Re-establishment Of Sinus Rhythm Research Articles

Emergency Department capacity to initiate thromboprophylaxis in patients with atrial fibrillation and thrombotic risk after discharge: URGFAICS cohort analysis.

Atrial fibrillation (AF) is the most prevalent heart rhythm disorder in the general population. Stroke prevention is one of the leading management objectives in the treatment of AF patients. The variables associated with the non-initiation of thromboprophylaxis in patients with thrombotic risk consulting for an episode of AF in Emergency Departments (ED) were investigated. This was a multipurpose, analytical, non-interventionist, multicenter Spanish study with a prospective 30-day follow-up. All patients ≥ 18years of age consulting to the ED for the casual finding of AF in an electrocardiogram (ECG) performed 12h prior to the consultation or with symptoms related to AF were enrolled from September 1, 2016 to February 28, 2017. Patients not previously received thromboprophylaxis were selected. Multivariate analysis was performed to calculate the odds ratio (OR) and the 95% confidence interval (CI). A total of 634 patients, not received thromboprophylaxis and at high thrombotic risk, were included. Of these, 251 (39.6%) did not receive thromboprophylaxis at ED discharge. In the multivariate analysis, non-initiation of anticoagulation at discharge from the ED was mostly related to cognitive impairment (OR 3.95; (95% CI 2.02-7.72), cancer history (OR 2.12; (95%CI 1.18-3.81), AF duration < 48h (OR 2.49; (95% CI 1.48-4.21) and patients with re-establishment of sinus rhythm (OR 3.65; (95% CI 1.47-9.06). Reinforcement of the use of CHA2DS2-VASC as a stroke risk scale and empowerment of ED physicians is a must to improve this gap in care.

Smart decisions in rhythmology : What should we know? What should be do? What do we still have to learn?

Heart rhythm disorders are one of the most common cardiac problems in Germany. Every year, about 95,000 ablation procedures, 42,000 implantable cardioverter-defibrillators (ICD) and 102,000 pacemaker implantations are performed with the annual numbers continuing to increase. Besides technological innovations in the field of therapeutic devices (e.g., ablation tools), there are fundamental changes in the diagnostic workup for arrhythmias since smartwatches and wearable devices are increasingly available on the market. In this article, an overview on the latest developments in the field of invasive electrophysiology and rhythmology is provided. The following are explained: why electrocardiograms (ECGs) from smartwatches/wearables are usually of good quality and can be used for screening or confirmation of a diagnosis; why we should consider re-establishment of sinus rhythm in patients with atrial fibrillation or limited left ventricular function; to what extent investigator and center experience influence patient safety; how we can induce a physiological contraction pattern in about 70% of AV block patients by direct stimulation of the specific conduction system, why the benefit of an implantable ICD is questionable in nonischemic cardiomyopathy and ejection fraction (EF) <35 %; and finally, why cardiomyopathies induced by ventricular extrasystoles (VES) are so difficult to predict.

Evaluation of shortness of breath after atrial fibrillation ablation—Is there a stiff left atrium?

Ablation has emerged as the most effective therapy for atrial fibrillation (AF), with the primary goal to improve symptoms. However, there is a subset of patients who develop limiting symptoms after successful ablation despite reestablishment of sinus rhythm. There is now recognition of “stiff left atrial (LA) syndrome” related to adverse consequences of ablation itself on LA hemodynamics, as described by Gibson and others. 1 Gibson D.N. Di Biase L. Mohanty P. et al. Stiff left atrial syndrome after catheter ablation for atrial fibrillation: clinical characterization, prevalence, and predictors. Heart Rhythm. 2011; 8: 1364-1371 Abstract Full Text Full Text PDF PubMed Scopus (157) Google Scholar , 2 Welch T.D. Coylewright M. Powell B.D. Asirvatham S.J. Gersh B.J. Dearani J.A. Nishimura R.A. Symptomatic pulmonary hypertension with giant left atrial v waves after surgical maze procedures: evaluation by comprehensive hemodynamic catheterization. Heart Rhythm. 2013; 10: 1839-1842 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar Although relatively uncommon (1.4% incidence in the Gibson series), this syndrome is important to diagnose, as it can cause severe unexplained dyspnea. In this review, we will discuss the hemodynamics of ablation-related injury and provide a diagnostic approach to persistent dyspnea after ablation.

Rhythmic and haemodynamic determinants of long-term survival after radiofrequency ablation of atrial fibrillation in mitral valve surgery.

The aim of the present study was to evaluate the effects of sinus rhythm recovery on long-term survival after radiofrequency (RF) ablation in patients with permanent atrial fibrillation (AF) undergoing surgery for mitral valve disease. This study included 173 consecutive patients (101 men and 72 women, age 67 ± 9 years) with AF and mitral valve disease who underwent RF ablation procedure associated with mitral valve surgery. Four patients died during hospitalization. At the 6-year follow-up, sinus rhythm was present in 68% of the surviving patients. Thirty-nine patients remained in persistent AF after hospital discharge. In patients with stable sinus rhythm, mortality (10 vs. 30%) and recurrent hospitalization were significantly lower than in patients with persistent AF, but functional capacity improved. The incidence of stroke was also lower in patients with stable sinus rhythm. A pre-operative higher right and left atrial area, pulmonary hypertension, and rheumatic disease were associated with the persistence of AF despite RF ablation. At multivariate analysis, only age and concomitant tricuspid valve repair were independently associated with mortality, whereas the right atria area and tricuspid valve repair were associated with persistent AF. Although the re-establishment of sinus rhythm by unipolar RF ablation is associated with a higher survival rate after mitral valve surgery, our data suggest that a more severe haemodynamic impairment, in particular in patients with rheumatic valve disease, may be responsible both for higher long-term mortality and lower rate of sinus rate maintenance.

Atorvastatin Reduces the Incidence of Postoperative Atrial Fibrillation in Statin-Naive Patients Undergoing Isolated Heart Valve Surgery: A Double-Blind, Placebo-Controlled Randomized Trial.

Atorvastatin has been demonstrated to reduce the incidence of postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery, but its effect on isolated heart valve surgery is unknown. In a randomized, double-blinded, placebo-controlled trial, 58 patients who underwent isolated heart valve surgery supported by on-pump cardiopulmonary bypass were randomly assigned to receive either placebo (n = 29) or 40 mg of atorvastatin once daily starting 3 days preoperatively and continuing within 5 days postoperatively (n = 29). A continuous monitoring tool and an electrocardiographic Holter monitoring were used for detecting the POAF (Clinical Trial Registration: www.clinicaltrials.gov; Unique Identifier: NTC02084069). The patients' median age was 49 years, and 67% were female. In all, 6 (21%) and 13 (45%) cases of POAF were observed in the atorvastatin and placebo groups, respectively (P = .050). The duration of AF before re-establishment of sinus rhythm was significantly lower in the atorvastatin group than in the placebo group (median of 70 vs 132 minutes, P = .026). The lengths of intensive care unit and hospital stay were comparable between the groups. The increase in postoperative white blood cell count was significantly lower in the atorvastatin group than in the placebo group (median of 1.5 vs 2.3 × 10(3)/µL, respectively, P = .019). After adjustment, the atorvastatin treatment was associated with a decrease in the risk of developing POAF (odds ratio 0.122, 95% confidence interval 0.027-0.548, P = .006). Perioperative treatment with 40 mg of atorvastatin is useful to decrease the incidence of POAF in the statin-naive patients undergoing isolated heart valve surgery.

Patients with persistent atrial fibrillation profit most from atrial remodelling after re-establishment of sinus rhythm after pulmonary vein isolation

Patients with persistent atrial fibrillation profit most from atrial remodelling after re-establishment of sinus rhythm after pulmonary vein isolation

Evaluation of atrial function by 2D strain echocardiography in patients with atrial fibrillation

Abstract Objectives To evaluate atrial function by 2D strain in patients with atrial fibrillation (AF) and normal or slightly increased atrial size and to verify whether lower atrial strain is associated with more frequent AF recurrences. Materials and methods We studied 50 patients with AF, mean age 59.6 ± 13 years and 50 age-and gender-matched controls. We analyzed left atrial function through 2Dstrain imaging, after the re-establishment of sinus rhythm (SR) and we investigated about the recurrences of the arrhythmia. Results Atrial strain (AS) was lower in AF patients vs controls (LA p Conclusions The assessment of atrial function by strain imaging might help to identify patients who need more aggressive therapeutic strategies. Due to the small studied population and the short follow up period our data need to be confirmed by further and wider studies.

Acute Pharmacological Conversion of Atrial Fibrillation to Sinus Rhythm

Atrial fibrillation is a common arrhythmia that affects >2 million adults in the United States, with ≈160 000 new cases diagnosed each year. Although many patients are asymptomatic, those with symptoms can experience palpitations, dyspnea, angina, exertional fatigue, and presyncope. The long-term consequences of atrial fibrillation are well described and include increased risk of thromboembolic events that require chronic anticoagulation in most patients. Reestablishment of sinus rhythm is a key long-term management strategy that would be expected to relieve symptoms, improve hemodynamics, and reduce the risk of thromboembolic complications. Cardioversion is recommended for patients with relatively new-onset atrial fibrillation who are hemodynamically unstable, have uncontrolled rapid ventricular response, or have cardiac ischemia or for acute management of symptoms.1 Options include synchronized direct current cardioversion, which requires conscious sedation to manage the discomfort of the procedure and is associated with ventricular fibrillation in 0.2% of cases, sinus bradycardia or sinus arrest in 1% of cases, and thromboembolism in 1% of cases not adequately anticoagulated.2,3 Pharmacological cardioversion is less effective than direct current cardioversion, but several drugs (dofetilide, flecainide, ibutilide, dofetilide, and propafenone) are currently approved for this indication. These drugs carry risks similar to those of electric cardioversion with the additional concerns of prolonging the QT interval and developing torsade de pointes arrhythmias. Rates of spontaneous conversion, without the attendant risks of pharmacological or electric conversion, have been reported to be as high as 73% within the first 24 hours after onset, with <50% of patients spontaneously converting after 72 hours of atrial fibrillation.4 Given this background, 2 new pharmacological agents to convert atrial fibrillation to sinus rhythm in the acute care setting were reviewed by the Cardiovascular and Renal Drugs Advisory Committee of …

Restoration of myocardial bioenergetic metabolism in swine after periods of ischemic ventricular fibrillation

Myocardial mitochondrial function and high energy phosphate levels were measured in normal swine, in swine after either 5 or 10 minutes of ischemic ventricular fibrillation (IVF) while on cardiopulmonary bypass, and in swine defibrillated after either 5 or 10 minutes of IVE. The damage to myocardial mitochondria induced by IVF, such as partial uncoupling, decreased oxygen uptake, and loss of cytochrome oxidase activity, was completely reversed almost instantly by coronary artery perfusion and the restoration of sinus rhythm. After either 5 or 10 minutes of IVF followed by coronary artery reperfusion and defibrillation, myocardial creatine phosphate (CP), adenosine monophosphate (AMP) and adenosine diphosphate (ADP) return to normal levels very rapidly. However, adenosine triphosphate (ATP) levels remain significantly lower than control levels. If the bioenergetic mechanisms of swine and human myocardium are similar, it appears that IVF at least for a 10 minute period produces no damage to myocardial mitochondria that is not corrected by perfusion of the coronary arteries and re-establishment of sinus rhythm. Furthermore, sinus rhythm can be re-established and maintained despite signficantly lower levels of myocardial ATP.

Alterations in cardiac function immediately following electrical conversion of atrial fibrillation to normal sinus rhythm.

An assessment was made of cardiac function by means of right heart catheterization before and immediately after conversion of atrial fibrillation to sinus rhythm in 11 studies on 10 human subjects. Comparable data during exercise were available in five studies. Medical management of patients in this study was identical to that employed routinely for this procedure. After conversion to normal sinus rhythm cardiac output response was significantly increased only during exercise. The relationship of mean right atrial and mean pulmonary wedge pressures to right and left ventricular stroke work was uniformly improved both because of decreases in these pressures and increases in work. Indirect evidence of mitral valvular regurgitation was diminished to absent after conversion. "A" waves and the pulse pressure of atrial contraction were very small in the right atrial tracings after conversion and these contours were usually inapparent on pulmonary wedge tracings. It is concluded that over-all cardiac performance was improved with re-establishment of sinus rhythm and that diminutions in atrial-venous pressure behind each ventricle may be important in explaining symptomatic improvement following electroconversion. Measures of both pressure and flow were required for complete description of the alterations induced by this intervention.