Background
Enlarged left atrium is an established predictor of atrial fibrillation recurrence after pulmonary vein isolation but arrhythmia recurrence is also observed in patients with normal anatomy of the left atrium. The aim of the study is to evaluate arrhythmia recurrence predictors in patients with normal anatomy of the left atrium.
Methods
The study included 182 patients with normal anatomy of the left atrium who underwent pulmonary vein isolation using catheter ablation. Various parameters were also compared, including age, gender, history of arrhythmia, arterial hypertension, concomitant coronary pathology, echocardiography findings, such as mitral valve and tricuspid valve regurgitation and procedure parameters, between patients with and without relapses. Statistical analysis was performed using the IBM SPSS Statistics‐19 software.
Results
Transthoracic echocardiography was performed by independent specialists with extensive experience. Trans‐esophageal echocardiography was performed before each ablation procedure. Standard trans‐septal puncture was performed under fluoroscopic control. Radiofrequency ablation was performed in the ipsilateral pulmonary vein antrum with a wide capture of nearby lung tissue.
Conclusions
It was concluded that the tricuspid valve regurgitation and arterial hypertension correlate with atrial fibrillation recurrence after pulmonary vein isolation in patients with normal left atrial anatomy.
Thoracoscopic ablation using the ‘box lesion’ technique was performed using a bipolar radio frequency clamp. A total of 48 patients, including 38 men and 10 women, mean age 58 years (range 33 74). The mean duration of AF was 4 yrs (range 1.5 months 21), the mean size of the atrium 4.15 ± 0.9 cm (2.9-8.8 cm), mean LVEF was 57.7% (39 -73%). Mitral regurgitation of 1-2 degrees was present in 14 patients, EDV LV 147.7 ml (81-224). Primary catheter ablation was performed in 22 patients, where 5 of them (22,7%) were performed repeatedly. Resection of the left atrial appendage (LAA) during the operation was performed in 44 patients (91%). Input and output block was achieved in all patients. In the postoperative period, all patients were administered supporting antiarrhythmic therapy with amiodarone and β-blockers, anticoagulant therapy with warfarin or PLA for 6-12 months. The effectiveness of treatment was monitored by a cardiomonitor Reveal XT in the period 1, 3, 6, 12, 24 months after surgery, the mean follow-up length was 498 ± 19 days. Sinus rhythm was restored during surgery in all patients and remained until discharge.
We present review of current evidence on ischemic heart disease in women. The risk factors, clinical manifestations, diagnosis and treatment and prevention of ischemic heart diseases in women are discussed.
Prevalence of anomalous origin of right coronary artery (RCA) from left coronary sinus in population according to autopsy studies is 0.026%. Origin of left main coronary artery and RCA from opposite sinus of Valsalva with further course of anomalous vessels between aorta and pulmonary artery often is linked to sudden death. We present a case of anomalous origin of RCA from left coronary sinus and aneurysm of aortic root. Our case demonstrates that when both coronary arteries` ostia are close to each other coronary arteries can be re-implanted on common area. Firstly, this prevents distention and deformation of coronary arteries that might cause myocardial infarction. Secondly, it reduces time of placing anastomosis thus decreasing period of myocardial ischemia and cardiopulmonary bypass time.
Letter to the editorAuthors` reply to Letter to the editor on article ``Anomalous origin of right coronary artery from left coronary sinus associated with aneurysm of aortic root`` Dear Editor, We have read the letter regarding our case report published in Heart, Vessels and Transplantation (1, 2). We thank authors for kind thought of our case report. We agree completely with authors about the lack of the additional method of diagnostics, also that the main factor determining the clinical importance of coronary artery anomalies is their hemodynamic significance. In our case we determined the hemodynamically significant dysfunction of the coronary circulation by clinical symptoms and electrocardiogram to choose advanced treatment tactic. Unfortunately, in our practice we did not use such method of diagnostic as MIP, which you noted. But we hope that in the immediate future we will be able to contribute more efficiency data to answer on all issues exercising scientific commonwealth.
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