Atrial Infarction Research Articles

Retrieving hidden atrial repolarization waves from standard surface ECGs

BackgroundThis study estimates atrial repolarization activities (Ta waves), which are typically hidden most of the time from body surface electrocardiography when diagnosing cardiovascular diseases. The morphology of Ta waves has been proven to be an important marker for the early sign of inferior injury, such as acute atrial infarction, or arrhythmia, such as atrial fibrillation. However, Ta waves are usually unseen except during conduction system malfunction, such as long QT interval or atrioventricular block. Therefore, justifying heart diseases based on atrial repolarization becomes impossible in sinus rhythm.MethodsWe obtain TMPs in the atrial part of the myocardium which reflects the correct excitation sequence starting from the atrium to the end of the apex.ResultsThe resulting TMP shows the hidden atrial part of ECG waves.ConclusionsThis extraction makes many diseases, such as acute atrial infarction or arrhythmia, become easily diagnosed.

P4639Electrocardiographic diagnosis of atrial infarction in patients with acute inferior ST-segment elevation myocardial infarction

P4639Electrocardiographic diagnosis of atrial infarction in patients with acute inferior ST-segment elevation myocardial infarction

Electrocardiographic diagnosis of atrial infarction in patients with acute inferior ST-segment elevation myocardial infarction.

Patients with atrial myocardial infarction (ATMI) have frequent cardiac and noncardiac complications. However, ATMI is uncommonly diagnosed because of its nonspecific ECG changes. Our objective was to analyze the ECG characteristics of ATMI in patients with inferior STEMI. Electrocardiographic P wave parameters can help in diagnosis of ATMI. We evaluated 932 patients who underwent coronary angiography and recruited 39 patients with ATMI and 33 patients without ATMI with inferior STEMI for a retrospective study. Twelve-lead ECGs were obtained to measure P-wave parameters in diagnosis of ATMI. P-wave parameters and PR-segment displacement were compared in patients with and without ATMI. In inferior leads, PWD and PWDisp were significantly longer in the ATMI group than in the non-ATMI group (limb lead II, 109.79 ±15.51 ms and 86.65 ±5.02 ms, respectively; P < 0.001; limb lead III, 108.31 ±12.51 ms and 85.27 ±7.47 ms, P < 0.001; aVF, 106.49 ±13.68 ms and 83.01 ±7.89 ms, P < 0.001; PWDisp, 41.67 ±10.72 ms and 25.18 ±5.17 ms, P < 0.001). By contrast, PWA was significantly lower in the ATMI group than in the non-ATMI group (limb lead II, 0.96 ±0.18 mV and 1.39 ±0.22 mV, respectively; P < 0.001; limb lead III, 0.90 ±0.11 and 1.21 ±0.23, P < 0.001; aVF, 0.88 ±0.17 and 1.26 ±0.28, P < 0.001). PR-segment displacement was found in 8 (20.5%) patients with ATMI. A PWD ≥95.5 ms in lead DII diagnosed ATMI with a higher sensitivity and specificity (90%, 94%) than did PWA or PWDisp. This study suggests P-wave parameters might be considered ECG findings in diagnosis of ATMI in patients with inferior STEMI.

A Combination of Tachycardia-Mediated Heart Failure and Coronary Artery Vasospasm-Induced Silent Myocardial Infarction in a Patient with Severe Thyrotoxicosis

Severe thyrotoxicosis can present with a myriad of cardiovascular complications. It may be mild features such as palpitations, tachycardia, and exertional dyspnea or may progress to life-threatening consequences such as atrial fibrillation, tachyarrhythmias, heart failure, myocardial infarction, and shock. In rare cases, they may present with myocardial ischemia secondary to coronary artery vasospasm. We report a case of a 59-year-old Malay gentleman who presented with fast atrial fibrillation and tachycardia-mediated heart failure that evolved to a silent myocardial infarction secondary to severe coronary artery vasospasm with undiagnosed severe thyrotoxicosis. He had complete resolution of heart failure and no further recurrence of coronary artery vasospasm once treatment for thyrotoxicosis was initiated and euthyroidism achieved. This life-threatening consequence has an excellent prognosis if recognised early and treated promptly.

Atrial Infarction and Ischemic Mitral Regurgitation Contribute to Post-MI Remodeling of the Left Atrium

BackgroundLeft atrial (LA) remodeling after an acute myocardial infarction (MI) is poorly characterized regarding its determinants or its effect on ischemic mitral regurgitation (MR) development. ObjectivesThe purpose of this study was: 1) to compare LA structural remodeling in experimental MI swine models recapitulating the effects of left ventricular (LV) dysfunction, ischemic MR, and left atrial infarction (LAI); and 2) to analyze how LA remodeling influences ischemic MR development. MethodsThree models of MI were generated: 1) proximal left circumflex (LCx) coronary artery occlusion involving the LA branch (LAI group); 2) proximal LCx occlusion not involving the LA branch (LCx group); and 3) left anterior descending (LAD) occlusion (LAD group). Serial cardiac magnetic resonance scans were performed to define LA and LV remodeling and ischemic MR, and were correlated with histology. ResultsOcclusion of the LA branch (LAI group) induced a greater degree of LA dilation at 1 and 8 weeks post-MI than the LCx and LAD groups, along with early and severe impairment of LA function. In the LCx and LAD groups, LA dysfunction was less pronounced and not consistent. Development of ischemic MR was more pronounced in the LAI group than in the LCx group. Histology confirmed atrial infarction with extensive fibrosis in the LAI group and interstitial fibrosis in the LCx group. In the LAD group, LA remodeling was not observed by cardiac magnetic resonance or histology. ConclusionsWe provide the first experimental evidence of the deleterious effect of acute LAI on atrial structural remodeling, characterized by early LA dilation, dysfunction, and fibrosis, and early occurrence of ischemic MR.

TCTAP C-146 A Patient Saved by Bailout Using the Mini Crush Technique for Guiding Catheter-induced Spiral Dissection from the LMT to the LAD and LCx Peripheral Segments

### Patient initials or identifier number 00031072 ### Relevant clinical history and physical exam The patient was a 76-year-old woman with a history of atrial fibrillation and cerebral infarction. On March 7, 2016, she was admitted to our hospital’s orthopedicsurgery ward to undergo surgery

Atrial Infarct: An Easily Missed Reality with Hidden Threat – A case report with Review of Literature

Atrial infarction is a very rare diagnosis. Though available literature suggests, the condition per se may have been not so rare. Over the past few decades, atrial infarction have been reported several times, even some case series have been reported, but there is no consensus on the diagnosis of this condition, and its true importance also has not been understood completely. Previous works have shown that this condition is associated with several serious complications; hence recognition of this condition in early period is important, which is at the same time not so easy due to subtlety of the known features and less availability of information. We report a case of 70 year old Muslim, Bengali, male suffering from acute coronary syndrome, in whom, right atrial infarction was recognized by electrographic features, which is very rarely diagnosed with confidence in ante-mortem patients. Since, in Bangladesh, post-mortem autopsy to find out causes behind cardiac death is not done routinely and in the light of possibility of serious life-threatening complications, ante-mortem diagnosis of atrial infarction is necessary. So, Cardiologists should be aware of this uncommon condition.Cardiovasc. j. 2015; 8(1): 65-68

ELECTROCARDIOGRAPHIC CHANGES CONSISTENT WITH ATRIAL INFARCTION IS A POTENTIAL INDEPENDENT PREDICTOR OF 30 DAY AND 1 YEAR MORTALITY IN PATIENTS WITH ACUTE ST-ELEVATION MYOCARDIAL INFARCTION

Atrial Infarction is an uncommonly diagnosed disease and data on its significance are limited. Its incidence in patients with ST-segment elevation myocardial infarction (STEMI) reportedly ranges from 0.7-52%. Several atrial infarction electrocardiographic (ECG) patterns have been described but none

ATRIAL MYOCARDIAL INFARCTION INDUCED DURING ELECTIVE PERCUTANEOUS CORONARY INTERVENTION

Accidental occlusion of atrial coronary artery branches during percutaneous coronary intervention (PCI) may lead to atrial myocardial infarction, but this complication has not been systematically analyzed. This study aimed to prospectively characterize the incidence and consequences of atrial branch

Managing coagulopathy and thromboprophylaxis in the neurosurgical patient

Our understanding of the mechanisms underlying coagulation have advanced rapidly in recent years. In addition, there are new methods to assess coagulation and new agents in the treatments of thromboembolic diseases such as atrial fibrillation, myocardial infarction and venous thromboembolism. It is particularly important for the neurosurgeon to be familiar with this topic in order to balance risks between bleeding and thrombosis in association with surgery. This review provides an overview of the ‘cell-based’ theory of coagulation and the technique of rotational thromboelastograpy to measure wholeblood coagulation. We discuss current management strategies related to haemorrhage control, haemostasis in polytrauma, and the elective and emergency peri-operative management of aspirin, thienopyridines, warfarin and the novel oral anticoagulants (rivaroxaban, dabigatran, apixaban). Finally, the current evidence regarding neurosurgical thromboprophylaxis is reviewed.

Left Atrial Size: An Underappreciated Perioperative Cardiac Risk Factor

LEFT ATRIAL (LA) VOLUME MEASUREMENT has been shown to have a role in the prognosis of long-term cardiovascular mortality in the community setting as well as in the prediction of adverse perioperative events. Different clinical methods have been described for LA size measurement, including magnetic resonance imaging (MRI), computerized tomography (CT), and echocardiography. In recent literature, the LA size has been shown to positively predict the risk of several pathologies (Table 1), including the recurrence of atrial fibrillation (AF), cerebrovascular accidents (CVA), myocardial infarction (MI), and overall mortality. As a result, assessment of LA size recently has received significant clinical attention as a prognostic marker as well as a tool for following response to therapy. In this regard, the value of LA size as a prognostic marker also can be extrapolated to the perioperative assessment of diastolic function. Since the Doppler-derived variables for assessment of diastolic function are extremely load-dependent, LA size provides an alternative marker of the chronicity and significance of elevated left ventricular end-diastolic pressure (LVEDP). Commonly termed as the “HbA1c” for assessment of diastolic dysfunction, the role of LA size in the recognition of long-standing diastolic dysfunction is well recognized. The presence of perioperative diastolic dysfunction has been shown to be an independent predictor of outcome in cardiac and noncardiac surgery. Therefore, knowledge of the LA size possibly can be used for perioperative risk stratification and has the potential to impact intraoperative decision-making. In this article, the authors review the physiologic importance of LA size and its impact on the assessment of diastolic dysfunction, the evidence for its use as a perioperative marker

Atrial fibrillation and incident myocardial infarction.

Atrial fibrillation and incident myocardial infarction.

The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms.

Atrial fibrillation (AF) is the most common arrhythmia (estimated lifetime risk, 22%-26%). The aim of this article is to review the clinical epidemiological features of AF and to relate them to underlying mechanisms. Long-established risk factors for AF include aging, male sex, hypertension, valve disease, left ventricular dysfunction, obesity, and alcohol consumption. Emerging risk factors include prehypertension, increased pulse pressure, obstructive sleep apnea, high-level physical training, diastolic dysfunction, predisposing gene variants, hypertrophic cardiomyopathy, and congenital heart disease. Potential risk factors are coronary artery disease, kidney disease, systemic inflammation, pericardial fat, and tobacco use. AF has substantial population health consequences, including impaired quality of life, increased hospitalization rates, stroke occurrence, and increased medical costs. The pathophysiology of AF centers around 4 general types of disturbances that promote ectopic firing and reentrant mechanisms, and include the following: (1) ion channel dysfunction, (2) Ca(2+)-handling abnormalities, (3) structural remodeling, and (4) autonomic neural dysregulation. Aging, hypertension, valve disease, heart failure, myocardial infarction, obesity, smoking, diabetes mellitus, thyroid dysfunction, and endurance exercise training all cause structural remodeling. Heart failure and prior atrial infarction also cause Ca(2+)-handling abnormalities that lead to focal ectopic firing via delayed afterdepolarizations/triggered activity. Neural dysregulation is central to atrial arrhythmogenesis associated with endurance exercise training and occlusive coronary artery disease. Monogenic causes of AF typically promote the arrhythmia via ion channel dysfunction, but the mechanisms of the more common polygenic risk factors are still poorly understood and under intense investigation. Better recognition of the clinical epidemiology of AF, as well as an improved appreciation of the underlying mechanisms, is needed to develop improved methods for AF prevention and management.

Isolated right atrial infarction from occluded non‐dominant right coronary artery

Isolated right atrial infarction from occluded non‐dominant right coronary artery

Isolated right atrial infarction from occluded non‐dominant right coronary artery

Isolated right atrial infarction from occluded non‐dominant right coronary artery

Significant gender-related differences in CVD have been recognised only recently: deficits in female healthcare

Evidence-based publications indicating significant gender-related differences in CVD diagnosis, manifestation and treatments as well as particular problems shifted to the female subpopulations appeared quite recently [1]. Although CVD is traditionally considered as the major health burden of male subpopulations surprising statistics have been collected for worsening the situation in females. New trends obviously demonstrate a shifting of the problem into healthcare of female populations: from 25 countries selected by World Health Organisation in the years 1990-2000, more than a half (15 countries, 60 %) currently demonstrate either increase in CVD-related death in females or, even if the rates are decreased then less compared to men [1]: 1st group: increased CVD-related death in females ❖ Ukraine – 63% ❖ Kazakhstan – 58% ❖ Belarus – 48 % ❖ Russian Federation – 33% ❖ Romania – 20% ❖ Japan – 13% ❖ Mexico – 2% 2nd group: CVD-related death is less decreased in females versus males ❖ Norway – 17% less ❖ Germany – 4% less ❖ Hungary – 4% less ❖ Luxemburg – 4% less ❖ USA – 4% less ❖ Italy – 2% less ❖ Portugal – 2% less ❖ Armenia – 1% less Further, current reports (as summarised in [1]) indicate that • women experience longer stays in hospital related to CVD and suffer greater complications and disability than men: negative social and economical impacts • diagnostic approaches have been created for men but not adapted for females • Women experience delayed care in the case of CVD emergency • Women with acute myocardial infarction have higher rates of mortality than men of the same age • Short-term mortality after coronary intervention is higher in women than in men • Although the coincidence of CVD with other fatal diseases is common in women, consistent data do not exist to recognise co-morbidities by patient profiling. In this context it becomes clear, why women have been reported to consume more hospital resources than men [2]. Those statistics have been collected for CVD in general but, the particular significance is reported for diagnosed atrial fibrillation, heart failure and acute myocardial infarction [1,2]. Hence, the American National Hospital Discharge Survey reports stable rates of hospital admission for men versus permanently increasing ones for the age-matched women with diagnosed heart failure [3]: the female gender-specific increase comprises about 19% in North America since 1990. Further, high risk of stroke as the secondary complication is the gender particularity acknowledged in women diagnosed with atrial fibrillation, in contrast to none of the predisposition as observed in men [4]. Delayed recognition of the mounting problems creates a consequent delay in covering multifaceted knowledge deficits accumulated in CVD-related female healthcare which societies around the world are currently facing. Consequently there is an urgent need to elaborate the targeted measures forcing the improvement. The recommendations might be proposed as follows: 1. identify deficits that altogether have resulted in current unsatisfactory situation; 2. analyse rapidly worsening versus improving regional healthcare situations and identify the most specific particularities of both; 3. elaborate effective strategies for covering the recognised deficits at all levels of stakeholders that should be obligatory involved in the process of reorganisation including applicative science, social, economical and political levels; 4. consider to force the practical implementation of innovative approaches in predictive diagnostics and targeted prevention that are rapidly developing in pre-clinical trials; 5. create/ readdress sufficient budgets for educational measures, training purposes and staffing the experts essentially involved in the field.

Atrial fibrillation and prior MI: searching for balance in ischaemic and bleeding events in patients treated with factor-specific anticoagulants

This editorial refers to ‘Ischaemic cardiac outcomes in patients with atrial fibrillation treated with vitamin K antagonism or factor Xa inhibition: results from the ROCKET AF trial’, by K.W. Mahaffey et al. doi:10.1093/eurheartj/eht428 Patients with both atrial fibrillation (AF) and prior myocardial infarction (MI) represent a unique and potentially high risk population. Strategies for managing these patients using the newer factor-specific oral anticoagulants are somewhat limited, as these patients represent a small fraction of the overall cohorts studied and only limited results have been published previously.1,2 Mahaffey et al. , investigators from the ROCKET AF (Rivaroxaban Once-daily, oral, direct Factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation) trial,3 now report on the prevalence of prior MI in that study; the incidence of new cardiovascular (CV) events; and the treatment effect of rivaroxaban, a direct factor Xa inhibitor, compared with warfarin on the risk of new CV events in those with and without a history of MI. In the ROCKET AF trial, 17% of patients had prior MI at enrolment ( n = 2468/14 264).3 These subjects were significantly more likely to have other co-morbidities and risk factors, notably more heart failure, diabetes, and peripheral arterial disease. Additionally, concomitant aspirin (47% vs. 34%) and thienopyridine (3.4% and 2.1%) were more common in this subgroup. Patients with and without prior MI had similar rates of stroke and systemic embolism during a median 2 years of follow-up, but recurrent CV events and mortality were more frequent …

Myocardial Infarction and Atrial Fibrillation

Background— Myocardial infarction (MI) is associated with the development of atrial fibrillation (AF). We aimed to characterize the atrial abnormalities because of MI and determine the role of ischemia to the AF substrate. Methods and Results— Forty-four sheep were studied. MI was induced by occlusion of the left circumflex artery (LCX) or left anterior descending artery (LAD). Excluding 11 with fatal arrhythmias, equal groups of animals (LCX; LAD; and sham-operated) underwent sequential electrophysiology study for 45 minutes to determine atrial effective refractory periods, conduction velocity, conduction heterogeneity index, and AF inducibility. Postmortem evaluation was performed with 2,3,5 triphenyl tetrazolium chloride staining. MI resulted in greater left ventricular dysfunction ( P &lt;0.05), LA pressure ( P &lt;0.0003), and reduction in atrial effective refractory periods ( P &lt;0.0001) compared with control. 2,3,5 triphenyl tetrazolium chloride staining demonstrated that the left circumflex artery, and not the LAD, group had atrial infarction. The left circumflex artery group demonstrated the following compared with the LAD or control groups: greater slowing in atrial conduction velocity ( P &lt;0.0001 and P &lt;0.001); increased absolute range of conduction phase delay ( P &lt;0.001 and P &lt;0.001); increased conduction heterogeneity index ( P &lt;0.0001 and P &lt;0.001); greater AF vulnerability ( P &lt;0.05 for both); and longer AF duration ( P &lt;0.05 for both). LAD group had modest but significant slowing in conduction velocity ( P &lt;0.01) but no change in conduction heterogeneity index or AF duration compared with control. Conclusions— Left ventricular infarction, which is known to result in atrial stretch, hemodynamic change, and neurohumoral activation, contributes partially to the atrial abnormalities in MI. Atrial ischemia/infarction results in greater atrial electrophysiological changes and propensity for AF forming the dominant substrate for AF in MI.

Abstract 2: Thrombolytic Therapy and Survival for Medicare Beneficiaries with Acute Ischemic Stroke

Background: Thrombolytic therapy (tPA) is the only fibrinolytic agent used in the treatment of acute ischemic stroke. It is recommended due to its ability to achieve early reperfusion and improve neurologic outcomes. This study assesses the survival outcome of tPA use among Medicare beneficiaries with acute ischemic stroke in the Paul Coverdell National Acute Stroke Registry (PCNASR). Methods: A total of 24,625 patients with a clinical diagnosis of acute ischemic stroke enrolled in the PCNASR from January 2008-December 2010 were linked to MEDPAR 2008-2010 database. Patients with documented reasons for not giving tPA (intravenous and/or intra-arterial) were excluded. A propensity score 1:1 matched-pair sample was created to assess survival among patients receiving tPA and not receiving tPA. The probability of survival was estimated by the Kaplan-Meier method and was compared by the test described by Klein and Moeschberger. The hazard ratio was obtained by using Cox proportional hazard regression model stratified on matched pairs. Results: A total of 3370 matched patients were selected based on age, gender, race, National Institutes of Health Stroke Scale (NIHSS), medical history of atrial fibrillation, diabetes, heart failure, smoking, prior stroke and myocardial infarction or coronary disease. Patients who received tPA had better survival than patients with no tPA (p=0.0109). The adjusted hazard ratios were 0.84, [0.72, 0.98], 0.86 [0.75, 0.99] and 0.84 [0.74, 0.96] for 30-days, 90-days and one-year survival, respectively. Limitation: In the absence of direct identifiers, the linked datasets might contain possible incorrect information. Conclusion: This analysis found approximately 15% improved short and long term survival among patients receiving tPA for acute ischemic stroke in a non-clinical trial setting.

Usefulness of Heart Rate to Predict One-Year Mortality in Patients With Atrial Fibrillation and Acute Myocardial Infarction (from the OMEGA Trial)

In the setting of acute myocardial infarction and sinus rhythm, the heart rate (HR) has been demonstrated to correlate closely with mortality. In patients presenting with acute myocardial infarction and atrial fibrillation (AF) on admission, however, the prognostic relevance of the HR has not yet been systematically addressed. A post hoc subgroup analysis of the data from the OMEGA trial was conducted to analyze whether the admission HR determines the 1-year mortality in patients presenting with AF in the setting of acute myocardial infarction. Of 3,851 patients enrolled in the OMEGA study, 211 (6%) presented with AF on admission. This subgroup was dichotomized according to the admission HR (cutoff 95 beats/min). Multiple regression analysis revealed that an admission HR of ≥95 beats/min independently determined the 1-year mortality in patients with AF (odds ratio 4.69, 95% confidence interval 1.47 to 15.01; p = 0.01). In conclusion, this is the first study demonstrating that a high HR (≥95 beats/min) on admission in patients with AF and acute myocardial infarction is associated with an almost fivefold mortality risk.