- Email: [email protected]
Duration of atrial fibrillation predicts cardioversion parameters and success. A report from the acute registry
A146
48th Annual
Scientific
Meeting
of CSANZ
Heart,
Lung
and Circulation
2000; 9
TRANSTHORACIC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHIC DETECTION OF CARDIOGENIC EMBOLIC SOURCE IN “STROKE IN THE YOUNG” PATIENTS &cd.ks S*.. Kiatchoosakun S.. Tatsanavivat P.. Tiamkao S, 01 V.. Kluneboonkrong V. Division of Cardiology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen,Thailand.
DURATION OF ATRIAL. PREDICTS FIBRILLATION CARDIOVERSION PARAME TERS AND SUCCESS. A REPORT ‘or* PROM THE ACUTE REGISTRY DL. C R. As&r. P L. a S E. Jasper.. The Cleveland Clinic Foundation, Cleveland, Ohio, USA. Previous studies have shown that the duration of atria1 fibrillation (AF) is a determinant of successful cardioversion (CV) and long-term maintenance of normal sinus rhythm (NSR).
Background:Stroke in the young poses a diagnostic challenge. A thorough search for the cause to prevent recurrence is of paramount importance. The study aim is to determine the prevalence of a cardiogenic embolic source in these patients by using transthoracic and transesophageal echocardiography (TTE, TEE).
Methods: We sought to confirm this in a large prospectively collected database from the ACUTE registry, which enrolled patients in AF prior to CV. Furthermore, we assessed the impact of duration of atrial fibrillation on cardioversion parameters. The study group consisted of 281 patients (M/F = 200181). Spearman correlation coefficient was used to evaluate the effects of AF duration (< 3 days, < 30 days, and < 6 months) on CV parameters and CV success. Results: Mean patient age was (67.7 f 11.7 yrs). AF recurred in 66 patients (23.5%) at 24 hours and in 141 patients (50.1%) at one year. AF duration of less than 3 days did not affect the CV parameters or recurrence (p = NS). Compared to pts with AF > 30 days and AF > 6 months, respectively, fewer DC shocks were required in pts with AF < 30 days (Mean = 1.5 ? 0.9, p = 0.001) and AF < 6 months (1.5 f 0.97, p = 0.01). Similarly, the total and the maximal DC energy needed for CV was lower in pts in AF < 30 days (p = 0.003, p = 0.004) and < 6 months (p = 0.0002, p = 0.0002) respectively.
Methods: TTE and TEE with a contrast study were prospectively performed in the young stroke patients aged 15 to 45 years old who were admitted at Srinagarind Hospital during August 1996 to December 1999. Results: There were 135 young stroke patients studied (M:F= 59:76,mean age = 35.9 + 6.2 years). Rheumatic mitral stenosis(MS) was the most common cardiac embolic source (47 %). Of 64 MS patients, left atrial spontaneous contrast echo was found in all, but only nine demonstrated LA thrombus, which detected by TEE. Atria1 fibrillation (AF) was present in 27 %. Infective endocarditis of the mitral valve (MV) was found in 3 %.The prevalence of MV prolapse was 9%, PFO was 3 %. Four patients with dilated cardiomyopathy demonstrated large left ventricular apical thrombus. None of our series had evidence of aortic atherosclerotic plaque or dissection. Atherosclerotic risk factors were 19 %, found in 21% of those without other identifiable cause (smoking hypertension 6 %, hyperlipidemia 4 %, diabetes 3 %). A cardiogenic embolic source was detected in 65 % of young patients with stroke. Our study further supports the need for public health campaigns to lower the prevalence of rheumatic heart disease in young adults. Conclusion:
IN VIVO QUANTIFICATION OF ATHEROSCLEROTIC PLAQUE COMPONENTS WITH MRI IN A RABBIT MODEL * OF ATHEROSCLEROSIS. AG V Fuster. ZA Fayad. JT Fallon. JJ Bm, Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, 10029-6574, and the Cardiovascular Centre, Monash Medical Centre, Clayton, VIC, 3168. Noninvasive high resolution MR imaging may be used to serially study the effects of therapeutic interventions on atherosclerotic plaque stabilization in viva. This stabilization results from changes in lesion composition. We report the feasibility of MRl to quantify lipidic and fibrotic components of lesions in a rabbit model. Thoracic and abdominal aortic atherosclerosis was induced in New Zealand white rabbits (n=15) by a combination of atherogenic diet and balloon injury. MRI of the aorta was performed in a clinical 1.5T system. T2W and PDW images were obtained with fast spin echo sequences and an in-plane resolution of 0.35mm. After euthanasia, histopathology sections were matched with the MR images. A significant correlation between MRI and histology (Oil red 0 staining) for analysis of lipidic (low signal on T2W, 1=0.81) and fibrous (high signal on T2W, 1=0X6) areas was observed. Mean wall thickness correlated significantly between MFU and histopathology. Noninvasive high resolution MRI allows qualitative and quantitative analysis of aortic atherosclerotic components in this rabbit model. The in vivo feasibility of this technique permits the serial analysis of therapeutic strategies on atherosclerotic plaque stabilization.
RRt, AF < 30 days
RR+, AF c 6 months
Recurrent
AF at 24 hrs
0.87 (p = 0.06)
0.81 (p = 0.005)
Recurrent
AF at 1 year
0.72 (p = 0.025)
0.97 (p = 0.370)
t compared months.
to pts with AF >30 days. $ compared
to pts with AF >6
Conclusions: Patients with shorter duration of AF (< 6 months) require a lower number of shocks with less DC energy for CV. The analysis from this prospective registry confirms the positive impact of a shorter duration of AF on the immediate and long-term success of maintaining NSR.
2 YEAR EXPERIENCE WITH THE FRACTAL LEADS POLYROX PX 60-BP (VENTRICULAR) AND PX 63.JBP ( ATRIAL ) . J . Van den BIQ&, Ballarat Heafth Services, Ballarat , Australia, C. DrosSpS, Biotrunik,Australia. Recent pacemaker lead development has aimed to reduce energy consumption and ensure good detection of cardiac signal. The main priorities in low energy pacing are to reduce the inflammatory reaction at the lead tip, and to maximise the Electrochemicalfy Active Surface area (EAS). Inflammatory reaction has been reduced by using biocompatible materials (Platinum alloys and Titanium) and the use of steroid efuting leads. Further reduction in stimulation threshold has been achieved with reduction in Geometrical Surface area (GSA), however this is limited with conventional leads in view of increasing resistance to charge transfer with reduction in EAS. Iridium fractal surface treatment increases EAS ,with smaller GSA. Methods: We entered patients with usual indications to Cardiac Pacing in a prospective non randomised clinical investigation with an aim to follow up for 24 months. The Biotronik Polyrox PX 60-BP and PX53-JBP leads with an Iridium fractal surface were implanted. We present the data on 17 patients, (12 atrial leads and 17 ventricular leads) to 24 month follow up. Lead Atr. Thresh Vent. Thresh P-Wave Amp R-Wave Amp Attial Imp Vent. Imp
Implant .6f .3 .6f.l 3.6 f 2.0 12.0fl.O 726f173 474fllO
1 mth .9 f .2 .9 f .3 2.8 f 1.5 lO.lf4.0 465f61 654fll2
3mth a f .3 .7f.2 2.8fl.5 11.2f4.0 5llf85 700f89
72 mth .6 f 3 .6 f .2 3.1f1.2 11.2f3.8 528flO4 655fiOl
24mths .6 f 3 .5 f .2 3f 1.1 9.9f3.8 568f112 65lf98
Conclusions: These thresholds were comparable to thresholds achieved with current steroid leads and maintained at 24 months, an initial rise was apparent due to early inflammation which was improving by 1 month and back to implant levels by 12 months. Advantages with this lead are low energy pacing, equivalent threshold in unipofar and bipolar stimulation, superior sensing with application to rate adaptive pacing algorithms, and may have novel applications such as early detection of cardiac transplant rejection.
48th Annual
Scientific
Meeting
of CSANZ
Heart,
Lung
and Circulation
2000; 9
TRANSTHORACIC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHIC DETECTION OF CARDIOGENIC EMBOLIC SOURCE IN “STROKE IN THE YOUNG” PATIENTS &cd.ks S*.. Kiatchoosakun S.. Tatsanavivat P.. Tiamkao S, 01 V.. Kluneboonkrong V. Division of Cardiology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen,Thailand.
DURATION OF ATRIAL. PREDICTS FIBRILLATION CARDIOVERSION PARAME TERS AND SUCCESS. A REPORT ‘or* PROM THE ACUTE REGISTRY DL. C R. As&r. P L. a S E. Jasper.. The Cleveland Clinic Foundation, Cleveland, Ohio, USA. Previous studies have shown that the duration of atria1 fibrillation (AF) is a determinant of successful cardioversion (CV) and long-term maintenance of normal sinus rhythm (NSR).
Background:Stroke in the young poses a diagnostic challenge. A thorough search for the cause to prevent recurrence is of paramount importance. The study aim is to determine the prevalence of a cardiogenic embolic source in these patients by using transthoracic and transesophageal echocardiography (TTE, TEE).
Methods: We sought to confirm this in a large prospectively collected database from the ACUTE registry, which enrolled patients in AF prior to CV. Furthermore, we assessed the impact of duration of atrial fibrillation on cardioversion parameters. The study group consisted of 281 patients (M/F = 200181). Spearman correlation coefficient was used to evaluate the effects of AF duration (< 3 days, < 30 days, and < 6 months) on CV parameters and CV success. Results: Mean patient age was (67.7 f 11.7 yrs). AF recurred in 66 patients (23.5%) at 24 hours and in 141 patients (50.1%) at one year. AF duration of less than 3 days did not affect the CV parameters or recurrence (p = NS). Compared to pts with AF > 30 days and AF > 6 months, respectively, fewer DC shocks were required in pts with AF < 30 days (Mean = 1.5 ? 0.9, p = 0.001) and AF < 6 months (1.5 f 0.97, p = 0.01). Similarly, the total and the maximal DC energy needed for CV was lower in pts in AF < 30 days (p = 0.003, p = 0.004) and < 6 months (p = 0.0002, p = 0.0002) respectively.
Methods: TTE and TEE with a contrast study were prospectively performed in the young stroke patients aged 15 to 45 years old who were admitted at Srinagarind Hospital during August 1996 to December 1999. Results: There were 135 young stroke patients studied (M:F= 59:76,mean age = 35.9 + 6.2 years). Rheumatic mitral stenosis(MS) was the most common cardiac embolic source (47 %). Of 64 MS patients, left atrial spontaneous contrast echo was found in all, but only nine demonstrated LA thrombus, which detected by TEE. Atria1 fibrillation (AF) was present in 27 %. Infective endocarditis of the mitral valve (MV) was found in 3 %.The prevalence of MV prolapse was 9%, PFO was 3 %. Four patients with dilated cardiomyopathy demonstrated large left ventricular apical thrombus. None of our series had evidence of aortic atherosclerotic plaque or dissection. Atherosclerotic risk factors were 19 %, found in 21% of those without other identifiable cause (smoking hypertension 6 %, hyperlipidemia 4 %, diabetes 3 %). A cardiogenic embolic source was detected in 65 % of young patients with stroke. Our study further supports the need for public health campaigns to lower the prevalence of rheumatic heart disease in young adults. Conclusion:
IN VIVO QUANTIFICATION OF ATHEROSCLEROTIC PLAQUE COMPONENTS WITH MRI IN A RABBIT MODEL * OF ATHEROSCLEROSIS. AG V Fuster. ZA Fayad. JT Fallon. JJ Bm, Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, 10029-6574, and the Cardiovascular Centre, Monash Medical Centre, Clayton, VIC, 3168. Noninvasive high resolution MR imaging may be used to serially study the effects of therapeutic interventions on atherosclerotic plaque stabilization in viva. This stabilization results from changes in lesion composition. We report the feasibility of MRl to quantify lipidic and fibrotic components of lesions in a rabbit model. Thoracic and abdominal aortic atherosclerosis was induced in New Zealand white rabbits (n=15) by a combination of atherogenic diet and balloon injury. MRI of the aorta was performed in a clinical 1.5T system. T2W and PDW images were obtained with fast spin echo sequences and an in-plane resolution of 0.35mm. After euthanasia, histopathology sections were matched with the MR images. A significant correlation between MRI and histology (Oil red 0 staining) for analysis of lipidic (low signal on T2W, 1=0.81) and fibrous (high signal on T2W, 1=0X6) areas was observed. Mean wall thickness correlated significantly between MFU and histopathology. Noninvasive high resolution MRI allows qualitative and quantitative analysis of aortic atherosclerotic components in this rabbit model. The in vivo feasibility of this technique permits the serial analysis of therapeutic strategies on atherosclerotic plaque stabilization.
RRt, AF < 30 days
RR+, AF c 6 months
Recurrent
AF at 24 hrs
0.87 (p = 0.06)
0.81 (p = 0.005)
Recurrent
AF at 1 year
0.72 (p = 0.025)
0.97 (p = 0.370)
t compared months.
to pts with AF >30 days. $ compared
to pts with AF >6
Conclusions: Patients with shorter duration of AF (< 6 months) require a lower number of shocks with less DC energy for CV. The analysis from this prospective registry confirms the positive impact of a shorter duration of AF on the immediate and long-term success of maintaining NSR.
2 YEAR EXPERIENCE WITH THE FRACTAL LEADS POLYROX PX 60-BP (VENTRICULAR) AND PX 63.JBP ( ATRIAL ) . J . Van den BIQ&, Ballarat Heafth Services, Ballarat , Australia, C. DrosSpS, Biotrunik,Australia. Recent pacemaker lead development has aimed to reduce energy consumption and ensure good detection of cardiac signal. The main priorities in low energy pacing are to reduce the inflammatory reaction at the lead tip, and to maximise the Electrochemicalfy Active Surface area (EAS). Inflammatory reaction has been reduced by using biocompatible materials (Platinum alloys and Titanium) and the use of steroid efuting leads. Further reduction in stimulation threshold has been achieved with reduction in Geometrical Surface area (GSA), however this is limited with conventional leads in view of increasing resistance to charge transfer with reduction in EAS. Iridium fractal surface treatment increases EAS ,with smaller GSA. Methods: We entered patients with usual indications to Cardiac Pacing in a prospective non randomised clinical investigation with an aim to follow up for 24 months. The Biotronik Polyrox PX 60-BP and PX53-JBP leads with an Iridium fractal surface were implanted. We present the data on 17 patients, (12 atrial leads and 17 ventricular leads) to 24 month follow up. Lead Atr. Thresh Vent. Thresh P-Wave Amp R-Wave Amp Attial Imp Vent. Imp
Implant .6f .3 .6f.l 3.6 f 2.0 12.0fl.O 726f173 474fllO
1 mth .9 f .2 .9 f .3 2.8 f 1.5 lO.lf4.0 465f61 654fll2
3mth a f .3 .7f.2 2.8fl.5 11.2f4.0 5llf85 700f89
72 mth .6 f 3 .6 f .2 3.1f1.2 11.2f3.8 528flO4 655fiOl
24mths .6 f 3 .5 f .2 3f 1.1 9.9f3.8 568f112 65lf98
Conclusions: These thresholds were comparable to thresholds achieved with current steroid leads and maintained at 24 months, an initial rise was apparent due to early inflammation which was improving by 1 month and back to implant levels by 12 months. Advantages with this lead are low energy pacing, equivalent threshold in unipofar and bipolar stimulation, superior sensing with application to rate adaptive pacing algorithms, and may have novel applications such as early detection of cardiac transplant rejection.