Occurrence Of Atrial Arrhythmias Research Articles

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A prominent crista terminalis associated with atrial septal aneurysm that mimics right atrial mass leading to atrial arrhythmias: a case report

IntroductionThe crista terminalis is a variant of normal anatomical structures within the right atrium that mimics an atrial mass on a transthoracic echocardiogram. Atrial septal aneurysm is a rare but well-recognized cardiac abnormality of uncertain clinical significance. The association between crista terminalis and atrial septal aneurysm is unusual but not completely casual. Both anatomical heart structures can lead to atrial arrhythmias.Case presentationThis case report describes the accidental discovery during an echocardiographic examination of a 64-year-old Caucasian woman who had a left bundle branch block and palpitations.ConclusionThe clinical relevance of this anatomical evidence in unknown. This was an occasional finding of transthoracic echocardiography, but in this case it is possible to assume its relationship with the occurrence of atrial arrhythmias, and also that computed tomography scan and cardiovascular magnetic resonance is mandatory to define the structure and function of these incidental findings.

Relation of Prolonged Tissue Doppler Imaging-Derived Atrial Conduction Time to Atrial Arrhythmia in Adult Patients With Congenital Heart Disease

Atrial arrhythmia (AA) is common in adult patients with congenital heart disease (CHD). To enable the prevention of AA or its complications, timely identification of adult patients with CHD at risk of AA is crucial. Long total atrial activation times have been related to AA. Tissue Doppler imaging (TDI) permits noninvasive evaluation of the total atrial conduction time (PA-TDI duration). The present study evaluated the association between the PA-TDI duration and the development of AA in adult patients with CHD. A total of 223 adult patients with CHD were followed up for the occurrence of AA after PA-TDI duration assessment. The PA-TDI duration was defined as the interval from the onset of the P wave on the electrocardiogram to the peak of the A' wave at the lateral atrial wall on TDI tracings. Among the various clinical and echocardiographic parameters, the association between the PA-TDI duration and AA occurrence was investigated. The median follow-up was 39 months (interquartile range 21 to 57). A PA-TDI duration of ≥126 ms was associated with AA during follow-up (log-rank, p <0.001). On multivariate analysis, a PA-TDI duration >126 ms (hazard ratio 2.25, 95% confidence interval 1.21 to 4.19) and history of AA (hazard ratio 4.89, 95% confidence interval 2.75 to 8.71) were independently associated with the occurrence of AA. In conclusion, PA-TDI duration and a history of AA were independently associated with the occurrence of AA in adult patients with CHD. The PA-TDI duration is a useful tool to identify patients with CHD at risk of AA during follow-up.

212 Interest of a new « Mode Switch » function in follow-up of atrial arrhythmias with dual-chamber pacemakers

Dual-chamber (DC) pacing benefits are impaired by the occurrence of atrial arrhythmias (AA). Pacemakers (PM) have been enhanced by a mode-switch function (MSF) which allows the switch from DDD(R) to DDIR pacing in presence of AA. We analyzed MSF at 6 and 12-month (m) follow-up in 369 patients (Pts) aged 77+/−9 y, free of permanent AA (59%), implanted with Kappa® DC PMs (Medtronic, MN, USA) for II and III AV block (65%), and sinus dysfunction (SD) (35%). 52% had no cardiopathy and there was no difference in electrical parameters at implant regardless lead and indication. No specific programming was imposed. MS function data was collected at each follow-up: number of MS, average percentage of time in AA. EGM was used to confirm AA in most cases. The MSF shows AA episode rate of 61% at 6 m and 48% at 12 m. Moreover, 29% of pts (Gr1) had no AA during the 12 m, 11% had AA only during the last 6 m (Gr2), 24% only during the first 6 m (Gr3 and Gr5) and 37% during the 12 m (Gr4 and Gr6). Statistically, there was no significant difference between groups concerning the number of MS and between the percentage of time in AA at each follow-up. Long-term follow-up confirms results already described in the literature, and the MS event counters may predict the existence of AA. EGM confirms the specificity of this function. Number of MS is significantly high in SD (p < 0.05), whereas the observation of a high number of MS may also point to oversensitivity of the MSF. Percentage time spent in AA is a revealing parameter, as it represents average time during which pts had been in AA since the previous follow-up. This study confirms that AA occurrence remains an important complication in PM patients, regardless indication. Simple examination of MS recordings can lead to suspicion of major AA. The gravity of this AA can be quickly determined, but only detailed examination of MS episodes can confirm the diagnosis.

Combined Atrial Septal Defect Surgical Closure and Irrigated Radiofrequency Ablation in Adult Patients

Atrial arrhythmias are relatively common among patients over 40 years old with atrial septal defect (ASD) and are a precipitating cause of heart failure. Surgical closure of the ASD in these patients is feasible and is associated with a low mortality rate and a beneficial effect on the clinical status; however the occurrence of atrial arrhythmia does not decrease after surgery. We present the results of our preliminary experience with surgical ASD closure combined with intraoperative irrigated radiofrequency (IRF) ablation in adult patients. During a 26-month period between September 2002 and December 2004, 15 patients more than 40 years old with ASD and atrial arrhythmia underwent elective surgical closure of the defect and intraoperative IRF ablation. All patients had supraventricular arrhythmias: 8 had permanent atrial fibrillation, whereas 7 had previous episodes of atrial flutter or intra-atrial reentry tachycardia. The biatrial approach (Cox-Maze III procedure) was used in 7 patients and a right-sided Maze procedure (ablation lines on the right atrium only) was carried out in the remaining 8 patients. All patients survived the procedure. Fourteen patients left the operating room in sinus rhythm and 1 had a pacemaker implanted. There were no complications resulting from the IRF ablation. All 15 patients survived over the average follow-up period of 24 months. Thirteen patients were still in sinus rhythm, 1 had pacemaker rhythm, and only 1 (1 of 15; 6.5%) suffered a recurrence of atrial fibrillation 3 months after the procedure. We suggest adding intraoperative IRF ablation during surgical closure of an ASD in all adult ASD patients with arrhythmias. The IRF ablation is easy to perform, safe, and effective.

P-051 influence of ventricular pacing rate in the occurrence of atrial arrhythmias in pacemaker patients

P-051 influence of ventricular pacing rate in the occurrence of atrial arrhythmias in pacemaker patients

P-051 influence of ventricular pacing rate in the occurrence of atrial arrhythmias in pacemaker patients

P-051 influence of ventricular pacing rate in the occurrence of atrial arrhythmias in pacemaker patients

Interaction between the autonomic nervous system and atrial tachyarrhythmias.

Atrial tachyarrhythmias are the most common arrhythmias in the general population. The abundant experimental evidence suggests that the autonomic nervous system plays an important role in the occurrence of atrial arrhythmias. However, complex interactions of the autonomic nervous system with the arrhythmogenic substrate make it difficult to correlate human arrhythmias with the laboratory data. Development of new methods to explore the subtle modulation of the autonomic nervous system may have implications for understanding the arrhythmogenic mechanism and providing an effective therapy.

Thoracic epidural analgesia: Its role in postthoracotomy atrial arrhythmias

Objective: To determine the effects of thoracic epidural analgesia (TEA) management on the incidence of atrial arrhythmias (AAs) after thoracotomy for lung resection. Design: Retrospective. Setting: A major university medical center. Participants: The medical records of 185 consecutive patients who underwent thoracotomy between 1993 and 1997 were reviewed; patients with TEA only were included in the analysis. Interventions: None. Measurements and Main Results: There was a 20% incidence of AAs after thoracotomy. Preoperative predictors of AAs were age >65 years, cardiac history, and an abnormal electrocardiogram (ECG). There was a temporal relationship between epidural catheter removal and occurrence of AAs. Fourteen patients developed AAs before TEA catheter removal, whereas 29 patients developed AAs after TEA catheter removal (p = 0.01). There was no relationship between anatomic site of epidural catheter placement or choice of epidural agent and AAs. Conclusions: AAs after thoracotomy were common. These AAs were associated with increased age, cardiac history, abnormal ECG, increased cost, increased length of hospital stay, and time of epidural catheter removal. Although a cause-and-effect relationship cannot be inferred from this study, the presence or absence of TEA was found to have a temporal relationship with the incidence of AAs. Copyright © 2000 by W.B. Saunders Company