Electrical remodelling of the left and right atria due to rheumatic mitral stenosis
| Autor: | Prashanthan Sanders, Lorraine Mackenzie, Pawel Kuklik, Jonathan M. Kalman, Glenn D. Young, Sunil Thomas Chandy, Bobby John, Lukasz Szumowski, George Joseph, Martin K. Stiles, Jacob Jose, Stephen G. Worthley |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Refractory Period Electrophysiological medicine.medical_treatment Catheter ablation Nerve conduction velocity Mitral valve stenosis Internal medicine Atrial Fibrillation Humans Mitral Valve Stenosis Medicine Fibrillation Atrium (architecture) business.industry Electric Conductivity Effective refractory period Atrial fibrillation Middle Aged Atrial Function medicine.disease Treatment Outcome medicine.anatomical_structure Anesthesia Catheter Ablation Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business Crista terminalis |
| Zdroj: | European Heart Journal. 29:2234-2243 |
| ISSN: | 1522-9645 0195-668X |
| Popis: | Aims To characterize the atrial remodelling in mitral stenosis (MS). Methods and results Twenty-four patients with severe MS undergoing commissurotomy and 24 controls were studied. Electrophysiological evaluation was performed in 12 patients in each group by positioning multi-electrode catheters in both atria to determine the following: effective refractory period (ERP) at 10 sites at 600 and 450 ms; conduction time; conduction delay at the crista terminalis (CT); and vulnerability for atrial fibrillation (AF). P-wave duration (PWD) was determined on the surface ECG. In the remaining 12 patients in each group, electroanatomic maps of both atria were created to determine conduction velocity and identify regions of low voltage and electrical silence. Patients with MS had larger left atria (LA) ( P < 0.0001); prolonged PWD ( P = 0.0007); prolonged ERP in both LA ( P < 0.0001) and right atria (RA) ( P < 0.0001); reduced conduction velocity in the LA ( P = 0.009) and RA ( P < 0.0001); greater number ( P < 0.0001) and duration ( P < 0.0001) of bipoles along the CT with delayed conduction; lower atrial voltage in the LA ( P < 0.0001) and RA ( P < 0.0001); and more frequent electrical scar ( P = 0.001) compared with controls. Five of twelve with MS and none of the controls developed AF with extra-stimulus ( P = 0.02). Conclusion Atrial remodelling in MS is characterized by LA enlargement, loss of myocardium, and scarring associated with widespread and site-specific conduction abnormalities and no change or an increase in ERP. These abnormalities were associated with a heightened inducibility of AF. |
| Databáze: | OpenAIRE |
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