Effect of left atrial circumferential ablation for atrial fibrillation on left atrial transport function

BACKGROUND: The effects of left atrial (LA) circumferential ablation on LA function in patients with atrial fibrillation (AF) have not been well described. OBJECTIVES: The purpose of this study was to determine the effect of LA circumferential ablation on LA function. METHODS: Gated, multiphase, dynamic contrast-enhanced computed tomographic (CT) scans of the chest with three-dimensional reconstructions of the heart were used to calculate the LA ejection fraction (EF) in 36 patients with paroxysmal (n = 27) or chronic (n = 9) AF (mean age 55 +/- 11 years) and in 10 control subjects with no history of AF. Because CT scans had to be acquired during sinus rhythm, a CT scan was available both before and after (mean 5 +/- 1 months) LA circumferential ablation (LACA) in only 10 patients. A single CT scan was acquired in 8 patients before and in 18 patients after LACA ablation. Radiofrequency catheter ablation was performed using an 8-mm-tip catheter to encircle the pulmonary veins, with additional lines along the mitral isthmus and the roof. RESULTS: In patients with paroxysmal AF, LA EF was lower after than before LACA (21% +/- 8% vs 32 +/- 13%, P = .003). LA EF after LA catheter ablation was similar among patients with paroxysmal AF and those with chronic AF (21% +/- 8% vs 23 +/- 13%, P = .7). However, LA EF after LA catheter ablation was lower in all patients with AF than in control subjects (21% +/- 10% vs 47% +/- 5%, P < .001). CONCLUSION: During medium-term follow-up, restoration of sinus rhythm by LACA results in partial return of LA function in patients with chronic AF. However, in patients with paroxysmal AF, LA catheter ablation results in decreased LA function. Whether the impairment in LA function is severe enough to predispose to LA thrombi despite elimination of AF remains to be determined.     

缬沙坦对高血压合并持续性心房颤动患者左心房结构及左心室功能的影响

目的观察缬沙坦对高血压合并持续性心房颤动(房颤)患者在降压同时对其心率(HR)、血压(BP)、左心房结构及左心室功能的影响。方法对2004年1月至2005年6月哈尔滨医科大学第一临床医学院收治的高血压合并持续性房颤患者106例,在控制心室率、预防血栓治疗的基础上应用缬沙坦80mg/d,对照组用依那普利10mg/d。3个月、6个月后对照观察其对心率、血压、左心房结构及左心室功能的影响。缬沙坦组54例,依那普利组52例。结果分别观察3个月、6个月后两组血压、心率均控制理想,两组间差异无显著性意义(P>0.05)。左心房直径缬沙坦组治疗前平均(50±7)mm,3个月后为(46±4)mm,6个月后为(40±3)mm,与治疗前相比差异有显著性意义。依那普利组3个月、6个月后左心房也有缩小,但差异不显著。治疗组治疗前NY分级Ⅱ、Ⅲ级占64%,治疗后3个月、6个月分别下降至33%、15%。而依那普利组也有明显下降,3个月、6个月分别下降至45%、25%,下降程度不如缬沙坦组明显。结论长期应用缬沙坦(3个月以上)可以显著改善左心房结构、左心室功能和持续性房颤患者的长期预后。     

Atrial conduction delay and its association with left atrial dimension, left atrial pressure and left ventricular diastolic dysfunction in patients at risk of atrial fibrillation

BACKGROUND: Atrial conduction delay and its association with left atrial dimension, left atrial pressure and left ventricular (LV) diastolic dysfunction in patients at risk of atrial fibrillation (AF) may be assessed by high-resolution electrocardiography of P wave. OBJECTIVES: To determine how left atrial size, left atrial pressure and LV diastolic dysfunction, measured noninvasively by transthoracic echocardiography, influence atrial conduction time. METHODS: Signal-averaged electrocardiography of P wave and echocardiogram were performed on 70 patients (average age of 63+/-10 years; 37 male and 33 female), divided into three groups: group A, patients with paroxysmal AF (n=29); group B, patients with type 2 diabetes mellitus and arterial hypertension, but without AF (n=23); and group C, healthy control patients (n=18). Standard statistical methods were used. RESULTS: Filtered P wave duration, measured by signal-averaged electrocardiography, was significantly prolonged in group A and group B compared with control group C (138+/-12 ms and 125+/-9 ms versus 117+/-8 ms; P 相似文献   

左心房追踪技术评价高血压心房颤动和孤立性心房颤动患者左心房功能

目的应用左心房追踪技术(LAVT)评价高血压心房颤动(房颤)和孤立性房颤患者左心房功能。方法实验组为50例房颤患者,分为孤立性房颤组24例,高血压房颤组26例,对照组为25例健康成人,用M型超声测量左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、舒张末期室间隔厚度(IVSTd)、舒张末期左心室后壁厚度(LVPWTd),用校正立方体积法(Teich)计算左心室射血分数(LVEF);二维超声测量患者收缩末期左心房前后径(LAD1)、上下径(LAD2)、横径(LAD3),收缩末期右心房上下径(RAD1)、横径(RAD2),应用LAVT测量左心房最大面积(LAAmax)、左心房最大容积(LAVmax)、最小容积(LAVmin)、收缩期左心房充盈速率峰值(dv/dtS)、舒张早期左心房排空速率峰值(dv/dtE)及舒张晚期左心房排空速率峰值(dv/dtA),并计算左心房排空分数(LAEF)。比较左心房的收缩及舒张功能。结果孤立性房颤组LAD1:(42.43±4.24)mm、LAD2:(60.22±5.79)mm、LAD3:(47.90±4.86)mm、RAD1:(55.04±5.06)mm、RAD2:(43.25±2.56)mm、LAAmax、LAVmax、LAVmin、dv/dtE与正常对照组LAD1:(33.81±2.96)mm、LAD2:(47.29±6.79)mm、LAD3:(39.04±3.53)mm、RAD1:(44.34±4.12)mm、RAD2:(36.06±3.16)mm、LAAmax、LAVmax、LAVmin、dv/dtE比较均明显升高(均为P<0.05),孤立性房颤组LAEF、dv/dtS、dv/dtA与正常对照组比较均明显减低(均为P<0.05),LVEDD、LVESD、IVSTd、LVPWTd、LVEF与正常对照组比较差异均无统计学意义(均为P>0.05)。与正常对照组比较,高血压房颤组的LAD1:(45.47±7.33)mm、LAD2:(61.35±7.39)mm、LAD3:(49.27±5.25)mm、RAD1:(56.18±4.36)mm、RAD2:(45.13±3.21)mm、LAAmax、LAVmax、LAVmin、dv/dtE均明显升高,LAEF、dv/dtS、dv/dtA均明显减低(均为P<0.05),LVEDD、LVESD、IVSTd、LVPWTd、LVEF差异均无统计学意义(均为P>0.05)。与孤立性房颤组相比,高血压房颤组LAAmax、LAVmax、LAVmin均明显升高(均为P<0.05),LAEF、dv/dtS、dv/dtE、dv/dtA均明显减低(均为P<0.05),LVEDD、LVESD、IVSTd、LVPWTd、LVEF、LAD1、LAD2、LAD3、RAD1、RAD2差异均无统计学意义(均为P>0.05)。结论 AF患者左心房功能明显下降高血压房颤患者左心房功能损害较孤立性房颤患者明显。LAVT能准确、快速的反映房颤患者左心房大小及功能的变化,在评价左心房功能方面有较高的重复性。     

全胸腔镜下左心房黏液瘤切除15例

目的 总结15 例全胸腔镜左房黏液瘤切除术的初步经验,探讨全胸腔镜下心内手术的安全性和适应证.方法 2012年1 月至2013 年10 月,收治15例左房黏液瘤患者,女性10 例,男性5 例,其中5例合并二尖瓣关闭不全行二尖瓣成型术.全身麻醉下,双腔气管插管,采用股动静脉插管、右侧颈内静脉引流进行体外循环.右侧胸壁3个1～2 cm切口,在全胸腔镜下行左房黏液瘤切除术.结果 15 例手术均顺利进行.1例因瘤蒂位于左房底,瘤体大暴露困难,正中切口开胸手术,其余均全腔镜下完成手术.体外循环（40±15）min,升主动脉阻断（30±12）min,术后呼吸机辅助（4.5±1.4）h,术后住院（5.6±1.3）d.无大出血、术后再次开胸止血、脑栓塞等并发症.术后病理检查,1例为左房肉瘤,其余均为左房黏液瘤.结论 全胸腔镜左房黏液瘤切除技术可行、安全,既减少了常规正中开胸的手术创伤,又没有过度延长体外循环时间造成的进一步全身器官损害,有利于患者的术后早日康复,手术切口小、美观.     

非瓣膜病心房颤动对左心房大小的影响

目的　研究非瓣膜病心房颤动对左心房大小及左心室结构和功能的影响 ,探讨心房颤动与左心房扩大之间的因果关系。方法　选择 32 9例非瓣膜病心房颤动患者 ,根据心房颤动类型及心房颤动发作时间分组 ,比较各组间超声心动图参数。结果　心房颤动发作 1～ 3年组和 3年以上组左心房内径 ( L AD)均大于 1年以下组 ( P<0 .0 5 ,P<0 .0 1) ,而 3年以上组 L AD又大于 1～ 3年组 ( P<0 .0 5 ) ,3年以上组左心室舒张末期内径 ( L VED)大于 1年以下组 ( P<0 .0 5 ) ;持续性心房颤动组 L AD和 L VED均明显大于阵发性心房颤动组 ( P<0 .0 1) ;而持续性心房颤动患者心房颤动发作 3年以上组 L AD大于 1年以下组及 1～ 3年组 ( P<0 .0 1,P<0 .0 5 )。结论　心房颤动本身可引起左心房扩大 ,且左心房扩大常发生在心房颤动持续以后 ,因此转复心房颤动应尽早进行 ;心房颤动对左心室结构及功能也有一定影响 ,且持续性心房颤动的影响较大。     

正交心电图对左房肥大的诊断价值

目的探讨正交心电图对左心房肥大的诊断价值。方法观察以超声心动描记术诊断的144例左心房正常人和124例左心房增大患者的正交心电图并与常规心电图比较。结果正交心电图与左心房前后径有直线相关关系。正交心电图综合标准和简化标准诊断左房肥大的敏感性、准确性和阴性预测性分别为83.1%、82.1%、84.8%和79.8%、81.75%、82.6%(p>0.05),显著高于常规心电图的51.6%、71.3%、67.9%(p>0.01)。结论认为正交心电图简化标准操作简便,是一种较好的诊断左心房肥大的方法。     

P-wave morphology correlation with left atrial volumes assessed by 2-dimensional echocardiography

To correlate prespecified P-wave morphologies with echocardiographically derived left atrial volumes (LAVs), we studied a convenience sample of 71 patients with predominantly normal left ventricular systolic function (mean ejection fraction = 58.2% +/- 6.6%) who underwent concurrent 2-dimensional echocardiogram and 12-lead electrocardiogram. Left atrial volume was calculated from apical end-systolic images by the biplane method of disks and was indexed for body surface area (BSA). Electrocardiograms were assessed manually with calipers, measuring leading edge to leading edge. Patients included 34 men and 37 women with a mean age of 53 +/- 14 years. P-wave duration/PR-segment duration in lead II and depth and duration of terminal P wave in lead V1 (P terminal force) correlate poorly with LAV and provided only modest predictive power (area under receiver operating characteristic curve = 0.466-0.619 and r = 0.30-0.42, P = .014-.021). Total P-wave duration in lead II correlated moderately (r = 0.47, P < .001) and predicted LAV (LAV/BSA = 8.0 + 0.2 [P-wave duration in lead II]), as did P-wave area in lead II (r = 0.49, P < .001) (LAV/BSA = 18.6 + 1.7 [P-wave duration in lead II]). The 4 P-wave morphologies were found to be poorly sensitive but highly specific for left atrial enlargement.     

CARTO-3三维重建在心房颤动患者左心耳解剖形态评价中的应用

目的:探讨CARTO-3三维重建在心房颤动(房颤)患者左心耳解剖形态评价中的应用价值。方法:回顾性研究2014年8月至2015年9月89例接受射频消融术的房颤患者,所有患者进行64排螺旋CT增强扫描,应用CARTO-3对左心房、左心耳、肺静脉进行三维重建,测量左心耳口横径、左心耳深度以及左心耳口至左上肺静脉的距离等参数,对左心耳解剖形态进行相关分型。结果:运用CARTO-3三维重建技术,患者左心耳口形态分型:椭圆形76例(85.4%),足形6例(6.7%),类圆形4例(4.5%),水滴形3例(3.4%);左心耳形态分型:鸡翅型37例(41.6%),菜花型32例(36.0%),仙人掌型10例(11.2%),风向标型10例(11.2%);左心耳口平均最大横径为(30.1±6.7)mm,左心耳平均深度为(38.3±9.3)mm,左心耳口至左上肺静脉的平均距离仅为(5.9±3.9)mm。结论:CARTO-3三维重建可对左心耳及其相邻结构提供直观的解剖参考,并可定量评价左心耳解剖参数,对左心耳封堵术具有较好的指导意义。     

Congenital aneurysm of the left atrial appendage

Congenital aneurysm of the left atrial appendage is quite infrequent.Most instances are asymptomatic. Patients can report a varietyof symptoms, one of the most frequent being onset of auriculartachyarrhythmia. Various imaging techniques are useful in diagnosisand allow the differential diagnosis with other pathologies. We describe the case of a 24-year-old male with congenital aneurysmof the left atrial appendage. The patient presented with auricularfibrillation. Diagnosis was based on transthoracic and trans-esophagealechocardiography, and the patient was treated by surgical resectionof the aneurysm under extracorporeal circulation.     

Huge left atrial appendage aneurysm revealed by chronic hiccups

Left atrial appendage (LAA) aneurysm is an extremely rare anomaly. So far, less than one hundred cases only have been reported worldwide. Revelation modes are dominated by complications such as arrhythmias and thromboembolic events. We herein report a pediatric case of huge congenital LAA aneurysm with an original revelation mode that has never been described before in medical literature.     

Formulaic quantification of echocardiographic left atrial volume

Introduction

The association between increasing severity in abnormal atrial depolarization and left atrial (LA) volume derived by transthoracic echocardiogram (TTE) has been described through the following regression formula: LA end-systolic volume index (LAVI [milliliter]) = 8.0 + 0.2 (P-wave duration [millisecond]) (r = 0.47; P = .0002). However, prospective assessment of this formula has not been validated among inpatients outside the institution where it was first derived.

Methods

We prospectively obtained 12-lead electrocardiograms (ECGs) and TTEs on consecutive inpatients who were scheduled for nonemergent echocardiographic assessment. P waves were assessed independently to the nearest 10 milliseconds for application of the formula with a Bland-Altman plot. P-wave durations were obtained specifically from lead II and also from the any lead that yielded the widest measurement.

Results

After excluding those with poor ECG tracing and TTE images, 72 patients were studied. We found a strong formulaic correlation with LAVI by TTE when maximal P-wave measurements were obtained from any ECG lead (r = 0.67; P < .0001) and more so, when restricted only to lead II (r = 0.89; P < .0001). Correlation was strongest when there was no or minimal difference between P-wave measurements in lead II and all other leads (r = 0.84; P < .0001 for no difference vs r = 0.67; P < .0001 for 60-millisecond difference). The Bland-Altman plot showed good agreement of LAVI assessment using the formulaic estimation when compared to TTE measurements derived by Simpson's rule (coefficient of reproducibility for 2 SD equivalent to 8.8% for lead II and 11.4% for any lead).

Conclusion

There is good agreement and correlation between formulaic estimation and that of TTE for LAVI among inpatients. Such quantification of LA size not only serves as an indirect asset that could perhaps supplement TTE measurements in certain circumstances but also can facilitate risk stratification of patients.     

阵发性房颤射频消融治疗对左房的影响

目的评价阵发性房颤首次射频消融治疗对左房大小的影响。方法50例药物治疗无效的症状性阵法性房颤患者,在EnsiteVelocity三维标测系统指导下行环肺静脉前庭线性消融,消融终点为肺静脉电隔离。结果术中肺静脉隔离率100％。术后32例成功维持窦律（维持窦律组）,18例复发（复发组）。维持窦律组左房从38．3mm降至34．2mm,与射频消融前比较差异有统计学意义;复发组左房从38．6min升至39．1mm,但与射频消融前比较差异无统计学意义。结论阵发性房颤射频消融治疗能明确逆转左房重构。     

非风湿性心房颤动患者经药物复律后左房收缩功能的改变

目的探讨非风湿性心房颤动患者经药物复律后左房收缩功能的改变。方法观察了23例患者药物复律第1、8、15、30及60天时的二尖瓣血流变化并与20例正常人作对比研究。结果患者复律后2周内的左室舒张晚期二尖瓣血流峰速、速度积分显著增大,此后2周内渐大,而同期的左室舒张早期血流峰速、速度积分减小;与正常人相比,患者1个月、2个月时左室舒张晚期二尖瓣血流仍有显著性不同(P<0．05),但两者间无显著性差异。结论患者恢复窦性心律后左房收缩功能恢复主要在1个月内逐步进行,且2个月内不能完全恢复,多普勒超声观察有助于指导药物治疗及疗效评价。     

A giant left atrial myxoma prolapsing to midlevel of the left ventricle causing severe pulmonary hypertension.

We present a patient with a giant left atrial myxoma occupyingmost of the left atrial cavity and prolapsing to the midlevelof the left ventricle. A previously     

环肺静脉射频消融心房颤动对左心房结构和功能的影响

目的评价环肺静脉射频消融心房颤动（房颤）对左心房结构和功能的影响。方法对98例房颤患者环肺静脉射频消融术前及术后1年行超声心动图检查。分别测量左心房内径（LAD）、左心房收缩末容积（LAESV）、左心房舒张末容积（LAEDV）、二尖瓣血流速度峰值（VA）并计算左心房管道容积、左心房排空容积、左心房射血分数（LAEF）。结果环肺静脉消融术后LAD、LAESV、LAEDV、左心房排空容积较术前减小（P〈0．05）,管道容积较术前增大（P〈0．05）,VA、LAEF与术前比较差异无统计学意义（P〉0．05）。结论房颤环肺静脉隔离术后左心房结构及功能发生重构。术后左心房的内径和容积较术前减小;房颤环肺静脉隔离术后左心房的机械功能发生变化,左心房的储存功能降低,左心房的辅助泵功能无明显变化,左心房的管道功能增强。     

Congenital absence of left atrial appendage: A case report and literature review

Congenital absence of left atrial appendage (LAA) is an extremely rare entity. A 50-year-old man with no past cardiac history was admitted with symptomatic atrial fibrillation (AF). Before subjecting him to direct current (DC) cardioversion, the patient underwent a transesophageal echocardiography (TEE) examination, but neither LAA nor a cardiac thrombus could be detected. Absence of both was confirmed by cardiac computer tomography (CT) and a cardiac magnetic resonance imaging (MRI) scan. The patient reverted to sinus rhythm with an uneventful synchronized biphasic DC shock of 100 joules.