Thrombus overlying the main stem crista: a three dimensional reconstruction

Abstract

Objective-To determine the importance of rhythm regulation or rate control in patients with permanent atrial fibrillation (AF) and normal left ventricular function. Patients and interventions-Thirty six patients with a mixed fast and slow ventricular response rate to their AF were randomised to either His bundle ablation (HBA) and VVIR pacemaker (HBA group) or VVI pacemaker and atrioventricular modifying drugs (Med group). Outcomes assessed at one, three, six, and 12 months included exercise duration and quality of life. Results-Exercise duration significantly improved from baseline in both groups. There was no diVerence in outcome between the groups (Med +40% v HBA +20%, p = NS). The heart rate profile on exercise was similarly slowed in both groups compared to baseline. Quality of life significantly improved in both treatment arms for the modified Karolinska questionnaire (KQ) (Med +50% v HBA +50%, p = NS) and the Nottingham health profile (NHP) (Med +40% v HBA +20%, p = NS). However, for the individual symptom scores of each questionnaire more were improved in the Med group (KQ-Med 6 improved v HBA 4, NHP-Med 3 v HBA 1). Left ventricular function was equally preserved by both treatments during follow up. Conclusion-In these patients control of ventricular response rate with either HBA + VVIR pacemaker or atrioventricular modifying drugs + VVI pacemaker will lead to a significant improvement in exercise duration and quality of life. Rhythm regulation by HBA did not confer additional benefit, suggesting rate control alone is necessary for the successful symptomatic treatment of these patients in permanent AF.

Myocardial Infarction and Normal Coronary Arteries: The Experience of the Cardiology Department of Sfax, Tunisia

“…The intravascular ultrasound (IVUS) was not systematically implemented as it should be due to the retrospective nature of the current study. It was carried out in just 6 patients in the literature and shows an absence of atherosclerosis in two cases (44,45) in addition to inconspicuous signs of atherosclerosis in the other cases (46,47). Thus, prospective studies on the pathophysiological mechanisms using new technologies such as intravascular ultrasound (48) would allow better analysis of the vessel structure.…”