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Article in Chinese | WPRIM | ID: wpr-879279


This study aims to explore the intraventricular pressure difference (IVPD) within left ventricle in patients with paroxysmal atrial fibrillation (PAF) by using the relative pressure imaging (RPI) of vector flow mapping (VFM). Twenty patients with paroxysmal atrial fibrillation (PAF) and thirty control subjects were enrolled in the study. Systolic and diastolic IVPD derived from VFM within left ventricle and conventional echocardiographic parameters were analyzed. It was found that the B-A IVPD of left ventricle in PAF patients showed the same pattern as controls-single peak and single valley during systole and double peaks and double valleys during diastole. Basal IVPD was the main component of base to apex IVPD (B-A IVPD). The isovolumetric systolic IVPD was associated with early systolic IVPD, early systolic IVPD was associated with late systolic IVPD, and late systolic IVPD was associated with isovolumic diastolic IVPD (all

Atrial Fibrillation/diagnostic imaging , Diastole , Heart Ventricles , Humans , Ventricular Function, Left , Ventricular Pressure
Rev. Assoc. Med. Bras. (1992) ; 66(10): 1437-1443, Oct. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1136138


SUMMARY INTRODUCTION: The present study aimed to determine independent predictors of left atrial thrombus (LAT) in acute ischemic stroke (AIS) patients without atrial fibrillation (AF) using transesophageal echocardiography (TEE). METHODS: In this single-center, retrospective study, we enrolled 149 consecutive AIS patients. All of the patients underwent a TEE examination to detect LAT within 10 days following admission. Multivariate logistic regression analysis was performed to assess independent predictors of LAT. RESULTS: Among all cases, 14 patients (9.3%) had a diagnosis of LAT based on the TEE examination. In a multivariate analysis, elevated mean platelet volume (MPV), low left-ventricle ejection fraction (EF), creatinine, and reduced left-atrium appendix (LAA) peak emptying velocity were independent predictors of LAT. The area under the receiver operating characteristic curve analysis for MPV was 0.70 (95%CI: 0.57-0.83; p = 0.011). With the optimal cut-off value of 9.45, MPV had a sensitivity of 71.4% and a specificity of 63% to predict LAT. CONCLUSION: AIS patients with low ventricle EF and elevated MPV should undergo further TEE examination to verify the possibility of a cardio-embolic source. In addition, this research may provide novel information with respect to the applicability of MPV to predict LAT in such patients without AF.

RESUMO INTRODUÇÃO: O presente estudo teve como objetivo determinar indicadores independentes do trombo auricular esquerdo (LAT) em doentes com acidente vascular cerebral isquêmico agudo (AIS) sem fibrilação auricular (AF) utilizando ecocardiografia transesofágica (TEE). MÉTODOS: Neste único centro, estudo retrospectivo, inscrevemos 149 pacientes consecutivos com AIS. Todos os pacientes foram submetidos a exame de TEE para detectar LAT no prazo de dez dias após a admissão. A análise de regressão logística multivariada foi realizada para avaliar preditores independentes do final. RESULTADO: Entre todos os casos, 14 pacientes (9,3%) tiveram um diagnóstico de exame tardio no TEE. Numa análise multivariada, volume médio de plaquetas (VMP) elevado, fração de ejeção do ventrículo esquerdo baixo (EF), creatinina e uma velocidade de pico de esvaziamento do átrio esquerdo reduzida (LAA) foram indicadores independentes da LAT. A área sob a análise da curva característica de operação do receptor para VMP foi de 0,70 (95% IC: 0, 57-0, 83; p=0,011). Com o valor-limite ideal de 9,45, o VMP teve uma sensibilidade de 71,4% e uma especificidade de 63% para prever mais tarde. CONCLUSÃO: Os doentes AIS com EF ventricular baixa e VMP elevado devem ser submetidos a um exame de TEE adicional para determinar a possibilidade de origem cardioembólica. Além disso, esta investigação pode fornecer novas informações sobre a aplicabilidade do VMP para prever tardiamente os doentes sem AF.

Humans , Atrial Fibrillation/complications , Atrial Fibrillation/diagnostic imaging , Thrombosis/etiology , Thrombosis/diagnostic imaging , Brain Ischemia/complications , Brain Ischemia/diagnostic imaging , Atrial Appendage , Stroke/diagnostic imaging , Cross-Sectional Studies , Retrospective Studies , Risk Factors
Rev. chil. cardiol ; 39(2): 154-158, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1138528


Abstract Atrial fibrillation (AF) is an increasing health care problem associated with thromboembolic risk about 5% per year, with high mortality and morbidity when associated to stroke. Oral anticoagulants (OAC) are the treatment of choice for preventing ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF). However, these drugs are associated with an increased risk of serious complications such an intracranial hemorrhage (ICH). In this context percutaneous closure of the left atrial appendage (LAA) is an effective therapeutic alternative to OACs, with an increasing success rate. Novel devices might allow or facilitate the procedure in some anatomically and technically complicated cases. Two patients with a complex morphology of the LAA, in which the LAmbre (Lifetech Scientific [Shenzhen] Co. Ltd.) device was implanted with good technical and clinical results are presented.

Humans , Female , Aged, 80 and over , Atrial Fibrillation/therapy , Cardiac Catheterization/instrumentation , Atrial Appendage/diagnostic imaging , Septal Occluder Device , Atrial Fibrillation/diagnostic imaging , Angiography , Echocardiography , Cardiac Catheterization/methods , Stroke/prevention & control
Rev. bras. cir. cardiovasc ; 35(3): 339-345, May-June 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1137254


Abstract Objective: The current study aims to investigate the role of echocardiographically measured epicardial adipose tissue (EAT) thickness in the prediction of new-onset atrial fibrillation (AF) following coronary artery bypass grafting (CABG) surgery. Methods: One hundred and twenty-four patients scheduled to undergo isolated on-pump CABG due to coronary artery disease were enrolled to the current study. Patient characteristics, medical history and perioperative variables were prospectively collected. EAT thickness was measured using transthoracic echocardiography (TTE). Any documented episode of new-onset postoperative AF (POAF) until discharge was defined as the study endpoint. Fortyfour participants with POAF served as AF group and 80 patients without AF served as Non-AF group. Results: Two groups were similar in terms of baseline echocardiographic and laboratory findings. In laboratory findings, the groups were similar in terms of the studied parameters, except N-terminal pro-brain natriuretic peptide (NT Pro-BNP), which was higher in AF group than in Non-AF group (P=0.035). The number of left internal mammary artery (LIMA) grafts was not different in both groups. AF group had higher cross-clamp (CC) and cardiopulmonary bypass (CPB) times than Non-AF group (P=0.01 and P<0.001). In multivariate logistic regression analysis, EAT was found an independent predictor for the development of POAF (OR 4.47, 95% CI 3.07-5.87, P=0.001). Conclusion: We have shown that EAT thickness is associated with increased risk of AF development and can be used as a prognostic marker for this purpose.

Humans , Male , Female , Middle Aged , Aged , Atrial Fibrillation/etiology , Atrial Fibrillation/diagnostic imaging , Cardiac Surgical Procedures , Postoperative Complications/etiology , Postoperative Complications/diagnostic imaging , Angiotensin-Converting Enzyme Inhibitors , Adipose Tissue/diagnostic imaging , Risk Factors , Angiotensin Receptor Antagonists
Rev. bras. cir. cardiovasc ; 34(4): 495-498, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1020498


Abstract Management of symptomatic atrial tachycardia (AT) during pregnancy seems challenging, especially those originating from left atrial appendage (LAA), which easily tend to be incessant and mediate cardiomyopathy. It's contradictory between therapy and pregnancy. In this study, we report a case of a woman who presented with persistent AT, which lead to heart failure, during early pregnancy. She underwent successful catheter ablation using CartoSound and electroanatomic mapping without fluoroscopy. An electrophysiology (EP) study confirmed a focal LAA tachycardia. Soon after, left ventricular function of her heart normalized, and the patient successfully delivered a healthy child.

Humans , Female , Pregnancy , Adult , Pregnancy Complications, Cardiovascular/surgery , Atrial Fibrillation/surgery , Catheter Ablation/methods , Atrial Appendage/surgery , Pregnancy Complications, Cardiovascular/diagnostic imaging , Atrial Fibrillation/diagnostic imaging , Atrial Appendage/diagnostic imaging , Electrocardiography , Electrophysiology
Arq. bras. cardiol ; 112(4): 441-450, Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1001289


Abstract Background: Recent studies suggest that left atrial (LA) late gadolinium enhancement (LGE) can quantify the underlying tissue remodeling that harbors atrial fibrillation (AF). However, quantification of LA-LGE requires labor-intensive magnetic resonance imaging acquisition and postprocessing at experienced centers. LA intra-atrial dyssynchrony assessment is an emerging imaging technique that predicts AF recurrence after catheter ablation. We hypothesized that 1) LA intra-atrial dyssynchrony is associated with LA-LGE in patients with AF and 2) LA intra-atrial dyssynchrony is greater in patients with persistent AF than in those with paroxysmal AF. Method: We conducted a cross-sectional study comparing LA intra-atrial dyssynchrony and LA-LGE in 146 patients with a history of AF (60.0 ± 10.0 years, 30.1% nonparoxysmal AF) who underwent pre-AF ablation cardiac magnetic resonance (CMR) in sinus rhythm. Using tissue-tracking CMR, we measured the LA longitudinal strain in two- and four-chamber views. We defined intra-atrial dyssynchrony as the standard deviation (SD) of the time to peak longitudinal strain (SD-TPS, in %) and the SD of the time to the peak pre-atrial contraction strain corrected by the cycle length (SD-TPSpreA, in %). We used the image intensity ratio (IIR) to quantify LA-LGE. Results: Intra-atrial dyssynchrony analysis took 5 ± 9 minutes per case. Multivariable analysis showed that LA intra-atrial dyssynchrony was independently associated with LA-LGE. In addition, LA intra-atrial dyssynchrony was significantly greater in patients with persistent AF than those with paroxysmal AF. In contrast, there was no significant difference in LA-LGE between patients with persistent and paroxysmal AF. LA intra-atrial dyssynchrony showed excellent reproducibility and its analysis was less time-consuming (5 ± 9 minutes) than the LA-LGE (60 ± 20 minutes). Conclusion: LA Intra-atrial dyssynchrony is a quick and reproducible index that is independently associated with LA-LGE to reflect the underlying tissue remodeling.

Resumo Fundamento: Estudos recentes sugerem que o realce tardio com gadolínio (RTG) no átrio esquerdo (AE) pode quantificar a remodelação tecidual subjacente que abriga a fibrilação atrial (FA). No entanto, a quantificação do RTG-AE requer um trabalho intenso de aquisição por ressonância magnética e pós-processamento em centros experientes. A avaliação da dessincronia intra-atrial no AE é uma técnica de imagem emergente que prediz a recorrência da FA após ablação por cateter. Nós levantamos as hipóteses de que 1) a dessincronia intra-atrial está associada ao RTG-AE em pacientes com FA e 2) a dessincronia intra-atrial é maior em pacientes com FA persistente do que naqueles com FA paroxística. Método: Realizamos um estudo transversal comparando a dessincronia intra-atrial no AE e o RTG-AE em 146 pacientes com história de FA (60,0 ± 10,0 anos, 30,1% com FA não paroxística) submetidos à ressonância magnética cardíaca (RMC) durante ritmo sinusal antes da ablação da FA. Com utilização de RMC com tissue tracking, medimos o strain longitudinal do AE em cortes de duas e quatro câmaras. Definimos a dessincronia intra-atrial como o desvio padrão (DP) do tempo até o pico do strain longitudinal (DP-TPS, em %) e o DP do tempo até o pico do strain antes da contração atrial corrigido pela duração do ciclo (DP-TPSpreA, em %). Utilizamos a razão da intensidade da imagem (RIM) para quantificar o RTG-AE. Resultados: A análise da dessincronia intra-atrial levou 9 ± 5 minutos por caso. A análise multivariada mostrou que a dessincronia intra-atrial no AE esteve independentemente associada ao RTG-AE. Além disso, a dessincronia intra-atrial no AE foi significativamente maior em pacientes com FA persistente do que naqueles com FA paroxística. Por outro lado, não houve diferença significativa no RTG-AE entre pacientes com FA persistente e paroxística. A dessincronia intra-atrial no AE mostrou excelente reprodutibilidade e sua análise foi menos demorada (5 ± 9 minutos) do que o RTG-AE (60 ± 20 minutos). Conclusão: A dessincronia intra-atrial no AE é um índice rápido, reprodutível e independentemente associado ao RTG-AE para indicar remodelação tecidual subjacente. (Arq Bras Cardiol. 2019; 112(4):441-450)

Humans , Male , Female , Middle Aged , Aged , Atrial Fibrillation/physiopathology , Atrial Fibrillation/diagnostic imaging , Magnetic Resonance Imaging/methods , Atrial Remodeling/physiology , Atrial Fibrillation/therapy , Stroke Volume/physiology , Time Factors , Echocardiography/methods , Linear Models , Observer Variation , Cross-Sectional Studies , Reproducibility of Results , Catheter Ablation/methods , Electrocardiography/methods , Heart Atria/physiopathology , Heart Atria/diagnostic imaging
Rev. bras. cir. cardiovasc ; 33(4): 347-352, July-Aug. 2018. tab
Article in English | LILACS | ID: biblio-958431


Abstract Objective: To assess the relationship between preoperative vitamin D (vitD) supplementation and the development of postoperative atrial fibrillation (POAF). Methods: The study group consisted of 328 consecutive patients. The ınfluence of preoperative vitD supplementation on POAF was reviewed in 136 patients who underwent coronary artery bypass graft surgery with vitD insufficiency (n=80) and vitD deficiency (n=56). Patients were assigned to receive either oral vitD (50.000 U) (treatment group, n=68) or not (control group, n=68) 48 hours before surgery. Patients were followed up during hospitalisation process with respect to POAF. Results: There was no significant difference between treatment and control groups with regards to age, gender, diabetes mellitus, smoking history, chronic obstructive pulmonary disease, left atrial diameter, and biochemical parameters. Also, there was no significant difference between these groups with regards to mean vitD level on both insufficiency and deficiency patients (24.6±3.7 vs. 24.9±3.9 ng/ml P=0.837, 11.4±4.9 vs. 10.9±5.2 ng/ml P=0.681, respectively). Although the occurrence of POAF was not significantly different among treatment and control groups in patients with vitD insufficiency (31% vs. 33% P=0.538), there was a significant difference between the two groups regarding to POAF in patients with vitD deficiency (18% vs. 29% P=0.02). Conclusion: Although preoperative vitD supplementation was not found to be associated with prevention of POAF in patients with vitD insufficiency, it was found to be strongly associated with prevention of POAF in those with vitD deficiency.

Humans , Male , Female , Middle Aged , Aged , Atrial Fibrillation/etiology , Atrial Fibrillation/prevention & control , Vitamin D/therapeutic use , Vitamin D Deficiency/complications , Coronary Artery Bypass/adverse effects , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Atrial Fibrillation/diagnostic imaging , Echocardiography , Reproducibility of Results , Risk Factors , Treatment Outcome , Statistics, Nonparametric , Preoperative Period
Arq. bras. cardiol ; 110(5): 440-448, May 2018. tab, graf
Article in English | LILACS | ID: biblio-950162


Abstract Background: The influence of pulmonary vein (PV) anatomy on cryo kinetics during cryoballoon (CB) ablation is unclear. Objective: To investigate the relationship between PV anatomy and cryo kinetics during CB ablation for atrial fibrillation (AF). Methods: Sixty consecutive patients were enrolled. PV anatomy, including ostial diameters (long, short and corrected), ratio between short and long diameters, ostium shape (round, oval, triangular, and narrow), and drainage pattern (typical, with common trunk, common antrum, ostial branch and supernumerary PV) were evaluated on multi-detector computed tomography (MDCT) images pre-procedure. Cryo kinetics parameters [balloon freeze time from 0 to -30ºC (BFT), balloon nadir temperature (BNT) and balloon warming time from -30 to +15ºC (BWT)] were recorded during procedure. All p values are two-sided, with values of p < 0.05 considered to be statistically significant. Results: 606 times of freezing cycle were accomplished. Moderate negative correlation was documented between BNT and corrected PV diameter (r = -0.51, p < 0.001) when using 23-mm CBs, and mild negative correlation (r = - 0.32, p = 0.001) was found when using 28-mm CBs. Multivariate logistic regression analysis revealed that PV corrected ostial diameter (OR, 1.4; p = 0.004) predicted a BNT < -51ºC when using 23-mm CBs, while PV ostium oval shape (OR, 0.3; p = 0.033) and PV locations (left inferior PV: OR, 0.04; p = 0.005; right superior PV: OR, 4.3; p = 0.025) predicted BNT < -51ºC when using 28-mm CBs. Conclusions: MDCT can provide PV anatomy accurate evaluation prior CB ablation. PV anatomy is associated with cryo kinetics during ablation.

Resumo Fundamentos: A influência da anatomia da veia pulmonar (VP) na criocinética durante a ablação por criobalão (CB) não está clara. Objetivo: Investigar a relação entre a anatomia da VP e a criocinética durante a ablação com CB para fibrilação atrial (FA). Métodos: sessenta pacientes consecutivos foram matriculados. Foram avaliados em imagens de tomografia computadorizada multidetectora (TCMD) pré-procedimento a anatomia da VP, incluindo diâmetros dos óstios (longo, curto e corrigido), relação entre diâmetros curtos e longos, forma do óstio (redondo, oval, triangular e estreito) e padrão de drenagem (típico, com tronco comum, antro comum, ramo ostial e VP supranumerária). Os parâmetros criocinéticos [tempo de congelamento de balão de 0 a -30ºC (TCB), temperatura do nadir do balão (TNB) e tempo de aquecimento do balão de -30 a + 15ºC (TAB)] foram registrados durante o procedimento. Todos os valores de p são bicaudais, com valores de p < 0,05 considerados estatisticamente significativos. Resultados: o ciclo de congelamento foi realizado 606 vezes. Correlação negativa moderada foi documentada entre o TNB e o diâmetro VP corrigido (r = - 0,51, p < 0,001) ao usar CBs de 23 mm e correlação negativa leve (r = - 0,32, p = 0,001) foi encontrada ao usar 28- mm CBs. A análise de regressão logística multivariada revelou que o diâmetro corrigido do óstio da VP (OR, 1,4; p = 0,004) previu um TNB < -51ºC ao usar CB de 23 mm, enquanto a forma oval do óstio VP (OR, 0,3; p = 0,033) e as localizações da VP (VP inferior: OR, 0,04; p = 0,005; VP superior direito: OR, 4,3; p = 0,025) previram TNB < -51ºC ao usar CBs de 28 mm. Conclusões: A TCMD pode fornecer uma avaliação precisa da anatomia da VP antes da ablação por CB. A anatomia da VP está associada à criocinética durante a ablação.

Humans , Male , Female , Middle Aged , Aged , Pulmonary Veins/anatomy & histology , Atrial Fibrillation/surgery , Catheter Ablation/methods , Cryosurgery/methods , Pulmonary Veins/physiopathology , Pulmonary Veins/diagnostic imaging , Atrial Fibrillation/diagnostic imaging , Kinetics , Tomography, X-Ray Computed , Prospective Studies , Treatment Outcome , Imaging, Three-Dimensional
Rev. medica electron ; 40(2): 360-370, mar.-abr. 2018. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-902296


Introducción: se realizó un estudio observacional transversal en pacientes con fibrilación auricular ingresados con ictus isquémico en la sala de neurología en el Hospital Universitario Comandante Faustino Pérez el año 2017. Objetivo: caracterizar la fibrilación auricular en estos pacientes en relación con edad y sexo, factores de riesgo, tipo de fibrilación y factores de riesgo de embolismo. Materiales y métodos: el universo del estudio fue de 40 pacientes con fibrilación auricular e ictus isquémico. Durante el ingreso a los pacientes y/o sus familiares se les aplicó una encuesta para la obtención de la información. Resultados: predominó el grupo de edades de 75-84 años y el sexo masculino con el 50 % y 70 % respectivamente. Los factores de riesgo más frecuentes en los pacientes con fibrilación auricular e ictus isquémico fueron la hipertensión arterial y edad mayor de 75 años con 85 % y la insuficiencia cardiaca con 70 %. La fibrilación auricular más frecuente fue la diagnosticada por primera vez con 55 %. Según la respuesta ventricular predominó la fibrilación auricular con respuesta ventricular rápida con 75 %. Los factores de riesgo de embolismo predominantes fueron la hipertensión arterial y la edad ≥ 75 años con 85 % seguida de la insuficiencia cardiaca con 70 %. Conclusiones: la fibrilación auricular en los pacientes con ictus isquémico predominó en hombres mayores de 75 años, hipertensos con insuficiencia cardiaca y en la mayoría de los pacientes se realizó el diagnóstico de la fibrilación auricular durante el ingreso con ictus isquémico (AU).

Introduction: it was carried out a transversal observational study in the in-patients with atrial fibrillation and ischemic stroke in the neurology ward of the Faustino Pérez Hospital in 2017. Objective: to characterize the atrial fibrillation in these patients taking into account age, sex, risk factors, fibrillation type and embolic risk. Materials and methods: the universe of the study was 40 patients with atrial fibrillation and ischemic stroke. During the hospitalization, a survey was applied to patients and/or their relatives for collecting the information. Results: The 75-84 age group predominated and male patients predominated. With 50 % and 70 % respectively. The most frequent risk factors in patients with atrial fibrillation and ischemic stroke were arterial hypertension and being more than 75 years old with 85 % and heart failure with 70 %. The most frequent atrial fibrillation was the one diagnosed for the first time with 55 %. According to the ventricular answer, atrial fibrillation with fast ventricular answer predominated, with 75 %. The predominant embolic risk factors were arterial hypertension and patients aged ≥ 75 years with 85 %, followed by heart failure with 70 %. Conclusions: atrial fibrillation in in-patients with ischemic stroke was predominant in male hypertensive patients aged 75 years and more with cardiac failure; in most of the patients the atrial fibrillation was made during the hospitalization with ischemic stroke (AU).

Humans , Male , Female , Aged , Aged, 80 and over , Arrhythmias, Cardiac/epidemiology , Atrial Fibrillation/epidemiology , Risk Factors , Stroke/epidemiology , Embolism/complications , Heart Failure/epidemiology , Atrial Fibrillation/complications , Atrial Fibrillation/diagnosis , Atrial Fibrillation/diagnostic imaging , Secondary Care , Developed Countries/statistics & numerical data , Cross-Sectional Studies , Surveys and Questionnaires , Electrocardiography , Observational Studies as Topic
Arq. bras. cardiol ; 110(4): 312-320, Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-888058


Abstract Background: Atrial fibrillation frequently affects patients with valvular heart disease. Ablation of atrial fibrillation during valvular surgery is an alternative for restoring sinus rhythm. Objectives: This study aimed to evaluate mid-term results of successful atrial fibrillation surgical ablation during valvular heart disease surgery, to explore left atrium post-ablation mechanics and to identify predictors of recurrence. Methods: Fifty-three consecutive candidates were included. Eligibility criteria for ablation included persistent atrial fibrillation <10 years and left atrium diameter < 6.0 cm. Three months after surgery, echocardiogram, 24-hour Holter monitoring and electrocardiograms were performed in all candidates who maintained sinus rhythm (44 patients). Echo-study included left atrial deformation parameters (strain and strain rate), using 2-dimensional speckle-tracking echocardiography. Simultaneously, 30 healthy individuals (controls) were analyzed with the same protocol for left atrial performance. Significance was considered with a P value of < 0.05. Results: After a mean follow up of 17 ± 2 months, 13 new post-operative cases of recurrent atrial fibrillation were identified. A total of 1,245 left atrial segments were analysed. Left atrium was severely dilated in the post-surgery group and, mechanical properties of left atrium did not recover after surgery when compared with normal values. Left atrial volume (≥ 64 mL/m2) was the only independent predictor of atrial fibrillation recurrence (p = 0.03). Conclusions: Left atrial volume was larger in patients with atrial fibrillation recurrence and emerges as the main predictor of recurrences, thereby improving the selection of candidates for this therapy; however, no differences were found regarding myocardial deformation parameters. Despite electrical maintenance of sinus rhythm, left atrium mechanics did not recover after atrial fibrillation ablation performed during valvular heart disease surgery.

Resumo Fundamento: A fibrilação atrial frequentemente afeta pacientes com doenças das valvas cardíacas. A ablação da fibrilação atrial durante a cirurgia das válvulas é uma alternativa para restaurar o ritmo sinusal. Objetivos: Este estudo teve como objetivos avaliar resultados em médio prazo da ablação cirúrgica bem sucedida da FA durante cirurgia para doença valvar, para explorar a mecânica do AE após a ablação e identificar preditores de recorrência. Métodos: Foram incluídos 53 candidatos consecutivos. Os critérios de elegibilidade para ablação foram fibrilação atrial persistente <10 anos e diâmetro do átrio esquerdo < 6 cm. Três meses após a cirurgia, foram realizados ecocardiografia, Holter por 24 horas, e eletrocardiografias em todos os candidatos que mantiveram o ritmo sinusal (44 pacientes). O estudo eco incluiu parâmetros de deformação ao átrio esquerdo (strain e taxa de strain) usando ecocardiografia bidimensional com speckle tracking. Simultaneamente, 30 indivíduos sadios (controles) foram analisados com o mesmo protocolo para o desempenho do átrio esquerdo. Um valor de P < 0,05 foi considerado significativo. Resultados: Após um período médio de acompanhamento de 17 ± 2 meses, 13 novos casos de fibrilação atrial no pós-operatório foram identificados. Um total de 1245 segmentos do átrio esquerdo foi analisado. O grupo pós-cirúrgico apresentou dilatação grave do átrio esquerdo, e as propriedades mecânicas do átrio esquerdo não se recuperaram após a cirurgia quando comparadas com valores normais. O volume do átrio esquerdo (≥ 64 mL/m2) foi o único preditor independente de recorrência de fibrilação atrial (p = 0,03). Conclusões: O volume do átrio esquerdo foi maior nos pacientes com fibrilação atrial recorrente, e desponta como o principal preditor de recorrência, melhorando, assim, a seleção de candidatos para essa terapia. No entanto, não foram encontradas diferenças em relação aos parâmetros de deformação do miocárdio. Apesar da manutenção elétrica do ritmo sinusal, a função mecânica do átrio esquerdo não se recuperou após a ablação da fibrilação atrial realizada durante a cirurgia para doença da valva cardíaca.

Humans , Male , Female , Middle Aged , Aged , Atrial Fibrillation/surgery , Atrial Fibrillation/diagnostic imaging , Cryosurgery/methods , Heart Valve Diseases/surgery , Heart Valve Diseases/diagnostic imaging , Recurrence , Atrial Fibrillation/physiopathology , Time Factors , Echocardiography/methods , Prospective Studies , Reproducibility of Results , Risk Factors , Follow-Up Studies , Atrial Function, Left/physiology , Treatment Outcome , Statistics, Nonparametric , Electrocardiography , Heart Atria/surgery , Heart Atria/physiopathology , Heart Atria/diagnostic imaging , Heart Rate/physiology , Heart Valve Diseases/physiopathology
Rev. bras. cir. cardiovasc ; 32(6): 542-544, Nov.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-897956


Abstract Left atrial dissection is a rare factor that may cause left ventricular assist device obstruction. Prompt diagnosis and surgical repair are essential. This case report describes our experience and a successful surgical management in a patient after HeartMate 3 implantation and mitral valve inflow obstruction due to a left atrial dissection.

Humans , Male , Adult , Atrial Fibrillation/surgery , Heart-Assist Devices/adverse effects , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/diagnostic imaging , Heart Atria/surgery , Atrial Fibrillation/diagnostic imaging , Echocardiography , Ventricular Dysfunction, Left/surgery , Extracorporeal Circulation , Heart Atria/diagnostic imaging , Heart Failure , Cardiac Surgical Procedures/methods
Arq. bras. cardiol ; 109(5): 440-447, Nov. 2017. tab, graf
Article in English | LILACS | ID: biblio-887971


Abstract Background: Left atrial appendage closure (LAAC) is an effective alternative to oral anticoagulation (OA) for the prevention of stroke in patients with non-valvular atrial fibrillation (NVAF). Objective: To present the immediate results and late outcomes of patients submitted to LAAC and included in the Brazilian Registry of Percutaneous Left Atrial Appendage Closure. Methods: 91 patients with NVAF, high stroke risk (CHA2DS2VASc score = 4.5 ± 1.5) and restrictions to OAC (HAS-BLED score = 3.6 ± 1.0) underwent 92 LAAC procedures using either the Amplatzer cardiac plug or the Watchman device in 11 centers in Brazil, between late 2010 and mid 2016. Results: Ninety-six devices were used (1.04 device/procedure, including an additional non-dedicated device), with a procedural success rate of 97.8%. Associated procedures were performed in 8.7% of the patients. Complete LAAC was obtained in 93.3% of the successful cases. In cases of incomplete closure, no residual leak was larger than 2.5 mm. One patient needed simultaneous implantation of 2 devices. There were 7 periprocedural major (5 pericardial effusions requiring pericardiocentesis, 1 non-dedicated device embolization and 1 coronary air embolism without sequelae) and 4 minor complications. After 128.6 patient-years of follow-up there were 3 deaths unrelated to the procedure, 2 major bleedings (one of them in a patient with an unsuccessful LAAC), thrombus formation over the device in 2 cases (both resolved after resuming OAC for 3 months) and 2 strokes (2.2%). Conclusions: In this multicenter, real world registry, that included patients with NVAF and high thromboembolic and bleeding risks, LAAC effectively prevented stroke and bleeding when compared to the expected rates based on CHA2DS2VASc and HASBLED scores for this population. Complications rate of the procedure was acceptable considering the beginning of the learning curve of most of the involved operators.

Resumo Fundamento: A oclusão percutânea do apêndice atrial esquerdo (OAAE) é uma alternativa eficaz à anticoagulação oral (ACO) para a prevenção de acidente vascular cerebral (AVC) em pacientes com fibrilação atrial não-valvular (FANV). Objetivo: Apresentar os resultados imediatos e o seguimento tardio de pacientes submetidos a OAAE e incluídos no Registro Brasileiro de Oclusão Percutânea do Apêndice Atrial Esquerdo. Métodos: 91 pacientes com FANV, alto risco de AVC (escore CHA2DS2VASc = 4,5 ± 1,5) e restrição à AO (escore HAS-BLED = 3,6 ± 1,0) foram submetidos a 92 procedimentos de OAAE com as próteses Amplatzer Cardiac Plug e Watchman em 11 centros do Brasil, entre o final de 2010 e a metade de 2016. Resultados: Utilizaram-se 96 próteses no total (1,04 próteses/procedimento, incluindo-se o uso de 1 prótese não-dedicada adicional em um dos casos), obtendo-se sucesso em 97,8% dos procedimentos. Realizaram-se procedimentos associados à OAAE em 8,7% dos pacientes. Observou-se oclusão total do AAE em 93,3% dos casos com sucesso, e nos casos de oclusão incompleta, nenhum leak foi > 2,5 mm. Um paciente necessitou do implante simultâneo de 2 próteses. Houve 7 complicações maiores periprocedimento (5 derrames pericárdicos necessitando pericardiocentese, 1 embolização da prótese não-dedicada e 1 embolia aérea coronariana sem sequelas) e 4 menores. No seguimento de 128,6 pacientes-ano, houve 3 óbitos não relacionados ao procedimento, 2 sangramentos maiores (um deles em um dos casos de insucesso da OAAE), formação de trombo sobre a prótese em 2 casos (tratados com sucesso com reinstituição da ACO por 3 meses), e 2 AVCs (2,2%). Conclusões: Neste registro multicêntrico de mundo real, que incluiu pacientes com FANV e alto risco de sangramento e de eventos tromboembólicos, a OAAE foi eficaz na prevenção de AVC e sangramento quando comparada às taxas de AVC previstas pelos escores CHA2DS2VASc e HASBLED para esta população. O índice de complicações do procedimento foi aceitável, considerando se tratar do início da curva de aprendizado da maioria dos operadores envolvidos.

Humans , Male , Female , Aged , Atrial Fibrillation/surgery , Atrial Appendage/surgery , Stroke/prevention & control , Septal Occluder Device , Atrial Fibrillation/diagnostic imaging , Follow-Up Studies , Treatment Outcome , Echocardiography, Transesophageal , Atrial Appendage/diagnostic imaging , Stroke/etiology
Arq. bras. cardiol ; 107(4): 305-313, Oct. 2016. tab
Article in English | LILACS | ID: biblio-827859


Abstract Background: Atrial fibrillation (AF) is the most common arrhythmia seen in adults. Atrial stunning is defined as the temporary mechanical dysfunction of the atrial appendage developing after AF has returned to sinus rhythm (SR). Objectives: We aimed to evaluate atrial contractile functions by strain and strain rate in patients with AF, following pharmacological and electrical cardioversion and to compare it with conventional methods. Methods: This study included 41 patients with persistent AF and 35 age-matched control cases with SR. All the AF patients included in the study had transthoracic and transesophageal echocardiography performed before and after. Septum (SEPsSR), left atrium (LAsSR) and right atrium peak systolic strain rate (RAsSR) were defined as the maximum negative value during atrial contraction and septum (SEPε), left atrium (LAε) and right atrium peak systolic strain (RAε) was defined as the percentage of change. Parameters of two groups were compared. Results: In the AF group, 1st hour and 24th hour LAε, RAε, SEPε, LAsSR, RAsSR, SEPsSR found to be significantly lower than in the control group (LAε: 2.61%±0.13, 3.06%±0.19 vs 6.45%±0.27, p<0.0001; RAε: 4.03%±0.38, 4.50%±0.47 vs 10.12%±0.64, p<0.0001; SEPε: 3.0%±0.22, 3.19%±0.15 vs 6.23%±0.49, p<0.0001; LAsSR: 0.61±0.04s-1, 0.75±0.04s- 1 vs 1.35±0.04s-1, p<0.0001; RAsSR: 1.13±0.06s-1, 1.23±0.07s-1 vs 2.10±0.08s- 1, p<0.0001; SEPsSR: 0.76±0.04s- 1, 0.78±0.04s- 1 vs 1.42±0.06 s- 1, p<0.0001). Conclusion: Atrial strain and strain rate parameters are superior to conventional echocardiographic parameters for the evaluation of atrial stunning in AF cases where SR has been achieved.

Resumo Fundamento: A fibrilação atrial (FA) é a arritmia mais comum em adultos. Define-se atordoamento atrial como a disfunção mecânica temporária do apêndice atrial que se desenvolve depois de reversão da FA ao ritmo sinusal (RS). Objetivos: Avaliar as funções atriais contráteis através de strain atrial e strain rate em pacientes com FA, após cardioversão farmacológica e elétrica, assim como compará-los com os métodos convencionais. Métodos: Este estudo incluiu 41 pacientes com FA persistente e 35 controles com RS e pareados por idade. Todos os pacientes com FA incluídos neste estudo foram submetidos a ecocardiografia transtorácica e transesofágica antes e após. Strain rates de pico sistólico do septo (SEPsSR), do átrio esquerdo (LAsSR) e do átrio direito (RAsSR) foram definidas como o máximo valor negativo durante contração atrial. Strains de pico sistólico do septo (SEPε), do átrio esquerdo (LAε) e do átrio direito (RAε) foram definidas como porcentagem de mudança. Resultados: No grupo com FA, os parâmetros LAε, RAε, SEPε, LAsSR, RAsSR e SEPsSR da 1a hora e da 24a hora foram significativamente mais baixos que no grupo controle (LAε: 2,61%±0,13; 3,06%±0,19 vs 6,45%±0,27; p<0,0001; RAε: 4,03%±0,38; 4,50%±0,47 vs 10,12%±0,64; p<0,0001; SEPε: 3,0%±0,22; 3,19%±0,15 vs 6,23%±0,49; p<0,0001; LAsSR: 0,61±0,04s-1; 0,75±0,04s-1 vs 1,35±0,04s-1; p<0,0001; RAsSR: 1,13±0,06s-1; 1,23±0,07s-1 vs 2,10±0,08s-1; p<0,0001; SEPsSR: 0,76±0,04s-1; 0,78±0,04s-1 vs 1,42±0,06 s-1; p<0,0001). Conclusão: Os parâmetros strain atrial e strain rate são superiores aos parâmetros ecocardiográficos convencionais para avaliar atordoamento atrial em pacientes com FA que reverteram ao RS.

Humans , Male , Female , Middle Aged , Atrial Fibrillation/complications , Atrial Fibrillation/physiopathology , Atrial Function/physiology , Myocardial Stunning/physiopathology , Atrial Appendage/physiopathology , Atrial Fibrillation/diagnostic imaging , Stroke Volume/physiology , Systole/physiology , Time Factors , Electric Countershock/methods , Echocardiography , Reproducibility of Results , Myocardial Stunning/diagnostic imaging , Statistics, Nonparametric , Atrial Appendage/diagnostic imaging
Article in English | WPRIM | ID: wpr-10195


OBJECTIVE: We wanted to evaluate the image quality and diagnostic value of 64-slice dual-source computed tomography (DSCT) coronary angiography in patients with atrial fibrillation (Afib). MATERIALS AND METHODS: The coronary arteries of 22 Afib patients seen on DSCT were classified into 15 segments and the imaging quality (excellent, good, moderate and poor) and significant stenoses (> or = 50%) were evaluated by two radiologists who were blinded to the conventional coronary angiography (CAG) results. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting important coronary artery stenosis were calculated. McNemar test was used to determine any significant difference between DSCT and CAG, and Cohen's Kappa statistics were calculated for the intermodality and interobserver agreement. RESULTS: The mean heart rate was 89 +/- 8.3 bpm (range: 80-118 bpm). A range from 250 msec to 300 msec within the RR interval was the optimal reconstruction interval for the patients with Afib. The respective overall sensitivity, specificity, PPV and NPV values were 74%, 97%, 81% and 96% for reader 1 and 72%, 98%, 85% and 96% for reader 2. No significant difference between DSCT and CAG was found for detecting a significant stenosis (reader 1, p = 1.0; reader 2, p = 0.727). Cohen's Kappa statistics demonstrated good intermodality and interobserver agreement. CONCLUSION: 64-slice DSCT coronary angiography provides good image quality in patients with atrial fibrillation without the need for controlling the heart rate. DSCT can be used for ruling out significant stenosis in patients with atrial fibrillation with its high NPV for detecting in important stenosis.

Aged , Aged, 80 and over , Algorithms , Atrial Fibrillation/diagnostic imaging , Contrast Media , Coronary Angiography/methods , Coronary Disease/diagnostic imaging , Echocardiography , Electrocardiography , Female , Heart Rate , Humans , Iohexol/analogs & derivatives , Male , Middle Aged , Prospective Studies , Radiation Dosage , Radiographic Image Interpretation, Computer-Assisted , Tomography, X-Ray Computed/methods