Noninvasive localization of accessory pathways in patients with Wolff-Parkinson-White syndrome: a strain imaging study

Noninvasive techniques for the localization of the accessory pathways [APs] might help guide mapping procedures and ablation techniques. We sought to examine the diagnostic accuracy of strain imaging for the localization of the APs in Wolff-Parkinson-White syndrome. We prospectively studied 25 patients [mean age = 32 +/- 17 years, 58.3% men] with evidence of pre-excitation on electrocardiography [ECG]. Electromechanical interval was defined as the time difference between the onset of delta wave and the onset of regional myocardial contraction. Time differences between the onset of delta wave [delta] and the onset of regional myocardial contraction [delta-So], peak systolic motion [delta-Sm], regional strain [delta-epsilon], peak strain [delta-epsilonp], and peak strain rate [delta-SRp] were measured. There was a significant difference between time to onset of delta wave to onset of peak systolic motion [mean +/- SD] in the AP location [A] and normal segments [B] versus that in the normal volunteers [C] [A: [57.08 +/- 23.88 msec] vs. B: [75.20 +/- 14.75] vs. C: [72.9 0 +/- 11.16]; p value [A vs. B] = 0.004 and p value [A vs. C] = 0.18] and [A: [49.17 +/- 35.79] vs. B: [67.60 +/- 14.51] vs. C: [67.40 +/- 6.06 msec]; p value [A vs. B] < 0.001 and p value [A vs. C] = 0.12, respectively]. Our study showed that strain imaging parameters [[delta-So] and [delta-Strain]] are superior to the ECG in the localization of the APs [84% vs. 76%]

Very late effects of postoperative atrial fibrillation on outcome of coronary artery bypass graft surgery

Atrial fibrillation [AF] after coronary artery bypass graft [CABG] is a common complication with potentially higher risk of adverse outcome and prolonged hospital stay. To determine the impact of postoperative AF [POAF] on long-term outcome in a large cohort of patients who underwent CABG. We conducted an observational cohort study of 989 patients who underwent isolated CABG with more than 5-year follow-up. Patient divided in two groups: patients with and without POAF. In this study, atrial fibrillation developed after CABG in 156 patients [15.8%]. Patients with POAF were generally older [P = 0.001] and presented more often with comorbidities including congestive heart failure [P = 0.001], hypertension [P = 0.001], peripheral vascular disease [P = 0.001], hyperlipidemia [P = 0.009], and renal failure [P = 0.001]. Five-year mortality was observed in 23 [2.3%] patients. Patients with POAF had higher five-year mortality rate than those without POAF. Multivariate logistic analysis showed that AF after surgery has a strong effect on mortality [HR, 3.3; 95% CI, 0.04-10.8, P = 0.04] and morbidity rates [HR, 4.0; 95% CI, 2.35-6.96, P = 0.001]. Postoperative atrial fibrillation strongly predicts higher long-term mortality and morbidity following coronary artery bypass graft

Pharmacological and nonpharmacological prevention of atrial fibrillation after coronary artery bypass surgery

Atrial fibrillation [AF] is the most common complication of coronary artery bypass graft surgery [CABG]. The reported incidence of AF after CABG varies from 20% to 40%. Postoperative AF [POAF] is associated with increased incidence of hemodynamic instability, thromboembolic events, longer hospital stays, and increased health care costs. A variety of pharmacological and nonpharmacological strategies have been employed to prevent AF after CABG. Preoperative and postoperative beta blockers are recommended in all cardiac surgery patients as the first-line medication to prevent POAF. Sotalol and amiodarone are also effective and can be regarded as appropriate alternatives in high-risk patients. Corticosteroids and biatrial pacing may be considered in selected CABG patients but are associated with risk. Magnesium supplementation should be considered in patients with hypomagnesemia. There are no definitive data to support the treatment with nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, procainamide, and prop afenone, or anterior fat pad preservation to reduce POAF

Signal-averaged electrocardiography in patients with advanced heart failure: a better indicator of left ventricular enlargement compared with conventional electrocardiography

The signal-averaged electrocardiograph is a noninvasive method to evaluate the presence of the potentials generated by tissues activated later than their usual timing in the cardiac cycle. The purpose of this study was to demonstrate the correlation between the filtered QRS duration obtained via the signal-averaged electrocardiography and left ventricular dimensions and volumes and then to compare it with the standard electrocardiography. We included patients with advanced systolic left ventricular dysfunction [ejection fraction

Approach to the patient with combined coarctation of aorta and Wolf-Parkinson-White syndrome

At the present time the treatment of choice for postductal coarctation of aorta is percutaneous angioplasty and stenting. One crucial step for successful stenting of coarctation is accurate positioning of the stent across the lesion, which is difficult due to high pressure blood flow at the site of the coarct. To solve this problem, rapid pacing has been used to decrease cardiac output and blood pressure for a few seconds and prevent excessive motion of the stent during deployment. However, if coarctation is combined with pre-excitation syndrome, rapid atrial/ventricular pacing could cause life-threatening tachyarrhythmias. In this paper, we report a 28-year-old women with combined coarctation of aorta and Wolf-Parkinson-White syndrome who underwent radio frequency catheter ablation of the accessory pathway and then stenting angioplasty of the coarctation was performed without any complication

Transient severe left ventricular diastolic dysfunction during intraoperative transesophageal echocardiography - A case report

A 55-year-old man with significant lesion of left anterior descending artery and left ventricular systolic dysfunction, became candidate for coronary artery bypass grafts surgery. Intraoperative transesophageal echocardiography [TEE] was done for evaluation of severity of mitral regurgitation. During surgery, suddenly systolic blood pressure dropped to 50 mmHg and lasted for 2 minutes and grade III left ventricular [LV] diastolic dysfunction occurred. After restoring blood pressure to 110/60 mmHg, LV diastolic pattern returned to baseline pattern. The decreased coronary perfusion pressure and its effect on diastolic function may be responsible for this pattern of diastolic dysfunction