A Potential Novel Indication for Preventing Thromboembolism in Patients with Atrial Arrhythmias: Remodeling of the Left Atrium

Objective:Thrombosis in patients with atrial arrhythmias might be associated with remodeling of the left atrium(LA).We aimed to describe this relationship and identify a novel factor,in addition to the CHA_(2)DS_(2)-VASc score,to guide therapeutic strategies for preventing thromboembolism in the hope of improving the prognosis for such patients.Methods:Patients diagnosed with atrial arrhythmias and who met our inclusion criteria were enrolled in this study.Various clinical parameters were recorded;diameters reflecting remodeling of the LA were measured and thrombosis was diagnosed by enhanced CT.Results:Totally,192 patients were enrolled in the study.The overall prevalence of left atrial thrombosis was 8.3%.Patients with persistent atrial fibrillation exhibited the highest anteroposterior diameter of the LA(45.1±7.2 mm)and prevalence of thrombosis(15.6%).An anteroposterior LA diameter of≥50 mm was a strong independent impact risk factor for thrombosis(OR=10.1,95%CI:2.8-36.9,P<0.OO1).The prevalence of LA thrombosis in patients with and without anteroposterior LA diameter of≥50 mm was 25.8%and 5.0%,respectively.Conclusion:Marked remodeling of the LA characterized by an anteroposterior LA diameter of≥50 mm is a strong independent risk factor of thrombosis,and should be considered for the prevention of thromboembolism through various strategies.

Mapping and ablation of atrial arrhythmia after valve surgery plus mini-maze procedure

Background Recurrent atrial arrhythmia is very common in patients after mitral valve surgery plus mini-maze procedure.Investigation about the mechanism for these patients may have important implication to improve the surgery strategy.Methods Mini-maze procedure was defined as follow: Pulmonary vein encircling incision and roof line connecting the two circles lesion,left atrial isthmus lesion,and the right atrial isthmus lesion.There were 517 patients with rheumatic valvular disease and pre-operative atrial fibrillation (AF) undergoing valve surgery plus mini-maze procedure in our hospital in the last 3 years,and 93 patients(18%) had recurrent atrial arrhythmia.Twelve patients(6 males and 6 females,mean age 53.8±7.8 ys) underwent electrophysiological study using 3-D mapping system(10 pts) or conventional mapping method(2 pts).Results The first recurrent time from surgery was 4.4±2.2 months.The mean follow-up time after catheter ablation was(12.0±6.0) months.One patient with sinus bradycardia had recurrent incessant atrial tachycardia (AT),but the AT was terminated by catheter position and never could be induced any more.She underwent a repeat procedure but failed just as the course in the first time, and was treated with DDDR pacemaker plus amiodarone.Six patients had 10 kinds of stable AT,including 5 at right atrial isthmus,2 at roof line,1 related to right atrial incision, 1 at anterior wall of left atrial,and 1 related to left superior pulmonary vene.All the stable AT were eliminated and remained sinus rhythm.Three patients had ATs with variable cycle length and the 3-D mapping suggested macro-reentry AT around mitral annulus.We tried to ablate at routine mitral isthmus and also in coronary sinus,but could not reach bi-directional conduction blocking.The other 2 patients were AF with reconnection at all previous ablation sites.Ablation strategy for AF included lesion at re-conduction sites and complex fractionated atrial electrogram.The patients with AF and mitral isthmus related AT were administrated with DC cardioversion and then took amiodarone.One AT and one AF recurred. Conclusions The recurrent atrial arrhythmia after mini-maze mostly related to reconnection at previous lesion sites and catheter ablation for AT could have a high success rate.It would be very hard to block mitral isthmus after valve replacement,so transmural lesion during surgery procedure is the most important strategy for preventing postoperative atrial arrhythmia.

Bilateral coronary-pulmonary artery fistula with paroxysmal atrial arrhythmia:a case report

Coronary-pulmonary artery fistula(CPAF)is a relatively rare type of congenital coronary artery variation,which is mostly asymptomatic and is discovered incidentally by coronary artery CT imaging or angiography.However,CPAF can cause a phenomenon of inter-artery steal and hemodynamic disorders,leading to myocardial ischemia,arrhythmia,heart failure,syncope and even cardiac sudden death in severe cases.Here we reported a case of a 53-year-old female who complained of intermittent palpitations and had a history of paroxysmal atrial fibrillation.The coronary angiography revealed bilateral coronary artery fistulae to pulmonary artery.In this case,the multiple fistulas were very rare and significant.Multidisciplinary treatment should be considered,including cardiologists,surgeons,anesthesiologists and nurses,etc.Regular follow-up is essential for long-term disease management after diagnosis or surgery.

Covert lung abscess as a cause of atrial arrhythmia: case report

Atrial arrhythmia is common in clinic. Recently, it was revealed that ectopicimpulses originating in sleeve muscles around the orifices of pulmonary veins (PVs) were deemed tobe one of the most important reasons that trigger or drive atrial arrhythmia, which was calledmyocardial sleeve related arrhythmia. Electrical isolation by radiofrequency ablation is becominghighlight and proved to be an effective method for the arrhythmia. We report a 55-year-old man withparoxysmal atrial tachy-arrhythmias admitted for PV electrical isolation. An abscess was discoveredin right inferior lung before the operation. The arrhythmia was disappeared after resection of theabscess. It implies that for such sufferer and recidivist after ablation, the factors outside thepulmonary veins should be excluded or treated as far as possible, especially before radiofrequencyablation therapy.