Isolated tear in left atrial appendage due to blunt trauma chest: A rare case report

Blunt traumatic cardiac rupture is associated with a high mortality rate. Motor vehicle accidents account for most cardiac ruptures, but crush injury is relatively rare. We describe a case of a 72-year-old man who had the left atrial appendage ruptured through blunt trauma due to a fall from scooter. Simple suture repair of the atrial appendage was achieved after clamping the base of the left atrium to control the bleeding. He recovered without complication. Traumatic injury to left atrial appendage is rarely seen and reported.     

Impact of Chronic Obstructive Pulmonary Disease on Procedural Outcomes and Quality of Life in Patients with Atrial Fibrillation Undergoing Catheter Ablation

Impact of COPD on Atrial Fibrillation Ablation. Background : Chronic obstructive pulmonary disease (COPD) is a risk factor for atrial fibrillation (AF). The aim of this study was to investigate the impact of COPD on outcomes of catheter ablation in patients with AF in terms of recurrence and quality of life (QoL). Methods : In this prospective study, 550 consecutive patients with symptomatic, medication‐refractory AF underwent first catheter ablation. Patients were classified into those with COPD (group 1, n = 54) and those without COPD (group 2, n = 496). Patients were followed up for atrial tachyarrhythmia (ATa) recurrence for at least 24 months. The Medical Outcomes Study SF‐36 Health Survey was used to assess QoL at baseline and 24 months after ablation. Results : After a single ablation, 24 patients in group 1 (44.4%) and 142 in group 2 (28.6%) had ATa recurrence during a mean follow‐up of 31.4 ± 4.8 months (P = 0.016). The second ablation was performed in 19 patients (35.2%) from group 1 and in 109 patients (22.0%) from group 2 (P = 0.029). Multivariate logistic analysis showed that nonparoxysmal AF (P = 0.013, OR = 1.767, 95% CI: 1.129–2.765) as well as the presence of COPD (P = 0.029, OR = 1.951, 95% CI: 1.070–3.557) was the independent predictor for higher ATa recurrence. Moreover, patients in group 1 had significantly lower baseline scores on all SF‐36 Health Survey subscales. At 24‐month follow‐up, both mental component summary and physical component summary scores improved markedly in group 1 and 2. Conclusions : Although the presence of COPD predicted higher recurrence after single‐catheter ablation in AF patients, significant improvements in QoL were observed in the postablation COPD population. (J Cardiovasc Electrophysiol, Vol. 24, pp. 148‐154, February 2013)     

Role of tumor necrosis factor alpha in the pathogenesis of atrial fibrillation: A novel potential therapeutic target?

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice and a major cause of morbidity and mortality. Although the fundamental mechanisms underlying AF remain incompletely understood, atrial remodeling, including structural, electrical, contractile, and autonomic remodeling, has been demonstrated to contribute to the substrate for AF maintenance. Accumulating evidence shows that tumor necrosis factor alpha (TNF-α) plays exceedingly important roles in atrial remodeling. This article reviews recent advances in the roles of TNF-α in the pathogenesis of AF, elucidates the related mechanisms, and exploits its potential usefulness as a novel therapeutic target.     

Atrial fibrillation: An anesthesiologist's perspective

Atrial fibrillation (AF) is not only the most common arrhythmia in the global population but also the most frequent one encountered in the operating room. For an anesthesiologist, it is crucial to have the ability to maintain hemodynamics and prevent complications of patients who present AF perioperatively. Here we provide a brief review in the novel concept of the classification, pathophysiology, and management of AF to provide a practical approach for physicians coming across this arrhythmia during the perioperative period.     

75例选择性右室流出道间隔部起搏对心功能影响临床观察

目的探讨流出道室间隔起搏对心功能的影响。方法选择心动过缓住院患者75例,行选择性右室流出道间隔部起搏,观察术前及术后一周内左房内径(LAD)、左室舒张末内径(LVEDD)、左室射血分数(LVEF)及美国纽约心脏病学会(NYHA)心功能分级等指标。结果 75例患者均顺利完成间隔起搏植入手术,其中LVEF正常者,术后有提高LVEF,缩小LAD和LVEDD趋势(P>0.05);LVEF低于正常非心房颤动者,间隔起搏能提高LVEF(P>0.05),缩小LAD、LVEDD(P<0.05),改善心功能;LVEF低于正常合并心房颤动者,室间隔起搏有明显提高LVEF、缩小LAD、LVEDD趋势(P<0.05)。按NYHA心功能分级,术后心功能显著改善(P<0.01)。结论对于有安装埋藏式起搏器适应证的患者,施行流出道室间隔起搏能改善心功能,是安全可行的,但仍需进行远期观察。     

The Effects of Rate and Rhythm Control on Blood Pressure and Antihypertensive Drug Usage in Patients with Atrial Fibrillation and Hypertension Enrolled in the AFFIRM Trial

AF and HTN in the AFFIRM trial . Introduction: Atrial fibrillation (AF) has been shown to be associated with activation of the renin–angiotensin–aldosterone system, endothelial dysfunction, and increased sympathetic activity, all of which could lead to hypertension (HTN). While the effects of HTN on AF incidence and arrhythmogenesis have been reported, the long‐term effects of AF on blood pressure (BP) remain unknown. We hypothesized that a rate control strategy is associated with an increase in BP and/or antihypertensive drug therapy when compared with a rhythm control strategy in patients with a history of AF and HTN. Methods and Results: Using the intention to treat method, BP readings and the number of antihypertensive medication categories were analyzed over the first year of follow‐up in patients with AF and HTN enrolled in the AFFIRM trial. No clinically significant changes in BP occurred. Medication data were available in 2,876 patients. In the rate control group, 27.8% of patients required a net increase in the number of antihypertensive medications when compared to 18.3% in the rhythm control group (P < 0.001). Furthermore, 27.1% of patients in the rate control group had a net decrease in the number of antihypertensive medications when compared with 41.7% in the rhythm control group (P < 0.001). Conclusions: Our findings suggest that AF could be contributing to BP elevation in patients with a history of HTN and that a rhythm control strategy might result in a decrease in BP in these patients. This hypothesis however, requires future testing. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1094‐1098)     

Atrial Myxomas Grow Faster Than We Think

The finding of a cardiac myxoma usually implies immediate consequent surgical excision to prevent embolic events. Reports with documented growth rate are therefore very rare, and the actual growth rate remains a controversial issue. We report the growth of a left atrial myxoma in an asymptomatic 65‐year‐old patient with several years of follow up for aortic valve disease. A MEDLINE search with the terms “cardiac myxoma and tumor growth” was performed. The calculated growth rate showed an average growth rate of 0.49 cm/month. These reports suggest that the growth rate of myxomas may be faster than is usually thought. (Echocardiography 2010,27:E128‐E131)