiovascular hospitalization by 24% (P < 0.05 in patients in SR but with other associated risks and a history of AF. However, the ANDROMEDA study, evaluating the use of dronedarone in patients with recent decompensated heart failure, and the PALLAS study, evaluating the use of dronedarone in patients with chronic AF, were both terminated prematurely due to a trend toward an increased risk of cardiovascular events. Conclusion: Dronedarone has been demonstrated to be effective in reducing the incidence of AF recurrence. It appears to be less effective but better tolerated than amiodarone. Dronedarone appears to have a low proarrhythmic risk and is the first anti-arrhythmic that has been demonstrated to reduce cardiovascular mortality and cardiovascular hospitalization

  11. Variations in Cause and Management of Atrial Fibrillation in a Prospective Registry of 15 400 Emergency Department Patients in 46 Countries The RE-LY Atrial Fibrillation Registry

    NARCIS (Netherlands)

    Oldgren, Jonas; Healey, Jeff S.; Ezekowitz, Michael; Commerford, Patrick; Avezum, Alvaro; Pais, Prem; Zhu, Jun; Jansky, Petr; Sigamani, Alben; Morillo, Carlos A.; Liu, Lisheng; Damasceno, Albertino; Grinvalds, Alex; Nakamya, Juliet; Reilly, Paul A.; Keltai, Katalin; Van Gelder, Isabelle C.; Yusufali, Afzal Hussein; Watanabe, Eiichi; Wallentin, Lars; Connolly, Stuart J.; Yusuf, Salim

    2014-01-01

    Background Atrial fibrillation (AF) is the most common sustained arrhythmia; however, little is known about patients in a primary care setting from high-, middle-, and low-income countries. Methods and Results This prospective registry enrolled patients presenting to an emergency department with AF

  12. Risk factors for stroke and thromboembolism in relation to age among patients with atrial fibrillation: the loire valley atrial fibrillation project

    DEFF Research Database (Denmark)

    Olesen, Jonas Bjerring; Fauchier, Laurent; Lane, Deirdre A; Taillandier, Sophie; Lip, Gregory Y H

    2012-01-01

    According to the latest European guidelines on the management of nonvalvular atrial fibrillation (NVAF), all patients aged ≥ 65 years should be treated with oral anticoagulation (if not contraindicated). Therefore, stroke risk factors should be investigated exclusively in patients with NVAF aged ...

  13. Homogenization of atrial electrical activities: conceptual restoration of regional electrophysiological parameters to deter ischemia-dependent conflictogenic atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Dr. Petras Stirbys

    2013-08-01

    Full Text Available Atrial fibrillation (AF as a severe arrhythmia is now spreading worldwide at overwhelmingly high rates, particularly in elderly patients. Despite new insights, the mechanisms underlying AF are not conclusively determined yet. Taking into account the ischemic origin of arrhythmia induction (according to the so-called conflictogenic atrial fibrillation, declared recently restoration of regional electrophysiological parameters is essential in tackling AF. We hypothesized that some atrial electrophysiological parameters, preferably the effective refractory period, might need to be controlled to prevent AF. All the remaining parameters - conduction velocity, conduction time, recovery time, vulnerability, excitability, repolarization etc. being as if secondary and less important could be ignored. Homogenization of the milieu producing AF might be implemented, at least theoretically, through restoration of blood supply in ischemic areas and/or via attenuation of electrophysiological differences between conflicting regions by delivery of atrial sub-threshold non-captured pulse-trains. Adjunctive therapy by drugs containing vasodilatory features and affecting the effective refractory period appears to be fundamental. Thus, stabilization of disorganized atrial cellular activities likely may lead to the recovery of atrial excitable characteristics. Despite the lack of compelling evidence, the application of the concept may be helpful in order to search for more precise and more effective methods to favorably change the refractory period. Further studies are necessary to determine whether restoration or improvement of blood circulation of atrial wall is feasible. On the basis of such considerations a novel preventive AF strategies are to be designed. Abbreviations: AF=atrial fibrillation, ERP=effective refractory period, TMR=transmyocardial revascularization

  14. Development of a transgenic goat model wih cardiac-specific overexpression of transforming growth factor - {beta} 1 to study the relationship between atrial fibrosis and atrial fibrillation

    Science.gov (United States)

    Studies on patients, large animal models and transgenic mouse models have shown a strong association of atrial fibrosis with atrial fibrillation (AF). However, it is unclear whether there is a causal relationship between atrial fibrosis and AF or whether these events appear as a result of independen...

  15. Completely thoracoscopic pulmonary vein isolation with ganglionic plexus ablation and left atrial appendage amputation for treatment of atrial fibrillation

    NARCIS (Netherlands)

    A. Yilmaz; G.S.C. Geuzebroek; B.P. van Putte; L.V.A. Boersma; U. Sonker; J.M.T. de Bakker; W.J. van Boven

    2010-01-01

    Objective: Percutaneous catheter pulmonary vein isolation (PVI) has been the preferred choice for invasive treatment of symptomatic, drug-refractory lone atrial fibrillation (AF). Incomplete ablation lines, procedure-related morbidity and long-term success remain, however, a problem. A minimally inv

  16. INCIDENCE AND CLINICAL-SIGNIFICANCE OF ST SEGMENT ELEVATION AFTER ELECTRICAL CARDIOVERSION OF ATRIAL-FIBRILLATION AND ATRIAL-FLUTTER

    NARCIS (Netherlands)

    VANGELDER, IC; CRIJNS, HJ; VANDERLAARSE, A; VANGILST, WH; LIE, KI

    1991-01-01

    To study the incidence and clinical significance of postshock ST segment elevations, we recorded 12-lead ECGs immediately after transthoracic direct-current electrical cardioversion in 146 patients with atrial fibrillation or flutter. Among 23 patients (19%), acute ST segment elevations amounted to

  17. Watchman Device: Left Atrial Appendage Closure for Stroke Prophylaxis in Atrial Fibrillation.

    Directory of Open Access Journals (Sweden)

    Dr. Manoj N Obeyesekere

    2014-08-01

    Full Text Available A concerning proportion of patients with atrial fibrillation (AF with indications for oral anticoagulation (OAC discontinue OAC or are never prescribed OAC therapy and many AF patients with the highest risk for embolic events off OAC also have the greatest risk for hemorrhagic complications on OACs. Medium-term efficacy and safety data provide evidence that the WATCHMAN device, the most studied device and the only one with randomized and medium-term follow-up data, may be a viable alternative to chronic warfarin therapy in nonvalvular AF patients. In addition to presenting key data pertaining to LAA closure techniques including the WATCHMAN device, this review will discuss crucial WATCHMAN implantation technical points.

  18. Effect of atrial pacing therapy with selective pacing algorithms on paroxysmal atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    潘晓宏; 张雪华; 徐耕; 傅国胜; 单江

    2004-01-01

    @@ Atrial fibrillation (AF) is the most common cardiac arrhythmia among the elderly. Its incidence increases dramatically with increasing age and decreasing left ventricular function, peaking in subjects with overt congestive heart failure.1 Because of the unsatisfactory efficacy and possible serious side effects of clinically available anti-AF drugs for AF patients with sick sinus syndrome, pacing techniques have recently been applied in the treatment of AF. The cardiac pacemaker Vitatron Selection 900E has special AF diagnostic and prophylactic therapy algorithms. The objective of this study was to use the diagnostic information concerning the onset mechanisms of AF to program the preventive pacing algorithms for each patient individually and to find out whether a reduction in AF burden could be achieved.

  19. Helicobacter pylori infection in Chinese patients with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Wang DZ

    2015-04-01

    Full Text Available De-Zhao Wang,1 Wei Chen,1 Song Yang,2 Jun Wang,3 Qun Li,1 Qiang Fu,2 Shi-Jing Li,3 Bu-Xing Chen1 1Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, 2Department of Ultrasonography, Beijing Tiantan Hospital, Capital Medical University, 3Department of Cardiology, Beijing Mentougou District Hospital, Beijing, People’s Republic of China Objective: To explore the relationship between Helicobacter pylori (Hp infection and atrial fibrillation (AF in Chinese patients.Methods: A total of 285 hospitalized patients with AF and 300 patients from Health Screening Center who matched age and sex with AF group were enrolled. AF patients were divided into two groups: the short-standing AF category (less than a year and the long-standing AF category (more than a year. All patients had laboratory testing of 13C urea breath test, high-sensitive C-reactive protein (hs-CRP and left atrial diameter (LAD. We analyzed the difference of these factors in all groups and explored the correlation between Hp infection and AF using logistic regression analysis.Results: Both AF groups had more hypertension, diabetes, and Hp infection than the control group. The Hp value and the hs-CRP level in patients with long-standing AF were higher than those in the short-standing AF and the control groups (for Hp value: P<0.001 for both and for hs-CRP level: P=0.003, 0.002, respectively. The LAD of patients in the long-standing AF group was significantly larger than those in the short-standing AF group and control group (P=0.001 and P<0.001, respectively. The values of Hp, hs-CRP, and LAD in the long-standing AF category were significantly higher than those in the short-standing AF category (all P<0.05. After controlling the potential confounders, Hp value ≥4‰, hs-CRP >5 mg/L, and LAD >36 mm were significantly related to long-standing AF.Conclusion: The values of Hp in patients with long-standing AF were significantly higher than those in short

  20. Association between CHADS2 score and long-term atrial fibrillation recurrence rate after catheter ablation

    Institute of Scientific and Technical Information of China (English)

    胡晓锋

    2014-01-01

    Objective To investigate the association between CHADS2score and long-term(≥3 years)outcomes post catheter ablation in patients with atrial fibrillation(AF).Methods AF patients who received single catheter ablation in our hospital from January 2004 to March 2009 in our department were included and patients received regular follow-up.AF recurrence was defined as the occurrence of atrial arrhythmias(AF,atrial flutter and atrial tachycardia)recorded by electrocardiogram monitor(≥30 seconds)after ablation during follow-up period(after