left atrial function
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European heart journal, ISSN 1520-765X vol. 2, suppl. K, November 2000
K90 s. : il., tab., grafy ; 30 cm
- MeSH
- kardiologie MeSH
- kardiovaskulární nemoci MeSH
- srdce - funkce levé síně MeSH
- Publikační typ
- kongresy MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- kardiologie
- angiologie
S rozvojem intervenčních metod se v poslední době mění pohled na levou srdeční síň. Její dilatace a dysfunkce byly považovány za nevratné změny, ale ukazuje se, že patologická remodelace může být reverzibilní. Roste množství intervencí, kde levá síň je jejich prostředím nebo cílovou oblastí. Nejvíce výkonů je spojeno s fibrilací síní. Článek pojednává o anatomii a funkci levé síně, jejichž znalost je nezbytná jak pro vlastní intervenční výkony, tak pro jejich optimální indikaci.
With the development of invasive procedures, the view of the left atrium has been changed. Left atrial dilatation and dysfunction used to be considered permanent, but it has been shown that the pathological remodelation can be reversible. The number of invasive procedures where the left atrium is their place or target is increasing. Most of this procedures is connected with atrial fibrillation. This article deals with the anatomy and function of the left atrium that is important for interventional procedures as well as for their optimal indication.
- MeSH
- dilatace patologická MeSH
- echokardiografie MeSH
- lidé MeSH
- prognóza MeSH
- srdce - funkce levé síně * MeSH
- srdeční síně * anatomie a histologie patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
The present popularity of catheter ablation for atrial fibrillation has generated interest in the pathophysiology of arrhythmias originating from the left atrium. An improved understanding of ECG manifestations of reentrant left atrial arrhythmias has obvious clinical implications. An ideal goal would be to achieve diagnostic precision similar to the 'sawtooth' ECG morphology of typical atrial flutter. RECENT FINDINGS: Recent studies have shown that nonreentrant arrhythmias originating from the left atrium are characterized by specific ECG features of the P wave, the most consistent being a positive or a dominantly positive deflection in V1. Similarly, bystander activation of the right atrium generates a dominantly positive deflection in V1 even during left atrial reentry. Although continuous reentrant activation should generate continuous electrical activity on surface ECG, this may not be the case if part of the reentry circuit generates feeble electrical forces, for example, a thin strand of myocardium. As a result, discrete P waves separated by a 12-lead synchronous isoelectric interval may be produced. Their morphology can be used to infer the location of the exit from this slow-conducting isthmus and facilitate ablation. SUMMARY: The progressive accumulation of accurate activation mapping data of the full spectrum of left atrial reentry will certainly allow the development of clinically useful ECG algorithms.
- MeSH
- elektrokardiografie MeSH
- flutter síní diagnóza parazitologie MeSH
- lidé MeSH
- srdce - funkce levé síně MeSH
- Check Tag
- lidé MeSH
INTRODUCTION: Atrial fibrillation (AF) is the most common sustained arrhythmia in humans. The onset of the arrhythmia can significantly impair cardiac function. This hemodynamic deterioration has been explained by several mechanisms such as the loss of atrial contraction, shortening of ventricular filling, or heart rhythm irregularity. This study sought to evaluate the relative hemodynamic contribution of each of these components during in vivo simulated human AF. METHODS: Twelve patients undergoing catheter ablation for paroxysmal AF were paced simultaneously from the proximal coronary sinus and the His bundle region according to prescribed sequences of irregular R-R intervals with the average rate of 90 and 130 bpm, which were extracted from the database of digital ECG recordings of AF from other patients. The simulated AF was compared to regular atrial pacing with spontaneous atrioventricular conduction and regular simultaneous atrioventricular pacing at the same heart rate. Beat-by-beat left atrial and left ventricular pressures, including LV dP/dT and Tau index were assessed by direct invasive measurement; beat-by-beat stroke volume and cardiac output (index) were assessed by simultaneous pulse-wave doppler intracardiac echocardiography. RESULTS: Simulated AF led to significant impairment of left ventricular systolic and diastolic function. Both loss of atrial contraction and heart rate irregularity significantly contributed to hemodynamic impairment. This effect was pronounced with increasing heart rate. CONCLUSION: Our findings strengthen the rationale for therapeutic strategies aiming at rhythm control and heart rate regularization in patients with AF.
Cieľ: Hodnotenie echokardiografických parametrov a poukázanie na rôzne spôsoby merania veľkosti ľavej predsiene (ĽP). Nájsť vhodný parameter, ktorý by bol čo najpresnejší prediktor pre recidívu fibrilácie predsiení (FiP). Metódy a výsledky: Bola realizovaná prospektívna analýza v období od júna 2016 do júna 2018. Vstupným kritériom bola nevalvulárna FiP a plánovaná elektrická kardioverzia (EKV). Sledované parametre: anatomické parametre (rozmer ĽP v M-mode, objem ĽP meraný Simpsonovou metódou) a funkčné parametre (hodnotenie rezervoárovej funkcie prostredníctvom 3D echokardiografie: vyprázdňovacie frakcie [EF] ĽP a 2D speckle trackingu: strain ĽP). Štatistická analýza bola uskutočnená pomocou programu STATISTICA Cz 10. Celkovo bolo vyšetrených 56 pacientov, po uplatnení exklúznych kritérií sme sledovali 36 pacientov v dvoch intervaloch (po 1. a 6. mesiaci). Priemerný vek nášho súboru bol 60 ± 17 rokov. Prevažovali muži a pacienti s perzistujúcou FiP. Pri porovnaní anatomických a funkčných parametrov ĽP ako prediktora recidívy FiP nám štatisticky významne vyšli funkčné parametre. V skupine so sinusovým rytmom (SR) bola signifikantne vyššia EF ĽP a GLS ĽP v porovnaní so skupinou s FiP (EF ĽP: 38,3 ± 6,4 vs. 28,5 ± 3,20; globálny longitudinálny strain ľavej predsiene [GLS ĽP]: 18,5 ± 5,32 vs. 9,7 ± 5,10, p < 0,001). Pri použití 3D volumetrie ĽP sa ukázal ako štatisticky významný rozdiel v endsystolických objemoch (ml/m2) v skupine so SR v porovnaní s FiP (21,5 ± 9,08 vs. 26,8 ± 4,44, p < 0,05). Záver: Anatomické parametre ako prediktor rizika recidívy FiP nevyšli štatisticky významne. Naproti tomu funk- čné parametre ĽP vyšli štatisticky významne. Skutočnosť, že existujú nové techniky na hodnotenie funkcie ĽP nám otvára možnosti lepšej predikcie kardiovaskulárnych príhod, a teda aj stratifikácie pacientov k recidíve FiP.
Aim: The evaluation of echocardiographic parameters and indication of various methods of measurement of the left atrium (LA) size. To find an appropriate parameter which would be the most precise predictor for the atrial fibrillation (AF) recurrence. Methods and results: A prospective analysis was executed during the period of June 2016 to June 2018. The inclusion criteria were non-valvular AF and planned electric cardioversion. Monitored parameters: anatomical parameters (LA size in M-mode, LA capacity measured by the Simpson's method) and functional parameters (reservoir function evaluation via 3D echocardiography, LA EF and 2D speckle tracking, LA strain). The statistical analysis was carried out via the STATISTICA Cz 10 programme. We examined 56 patients in total, after application of the exclusion criteria, we analysed 36 patients in two intervals (after 1st and 6th month). The average age of our group was 60 ± 17 years. Men and patients with persisting AF predominated in our group. Upon the comparison of the anatomic and functional parameters of LA, as the predictor of the AF recurrence, the functional parameters showed to be statistically significant. In the group with a sinus rhythm the value of LA EF and LA GLS was much higher compared to the group with AF (LA EF: 38.3±6.4 vs 28.5±3.20; LA GLS: 18.5±5.32 vs 9.7±5.10, p <0.001). When applying the 3D LA volumetry, the difference between the endsystolic volumes (ml/m2) in the group with a sinus rhythm compared to the AF (21.5±9.08 vs 26.8±4.44, p <0.05) turned out as statistically significant.
To assess the feasibility of left atrial flow propagation velocity (LAFPV) measurement and to evaluate the influence of preload alterations on this new parameter of left atrial (LA) reservoir function as compared to conventional echocardiographic indices. 30 healthy volunteers (26 ± 5 years, 20 males) underwent echocardiographic examination at rest, during passive leg lifting and after sublingual administration of nitroglycerine with subsequent Valsalva maneuver. LA reservoir function was assessed by conventional indices including LA expansion index, peak velocity and velocity-time integral of pulmonary venous systolic flow. As well, LAFPV was measured by color M-mode in an apical 4-chamber view as the slope of the transatrial flow wave during LA reservoir phase. LAFPV measurement was feasible in 25 subjects (83%). All conventional parameters of LA reservoir function were significantly altered from resting values by both load-modifying conditions. However, LAPFV was not significantly altered by such maneuvers (228 ± 28 cm s⁻¹ at rest vs. 238 ± 3 cm s⁻¹ during leg lifting, P = NS, vs. 218 ± 38 cm s(-1) after nitroglycerin with Valsalva maneuver, P = NS vs. rest, P < 0.01 vs. leg lifting). LAFPV can be measured in a majority of subjects and represents a new, less load-dependent index of LA reservoir function that may more appropriately reflect LA compliance.
- MeSH
- analýza rozptylu MeSH
- barevná dopplerovská echokardiografie MeSH
- dospělí MeSH
- hemodynamika MeSH
- lidé MeSH
- mladý dospělý MeSH
- nitroglycerin aplikace a dávkování MeSH
- odchylka pozorovatele MeSH
- poddajnost MeSH
- prediktivní hodnota testů MeSH
- pulzní dopplerovská echokardiografie MeSH
- reprodukovatelnost výsledků MeSH
- rychlost toku krve MeSH
- srdce - funkce levé síně MeSH
- srdeční síně patofyziologie ultrasonografie MeSH
- studie proveditelnosti MeSH
- svalová kontrakce MeSH
- Valsalvův manévr MeSH
- vazodilatancia aplikace a dávkování MeSH
- venae pulmonales patofyziologie ultrasonografie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
- práce podpořená grantem MeSH
Left atrial appendage is the most frequent place of blood clot formation in heart cavities. The thrombus formation increases a risk of a systemic embolism especially in patients with a permanent atrial fibrillation. The standard preventive treatment is the oral anticoagulation therapy. Another possible a treatment is an exclusion of a left atrial appendage. We present current overview a risks and benefits of surgical and percutaneous elimination of a left atrial appendage. We present the first experience with Amplatzer Cardiac Plug system in an elimination of a left atrial appendage. We concluded that an exclusion of left atrial appendage could become a useful possibility of prevention of systemic embolization in patients with an atrial fibrillation, but is not still an alternative therapy for anticoagulation therapy at present.
- Klíčová slova
- AMPLATZER Cardiac Plug, aktikoagulační léčba, ouško levé srdeční síně,
- MeSH
- fibrilace síní komplikace terapie MeSH
- katetrizace metody trendy využití MeSH
- lidé MeSH
- síňové ouško chirurgie MeSH
- srdce - funkce levé síně MeSH
- tromboembolie patologie prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
