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4.
Arq. bras. cardiol ; 112(4): 441-450, Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1001289

ABSTRACT

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)


Subject(s)
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
5.
ABC., imagem cardiovasc ; 32(2): 109-115, abr.-junh. 2019. ilus, tab, graf
Article in Portuguese | LILACS | ID: biblio-994681

ABSTRACT

A análise da função diastólica utilizando a ecocardiografia convencional (método bidimensional, Doppler espectral e Doppler tecidual) pode não determinar alguns casos de disfunção diastólica ou elevação da pressão do átrio esquerdo. Os parâmetros que estudam a deformação miocárdica (strain rate e strain longitudinal do átrio esquerdo) podem auxiliar no diagnóstico. Descrevem-se aqui os métodos do strain rate diastólico durante o tempo de relaxamento isovolumétrico e no pico do enchimento, a taxa de torção apical e o strain longitudinal máximo do átrio esquerdo, analisando suas aplicações e vantagens


Subject(s)
Humans , Male , Female , Blood Pressure , Echocardiography/methods , Ventricular Dysfunction , Aortic Valve , Atrial Fibrillation , Stroke Volume , Cardiovascular Diseases/diagnosis , Echocardiography, Doppler/methods , Heart Atria/physiopathology , Heart Ventricles , Mitral Valve
6.
Arq. bras. cardiol ; 111(3): 384-391, Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-973761

ABSTRACT

Abstract Background: Light-chain (AL) cardiac amyloidosis (CA) is characterized by fibril deposits, which are composed of monoclonal immunoglobulin light chains. The right ventricle is mostly involved in AL-CA and impairment of its function is a predictor of worse prognosis. Objectives: To characterize the volumetric and functional properties of the right atrium (RA) in AL-CA by three-dimensional speckle-tracking echocardiography (3DSTE). Methods: A total of 16 patients (mean age: 64.5 ± 10.1 years, 11 males) with AL-CA were examined. Their results were compared to that of 15 age- and gender-matched healthy controls (mean age: 58.9 ± 6.9 years, 8 males). All cases have undergone complete two-dimensional Doppler and 3DSTE. A two-tailed p value of less than 0.05 was considered statistically significant. Results: Significant differences could be demonstrated in RA volumes respecting cardiac cycle. Total (19.2 ± 9.3% vs. 27.9 ± 10.7%, p = 0.02) and active atrial emptying fractions (12.1 ± 8.1 vs. 18.6 ± 9.8%, p = 0.05) were significantly decreased in AL-CA patients. Peak global (16.7 ± 10.3% vs. 31.2 ± 19.4%, p = 0.01) and mean segmental (24.3 ± 11.1% vs. 38.6 ± 17.6%, p =0.01) RA area strains, together with some circumferential, longitudinal and segmental area strain parameters, proved to be reduced in patients with AL-CA. Global longitudinal (4.0 ± 5.2% vs. 8.2 ± 5.5%, p = 0.02) and area (7.8 ± 8.1% vs. 15.9 ± 10.3%, p = 0.03) strains at atrial contraction and some circumferential and area strain parameters at atrial contraction were reduced in AL-CA patients. Conclusion: Significantly increased RA volumes and deteriorated RA functions could be demonstrated in AL-CA.


Resumo Fundamento: A amiloidose cardíaca (AC) de cadeias leves (AL) é caracterizada por depósitos fibrilares, que são compostos por cadeias leves de imunoglobulina monoclonal. O ventrículo direito é mais afetado pela AC-AL, e o comprometimento da sua função é preditor de um prognóstico pior. Objetivos: Caracterizar as propriedades volumétricas e funcionais do átrio direito (AD) na AC-AL por ecocardiografia tridimensional de speckle-tracking (3DSTE). Métodos: Um total de 16 pacientes (idade média: 64,5 ± 10,1 anos, 11 homens) com AC-AL foram examinados. Seus resultados foram comparados aos de 15 controles saudáveis pareados por idade e gênero (média de idade: 58,9 ± 6,9 anos, 8 homens). Todos os casos foram submetidos a Doppler bidimensional completo e 3DSTE. Um valor p bicaudal inferior a 0,05 foi considerado estatisticamente significativo. Resultados: Diferenças significativas foram demonstradas em volumes do AD com respeito ao ciclo cardíaco. O total (19,2 ± 9,3% vs. 27,9 ± 10,7%, p = 0,02) e as frações ativas de esvaziamento atrial (12,1 ± 8,1 vs. 18,6 ± 9,8%, p = 0,05) foram significativamente menores nos pacientes com AC-AL. Picos de strain no AD em áreas globais (16,7 ± 10,3% vs. 31,2 ± 19,4%, p = 0,01) e segmentares médias (24,3 ± 11,1% vs. 38,6 ± 17,6%, p = 0,01), juntamente com alguns parâmetros de strain por áreas circunferenciais, longitudinais e segmentares, mostraram-se menores em pacientes com AC-AL. Strains globais longitudinais (4,0 ± 5,2% vs. 8,2 ± 5,5%, p = 0,02) e por área (7,8 ± 8,1 vs. 15,9 ± 10,3%, p = 0,03) na contração atrial e alguns parâmetros de circunferência e de strain por área na contração atrial foram menores em pacientes com AC-AL. Conclusão: Foi possível demonstrar o aumento significativo dos volumes do AD e a deterioração de suas funções na AC-AL.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Echocardiography, Three-Dimensional/methods , Heart Atria/pathology , Heart Atria/diagnostic imaging , Heart Diseases/diagnostic imaging , Amyloidosis/pathology , Amyloidosis/diagnostic imaging , Prognosis , Reference Values , Echocardiography, Doppler/methods , Case-Control Studies , Reproducibility of Results , Risk Factors , Statistics, Nonparametric , Heart Atria/physiopathology , Heart Diseases/physiopathology , Heart Diseases/pathology , Amyloidosis/physiopathology
7.
Arq. bras. cardiol ; 111(3): 364-372, Sept. 2018. tab, graf
Article in English | LILACS | ID: biblio-973751

ABSTRACT

Abstract Background: Chagas Disease (CD) is an important cause of morbimortality due to heart failure and malignant arrhythmias worldwide, especially in Latin America. Objective: To investigate the association of obstructive sleep apnea (OSA) with heart remodeling and cardiac arrhythmias in patients CD. Methods: Consecutive patients with CD, aged between 30 to 65 years old were enrolled. Participants underwent clinical evaluation, sleep study, 24-hour Holter monitoring, echocardiogram and ambulatory blood pressure monitoring. Results: We evaluated 135 patients [age: 56 (45-62) years; 30% men; BMI: 26 ± 4 kg/m2, Chagas cardiomyopathy: 70%]. Moderate to severe OSA (apnea-hypopnea index, AHI, ≥ 15 events/h) was present in 21% of the patients. OSA was not associated with arrhythmias in this population. As compared to patients with mild or no OSA, patients with moderate to severe OSA had higher frequency of hypertension (79% vs. 72% vs. 44%, p < 0.01) higher nocturnal systolic blood pressure: 119 ± 17 vs. 113 ± 13 vs. 110 ± 11 mmHg, p = 0.01; larger left atrial diameter [37 (33-42) vs. 35 (33-39) vs. 33 (30-36) mm, p < 0.01]; and a greater proportion of left ventricular dysfunction [LVEF < 50% (39% vs. 28% vs. 11%), p < 0.01], respectively. Predictor of left atrial dimension was Log10 (AHI) (b = 3.86, 95% CI: 1.91 to 5.81; p < 0.01). Predictors of ventricular dysfunction were AHI > 15 events/h (OR = 3.61, 95% CI: 1.31 - 9.98; p = 0.01), systolic blood pressure (OR = 1.06, 95% CI: 1.02 - 1.10; p < 0.01) and male gender (OR = 3.24, 95% CI: 1.31 - 8.01; p = 0.01). Conclusions: OSA is independently associated with atrial and ventricular remodeling in patients with CD.


Resumo Fundamento: A doença de Chagas (DC) é uma causa importante de morbimortalidade por insuficiência cardíaca e arritmias malignas em todo o mundo, especialmente na América Latina. Objetivo: Investigar a associação entre apneia obstrutiva do sono (AOS) com remodelação cardíaca e arritmias cardíacas em pacientes com DC. Métodos: Foram incluídos pacientes consecutivos com DC, com idade entre 30 e 65 anos. Os participantes foram submetidos à avaliação clínica, estudo do sono, Holter de 24 horas, ecocardiograma e monitorização ambulatorial da pressão arterial. Resultados: Foram avaliados 135 pacientes [idade: 56 (45-62) anos; 30% homens; IMC: 26 ± 4 kg/m2, cardiomiopatia chagásica: 70%]. AOS moderada a grave (índice de apneia-hipopneia, IAH, ≥ 15 eventos/h) estava presente em 21% dos pacientes. AOS não estava associada a arritmias nessa população. Em comparação com pacientes com AOS leve ou ausente, pacientes com AOS moderada a grave apresentaram maior frequência de hipertensão (79% vs. 72% vs. 44%, p < 0,01) e pressão arterial sistólica noturna mais alta: 119 ± 17 vs. 113 ± 13 vs. 110 ± 11 mmHg, p = 0,01; diâmetro do átrio esquerdo maior [37 (33‑42) vs. 35 (33-39) vs. 33 (30-36) mm, p < 0,01]; e maior proporção de disfunção ventricular esquerda [FEVE < 50% (39% vs. 28% vs. 11%), p < 0,01], respectivamente. O preditor de dimensão do átrio esquerdo foi Log10 (IAH) (β = 3,86, IC 95%: 1,91 a 5,81; p < 0,01). Os preditores de disfunção ventricular foram IAH >15 eventos/h (OR = 3,61, IC 95%: 1,31 - 9,98; p = 0,01), pressão arterial sistólica (OR = 1,06, IC95%: 1,02 - 1,10; p < 0,01) e sexo masculino (OR = 3,24, IC 95%: 1,31 - 8,01; p = 0,01). Conclusões: A AOS está independentemente associada à remodelação atrial e ventricular em pacientes com DC.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Arrhythmias, Cardiac/etiology , Chagas Cardiomyopathy/complications , Ventricular Remodeling , Sleep Apnea, Obstructive/etiology , Arrhythmias, Cardiac/physiopathology , Arrhythmias, Cardiac/pathology , Reference Values , Severity of Illness Index , Echocardiography , Chagas Cardiomyopathy/physiopathology , Chagas Cardiomyopathy/pathology , Anthropometry , Multivariate Analysis , Analysis of Variance , Electrocardiography, Ambulatory , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/physiopathology , Statistics, Nonparametric , Blood Pressure Monitoring, Ambulatory , Sleep Apnea, Obstructive/physiopathology , Sleep Apnea, Obstructive/pathology , Heart Atria/physiopathology , Heart Atria/pathology
9.
Arq. bras. cardiol ; 110(4): 312-320, Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-888058

ABSTRACT

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.


Subject(s)
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
11.
Arq. bras. cardiol ; 105(1): 65-70, July 2015. tab, ilus
Article in English | LILACS | ID: lil-754999

ABSTRACT

Background:

Left atrial volume (LAV) is a predictor of prognosis in patients with heart failure.

Objective:

We aimed to evaluate the determinants of LAV in patients with dilated cardiomyopathy (DCM).

Methods:

Ninety patients with DCM and left ventricular (LV) ejection fraction ≤ 0.50 were included. LAV was measured with real-time three-dimensional echocardiography (eco3D). The variables evaluated were heart rate, systolic blood pressure, LV end-diastolic volume and end-systolic volume and ejection fraction (eco3D), mitral inflow E wave, tissue Doppler e´ wave, E/e´ ratio, intraventricular dyssynchrony, 3D dyssynchrony index and mitral regurgitation vena contracta. Pearson´s coefficient was used to identify the correlation of the LAV with the assessed variables. A multiple linear regression model was developed that included LAV as the dependent variable and the variables correlated with it as the predictive variables.

Results:

Mean age was 52 ± 11 years-old, LV ejection fraction: 31.5 ± 8.0% (16-50%) and LAV: 39.2±15.7 ml/m2. The variables that correlated with the LAV were LV end-diastolic volume (r = 0.38; p < 0.01), LV end-systolic volume (r = 0.43; p < 0.001), LV ejection fraction (r = -0.36; p < 0.01), E wave (r = 0.50; p < 0.01), E/e´ ratio (r = 0.51; p < 0.01) and mitral regurgitation (r = 0.53; p < 0.01). A multivariate analysis identified the E/e´ ratio (p = 0.02) and mitral regurgitation (p = 0.02) as the only independent variables associated with LAV increase.

Conclusion:

The LAV is independently determined by LV filling pressures (E/e´ ratio) and mitral regurgitation in DCM.

.

Fundamento:

O Volume do Átrio Esquerdo (VAE) é preditor prognóstico em pacientes com insuficiência cardíaca.

Objetivo:

O objetivo do estudo foi avaliar os determinantes do VAE em pacientes com Cardiomiopatia Dilatada (CMD).

Métodos:

Incluídos 90 pacientes com CMD e fração de ejeção do Ventrículo Esquerdo (VE) ≤ 0,50. O VAE foi medido pela ecocardiografia tridimensional (eco3D). Foram avaliados frequência cardíaca, pressão arterial sistólica, volume diastólico e sistólico final do VE, fração de ejeção do VE, onda E mitral, onda e´ do anel mitral (Doppler tecidual), relação E/e´, dissincronia intraventricular, índice de dissincronia tridimensional e insuficiência mitral. O coeficiente de correlação de Pearson analisou a correlação do VAE com as variáveis avaliadas e a regressão linear múltipla as variáveis independentes associadas ao VAE.

Resultados:

A idade média foi 53 ± 11 anos, fração de ejeção do VE: 31,5 ± 8,0% e VAE: 39,2 ± 15,7 ml/m2. As variáveis que se correlacionaram com o VAE foram: volume diastólico final do VE (r = 0,38; p < 0,01), volume sistólico final do VE (r = 0,43; p < 0,001), fração de ejeção do VE (r = -0,36; p v 0,01), onda E (r = 0,50; p < 0,01), relação E/e´ (r = 0,51; p < 0,01) e insuficiência mitral (r = 0,53; p < 0,01). A análise multivariada identificou relação E/e´ (p = 0,02) e insuficiência mitral (p = 0,02) como os únicos preditores independentes do aumento do VAE.

Conclusão:

O VAE na CMD é determinado independentemente pelas pressões de enchimento do VE (relação E/e´) e insuficiência mitral.

.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Atrial Function, Left/physiology , Cardiac Volume/physiology , Cardiomyopathy, Dilated/physiopathology , Cardiomyopathy, Dilated , Blood Pressure/physiology , Echocardiography, Doppler , Echocardiography, Three-Dimensional , Heart Atria/physiopathology , Heart Atria , Predictive Value of Tests , Prognosis , Statistics, Nonparametric , Stroke Volume/physiology , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Left
12.
Arq. bras. cardiol ; 104(1): 45-52, 01/2015. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: lil-741127

ABSTRACT

Background: Heart failure and atrial fibrillation (AF) often coexist in a deleterious cycle. Objective: To evaluate the clinical and echocardiographic outcomes of patients with ventricular systolic dysfunction and AF treated with radiofrequency (RF) ablation. Methods: Patients with ventricular systolic dysfunction [ejection fraction (EF) <50%] and AF refractory to drug therapy underwent stepwise RF ablation in the same session with pulmonary vein isolation, ablation of AF nests and of residual atrial tachycardia, named "background tachycardia". Clinical (NYHA functional class) and echocardiographic (EF, left atrial diameter) data were compared (McNemar test and t test) before and after ablation. Results: 31 patients (6 women, 25 men), aged 37 to 77 years (mean, 59.8±10.6), underwent RF ablation. The etiology was mainly idiopathic (19 p, 61%). During a mean follow-up of 20.3±17 months, 24 patients (77%) were in sinus rhythm, 11 (35%) being on amiodarone. Eight patients (26%) underwent more than one procedure (6 underwent 2 procedures, and 2 underwent 3 procedures). Significant NYHA functional class improvement was observed (pre-ablation: 2.23±0.56; postablation: 1.13±0.35; p<0.0001). The echocardiographic outcome also showed significant ventricular function improvement (EF pre: 44.68%±6.02%, post: 59%±13.2%, p=0.0005) and a significant left atrial diameter reduction (pre: 46.61±7.3 mm; post: 43.59±6.6 mm; p=0.026). No major complications occurred. Conclusion: Our findings suggest that AF ablation in patients with ventricular systolic dysfunction is a safe and highly effective procedure. Arrhythmia control has a great impact on ventricular function recovery and functional class improvement. .


Fundamento: Insuficiência cardíaca e fibrilação atrial (FA) frequentemente coexistem em um ciclo deletério. Objetivo: Avaliar a evolução clínica e ecocardiográfica de portadores de disfunção ventricular e FA tratados com ablação por radiofrequência (RF). Métodos: Portadores de disfunção sistólica [fração de ejeção (FE) < 50%] e FA rebelde a tratamento clínico foram submetidos à ablação por RF escalonada em três etapas na mesma sessão com isolamento das veias pulmonares, ablação dos ninhos de FA, pesquisa e ablação de taquicardias atriais e "taquicardia de background". Os dados clínicos (classe funcional da NYHA) e ecocardiográficos (FE; diâmetro do átrio esquerdo) pré- e pós-procedimento foram comparados (teste de McNemar e teste t, respectivamente). Resultados: 31 pacientes (6 mulheres, 25 homens) de 37 a 77 anos (média, 59,8 ± 11 anos) foram submetidos à ablação por RF. A cardiopatia foi predominantemente idiopática (19 p; 61%). Na evolução média de 20,3 ± 17 meses, 24 pacientes (77%) estavam em ritmo sinusal, sendo 11 (35%) com amiodarona. Oito pacientes (26%) foram submetidos a mais de um procedimento (6 submetidos a 2 procedimentos e 2 a 3 procedimentos). Observou-se melhora expressiva da classe funcional da NYHA (pré-ablação: 2,23 ± 0,56; pós: 1,13 ± 0,35; p < 0,0001). A avaliação ecocardiográfica evolutiva também mostrou melhora significativa da função ventricular (FE pré: 44,68% ± 6,02%; pós: 59% ± 13,2%; p = 0,0005) e redução significativa no diâmetro do átrio esquerdo (pré: 46,61 ± 7,3 mm; pós: 43,59 ± 6,6 mm; p = 0,026). Não ocorreram complicações maiores. Conclusão: Os resultados deste estudo sugerem que ablação de FA em portadores de disfunção ventricular seja um procedimento seguro e com eficácia elevada a médio prazo. O controle da arritmia tem grande impacto na recuperação da função ventricular e na melhora clínica avaliada pela classe funcional. .


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Atrial Fibrillation/surgery , Catheter Ablation/methods , Heart Failure, Systolic/surgery , Ventricular Dysfunction/surgery , Atrial Fibrillation/physiopathology , Atrial Fibrillation , Echocardiography, Transesophageal , Electrocardiography , Heart Atria/physiopathology , Heart Atria , Heart Failure, Systolic/physiopathology , Heart Failure, Systolic , Retrospective Studies , Statistics, Nonparametric , Stroke Volume/physiology , Time Factors , Treatment Outcome , Ventricular Dysfunction/physiopathology , Ventricular Dysfunction
13.
Professional Medical Journal-Quarterly [The]. 2015; 22 (4): 447-450
in English | IMEMR | ID: emr-162229

ABSTRACT

Cost effectiveness in any surgical procedure is a major contributory factor in the continuation of medical services in developing countries. Limited data is available in assessing the factors related with the duration of ICU stay and treatment after valvular replacement surgeries. Our aim was to see the correlation of pre operative Left Atrial size of the patient and duration of post operative stay in ICU. Observational Study. March 2010 to April 2014. Faisalabad Institute of Cardialogoy, Faisalabad. A total of 550 consecutive patients with valvular lesions were included in the study. Their Left Atrial size was measured echocardiographically pre-operatively and their stay /course in the ICU was monitored. Three categories were identified in regard with the Left Atrial size and the ICU stay. If LA size is below 60 cm2, the post operative course and stay in ICU is normal and lasts for about 1-2 days. If LA size is between 60-65 mm2, the post operative course may be complicated and prolonged by the atrial fibrillation / flutter for which pharmacological cardio version may be needed and the stay in ICU is prolonged and may last for about 2-3 days. And if pre-operative LA size is more the 65 mm2 the patient may behave in entirely different way. His atrial fibrillation persists in spite of electro cardiovertion or pharmacological cardiovertion and his stay in ICU may last up to 4-5 days and thus the cost of treatment is raised. LA size can predict the post operative behavior of the patient in ICU and duration of stay and expected cost of the treatment. Smaller is the size of LA, shorter is the stay in ICU and thus lesser is the post operative cost and vice versa


Subject(s)
Humans , Female , Male , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Cost-Benefit Analysis , Heart Atria/physiopathology , Echocardiography , Atrial Fibrillation , Intensive Care Units , Cost of Illness , Electric Countershock
14.
Rev. bras. cardiol. invasiva ; 22(4): 382-385, Oct-Dec/2015. graf
Article in Portuguese | SES-SP, LILACS, SES-SP | ID: lil-744578

ABSTRACT

A oclusão do apêndice atrial esquerdo tem sido realizada com sucesso para a prevenção de fenômenos embólicos em pacientes com fibrilação atrial, como alternativa à anticoagulação oral. O acesso atrial, através de forame oval ou comunicação interatrial tipo ostium secundum, tem sido evitado em função da crença de que o posicionamento do dispositivo é dificultado pela disposição mais alta do forame no septo interatrial. Neste manuscrito, relatamos um caso em que foram ocluídos, sequencialmente, o apêndice atrial esquerdo e o forame oval sem a necessidade de punção transeptal, que simplificou e tornou mais seguro o procedimento.


Left atrial appendage occlusion has been successfully employed to prevent embolic events in patients with atrial fibrillation as an alternative to oral anticoagulation. Left atrial access through the patent foramen ovale or ostium secundum atrial septal defect has been discouraged due to the fear that entering the septum in a higher position through the foramen would prevent adequate device positioning. In this manuscript we report a case in which the left atrial appendage and the foramen ovale were sequentially occluded avoiding transseptal puncture, making the procedure simpler and faster.


Subject(s)
Humans , Female , Aged , Atrial Appendage/physiopathology , Atrial Fibrillation/therapy , Foramen Ovale, Patent/physiopathology , Prostheses and Implants , Cardiac Catheterization , Heart Septal Defects, Atrial , Heart Atria/physiopathology
15.
Arq. bras. cardiol ; 103(4): 282-291, 10/2014. tab, graf
Article in English | LILACS | ID: lil-725319

ABSTRACT

Background: According to some international studies, patients with acute coronary syndrome (ACS) and increased left atrial volume index (LAVI) have worse long-term prognosis. However, national Brazilian studies confirming this prediction are still lacking. Objective: To evaluate LAVI as a predictor of major cardiovascular events (MCE) in patients with ACS during a 365-day follow-up. Methods: Prospective cohort of 171 patients diagnosed with ACS whose LAVI was calculated within 48 hours after hospital admission. According to LAVI, two groups were categorized: normal LAVI (≤ 32 mL/m2) and increased LAVI (> 32 mL/m2). Both groups were compared regarding clinical and echocardiographic characteristics, in- and out-of-hospital outcomes, and occurrence of ECM in up to 365 days. Results: Increased LAVI was observed in 78 patients (45%), and was associated with older age, higher body mass index, hypertension, history of myocardial infarction and previous angioplasty, and lower creatinine clearance and ejection fraction. During hospitalization, acute pulmonary edema was more frequent in patients with increased LAVI (14.1% vs. 4.3%, p = 0.024). After discharge, the occurrence of combined outcome for MCE was higher (p = 0.001) in the group with increased LAVI (26%) as compared to the normal LAVI group (7%) [RR (95% CI) = 3.46 (1.54-7.73) vs. 0.80 (0.69-0.92)]. After Cox regression, increased LAVI increased the probability of MCE (HR = 3.08, 95% CI = 1.28-7.40, p = 0.012). Conclusion: Increased LAVI is an important predictor of MCE in a one-year follow-up. .


Fundamento: Portadores de síndrome coronária aguda (SCA) com aumento do índice de volume atrial esquerdo (IVAE) apresentam pior prognóstico em longo prazo segundo alguns estudos internacionais. Todavia, há carência de estudos nacionais ratificando esta predição. Objetivo: Avaliar o IVAE como preditor de evento cardiovascular maior (ECM) em seguimento tardio de pacientes com SCA. Métodos: Coorte prospectiva de 171 pacientes com diagnóstico de SCA e com IVAE calculado dentro de 48 horas após evento índice. Portadores de IVAE normal (≤ 32 ml/m2) e de IVAE aumentado (> 32 ml/m2) foram comparados quanto às características clínicas e ecocardiográficas, evolução intra e extra-hospitalar e ocorrência, em até 365 dias, de ECM. Resultados: Um total de 78 pacientes (45%) apresentaram IVAE > 32 ml/m2. Ocorreu associação entre IVAE aumentado e maior idade, índice de massa corpórea, hipertensão arterial, história de infarto agudo do miocárdio e angioplastia prévia, assim como menor clearance de creatinina e fração de ejeção. Na evolução hospitalar, o edema agudo de pulmão foi mais frequente em pacientes com IVAE aumentado (14,1% vs. 4,3%, p = 0,024). Após a alta hospitalar, a ocorrência do desfecho composto para ECM foi significativamente superior (p = 0,001) no grupo com IVAE aumentado (26%) quando comparado ao grupo de IVAE normal (7%) [RR (IC 95%) = 3,46 (1,54-7,73) vs. 0,80 (0,69-0,92)]. Na regressão de Cox, IVAE aumentado elevou a probabilidade de ECM (HR = 3,08; IC 95% = 1,28-7,40; p = 0,012). Conclusão: O aumento do IVAE é importante preditor de ECM em um ano de seguimento. .


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Acute Coronary Syndrome/physiopathology , Atrial Function, Left/physiology , Cardiac Volume/physiology , Acute Coronary Syndrome/mortality , Acute Coronary Syndrome/therapy , Echocardiography , Follow-Up Studies , Heart Atria/physiopathology , Kaplan-Meier Estimate , Prognosis , Prospective Studies , Registries , Risk Assessment , Risk Factors , Statistics, Nonparametric , Time Factors , Treatment Outcome , Ventricular Dysfunction, Left/physiopathology
16.
Rev. bras. cardiol. (Impr.) ; 27(5): 349-355, set.-out. 2014. tab
Article in Portuguese | LILACS | ID: lil-742406

ABSTRACT

As doenças cardiovasculares representam a principal causa de mortalidade e incapacidade no Brasil e no mundo. O infarto agudo do miocárdio (IAM) é uma das afecções coronarianas mais comuns, e reflete a morte dos cardiomiócitos causada por um desequilíbrio entre a oferta e demanda de nutrientes ao tecido, consequente à obstrução do fluxo coronariano,podendo ser transitório ou permanente. Com base nessas informações, foi realizada revisão da literatura em bancos de bases bibliográficas e acervos de livros, objetivando um estudo das alterações morfológicas do IAM e as variações morfológicas que favorecem o acometimento dessa doença. Observa-se que há vários trabalhos relacionados ao assunto, porém poucos estão relacionados às alterações morfofuncionais do sistema cardiovascular. São encontrados estudos que relatam a melhora da função cardíaca, remodelamento cardíaco e redução das placas de ateroma.


Cardiovascular diseases are the leading cause of mortality and disability in Brazil and worldwide, with acute myocardial infarction (AMI) being one of the most common coronary diseases. This reflects cardiac myocyte death caused by an imbalance between the supply and demand of nutrients to the tissue caused by obstruction of the coronary flow, which may be atransient or permanent condition. Based on this information, a review of the literature was conducted in bibliographical databases and book collections,providing input for a study of morphological changes in AMI and morphological variations that may lead to the appearance of this pathology. There a reseveral works on this subject, although few explore morpho-functional alterations to the cardiovascular system. Some studies reported improved cardiac function and remodeling, together with a decrease in atherosclerotic plaque, among patients undergoing cardiac rehabilitation.


Subject(s)
Humans , Exercise , Myocardial Infarction/physiopathology , Myocardial Infarction/mortality , Rehabilitation/methods , Heart Ventricles/anatomy & histology , Anatomy , Heart Atria/physiopathology , Coronary Artery Disease/physiopathology , Coronary Artery Disease/mortality , Ischemia/complications , Plaque, Atherosclerotic/complications , Risk Factors , Thrombosis/complications , Thrombosis/physiopathology , Coronary Vessels/pathology
17.
Rev. bras. cir. cardiovasc ; 29(3): 367-373, Jul-Sep/2014. tab, graf
Article in English | LILACS | ID: lil-727157

ABSTRACT

Objective: In this study, we aimed to compare clinical outcomes of superior transseptal approach with the conventional left atriotomy in patients undergoing mitral valve surgery. Methods: Between January 2010 and November 2012, a total of 91 consecutive adult patients (39 males, 52 females; mean age: 54.0±15.4 years; range, 16 to 82 years) who underwent mitral valve surgery in the Division of Cardiovascular Surgery at Koşuyolu Training Hospital were included. The patients were randomized to either superior transseptal approach (n=47) or conventional left atriotomy (n=44). Demographic characteristics of the patients, comorbidities, additional interventions, intraoperational data, pre- and postoperative electrophysiological study findings, and postoperative complications were recorded. Results: Of all patients, 86.7% (n=79) were in New York Heart Association Class III, while 12 were in New York Heart Association Class IV. All patients underwent annuloplasty (42.9%) or valve replacement surgery (57.1%). There was no significant difference in pre- and postoperative electrocardiogram findings between the groups. Change from baseline in the cardiac rhythm was statistically significant in superior transseptal approach group alone (P<0.001). There was no statistically significant difference in mortality rate between the groups. Permanent pacemaker implantation was performed in 10.6% of the patients in superior transseptal approach group and 4.5% in the conventional left atriotomy group. No statistically significant difference in bleeding, total length of hospital and intensive care unit stay, the presence of low cardiac output syndrome was observed between the groups. Conclusion: Our study results suggest that superior transseptal approach does not lead to serious or fatal adverse effects on sinus node function or atrial vulnerability, compared to conventional approach. .


Objetivo: O objetivo deste estudo é comparar os resultados clínicos da abordagem septal superior com a atriotomia esquerda convencional em pacientes submetidos à cirurgia valvar mitral. Métodos: Entre janeiro de 2010 e novembro de 2012, foi incluído um total de 91 pacientes adultos consecutivos (intervalo de 16 a 82 anos, média 54,0±15,4 anos; 39 homens, 52 mulheres) submetidos à cirurgia valvar mitral no Serviço de Cirurgia Cardiovascular no Hospital Training Koşuyolu. Os pacientes foram randomizados para abordagem septal superior (n=47) ou atriotomia esquerda convencional (n=44). Foram registradas características demográficas dos pacientes, comorbidades, intervenções adicionais, dados intraoperatórios, achados do estudo eletrofisiológico pré e pós-operatório e complicações pós-operatórias. Resultados: Do total de pacientes, 86,7% (n=79) estavam na Classe III e 12 na Classe IV da New York Heart Association. Todos os pacientes foram submetidos à anuloplastia (42,9%) ou cirurgia de troca valvar (57,1%). Não houve diferença significativa nos resultados do eletrocardiograma pré e pós-operatórios entre os grupos. Mudança da linha de base no ritmo cardíaco foi estatisticamente significativa apenas no grupo abordagem septal superior (P<0,001). Não houve diferença estatisticamente significativa na taxa de mortalidade entre os grupos. Marca-passo definitivo foi implantado em 10,6% dos pacientes no grupo abordagem septal superior e em 4,5% dos pacientes no grupo atriotomia esquerda convencional. Não houve diferença estatisticamente significativa no sangramento, tempo total de internação e de permanência na UTI, tendo sido observada síndrome de baixo débito cardíaco entre os grupos. Conclusão: Nossos resultados sugerem que a ...


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Heart Septum/surgery , Heart Valve Diseases/surgery , Mitral Valve/surgery , Electrocardiography , Heart Atria/physiopathology , Heart Atria/surgery , Heart Septum/physiopathology , Heart Valve Diseases/physiopathology , Length of Stay , Mitral Valve/physiopathology , Postoperative Period , Statistics, Nonparametric , Stroke Volume/physiology , Treatment Outcome
18.
Arch. cardiol. Méx ; 84(1): 32-40, ene.-mar. 2014. ilus
Article in Spanish | LILACS | ID: lil-712908

ABSTRACT

En este artículo hemos querido establecer que el bloqueo interauricular existe como entidad anatomoeléctrica y que debe ser considerado como un verdadero bloqueo. El bloqueo interauricular presenta diferentes grados al igual que otros bloqueos del sistema de conducción. Puede presentarse como expresión de remodelado puramente eléctrico o acompañar alteraciones estructurales que dilaten las aurículas. Se encuentra asociado a arritmias supraventriculares y es probablemente un predictor de accidente cerebrovascular cardioembólico. El bloqueo interauricular puede presentarse de manera transitoria, y en ciertas circunstancias clínicas, puede ser reversible. El aporte del mapeo endocavitario ha incrementado el conocimiento sobre su anatomía y fisiopatología, y posiblemente la magnetocardiografía podría contribuir al estudio no invasivo de esta entidad. La terminología a utilizar debería ser bloqueo interauricular de primer, segundo y tercer grado o alternativamente, y en función de simplificar: parcial o avanzado. La morfología de la onda P, en función de diagnosticar el grado avanzado, siempre debería ser tenida en cuenta. Para finalizar, debemos reconocer el aporte fundamental que el Dr. Bayés de Luna ha establecido sobre la relación del bloqueo interauricular con las arritmias supraventriculares conformando un síndrome arrítmico indiscutido; lo cual a nuestro criterio representa un aporte mayor al conocimiento de la electrocardiografía y la electrofisiología, y hace meritorio que este síndrome arrítmico sea denominado <

In this article we aimed to establish that interatrial block exists as an anatomical-electrical entity, which should be considered a true block. Interatrial block presents with different degrees as other blocks in the conduction system. It shows a correlation with the left atrium size, however, it can be seen in patients with normal atrial size too. Interatrial block is strongly associated with atrial arrhythmias and it could be considered a predictor of cardioembolic stroke. Interatrial block is an expression of atrial electrical remodeling and dysfunction. IAB can be transient and in certain clinical circumstances, may be reversible. The contribution of endocardial mapping has increased our knowledge of the anatomy and pathophysiology of interatrial block. Magnetocardiography could be a possible non-invasive procedure to further investigate this entity. The interatrial block classification should include first, second and third degree or alternatively, in order to simplify the terminology: partial or advanced. The P wave morphology should always be taking into consideration when diagnosing this condition. Finally, without the initial description of interatrial block made by Dr. Bayés de Luna, it would be impossible to understand interatrial block as an anatomical and electrical substrate for atrial arrhythmias. It is our opinion that this represents a major contribution to the knowledge of electrocardiography and electrophysiology, and makes commendable that this arrhythmic syndrome should be called <

Subject(s)
Humans , Arrhythmias, Cardiac/physiopathology , Heart Atria/physiopathology , Heart Conduction System/abnormalities , Arrhythmias, Cardiac/complications , Electrophysiological Phenomena , Heart Conduction System/physiopathology , Syndrome
19.
Article in English | WPRIM | ID: wpr-124854

ABSTRACT

Although complex fractionated electrogram (CFE) is known to be a target for catheter ablation of fibrillation, its physiological meaning in fibrillation wave-dynamics remains to be clarified. We evaluated the spatiotemporal relationships among the parameters of fibrillation wave-dynamics by simulation modeling. We generated maps of CFE-cycle length (CFE-CL), local dominant frequency (LDF), wave break (WB), and phase singularity (PS) of fibrillation in 2-dimensional homogeneous bidomain cardiac modeling (1,000 x 1,000 cells ten Tusscher model). We compared spatiotemporal correlations by dichotomizing each maps into 10 x 10 lattice zones. In spatial distribution, WB and PS showed excellent correlation (R = 0.963, P < 0.001). CFE-CL had weak correlations with WB (R = 0.288, P < 0.001), PS (R = 0.313, P < 0.001), and LDF (R = -0.411, P < 0.001). However, LDF did not show correlation with PS or WB. PSs were mostly distributed at the periphery of low CFE-CL area. Virtual ablation (5% of critical mass) of CFE-CL < 100 ms terminated fibrillation at 14.3 sec, and high LDF ablation (5% of critical mass) changed fibrillation to organized tachycardia, respectively. In homogeneous 2D fibrillation modeling, CFE-CL was weakly correlated with WB, PS, and LDF, spatiotemporally. PSs are mostly positioned at the periphery of low CFE-CL areas, and virtual ablation targeting low CFE-CL regions terminated fibrillation successfully.


Subject(s)
Algorithms , Atrial Fibrillation/physiopathology , Body Surface Potential Mapping , Catheter Ablation , Electrocardiography , Electrodes , Heart Atria/physiopathology , Humans , Models, Biological
20.
Arq. bras. cardiol ; 101(6): 519-527, dez. 2013. ilus, tab
Article in Portuguese | LILACS | ID: lil-701268

ABSTRACT

FUNDAMENTO: Índices de ondas P são marcadores interessantes para prever recorrências de fibrilação atrial (FA) pós ablação. OBJETIVO: Esse estudo avalia o valor dos índices de onda P para prever recorrências após isolamento da veia pulmonar (IVP) em pacientes com fibrilação atrial paroxística. MÉTODOS: Foram selecionados 198 pacientes (57 ± 8 anos, 150 homens) com FA paroxística sintomática refratária a medicamentos submetidos ao IVP em nosso hospital. Um eletrocardiograma de 12 derivações foi utilizado para medir a duração da onda P na derivação II, a força terminal de P (FTP) na derivação V1, o eixo e a dispersão da onda P. RESULTADOS: No acompanhamento de 9 ± 3 meses, as recorrências ocorreram em 60 (30,3%) pacientes. Os pacientes que apresentaram recorrência de FA tiveram maior duração média de onda P (122,9 ± 10,3 versus 104,3 ± 14,2 ms, p < 0,001), maior dispersão da onda P (40,7 ± 1,7 ms vs 36,6 ± 3,2 ms, p < 0,001). A duração da onda P > 125 ms apresenta 60% de sensibilidade, especificidade de 90%, valor preditivo positivo (VPP) de 72% e valor preditivo negativo (VPN) de 83,7%, enquanto a dispersão da onda P > 40 ms tem 78% de sensibilidade, 67% de especificidade, PPV 51% e VPN de 87,6%. 48/66 (72,7%) dos pacientes com FTP < -0,04 mm/segundo vs 12/132 (9%) com FTP > -0,04 mm/segundo tiveram recorrência de FA (p < 0,001). O eixo da onda P não diferiu entre os dois grupos. Na análise multivariada, os índices da onda P não foram independentes do tamanho do átrio esquerdo e da idade. CONCLUSÕES: A duração da onda P > 125 ms, a dispersão da onda P > 40 ms e FTP em V1 < -0,04 mm/sec são bons preditores clínicos das recorrências de FA pós IVP em pacientes com fibrilação atrial paroxística; contudo, eles não foram independentes do tamanho do átrio esquerdo e da idade.


BACKGROUND: P-wave indices are appealing markers for predicting atrial fibrillation (AF) recurrences post ablation. OBJECTIVE: This study evaluates the value of P wave indices to predict recurrences post pulmonary vein isolation (PVI) in patients with paroxysmal AF. METHODS: We selected 198 patients (57 ± 8 years, 150 males) with symptomatic drug-refractory paroxysmal AF undergoing PVI in our hospital. A 12-lead electrocardiogram was used to measure P wave duration in lead II, P wave terminal force (PWTF) in lead V1, P wave axis and dispersion. RESULTS: During a follow-up of 9 ± 3 months, recurrences occurred in 60 (30.3%) patients. The patients that had AF recurrence had longer mean P wave duration (122.9 ± 10.3 vs 104.3 ± 14.2 ms, p < 0.001), larger P wave dispersion (40.7 ± 1.7 ms vs 36.6 ± 3.2 ms, p < 0.001). P wave duration > 125 ms has 60% sensitivity, 90% specificity, positive predictive value (PPV) of 72% and negative predictive value (NPV) of 83.7%, whereas P wave dispersion > 40 ms has 78% sensitivity, 67% specificity, PPV of 51% and NPV of 87.6% 48/66 (72.7%) patients with PWTF < -0.04 mm/second vs12/132(9%) with PWTF > -0.04 mm/second showed recurrence of AF (p < 0.001). P wave axis was not different between two groups. On multivariate analysis, P wave indices were not independent from left atrial size and age. CONCLUSIONS: P wave duration > 125 ms, P wave dispersion > 40 ms and PWTF in V1 < -0.04 mm/sec are good clinical predictors of AF recurrences post PVI in patients with paroxysmal atrial fibrillation; however they were not independent from left atrial size and age.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Atrial Fibrillation/diagnosis , Electrocardiography/standards , Heart Atria/physiopathology , Pulmonary Veins/surgery , Atrial Fibrillation/physiopathology , Atrial Fibrillation/surgery , Biomarkers/analysis , Catheter Ablation/methods , Heart Atria/surgery , Predictive Value of Tests , Pulmonary Veins/physiopathology , Recurrence , Sensitivity and Specificity
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