Pulmonary vein anatomy variants as a biomarker of atrial fibrillation - CT angiography evaluation.

BACKGROUND: It has been suggested that changes in pulmonary veins (PV) and left atrium (LA) anatomy may have an influence on initiating atrial fibrillation (AF) and the effectiveness of pulmonary vein isolation (PVI) in patients (pts) with atrial fibrillation. The aim of the study was to assess anatomy abnormalities of the PV and LA in the patients with the history of AF and compare it with the control group(CG). METHODS: The multi-slice tomography (MSCT) scans were performed in 224 AF pts. before PVI (129 males, mean age 59 ± 9 yrs). The CG consisted of 40 pts. without AF (26 males, age 45 ± 9 yrs). LA and PV anatomy were evaluated. Diameters of PV ostia were measured in two directions: anterior-posterior (AP) and superior-inferior (SI) automatically using Vitrea 4.0. RESULTS: Pulmonary veins anatomy variants were observed more frequently in the atrial fibrillation group - 83 pts. (37%) vs 6 pts. (15%) in CG; 9% (21 pts) left common ostia (CO), 2% (5 pts) right CO, 19% (42 pts) additional right PV (APV), (1.8%) 4 pts. APV left, 8% right early branching (EB) and 3.5% left EB. The LA diameter differed significantly in AF vs CG group (41.2 ± 6 mm vs 35 ± 4.2 mm, p < 0.0001) respectively. CONCLUSIONS: The anomalies of pulmonary vein anatomy occurred more often in pts. with AF. They can be defined as an image biomarkers of atrial fibrillation. Right additional (middle) pulmonary vein was the most important anomaly detected in AF patients as well as enlargered diameters of the LA and PV ostia.

Comparison of pulmonary veins anatomy in patients with and without atrial fibrillation: analysis by multislice tomography.

UNLABELLED: A possible role of anomalies in number and insertion of pulmonary veins (PV) in initiating atrial fibrillation (AF) has been suggested. It has been shown as well that changes in anatomy of PVs such as enlargement may have an effect on arrhythmogenesis. The aim of the study was to compare anatomy of the left atrium (LA) and PVs in patients with AF and control subjects. METHODS: Eighty two patients were evaluated with 64-slice computed tomography (MSCT). Fifty one of them were referred to catheter ablation with history of highly symptomatic AF--AF(+) group. Thirty one control subjects had no history of AF and were referred to MSCT for noninvasive evaluation of different pathologies which finally were excluded--AF(-) group. Study groups did not differ in regard to age, sex, presence of hypertension and left ventricular systolic function. Diameters of PV ostia were measured in anterior-posterior (AP) and superior-inferior (SI) directions. Venous ostium index was calculated as a ratio between these measurements. RESULTS: The diameter of LA was higher in AF(+) patients than in the AF(-) patients (39±6 mm vs. 35±4 mm, p<0.005). In 68.6% of AF(+) patients and in 83.9% of AF(-) patients the anatomical pattern was typical with two right and two left PVs. Additional PVs were detected in 6 patients, only in AF(+) group (p<0.05). Common ostia were more frequently found in AF(+) subjects (37.2% vs. 19.3, p=0,08), mainly left-sided. In AF(+) group mean SI diameters of both-sided superior PVs and left inferior veins were larger. All AP diameters except for right inferior PVs were also larger in AF(+) group than in control cases. CONCLUSIONS: Variations in the PVs anatomy are more common and diameters of ostial portions of the veins are larger in AF patients than in control subjects. These findings suggest that further studies on the role of structural abnormalities of PVs in arrhythmogenesis are needed.

Correlation of heart rate variability parameters and QT interval in patients after PTCA of infarct related coronary artery as an indicator of improved autonomic regulation.

UNLABELLED: The purpose of this study was to determine if PTCA of the infarct related coronary artery (IRA) in the late phase of myocardial infarction (MI) can improve autonomic regulation of sinus rhythm and electrical stability of the myocardium measured by heart rate variability (HRV), QT, QTc, and its dispersion (QTd) and if any correlation exists among these measures. The study was performed in 25 patients (21 male, age: 50 +/- 9 years, EF: 52% +/- 11%) in the late phase of MI (2.5 +/- 1.5 months). HRV parameters were calculated automatically. QT, QTc, and QTd were measured manually from a 12-lead surface ECG (50 mm/s). All measurements were made before and 3-5 days after PTCA. Day and night parameters of HRV were sampled over two periods: 2 pm to 10 pm (day) and 10 pm to 6 am (night). Parameters of HRV measured from whole recordings were significantly higher after successful PTCA: SDRR (116 +/- 31 vs 128 +/- 38 ms), SD (55 +/- 17 vs 62 +/- 22 ms), rMSSD (30 +/- 13 vs 36 +/- 14 ms) and HF (246 +/- 103 vs 417 +/- 224 ms2). Significant differences were found during daytime for SD, rMSSD, and HF, and during nighttime for SDRR, SDANN. QT interval duration, QT corrected to the heart rate, and QT dispersion were significantly lower after PTCA (QTd: 54 +/- 15 vs 39 +/- 12 ms). There was no correlation between HRV and QT values before PTCA. High correlations were found after the procedure, particularly between QTd and nighttime HRV. CONCLUSIONS: PTCA of IRA in the late phase of MI enhances sympathovagal regulation of the cardiac rhythm and the electrical stability of the heart, which may be prognostically important.

Dispersion of the QT interval as a predictor of cardiac death in patients with coronary heart disease.

Abnormal dispersion of the QT interval (QTd), measured as interlead variability of QT, may reflect a regional variation in duration of ventricular action potential and, hence, of cardiac electrical instability. In this retrospective study, we analyzed the effect of QTd on survival and its relation to other known predictors of subsequent cardiac death (CD) and sudden cardiac death (SCD) in 162 patients with coronary heart disease (CHD). QTd was calculated as the difference between the highest and lowest values measured in each of the 12 ECG leads (Qtmax - QTmin). Seventeen CDs occurred, including nine SCDs, during a 25 +/- 11 month follow-up. There were significant differences in CD (P < 0.001 in log-rank test) and in SCD (P < 0.01). The 1- and 3-year survivals were 87.5% and 76.5% in patients with QTd > 0.060 seconds versus 98% and 93.5% in patients with QTd < 0.060 seconds, respectively. Additionally, a stepwise Cox regression analysis revealed that increased QTd was an independent risk factor of CD and SCD. A cut-off value of 60 ms for QTd had a 53% sensitivity and 79% specificity in discriminating patients who are at risk of CD. The positive and negative prognostic values were 23% and 93%, respectively. Our findings support the hypothesis that increased QTd has a prognostic value in the stratification of patients with CHD independent of other known risk factors.

[The importance of the autonomic nervous system for sinus and atrioventricular node function in patients with sick sinus syndrome]. / Znaczenie ukladu wegetatywnego dla czynnosci wezlów zatokowego i przedsionkowo-komorowego, u chorych z zespolem chorego wezla zatokowego.

Autonomous nervous system (ANS) influence on sinus (SN) and atrioventricular (A-V N) nodes is still under investigation, especially in pathological states. We analysed role of ANS for SN and A-VN function in patients with different forms of sick sinus syndrome (SSS). From 310 patients (pts) after electrophysiological examinations before and after pharmacological denervation of the heart we selected 206 pts with SSS (group S) for further investigation. In group S were 124 men and 82 women from 17 years old (mean 46 +/- 16). Coronary heart disease was present in 102 pts (myocardial infarction in 7), mitral valve prolapse in 10, hypertrophic cardiomyopathy in 2. SSS was the only pathological finding in 75 pts. In 92 cases pacemaker was implanted (45%) of whole group S. Only sinus bradycardia was observed in 118 cases, tachycardia-bradycardia syndrome in 34 and sinus arrest or/and sinoatrial block in 53 cases. Electrophysiological examinations were performed using transesophageal stimulation of the left atrium before and after denervation of the heart. Pharmacological denervation of the heart was obtained by propranolol (i.v. 0.2 mg/kg body weight) and than atropine (i.v. 0.04 mg/kg body weight). We analysed sinus cycle length in basic state, after propranolol injection and after full denervation, maximal sinus nodes recovery time, maximal corrected sinus node recovery time, secondary pause, sino-atrial conduction time, Wenckebach point before and after full denervation. The whole group with SSS (group S) was divided: pts with normal (S1) and abnormal (S2) intrinsic properties of SN (104 and 102 pts respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical manifestations of extrinsic and intrinsic sinus node dysfunction (functional and organic factors)]. / Zespól niewydolnosci wezla zatokowego (postac czynnosciowa i organiczna). Obraz kliniczny.

UNLABELLED: We analysed the clinical data of 206 patients (pts) with sick sinus syndrome (group S). All the population was divided into two group; pts with normal (104 pts, group S1) and abnormal (102 pts, group S2) "intrinsic" properties of sinus node (SN). Intrinsic properties was defined as normal if intrinsic heart rate was normal and corrected sinus node recovery time after pharmacological heart denervation (propranolol 0.2 mg/kg body weight, atropine 0.04 mg/kg body weight) was no longer than 422 ms. In whole group S, in 131 pts we found organic heart disease (coronary heart disease, n = 102, hypertensive disease, n = 12, mitral valve prolapse, n = 10, history of myocarditis or mild mitral or aortic valve stenosis, n = 7). In groups S1 and S2 coronary heart disease was found in 31 and 71 pts, hypertensive disease in 6 and 6 pts respectively. All the patients with mitral valve prolapse were found in group S1. In 75 pts sinus node disease (SSS) was the only pathological finding, they were divided into group IS1 (n = 51) and IS2 (n = 24) according to the intrinsic properties of the SN. CONCLUSION: 1. In clinical practice sinus node dysfunction seems to be more frequent in men than in women, 2. In the large group of patients with sick sinus syndrome we analysed in this paper in about 36% we did not find any other diseases of the heart.(ABSTRACT TRUNCATED AT 250 WORDS)

[QT interval and the autonomic nervous system in coronary disease and sick sinus syndrome]. / Odstep QT elektrokardiogramu a uklad wegetatywny w chorobie wiencowej i niewydolnosci wezla zatokowego.

The autonomous nervous system influence on sinus node (SN) in both physiological and pathological states is the most important factor determining its function. There are only few publications about autonomous nervous system action on electrophysiological properties of the human heart (ventricles), specially in patients with different types of sick sinus syndrome (SSS). Electrocardiograms of 113 patients (pts) with coronary heart disease, suspected for SSS, recorded during transesophageal atrial pacing before and after pharmacological denervation of the heart, were analysed. For heart denervation propranolol (0.2 mg/kg body weights) and atropine (0.04 mg/kg body weights) intravenously were used. We analysed sinus cycle length (P-P), QT interval and QTc (QT interval corrected according to Bazett's formula) during both sinus and paced rhythm (100 bpm), before and after denervation of the heart. During clinical observations (including Holter monitoring) and after electrophysiological testing we excluded SSS in 28 pts (group A) and confirmed diagnosis of SSS in 85 pts (group B). Group B was divided in two parts; pts with normal (group B1) and abnormal (group B2) intrinsic properties of the SN. Group B1 included 23 pts (15 men and 8 woman from 36 to 74, mean 53 +/- 9) with normal sinus cycle length after denervation (according to Joses's formula) and maximal, corrected sinus node recovery time after denervation less than 422 ms. Group B2 included remaining 62 pts (26 men and 36 woman from 36 to 80, mean 59 +/- 9). In groups A and B1 denervation of the heart shortens P--P, QT, QT100 and QTc100 significantly. Only QTc in A and B1 and all parameters in group B2 didn't change significantly.(ABSTRACT TRUNCATED AT 250 WORDS)