Development Of Atrial Flutter Research Articles

Diabetes, prediabetes, and atrial fibrillation-A population-based cohort study based on national and regional registers.

Previous studies have shown an increased risk for atrial fibrillation and atrial flutter (AF) in people with type 2 diabetes and prediabetes. It is unclear whether this increase in AF risk is independent of other risk factors for AF. To investigate the association between diabetes and different prediabetic states, as independent risk factors for the onset of AF. We performed a population-based cohort study in Northern Sweden, including data on fasting plasma glucose, oral glucose tolerance test, major cardiovascular risk factors, medical history, and lifestyle factors. Participants were divided into six groups depending on glycemic status and followed through national registers for AF diagnosis. Cox proportional hazard model was used to assess the association between glycemic status and AF, using normoglycemia as reference. The cohort consisted of 88,889 participants who underwent a total of 139,661 health examinations. In the model adjusted for age and sex, there was a significant association between glycemic status and development of AF in all groups except the impaired glucose tolerance group, with the strongest association for the group with known diabetes (p-value <0.001). In a model adjusted for sex, age, systolic blood pressure, body mass index, antihypertensive drugs, cholesterol, alcohol, smoking, education level, marital status, and physical activity, there was no significant association between glycemic status and AF. The association between glycemic status and AF disappears upon adjustment for potential confounders. Diabetes and prediabetes do not appear to be independent risk factors for AF.

The Short QTc Is a Marker for the Development of Atrial Flutter and Atrial Fibrillation.

A short QT interval has been difficult to define, and there is debate whether it exists outside of an extremely small group of individuals with inherited channelopathies and whether it predicts cardiac arrhythmias. The objective was to identify cases with short QT and their consequences. Our hospital ECG database was screened for cases with a QTc based on the Bazett formula (QTcBZT) of less than 340 ms. The QTc was recalculated using the spline (QTcRBK) formula, which more accurately adjusts for the heart rate and identifies cases based on percentile distribution of the QT interval. The exclusion criteria were presence of bundle branch block, arrhythmias, or electronic pacemakers. An age- and sex-matched cohort was obtained from individuals with normal QT intervals with the same exclusion criteria. There were 28 cases with a short QTc (QTcRBK < 380 ms). The age was 69.6 ± 14.6 years (mean ± SD) (50% males). The QT interval was 305.7 ± 61.1 ms with QTcRBK 308.4 ± 31.4 ms. Subsequent ECGs showed atrial flutter in 21%, atrial fibrillation in 18%, and atrial tachycardia in 4% of cases. Thus, atrial arrhythmias occurred in 43% of cases. This incidence was significantly (p < 0.0001) greater than the incidence of atrial arrhythmias in age- and sex-matched controls. In conclusion, a short QT interval can be readily identified based on the first percentile of the new QTc formula. A short QTc is an important marker for the development of atrial arrhythmias, including atrial flutter and atrial fibrillation, with the former predominating. It should be part of patient assessment and warrants consideration to develop strategies for detection and prevention of atrial arrhythmias.

Development of atrial flutter after induction of general anesthesia and conversion to atrial fibrillation −A case report−

Development of atrial flutter after induction of general anesthesia and conversion to atrial fibrillation −A case report−

The Development of Atrial Flutter and Fibrillation

The Development of Atrial Flutter and Fibrillation

Arrhythmia surgery for atrial fibrillation associated with atrial septal defect: Right-sided maze versus biatrial maze

Although it has been inferred that a biatrial maze procedure for atrial fibrillation in left-sided heart lesions may lead to better outcomes compared with a limited left atrial lesion set, it remains controversial whether the biatrial maze procedure is superior to the right atrial maze procedure in right-sided heart lesions. A retrospective review was performed for 56 adults who underwent surgical closure of atrial septal defect and various maze procedures for atrial fibrillation between June 1998 and February 2011. The median age at operation was 59 years (range, 34-79 years). Clinical manifestations of atrial fibrillation were paroxysmal in 8 patients, persistent in 15 patients, and long-standing persistent in 33 patients. A right atrial maze procedure was performed in 23 patients (group 1), and a biatrial maze procedure was performed in 33 patients (group 2). Treatment failure was defined as atrial fibrillation recurrence, development of atrial flutter or other types of atrial tachyarrhythmia, or implantation of a permanent pacemaker. The Cox proportional hazards model was used to identify risk factors for decreased time to treatment failure. During the median follow-up period of 49 months (range, 5-149 months), there was no early death and 1 late noncardiac death. On Cox survival model, group 1 showed a significantly decreased time to treatment failure in comparison with group 2 (hazard ratio, 5.11; 95% confidence interval, 1.59-16.44; P = .006). Maintenance of normal sinus rhythm without any episode of atrial fibrillation recurrence at 2 and 5 years postoperatively was 57% and 45% in group 1, respectively, and 82% and 69% in group 2, respectively. Left-sided ablation in addition to a right atrial maze procedure leads to better electrophysiologic outcome in atrial fibrillation associated with atrial septal defect.

Fixed intercaval block in the setting of atrial fibrillation promotes the development of atrial flutter

Fixed intercaval block in the setting of atrial fibrillation promotes the development of atrial flutter

Electrophysiological Properties of the Right Atrial Septum in Patients with Atrial Tachyarrhythmias

Common-type atrial flutter (AFL) is a type of atrial tachyarrhythmia with counterclockwise rotation around the tricuspid annulus within the right atrium (RA). It was recently reported that the electrogram voltage reduction observed in the RA was involved in the development of AFL. However, the relationship between the low voltage areas and conduction velocity during AFL has not been fully described. In this study, patients with AFL (n = 17) and without AFL (n = 4) were examined using an electro-anatomical mapping system. The patients with AFL were divided into 2 groups; AFL group (n = 8) and coronary sinus ostium (CSO) group (n = 9). The AFL group was defined as exhibiting the maintenance of AFL and the CSO group sinus rhythm before the catheter ablation. The electrogram voltages of each area in the RA (septum, and posterior and lateral walls), conduction velocity during AFL and transverse and longitudinal conduction velocities were evaluated. In the septum, the mean electrogram voltage was significantly lower in the AFL and CSO groups than in the group without AFL. Moreover, the conduction velocity during AFL was significantly slower in the septum, and both the septal transverse and longitudinal conduction velocities were significantly slower in the AFL and CSO groups than in the group without AFL. In conclusion, these findings suggest that both the slower conduction velocities and lower voltage in the RA septum may be involved in the development of AFL. Thus, ablation of the RA septum may represent a therapeutic approach of AFL.

Anatomical characteristics of the cavotricuspid isthmus in patients with and without typical atrial flutter: Analysis with two- and three-dimensional intracardiac echocardiography

The cavotricuspid isthmus (CTI) is crucial in the ablation of typical atrial flutter (AFL), and consequently the CTI anatomy and/or its relation to resistant ablation cases have been widely described in human angiographic studies. Intracardiac echocardiography (ICE) has been shown to be a useful tool for determining detailed anatomical information. Thus, this technology may also allow the visualization of the anatomical characteristics of the CTI, providing an opportunity to further understand the anatomy. We conducted a study to compare the anatomy of the CTI between the patients with and without AFL and to characterize the anatomy of the CTI in the patients with AFL resistant to ablation. Twelve patients with typical AFL and 20 without AFL were enrolled in the study. Two-dimensional (2D) intracardiac echocardiography (ICE) was performed. The recordings were obtained with a 9F, 9-MHz ICE catheter from the right ventricular outflow tract to the inferior vena cava by pulling the catheter back 0.3 mm at a time under guidance with echocardiographic imaging in a respiration-gated manner. Three-dimensional (3D) reconstruction of the images of the CTI were made with a 3D reconstruction system. After the acquisition of the ICE, the CTI ablation was performed in the patients with AFL. The 2D and 3D images provided clear visualization of the tricuspid valve, coronary sinus ostium, fossa ovalis and Eustachian valve/ridge (EVR). The CTI was significantly longer in the patients with AFL than in those without AFL (median length 24.6 mm (range 17.0-39.1 mm) versus median length 20.6 mm (range 12.5-28.0 mm), respectively, P < 0.05). However, a deep recess due to a prominent EVR was observed in 9 of 12 (75%) patients with AFL and in 12 of 20 (60%) patients without AFL (N.S.). A deep recess and the relatively long CTI were related to aging in all the study patients, and that relationship was similar in a limited number of patients without AFL. In five patients with AFL resistant to ablation, a deep recess and prominent EVR were observed. The 2D and 3D ICE were useful for visualizing the complex anatomy of the CTI and identifying the anatomical characteristics of the CTIs refractory to ablation therapy. The anatomical changes observed in the CTI region may simply be the result of aging and may partially be involved in the development of AFL.

Factors Affecting the Development of Atrial Fibrillation and Atrial Flutter (AF) Following Autologous Hematopoietic Stem Cell Transplantation (auto-HSCT).

Background: The use of auto-HSCT has expanded to include older patients. Age is a risk factor for the development of AF in the general population. As more elderly patients undergo auto-HSCT, the risk of developing AF post-transplant may also increase. The development of AF may increase morbidity, may prolong hospitalization, and may increase the cost of hospitalization. However, few data exist evaluating the factors that contribute to the development of AF following auto-HSCT. At our institution, we have observed a large number of patients with this complication. Therefore, we performed a retrospective case-control study to determine the incidence of AF following auto-HSCT and to determine risk factors associated with the development of AF.Patients and Methods: We performed a chart review on all patients at our institution who received an auto-HSCT from November 1999 to May 2004. Cases were identified by reviewing EKGs performed post-transplant. Controls consisted of patients with similar age, year of transplant, and underlying hematologic malignancy. The following variables were examined for their association with AF: age, sex, diagnosis, disease stage at transplant, conditioning regimen, year of transplant, previous medical history including cardiac history, pre-transplant cardiology work-up, and electrolyte abnormalities immediately following auto-HSCT. Patients who developed AF were compared to controls. Multivariate logistic regression was done to evaluate the factors associated with the development of AF.Results: During the study period, 44 patients developed AF at a median of four days (range days 1–9) following auto-HSCT; incidence of 8.5%. We identified 516 patients who did not develop AF who had auto-HSCT in the same time period. Of these, 179 patients with similar characteristics were used as controls. The following variables were associated with developing AF in the multivariate model: age at transplant; median age 63 yrs (50–72) for cases vs 57 (49–72) for controls (p<0.001), abnormal renal function as determined by serum creatinine (p=0.008), history of previous arrhythmia (p<0.001), and a history of mediastinal irradiation (p=0.003). Although not significant in the multivariate model, we observed that 45% of the patients who developed AF had increased left atrial size on a pre-transplant echocardiogram as opposed to none in the controls (p<0.001). There was no difference in the length of hospital stay between the cases and controls (p=0.13). We did not detect a significant difference in the 100d survival between those who did and did not develop AF (90% vs 96%, p=0.25). However, patients who did not develop AF had a better overall survival (Log-rank p=0.04).Conclusions: Patients with older age, elevated serum creatinine level, history of previous arrhythmia, or history of previous mediastinal irradiation are more likely to develop AF following an auto-HSCT. Future studies should investigate whether interventions such as prophylactic beta-blockers can decrease the incidence of AF following auto-HSCT.

Ensuring Transmurality Using Irrigated Radiofrequency Modified Maze in Surgery for Atrial Fibrillation—A Simple and Effective Way

Transmural lesions are ensured with the cut and sew technique and with bipolar delivery of radiofrequency (RF) energy [Ann. Thorac. Surg. 74 (2002) 2210]. Unipolar sources of energy such as radiofrequency and microwave do not guarantee transmurality and may require intraoperative testing to evaluate complete lesion depth. Transmural lesions are generally effective electrophysiological lesions and are desirable as it does not allow atrial fibrillation (AF) breakthrough or development of atrial flutter in most instances. We describe a simple and effective way of ensuring transmurality using irrigated radiofrequency in the modified maze surgery for AF.

Hemodynamic sequelae of cardiac arrhythmias.

The hemodynamic consequences of cardiac arrhythmias depend on various factors, including the ventricular rate and the duration of the abnormal rate, the temporal relationship between atrial and ventricular activity, the sequence of ventricular activation, the functional state of the heart, the irregularity of the cycle length, associated drug therapy, the peripheral vascular vasomotor system, disease in organ systems other than the heart, and the degree of anxiety caused by the disease processes. Sinus bradycardia, even with rates as low as 40 beats/min, may not be associated with significant hemodynamic consequences unless the stroke volume is limited by myocardial or valvular disease, as in acute myocardial infarction. Cardiac output usually, but not invariably, falls when atrial fibrillation replaces normal sinus rhythm, even at comparable ventricular rates, both at rest and during exercise. Similar observations have been made during the development of atrial flutter despite the persistence of effective mechanical atrial activity in at least some cases. Marked hemodynamic changes are frequent in the course of ventricular tachycardia with systemic arterial hypotension, a decrease in cardiac output, and evidence of cerebral, coronary, and renal vascular insufficiency. Cyclic variations in systemic and pulmonary arterial pressures are common during atrioventricular dissociation. Cardiac output is generally depressed during the severe bradycardia of acquired complete heart block with evidence of atrioventricular valvular insufficiency. Increase of the heart rate by ventricular pacing reverses all or some of these abnormalities. The changes in congenital complete heart block are considerably less severe because myocardial insufficiency is less frequently seen in congenital complete heart block.

Hemodynamics in atrial flutter with spontaneous reversion to normal sinus rhythm

During cardiac catheterization of a 31-year-old woman with mitral stenosis, the development of atrial flutter and subsequent spontaneous reversion to normal sinus rhythm provided an opportunity to study the hemodynamic effects of the arrhythmia under ideally controlled conditions. The ventricular rate remained constant; no cardiac drugs were administered, and the patient, who was neither aware of the arrhythmia nor had symptoms referable to it, remained in a fairly stable, steady state. Neither cardiac output nor pressure levels in the heart and the pulmonary vascular bed were altered significantly by the atrial flutter. Evidence of mitral and tricuspid insufficiency appeared during the arrhythmia but was not present during sinus rhythm. The valvular dysfunction was related to the current concept of the importance of normal atrial contraction to adequate closure of the atrioventricular valves.

Atrial flutter during quinidine therapy of atrial fibrillation

1. 1. Development of atrial flutter is a common result of quinidine therapy given for conversion of atrial fibrillation to normal sinus rhythm. 2. 2. The fact that atrial fibrillation can be changed during quinidine therapy to atrial flutter or tachycardia before final conversion to sinus rhythm, and that when reversion takes place the rhythm again proceeds from sinus through atrial premature systoles, atrial tachycardia, and atrial flutter to atrial fibrillation lends support to the theory of unitary nature of the atrial arrhythmias.