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Assessment of silent microembolism by magnetic resonance imaging after cardioversion in atrial fibrillation.

INTRODUCTION AND OBJECTIVES: To study electrical cardioversion in patients with atrial fibrillation as a potential cause of acute ischemic brain lesions. METHODS: We performed prospective analysis of 62 consecutive patients (62 [10] years, 16 female). All of them were anticoagulated for at least 3 weeks with an international normalized ratio of 2.69 (0.66). In all cases a magnetic resonance imaging of the brain was performed before and 24h after the cardioversion, including diffusion-weighted sequences. A neurological exploration was also performed before and after the procedure, using the mo…

Arrhythmia type after persistent atrial fibrillation ablation predicts success of the repeat procedure.

BACKGROUND: The aim of the study was to investigate whether the type of arrhythmia recurrence after ablation of persistent atrial fibrillation (AF) has an impact on the maintenance of sinus rhythm after the repeat ablation procedure. METHODS AND RESULTS: Included were 78 consecutive patients (82% men; mean age, 61±10 years; mean left atrial diameter, 47±4 mm) with persistent AF who underwent ≥1 repeat ablation. The initial ablation procedure had consisted of pulmonary vein isolation with additional substrate modification (ablation of complex fractionated atrial electrograms [n=63] or linear l…

Antithrombotic management for transient ischemic attack and ischemic stroke (other than atrial fibrillation).

The new definition and risk stratification for transient ischemic attack (TIA) have clear implications for the urgency of evaluation and treatment. The optimal antithrombotic treatment for TIA is being intensively studied. New guidelines for prevention of non-cardioembolic stroke in patients with stroke or TIA recommend the use of antiplatelet agents rather than oral anticoagulation. New antiplatelet drugs are being used in cardiovascular patients, and their role in cerebrovascular patients is being studied. The impact of genetic CYP2C19 polymorphisms is becoming clarified in cardiovascular pa

Isolated severe tricuspid regurgitation in a post pneumonectomy patient with chronic atrial fibrillation.

Severe primary tricuspid regurgitation is a rare entity, with most cases of tricuspid regurgitation being functional and secondary to pulmonary hypertension from left heart pathologies. We report an unusual case of a female patient with a history of left pneumonectomy and chronic atrial fibrillation many years earlier, and who subsequently developed tricuspid annular dilatation, resulting in severe isolated primary tricuspid regurgitation despite normal pulmonary artery pressures and left ventricular systolic function. She required multiple hospitalizations for right heart failure and continue…

[Current status and prospect of off-pump pulmonary vein isolation for atrial fibrillation].

We reviewed our clinical experience in off-pump pulmonary vein isolation (PVI) using bipolar radiofrequency (RF) device for atrial fibrillation (Af). From August 2004 to July 2007, the combined off-pump PVI and coronary artery bypass grafting (CABG) was performed in 13 of the 22 planned patients. There was no operative mortality or major complication. Sinus rhythmus was established in 69.2% of the patients [paroxysmal Af (PAf), 8/8 patients; chronic Af, 1/5 patients]. Off-pump PVI using bipolar RF may not be indicated to the chronic Af due to the low curability, and bipolar RF is not safe, esp…

Warfarin use and outcomes in patients with atrial fibrillation complicating acute coronary syndromes.

BACKGROUND: We examined warfarin use at discharge (according to Congestive heart failure, Hypertension, Age>75 years, Diabetes, Prior Stroke/transient ischemic attack score and bleeding risk) and its association with 6-month death or myocardial infarction in patients with post-acute coronary syndrome atrial fibrillation. METHODS: Of the 23,208 patients enrolled in the Platelet IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy, Platelet IIb/IIIa Antagonist for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network A, and Superior Yield of the …

New-onset atrial fibrillation predicts long-term mortality after coronary artery bypass graft.

OBJECTIVES: We sought to investigate the association between new-onset atrial fibrillation after coronary artery bypass graft (CABG) (post-operative atrial fibrillation [POAF]) and long-term mortality in patients with no history of atrial fibrillation. BACKGROUND: POAF predicts longer hospital stay and greater post-operative mortality. METHODS: A total of 16,169 consecutive patients with no history of AF who underwent isolated CABG at our institution between January 1, 1996, and December 31, 2007, were included in the study. All-cause mortality data were obtained from Social Security Adminis…

Chronic kidney disease and prevalent atrial fibrillation: the Chronic Renal Insufficiency Cohort (CRIC).

BACKGROUND: The epidemiology of atrial fibrillation (AF) has been mainly investigated in patients with end-stage renal disease, with limited data on less advanced chronic kidney disease (CKD) stages. METHODS: A total of 3,267 adult participants (50% non-Hispanic blacks, 46% women) with CKD from the Chronic Renal Insufficiency Cohort were included in this study. None of the study participants had been on dialysis. Those with self-identified race/ethnicity other than non-Hispanic black or white (n = 323) or those without electrocardiographic data (n = 22) were excluded. Atrial fibrillation was …

Catheter ablation of primary supraventricular tachycardia substrate presenting as atrial fibrillation in adolescents.

BACKGROUND: Atrial fibrillation is rarely encountered in children and adolescents, and these cases are usually secondary to myocardial diseases, electrical abnormalities, or scar related in postoperative congenital heart disease patients. Untreated sustained atrial fibrillation may lead to tachycardia-induced cardiomyopathy and/or systemic thromboembolization. OBJECTIVE: The objective here is to describe our findings in four adolescent patients presenting with recurrent atrial fibrillation. DESIGN: We report here the results of the findings in four patients who presented with recurrent clini…

Ablation surgery in patients with persistent atrial fibrillation: an 8-year clinical experience.

OBJECTIVE: This analysis was undertaken to evaluate the results of persistent atrial fibrillation ablation procedures concomitant to open surgery and to identify risk factors for persistent atrial fibrillation recurrence. METHODS: Since 2001, a total of 325 consecutive patients with persistent atrial fibrillation (duration, 0.5-33 years) have undergone persistent atrial fibrillation ablation concomitant to open surgery by creating 2 encircling isolation lesions around the left and right pulmonary veins and a connecting lesion between both with the use of radiofrequency ablation procedures. Pa…

[Video-assisted minimally invasive radiofrequency ablation in the treatment of persistent atrial fibrillation].

OBJECTIVE: To evaluate the effectiveness of the video-assisted minimally invasive radiofrequency ablation combined irbesartan use for the treatment of the persistent atrial fibrillation (AF). METHODS: From January 2006 to December 2009, 83 patients with persistent AF having a video-assisted minimally invasive radiofrequency ablation. There were 58 males, 25 females with a mean age of (57 ± 11) years. Mean duration of preoperative AF was (61 ± 65) months. Follow-up for the whole patients ranged from 1.0 to 3.6 years [mean (2.2 ± 0.8) years]. Patients were randomly divided into irbesartan group…

Orthostatic hypotension and long-term incidence of atrial fibrillation: the Malmö Preventive Project.

OBJECTIVES: Orthostatic hypotension (OH), a common manifestation of autonomic dysfunction, has been identified as an independent risk factor for all-cause mortality and incident cardiovascular disease. However, the role of OH in the development of atrial fibrillation has not been studied. DESIGN: We investigated the incidence of atrial fibrillation in relation to baseline presence of OH according to international consensus criteria in the Swedish population-based prospective cohort of the Malmö Preventive Project. The study sample consisted of 33,346 individuals (67.3% men; mean age, 45.6 ± 7…

Different structural remodelling in atrial fibrillation with different types of mitral valvular diseases.

AIMS: The aim of this study was to determine the relationship between atrial structural remodelling and atrial fibrillation (AF) for different types of mitral valvular diseases (MVDs). METHODS AND RESULTS: Left atrial appendages tissue samples were obtained from 24 patients with MVDs undergoing mitral valve replacement surgery. Masson's trichrome staining and immunohistochemical staining were performed to assess the extent of the fibrosis. Ultrastructural changes in left atrial appendages were examined by electron microscope. The degree of fibrosis showed significant increases in patients wit…

Termination of sustained atrial flutter and fibrillation using low-voltage multiple-shock therapy.

BACKGROUND: Defibrillation therapy for atrial fibrillation (AF) and flutter (AFl) is limited by pain induced by high-energy shocks. Thus, lowering the defibrillation energy for AFl/AF is desirable. OBJECTIVE: In this study we applied low-voltage multiple-shock defibrillation therapy in a rabbit model of atrial tachyarrhythmias comparing its efficacy to single shocks and antitachycardia pacing (ATP). METHODS: Optical mapping was performed in Langendorff-perfused rabbit hearts (n = 18). Acetylcholine (7 ± 5 to 17 ± 16 μM) was administered to promote sustained AFl and AF, respectively. Single a…

The CHADS score role in managing anticoagulation after surgical ablation for atrial fibrillation.

BACKGROUND: Managing anticoagulation after surgical ablation is challenging, especially when sinus rhythm has been restored and the left atrial appendage has been surgically managed. The study purpose was to examine the applicability of the CHADS(2) in determining anticoagulation strategies after surgical ablation. CHADS(2) is a scoring system (0 to 6) used to indicate a patient's risk for a thromboembolic stroke and used for anticoagulation strategies. One point is given for any of the following conditions: C, congestive heart failure; H, hypertension; A, age 75 years old or greater; D, diabe

[Expression of angiotensin II receptor subtypes in atrial fibrillation underlying rheumatic heart disease].

OBJECTIVE: To examine the expression of angiotensin II (Ang II) receptor subtypes in human left and right atrial tissue in atrial fibrillation underlying rheumatic heart disease. METHODS: Atrial tissue samples were obtained from 39 patients with rheumatic heart disease, 25 with atrial fibrillation (AF) and 14 with sinus rhythm(SR) during open heart surgery. AT1 and AT2 mRNA levels were measured with semi-quantitative reverse transcription polymerase chain reaction techniques. AT1 and AT2 protein levels were measured with immunohistochemical techniques. RESULTS: Compared with that of the SR g…

Atorvastatin and persistent atrial fibrillation following cardioversion: a randomized placebo-controlled multicentre study.

AIMS: To evaluate the effect of atorvastatin in achieving stable sinus rhythm (SR) 30 days after electrical cardioversion (CV) in patients with persistent atrial fibrillation (AF). METHODS AND RESULTS: The study included 234 patients. The patients were randomized to treatment with atorvastatin 80 mg daily (n = 118) or placebo (n = 116) in a prospective, double-blinded fashion. Treatment was initiated 14 days before CV and was continued 30 days after CV. The two groups were well-balanced with respect to baseline characteristics. Mean age was 65 +/- 10 years, 76% of the patients were male and 4…

Предварительная фибрилляция как осложнение геморрагической лихорадки денге: самоограничение.

В то время как изменения в электрокардиограмме (ЭКГ) широко распространены во время вирусной инфекции денге, фибрилляция (АФ) является очень редким проявлением. Ранее подчеркивалось, что сердечные осложнения во время инфекции денге всегда носят временный характер и что они будут спонтанно урегулированы после выздоровления от этой болезни. Мы представляем случай с молодым пациентом с положительной геморрагической лихорадкой денге, вызванной АФ. ЭКГ выявила нормальное в структурном отношении сердце. Пациент остался в АФ, несмотря на решение проблемы болезни. Переход к нормальному синусовому ритм

Совпадение в аннотации оригинала
While electrocardiogram (ECG) changes are common during viral dengue infection, atrial fibrillation (AF) is a very rare manifestation. It has previously been highlighted that cardiac complications during dengue infection are invariably transient and will spontaneously resolve following recovery from the illness. We present the case of a young patient with Ig…

Does minimal-access aortic valve replacement reduce the incidence of postoperative atrial fibrillation?

As the most common sequela of cardiac valvular surgery, atrial fibrillation (AF) has an important impact on postoperative morbidity. Minimal-access aortic valve replacement (AVR), with purported benefits on operative outcomes, has emerged as an alternative to conventional AVR. We used meta-analysis to determine whether minimal access influences the incidence of postoperative AF after AVR. Further, we sought first to evaluate via sensitivity analysis the impact of any differences and to identify the sources of possible heterogeneity between studies; second, we sought to evaluate any indirect ef…