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JACC. Cardiovascular Imaging Nov 2019The management of atrial fibrillation (AF) is not only a clinical challenge but also an imaging challenge. The role of different imaging modalities to estimate the... (Review)
Review
The management of atrial fibrillation (AF) is not only a clinical challenge but also an imaging challenge. The role of different imaging modalities to estimate the thromboembolic risk in AF is a key clinical question. The present review summarizes the advances of myocardial imaging in the stratification of thromboembolic risk, diagnosis, and management of left atrial thrombosis in patients with AF. These imaging techniques are also important for understanding arrhythmias and their consequences. It is becoming fundamental for guiding therapy. Still, large studies are required, but be sure that left atrial imaging will become more and more clinically fundamental.
Topics: Action Potentials; Atrial Fibrillation; Atrial Function, Left; Echocardiography; Electrophysiologic Techniques, Cardiac; Heart Atria; Heart Rate; Humans; Magnetic Resonance Imaging; Multimodal Imaging; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Thromboembolism; Tomography, X-Ray Computed
PubMed: 30878420
DOI: 10.1016/j.jcmg.2018.06.031 -
Echocardiography (Mount Kisco, N.Y.) Dec 2023Atrial fibrillation (AF) is a devastating disease with a large global prevalence. The left atrial appendage (LAA) is a major source of thrombi in patients with AF.... (Review)
Review
Atrial fibrillation (AF) is a devastating disease with a large global prevalence. The left atrial appendage (LAA) is a major source of thrombi in patients with AF. Echocardiography plays an important role in identifying LAA thrombi and has become an invaluable imaging tool in planning for LAA occlusion (LAAO) in patients intolerant to anticoagulation. This review article will discuss the role of echocardiography in selecting patients for LAAO, intraprocedural monitoring, and identifying procedure-related complications.
Topics: Humans; Atrial Appendage; Echocardiography, Transesophageal; Echocardiography; Atrial Fibrillation; Thrombosis; Treatment Outcome
PubMed: 38009379
DOI: 10.1111/echo.15722 -
Interventional Cardiology Clinics Apr 2022Left atrial appendage closure aims to eliminate the stasis component of Virchow triad by eliminating a cul-de-sac that favors thrombosis, particularly when atrial... (Review)
Review
Left atrial appendage closure aims to eliminate the stasis component of Virchow triad by eliminating a cul-de-sac that favors thrombosis, particularly when atrial contractility becomes inefficient, such as in atrial fibrillation. Left atrial appendage closure devices have a common objective of sealing the appendage completely, with device stability and avoidance of device thrombosis. Two main device designs have been used to perform left atrial appendage closure: those that use a pacifier design (lobe + disk) and those that use a plug (single lobe) design. This review highlights the potential features and benefits of the single-lobe devices.
Topics: Atrial Appendage; Atrial Fibrillation; Cardiac Surgical Procedures; Heart Atria; Humans; Septal Occluder Device
PubMed: 35361464
DOI: 10.1016/j.iccl.2021.11.004 -
JACC. Clinical Electrophysiology Jan 2023Atrial standstill (AS) is a rare condition characterized by absence of electrical activity within the atria. Studies to date have been limited.
BACKGROUND
Atrial standstill (AS) is a rare condition characterized by absence of electrical activity within the atria. Studies to date have been limited.
OBJECTIVES
The authors sought to describe the clinical characteristics, genetics, and outcomes of patients with AS.
METHODS
This was a retrospective multicenter study of patients <18 years at AS diagnosis, defined as absence of atrial activity documented during an electrophysiology study, device placement, or noninvasive rhythm tracings and confirmed by echocardiogram. Patients with acquired disorders were excluded. Clinical details and genetic variants were recorded and analyzed.
RESULTS
Twenty patients were diagnosed at a median age of 6.6 years (IQR: 2.9-10.8 years). Arrhythmias included 16 (80%) with atrial/supraventricular arrhythmias and 8 (40%) with ventricular tachycardia, including 4 with cardiac arrests. A type 1 Brugada pattern was documented in 4. Pacemakers were implanted in 18 (90%). Although atrial leads were attempted in 15, only 4 achieved pacing at implantation. During a median follow-up of 6.9 years (IQR: 1.2-13.3 years), 7 (35%) had thromboembolic events. Of these, none had atrial pacing, 6 were not on anticoagulation, and 1 was on aspirin. Genetic testing identified SCN5A variants in 13 patients (65%). Analyses suggest SCN5A loss-of-function may be one mechanism driving AS. Ventricular arrhythmias and cardiac arrest were more commonly seen in patients with biallelic SCN5A variants.
CONCLUSIONS
AS may be associated with loss-of-function SCN5A variants. Patients demonstrate atrial and ventricular arrhythmias, and may present challenges during device placement. Patients without the capacity for atrial pacing are at risk for thromboembolic events and warrant anticoagulation.
Topics: Humans; Child; Child, Preschool; Atrial Fibrillation; Heart Atria; Heart Block; Heart Arrest; Anticoagulants
PubMed: 36435694
DOI: 10.1016/j.jacep.2022.08.022 -
Cardiac Electrophysiology Clinics Jun 2023Left atrial appendage closure aims to eliminate the stasis component of Virchow triad by eliminating a cul-de-sac that favors thrombosis, particularly when atrial... (Review)
Review
Left atrial appendage closure aims to eliminate the stasis component of Virchow triad by eliminating a cul-de-sac that favors thrombosis, particularly when atrial contractility becomes inefficient, such as in atrial fibrillation. Left atrial appendage closure devices have a common objective of sealing the appendage completely, with device stability and avoidance of device thrombosis. Two main device designs have been used to perform left atrial appendage closure: those that use a pacifier design (lobe + disk) and those that use a plug (single lobe) design. This review highlights the potential features and benefits of the single-lobe devices.
Topics: Humans; Follow-Up Studies; Treatment Outcome; Atrial Appendage; Echocardiography, Transesophageal; Atrial Fibrillation; Thrombosis; Cardiac Catheterization
PubMed: 37076231
DOI: 10.1016/j.ccep.2023.01.007 -
Acta Cardiologica May 2023Few data are available regarding the prevalence of left atrium (LA) thrombi in atrial fibrillation (AF) patients treated with non-vitamin K antagonist oral...
BACKGROUND
Few data are available regarding the prevalence of left atrium (LA) thrombi in atrial fibrillation (AF) patients treated with non-vitamin K antagonist oral anticoagulants (NOACs). Methods: We evaluated the prevalence and predictors of LA/LA appendage (LAA) thrombi in non-valvular AF patients treated with NOACs referring to a single centre for a scheduled electrical cardioversion (ECV) or catheter ablation (CA). Transesophageal echocardiography (TEE) was performed within 12 h prior to the index procedure.
RESULTS
A total of 352 consecutive patients with non-valvular AF treated with NOACs were included in this analysis (ECV group = 176 and CA group = 176) between 2013 and 2018. 85 patients (24.2%) were on dabigatran, 150 (42.7%) on rivaroxaban, 104 (29.6%) on apixaban and 13 (3.7%) on edoxaban. A LA/LAA thrombus was detected by TEE in 27 (7.7%) patients, 18 in the ECV group and nine in the ablation group; 18 (5.1%) patients presented dense LA/LAA spontaneous echo contrast (SEC). Predictors of LA/LAA thrombi were a CHADS-VASc score > 3 (OR 4.54, 95% CI 1.50 - 13.70, value = .007) and obesity (OR 6.01, 95% CI 1.95 - 18.50, value = .001).
CONCLUSIONS
Among real-world patients with non-valvular AF treated with NOACs, we found a high incidence of LA/LAA thrombi compared to previous reports. The main predictors of LA/LAA thrombosis were a CHADS-VASc score > 3 and obesity.
Topics: Humans; Atrial Fibrillation; Anticoagulants; Prevalence; Administration, Oral; Retrospective Studies; Heart Atria; Atrial Appendage; Heart Diseases; Thrombosis; Obesity; Echocardiography, Transesophageal
PubMed: 34821203
DOI: 10.1080/00015385.2021.2005307 -
International Journal For Numerical... Jun 2022The lack of mechanically effective contraction of the left atrium (LA) during atrial fibrillation (AF) disturbs blood flow, increasing the risk of thrombosis and...
The lack of mechanically effective contraction of the left atrium (LA) during atrial fibrillation (AF) disturbs blood flow, increasing the risk of thrombosis and ischemic stroke. Thrombosis is most likely in the left atrial appendage (LAA), a small narrow sac where blood is prone to stagnate. Slow flow promotes the formation of erythrocyte aggregates in the LAA, also known as rouleaux, causing viscosity gradients that are usually disregarded in patient-specific simulations. To evaluate these non-Newtonian effects, we built atrial models derived from 4D computed tomography scans of patients and carried out computational fluid dynamics simulations using the Carreau-Yasuda constitutive relation. We examined six patients, three of whom had AF and LAA thrombosis or a history of transient ischemic attacks (TIAs). We modeled the effects of hematocrit and rouleaux formation kinetics by varying the parameterization of the Carreau-Yasuda relation and modulating non-Newtonian viscosity changes based on residence time. Comparing non-Newtonian and Newtonian simulations indicates that slow flow in the LAA increases blood viscosity, altering secondary swirling flows and intensifying blood stasis. While some of these effects are subtle when examined using instantaneous metrics like shear rate or kinetic energy, they are manifested in the blood residence time, which accumulates over multiple heartbeats. Our data also reveal that LAA blood stasis worsens when hematocrit increases, offering a potential new mechanism for the clinically reported correlation between hematocrit and stroke incidence. In summary, we submit that hematocrit-dependent non-Newtonian blood rheology should be considered when calculating patient-specific blood stasis indices by computational fluid dynamics.
Topics: Atrial Appendage; Atrial Fibrillation; Heart Atria; Humans; Rheology; Thrombosis
PubMed: 35344280
DOI: 10.1002/cnm.3597 -
Open Heart May 2021Recent studies suggest left atrial (LA) dysfunction in cryptogenic stroke. We studied the dynamics of right atrium (RA) and right atrial appendage (RAA) in young adults...
BACKGROUND
Recent studies suggest left atrial (LA) dysfunction in cryptogenic stroke. We studied the dynamics of right atrium (RA) and right atrial appendage (RAA) in young adults with cryptogenic stroke. We hypothesised that bi-atrial dysfunction and blood stagnation might contribute to thrombosis formation in patients with patent foramen ovale (PFO), as deep venous thrombosis is detected only in the minority of patients.
METHODS
Thirty patients (aged 18-49) with a first-ever cryptogenic stroke and 30 age-matched and sex-matched stroke-free controls underwent cardiac magnetic resonance (CMR) imaging. An approach to estimate the RAA volume was developed, using crista terminalis and pectinate muscles as anatomical landmarks. Atrial expansion indices were calculated as (maximal volume - minimal volume) ×100%/minimal volume. Total pulmonary to systemic blood flow ratio (Qp/Qs) was based on phase contrast CMR. Right-to-left shunt (RLS) was evaluated with transoesophageal echocardiography in 29 patients and transcranial Doppler in 30 controls, moderate-to-severe RLS considered as clinically significant.
RESULTS
We found that RA and RAA volumes were similar between patients and controls. Also, RA expansion index was similar, but RAA (95.6%±21.6% vs 108.7%±25.8%, p=0.026) and LA (126.2%±28% vs 144.9%±36.3%, p=0.023) expansion indices were lower in patients compared with controls. Seven (24%) of 29 patients had an RLS compared with 1 (3%) of 30 controls (p=0.012). Among 59 study subjects, RLS was associated with lower RA (81.9%±15.9% vs 98.5%±29.5%, p=0.030), RAA (84.7%±18% vs 105.6%±24.1%, p=0.022), LA (109.8%±18.6% vs 140.1%±33.7%, p=0.017) and LAA (median 102.9% (IQR 65.6%-121.7%) vs 229.1% (151.8%-337.5%], p=0.002) expansion indices and lower Qp/Qs ratio (0.91±0.06 vs 0.98±0.07, p=0.027).
CONCLUSIONS
This study suggests bi-atrial dysfunction in young adults with cryptogenic stroke, associated with moderate-to-severe RLS. Dysfunction of the atria and atrial appendages may be an additional mechanism for PFO-related stroke.
TRIAL REGISTRATION NUMBER
NCT01934725.
Topics: Adolescent; Adult; Atrial Appendage; Atrial Function, Right; Case-Control Studies; Echocardiography, Transesophageal; Female; Heart Atria; Humans; Ischemic Stroke; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Ultrasonography, Doppler, Transcranial; Ventricular Dysfunction, Right; Young Adult
PubMed: 34006504
DOI: 10.1136/openhrt-2021-001596 -
Journal of Pediatric Hematology/oncology May 2021Right atrial thrombosis is a rare, but potentially serious complication of acute lymphoblastic leukemia treatment. We conducted a retrospective multicenter study to...
Right atrial thrombosis is a rare, but potentially serious complication of acute lymphoblastic leukemia treatment. We conducted a retrospective multicenter study to assess the incidence, treatment, and outcome of asymptomatic right atrial thrombosis detected at routine echocardiography of children after acute lymphoblastic leukemia treatment in the Nordic and Baltic countries. Eleven (2.7%, 95% confidence interval, 1.4-4.9) of 406 patients had asymptomatic right atrial thrombosis, ranging from 10 to 25 mm at detection. Three patients were treated with anticoagulation. None of the thromboses affected cardiac function, and they showed neither sign of progress nor spontaneous or treatment-related regress at follow-up.
Topics: Adolescent; Anticoagulants; Antineoplastic Combined Chemotherapy Protocols; Child; Child, Preschool; Female; Heart Atria; Heparin, Low-Molecular-Weight; Humans; Incidence; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies; Thrombosis
PubMed: 32555028
DOI: 10.1097/MPH.0000000000001848 -
Medical Ultrasonography Sep 2023
Topics: Humans; Ebstein Anomaly; Atrial Fibrillation; Heart Atria; Thrombosis
PubMed: 37778027
DOI: 10.11152/mu-4236