Arterial stiffness results in elevated left ventricular filling pressure and can promote atrial remodeling due to chronic pressure overload. However, the impact of arterial stiffness on the process of atrial remodeling in association with atrial fibrillation (AF) has not been fully evaluated. Methods:We enrolled 237 consecutive patients diagnosed with AF who had undergone ablation; data from 213 patients were analyzed. Cardio-ankle vascular index (CAVI) was used as a marker of arterial stiffness. The left atrial (LA) and right atrial (RA) volumes were determined by computed tomography imaging; atrial conduction and voltage amplitude were evaluated using a three-dimensional electromapping system used to guide the ablation procedure.
Background: Atrial remodeling associated with atrial fibrillation (AF) and sleep apnea is well known. Although sleep apnea is known to be associated with left atrial (LA) remodeling, its association with right atrial (RA) remodeling remains unclear. The study aimed to investigate the effect of sleep apnea on RA remodeling. Methods: We enrolled 141 AF patients who had undergone ablation. Sleep study results were evaluated using a portable sleep apnea test device. RA and LA volumes were determined by computed tomography (CT), and atrial structural remodeling was defined as atrial volume on CT ! 110 mL according to previous reports. The atrial substrate was evaluated by three-dimensional electroanatomical mapping. Results: After excluding 30 patients who received more than one catheter ablation or who could not receive enhanced CT, 111 patients were finally analyzed. The patients were classified into four groups according to the presence of RA and/or LA enlargement. Significant differences in AF type, N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and apnea-hypopnea index (AHI) were observed among the four groups. In univariate analysis, AHI values correlated with NT-proBNP levels (r = 0.293, p = 0.002), left ventricular ejection fraction (r = À0.198, p = 0.044), LA volume (r = 0.370, p < 0.001), and RA volume (r = 0.465, p < 0.001). Multiple regression analysis showed that AHI was an independent predictor of increased RA volume, and LA was excluded as a multiple risk factor in AHI. AF type-adjusted AHI levels correlated with RA volume, and RA remodeling correlated with the percentage of LA low-voltage area. Conclusions: Sleep apnea was strongly associated with RA structural remodeling regardless of paroxysmal and non-paroxysmal AF, and this relationship was more prominent than the effect of LA. Our results suggest that the association between sleep apnea and RA dilatation should be given attention.
Male rabbit's external urethral sphincter was examined by histochemical muscle fiber typing (myosin ATP-ase staining), and the analysis with construction of histograms regarding to muscle fiber types were performed. Rabbit's external urethral sphincter was predominantly composed of fast twitch (type 2) fibers (87.3%) as a whole. But the proportion of constituent fiber types varied according to the layers, i.e., the slow twitch (type 1) fibers constituted a relatively high percentage (33.4%) in the inner third layer, while few of the type 1 fibers were found in the outer third layer. The all histograms regarding to fiber type in different layers were normal bell-shaped distribution curves. The mena diameter of type 2 fibers (14.7 microns) was evidently larger than that of type 1 fibers (20.5 microns). All three kinds of muscle fibers equally tended to increase in size toward the outer direction, and in every three layers, the diameter of type 2 was larger than that of type 1 also. The definite differences in the proportion of fiber types and fiber sizes between layers may implicate that the inner and outer layers play different roles, i.e., continuous tonic constriction in the former and sporadic strong constriction of short duration in the latter, under different neural regulations. As far as rabbit's external urethral sphincter is concerned, sporadic strong constriction should be mainly dependent on the muscle fibers of large size composing the outer layer, especially the fast twitch fibers. It is possible that the rabbit is so adapted that it could interrupt urination promptly.
A 70-years-old male with a history of hypertension and drug resistant paroxysmal atrial fibrillation (AF) presented to our hospital for catheter ablation to his symptomatic AF. He had no prior surgical or percutaneous procedure to close or exclude the left atrial appendage (LAA). A transesophageal echocardiography (TEE) was performed to rule out intra-cardiac thrombus prior to the ablation procedure. Although the TEE imaging at multiple acquisition angles was obtained, the LAA could not be visualized and an absence of the LAA was suspected. An absence of the LAA was confirmed using cardiac computed tomography (CT), which included 3D reconstruction. Additionally, the LAA was not visualized with left atrium (LA) angiography. During the ablation procedure, 3D voltage mapping in LA was created and no low voltage area or abnormal potential was recorded around the usual root location of the LAA. Successful electrical pulmonary vein isolation was achieved with no major complications. After six months of follow-up, the patient remained in sinus rhythm without any antiarrhythmic drugs and showed no related clinical symptoms. He stopped his anticoagulation therapy due to lack of evidence of AF recurrence and an absence of LAA. Multimodality imaging allowed us to identify the congenital absence of LAA.
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