Clinical predictors and outcomes associated with acute return of pulmonary vein conduction during pulmonary vein isolation for treatment of atrial fibrillation

Radiofrequency ablation has become a common trend in management of cases of AF refractory to medical treatment. Recurrence of AF is a common observation both acutely and late during follow up. To determine the clinical predictors of acute reconnection of pulmonary vein potentials during PVI and late recurrence of AF on follow-up, respectively. A cohort of 14 patients referred to the EP labs of the NHI and Ain Shams University for PVI between January 2007 and February 2008 were studied. PVI of arrhythmogenic PVs was performed segmentally. PVI was defined as entry and exit block using a multipolar Lasso catheter. All veins were resampled to confirm isolation after 20-60niinutes. There were 14 patients who underwent isolation of 56 pulmonary veins during the study period. Acute reconnection of at least one vein occurred in 7 patients [50%] and 10 of the 56 pulmonary veins targeted [18%]. The left superior PV was most likely to acutely recover conduction compared with the other veins. Predictors of acute reconnection could not be accounted for given possible technical difficulties and the small sample size. During the three month follow up period, recurrence of AF occurred in 3 patients representing 21.4% of the cohort. It was found to be higher in female gender, left atrial size>or equal 4.Scms, age older than 50 years, non-paroxysmal type of AF and an EF of less than 50%. Many clinical criteria can affect acute reconnection of PVPs during PVI for patients with AF. According to previous studies large left atrium, older age, hypertension, non-paroxysmal type of AF are the most likely acute predictors. As regards short term follow-up, factors that could be considered include gender, age, left atrial size, EF and type of AF. The importance of detection of acute recurrence of PVPs and re-isolation has also become evident through this study

Assessment of right ventricular function in patients with chronic pulmonary hypertension using tissue doppler imaging

Chronic pulmonary hypertension [CPHT] has a great impact on both right ventricular [RV] systolic and diastolic properties and the assessment of those properties is not always feasible by traditional echocardiography examination. Tissue Doppler imaging [TDI] has recently emerged as a new, rapid and noninvasive tool for evaluation of RV systolic function. To determine the right ventricular systolic and diastolic function in patients with chronic pulmonary hypertension by tissue Doppler imaging and its correlation to conventional echocardiography parameters. The study included 30 consecutive patients with symptoms of right-sided heart failure due to CPHT who were in sinus rhythm, together with 10 normal subjects as controls. Pulsed-wave tissue Doppler imaging was used to measure peak systolic tricuspid annular velocity [Sa] as an index of RV function, peak early [Ea] and late [Au] diastolic tricuspid annular velocities. Among the 30 patients, 18 were females [60%] and 12 were males [40%]. Their mean age was 47.0 +/- 7.5 years. Among the 10 control subjects, 5 were males [50%] and 5 were females [50%]. The mean Sa velocity of the patient group was lower than the control group [9.57 +/- 2.06 vs. 15.05 +/- 1.75 cm/s., p < 0.001] signifying impairment of RV systolic function. The mean Ea velocity and the Ea/Aa ratio of the patient group was lower than the control group [9.85 +/- 3.21 vs. 17.95 +/- 2.27 cm/s., p < 0.001 and 0.98 +/- 0.58 vs. 1,54 +/- 0.18, p < 0.05 respectively], while the mean Aa velocity did not show any significant difference between the two groups [11.94 +/- 5.25 vs. 11.67 +/- 1.31 cm/s., p = NS]. In the patient group, there was a very good inverse correlation between both right ventricular diastolic dimension, right ventricular systolic pressure and Sa velocity as an index of RV systolic function [r = - 0.79, p < 0.001, and r = - 0.57, p < 0.001, respectively]. There was a very good correlation between E/A ratio of the trans-tricuspid Doppler flow and Ea/Aa ratio measured by TDI of the tricuspid annular motion "indices of diastolic function" [r = 0.79, p <0.001]. TDI is a new noninvasive method to detect systolic and diastolic dysfunction in patients with chronic pulmonary hypertension

Value of ST - segment elevation in predicting infarcts size and left ventricular function at discharge in patients with perfused acute anterior myocardial infarction

The electrocardiogram [ECG] is simple and non-invasive and can be recorded at bed side, its role in the diagnosis of acute myocardial infarction [AMI] is well established. We are aiming through this study to assess the predictive value of ST segment elevation pattern in reperfused anterior myocardial infarction as an index of infarct size and left ventricular function [LVF]. The study was conducted on 40 patients who were admitted to the Coronary Care Unit of the National Heart Institute between October 2000 and may 2001 with the diagnosis of first time acute anterior wall myocardial infarction. All patients included in the study were submitted to: Full history taking and clinical examination, laboratory investigation including: Serum cardiac enzymes CPK, LDH on admission, at 6 hour intervals for the first day and then daily until discharge, standard resting 12 electrocardiogram A 12 lead ECG was recorded immediately before reperfusion. Evaluation and classified the shape of ST elevation in V3 into 3 types: Concave type: ST-T segment rise with downward convexity group I, 2] straight type: ST-T segment raised obliquely like an inclined plane group II and convex type: ST-T segment rise with upward convexity Left ventricular function was evaluated by echocardiography: The left ventricle was divided into segments wall motion score is assigned [or each segment. Left sided cardiac catheterization with coronary angiography was performed to all patients within 2 weeks after the onset of infarction coronary artery patency was determined by TIMI grade 2,3. The grade of collateral filling in the LAD was evaluated according to the criteria of Rentrop et al. [no 0, visible filling of any collateral channel; 1] filling only of side branches without visualization of the epicardial segment; 2] partial filling of the epicardial segment; 3] complete filling of the epicardial segment, a good collateral channel was defined as grade 2,3 and poor collateral channel as grade 0 or 1. There was no significant difference in the smoking between the 3 groups regarding smoking, hypertension, Diabetes Mellitus and dyslipidemia. The infarct related artery [IRA] was the left anterior descending in 4.0 patient [100 percent of cases]

Non invasive evaluation of patients with ventricular septal defect after surgical correction

The present work is planned to study the cause of any residual cardiac murmur after surgical closure of ventricular septal defect and to evaluate cardiac function using Doppler echocardiography. Twenty cases of isolated VSD who underwent trans-atrial surgical closure of VSD were studied. They were 14 males and 6 females. Their age ranged between 3 and 20 years with a mean of 8. 5 +/- 4 years. Preoperative data were collected from patients files as cardiac catheterization data. Operative details were recorded during operation. Post operative study was also conducted and included clinical examination for any residual cardiac murmur. ECG, chest X-ray and Doppler echocardiography were performed to assess closure of the defect. Patients were classified into two groups. Group I included 8 patients with RV pressure < 50 mm Hg. Group 2: included 12 patients with RV pressure > 50 mm Hg. Doppler examination revealed 14 cases of 20 [70%] proved to have no residual shunt. 4 cases had mild shunt [20%], 2 cases had moderate shunt [10%] and no case showed large shunt. The shunt occurred along the suture line. Left ventricular function was assessed by the EF% which ranged between 47% and 63%. RV pressure decreased significantly in both groups postoperatively, post operative echo evaluation has also showed that 9 patients had TR 45%, 1 patient had pericardial effusion [5%], 1 showed vegetation on the patch [5%] and I patient had right atrial thrombus [5%]. We conclude that Doppler echocardiography is highly sensitive in the early post operative detection of VSD shunt, as well as other postoperative complications as pericardial effusion, vegetation on the patch and myocardial dysfunction. Results showed also that RV pressure decreased significantly after closure of the defect in both groups, however, in patients with VSD and at least moderate pulmonary hypertension, pulmonary artery pressure was not returning to normal therefore, it is advisable to operate on individuals with VSD and moderate pulmonary hypertension before there is the any increase of pulmonary vascular resistance