262 results on '"Atrial wall"'
Search Results
2. Animation of Atrial and Ventricular External Walls of a Virtual 3D Heart Based on Echocardiogram Images
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Ganem, Gabriela Colares Ali, Coelho, Regina Célia, de Godoy, Carlos Marcelo Gurjão, Magjarevic, Ratko, Series Editor, Ładyżyński, Piotr, Associate Editor, Ibrahim, Fatimah, Associate Editor, Lackovic, Igor, Associate Editor, Rock, Emilio Sacristan, Associate Editor, González Díaz, César A., editor, Chapa González, Christian, editor, Laciar Leber, Eric, editor, Vélez, Hugo A., editor, Puente, Norma P., editor, Flores, Dora-Luz, editor, Andrade, Adriano O., editor, Galván, Héctor A., editor, Martínez, Fabiola, editor, García, Renato, editor, Trujillo, Citlalli J., editor, and Mejía, Aldo R., editor
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- 2020
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3. Structure Fusion for Automatic Segmentation of Left Atrial Aneurysm Based on Deep Residual Networks
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Wang, Liansheng, Li, Shusheng, Chen, Yiping, Lin, Jiankun, Liu, Changhua, Hutchison, David, Series editor, Kanade, Takeo, Series editor, Kittler, Josef, Series editor, Kleinberg, Jon M., Series editor, Mattern, Friedemann, Series editor, Mitchell, John C., Series editor, Naor, Moni, Series editor, Pandu Rangan, C., Series editor, Steffen, Bernhard, Series editor, Terzopoulos, Demetri, Series editor, Tygar, Doug, Series editor, Weikum, Gerhard, Series editor, Wang, Li, editor, Adeli, Ehsan, editor, Wang, Qian, editor, Shi, Yinghuan, editor, and Suk, Heung-Il, editor
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- 2016
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4. Step-by-Step Closure of Atrial Septal Defects (ASDs)
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Thomson, John D. R., Butera, Gianfranco, editor, Chessa, Massimo, editor, Eicken, Andreas, editor, and Thomson, John, editor
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- 2015
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5. The Specific Development Period
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Filipoiu, Florin Mihail and Filipoiu, Florin Mihail
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- 2014
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6. The General Development Period
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Filipoiu, Florin Mihail and Filipoiu, Florin Mihail
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- 2014
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7. Closure of Patent Foramen Ovalis and Atrial Septal Defect
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Faletra, Francesco Fulvio, Perk, Gila, Pandian, Natesa G., Nesser, Hans-Joachim, Kronzon, Itzhak, Faletra, Francesco Fulvio, Perk, Gila, Pandian, Natesa G., Nesser, Hans-Joachim, and Kronzon, Itzhak
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- 2014
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8. Morphology of Mitral Annular Disjunction in Mitral Valve Prolapse
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Anna Giulia Pavon, Francesco Maisano, Laura Anna Leo, Francesco Faletra, Vera Lucia Paiocchi, Siew Yen Ho, and Susanne Anna Schlossbauer
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Mitral Valve Prolapse ,animal structures ,Normal anatomy ,business.industry ,Heart Ventricles ,Mitral Valve Insufficiency ,Anatomy ,Atrial wall ,medicine.disease ,Posterior segment of eyeball ,medicine.anatomical_structure ,Ventricle ,Mitral valve ,cardiovascular system ,medicine ,Humans ,Mitral Valve ,Mitral valve prolapse ,Radiology, Nuclear Medicine and imaging ,In patient ,Heart Atria ,cardiovascular diseases ,Mitral annulus ,Cardiology and Cardiovascular Medicine ,business - Abstract
Mitral annular disjunction (MAD) is an abnormal insertion of the hinge line of the posterior mitral leaflet on the atrial wall: the mitral annulus shows a separation or "disjunction" between the leaflet-atrial wall junction and the crest of the left ventricle myocardium. This anomaly is often observed in patients with myxomatous mitral valve prolapse. The anatomical substrate of MAD remains unclear for the following reasons: (1) most studies are focused on the association between MAD and arrhythmias, rather than on pathomorphological aspects of MAD; and (2) the complex anatomic architecture of the posterior mitral annulus is often simply described as the posterior segment of a fibrous ring. The aims of this paper are to review the pertinent normal anatomy of the mitral valve and to propose new hypotheses on the morphological nature of MAD.
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- 2022
9. Formation of low‐voltage zones on the anterior left atrial wall due to mechanical compression by the ascending aorta
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Yuji Wakamatsu, Sayaka Kurokawa, Koichi Nagashima, Seina Yagyu, Ryuta Watanabe, Yasuo Okumura, Masaru Arai, Satoshi Hayashida, Kazuki Iso, and Naoto Otsuka
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medicine.medical_specialty ,Anterior wall ,030204 cardiovascular system & hematology ,Anterior left ,03 medical and health sciences ,0302 clinical medicine ,Cardiothoracic ratio ,Physiology (medical) ,Internal medicine ,medicine.artery ,Atrial Fibrillation ,Ascending aorta ,Mechanical compression ,Humans ,Medicine ,Heart Atria ,030212 general & internal medicine ,Aorta ,business.industry ,Atrial fibrillation ,Anatomy ,medicine.disease ,Atrial wall ,medicine.anatomical_structure ,Ventricle ,Catheter Ablation ,Cardiology ,Electrophysiologic Techniques, Cardiac ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND Although low-voltage zones (LVZs) in the left atrium (LA) are considered arrhythmogenic substrates in some patients with atrial fibrillation (AF), the pathophysiologic factors responsible for LVZ formations remain unclear. OBJECTIVE To elucidate the anatomical relationship between the LA and ascending aorta responsible for anterior LA wall remodeling. METHODS We assessed the relationship between existence of LVZs on the anterior LA wall and the three-dimensional computed tomography image measurements in 102 patients who underwent AF ablation. RESULTS Twenty-nine patients (28%) had LVZs grearer than 1.0 cm2 on the LA wall in the LA-ascending aorta contact area (LVZ group); no LVZs were seen in the other 73 patients (no-LVZ group). The LVZ group (vs. no-LVZ group) had a smaller aorta-LA angle (21.0 ± 7.7° vs. 24.9 ± 7.1°, p = .015), greater aorta-left-ventricle (LV) angle (131.3 ± 8.8° vs. 126.0 ± 7.9°; p = .005), greater diameter of the noncoronary cusp (NCC; 20.4 ± 2.2 vs. 19.3 ± 2.5 mm; p = .036), thinner LA wall-thickness adjacent to the NCC (2.3 ± 0.7 vs. 2.8 ± 0.8 mm; p = .006), and greater cardiothoracic ratio (percentage of the area in the thoracic area, 40.1 ± 7.1% vs. 35.4 ± 5.7%, p
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- 2021
10. Utility of Radiofrequency Ablation in Atrial Fibrillation Surgery
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Santiago, Teresa, Gouveia, Rosa, Martins, Ana P., Melo, João, Liem, Liong Bing, editor, and Downar, Eugene, editor
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- 2001
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11. Anatomy of the Tricuspid Cavo Isthmus
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Becker, Anton. E., Liem, Liong Bing, editor, and Downar, Eugene, editor
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- 2001
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12. Cardiac and paracardiac masses
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Carreras-Costa, F., Pons-Lladö, Guillem, Carreras, Francesc, Borrás, Xavier, Subirana, Maite, and Jiménez-Borreguero, Luís J.
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- 1999
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13. The Role of Atrial Fibrosis Detected by Delayed - Enhancement MRI in Atrial Fibrillation Ablation
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Tamas Szili-Torok, István Kovács, Astrid Amanda Hendriks, Taulant Muka, Zsuzsanna Kis, Wichor M. Bramer, Cardiology, Epidemiology, and Erasmus MC other
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medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,Delayed enhancement ,030204 cardiovascular system & hematology ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Fibrosis ,Recurrence ,Internal medicine ,Atrial Fibrillation ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,030212 general & internal medicine ,business.industry ,Atrial fibrillation ,Ablation ,medicine.disease ,Atrial wall ,Magnetic Resonance Imaging ,Treatment Outcome ,Atrial fibrosis ,cardiovascular system ,Cardiology ,Catheter Ablation ,business - Abstract
Introduction: Atrial Fibrillation (AF) is associated with remodeling of the atrial tissue, which leads to fibrosis that can contribute to the initiation and maintenance of AF. Delayed- Enhanced Cardiac Magnetic Resonance (DE-CMR) imaging for atrial wall fibrosis detection was used in several studies to guide AF ablation. The aim of present study was to systematically review the literature on the role of atrial fibrosis detected by DE-CMR imaging on AF ablation outcome. Methods: Eight bibliographic electronic databases were searched to identify all published relevant studies until 21st of March, 2016. Search of the scientific literature was performed for studies describing DE-CMR imaging on atrial fibrosis in AF patients underwent Pulmonary Vein Isolation (PVI). Results: Of the 763 citations reviewed for eligibility, 5 articles (enrolling a total of 1040 patients) were included into the final analysis. The overall recurrence of AF ranged from 24.4 - 40.9% with median follow-up of 324 to 540 days after PVI. With less than 5-10% fibrosis in the atrial wall there was a maximum of 10% recurrence of AF after ablation. With more than 35% fibrosis in the atrial wall there was 86% recurrence of AF after ablation. Conclusion: Our analysis suggests that more extensive left atrial wall fibrosis prior ablation predicts the higher arrhythmia recurrence rate after PVI. The DE-CMR imaging modality seems to be a useful method for identifying the ideal candidate for catheter ablation. Our findings encourage wider usage of DE-CMR in distinct AF patients in a pre-ablation setting.
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- 2020
14. Two cases of pericardial tamponade due to nitinol wire fracture of a gore septal occluder
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James L. Orford, Jonathan M. Tobis, and Preetham Kumar
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medicine.medical_specialty ,Percutaneous ,business.industry ,Perforation (oil well) ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Atrial wall ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Paradoxical embolism ,Patent foramen ovale ,Medicine ,Radiology, Nuclear Medicine and imaging ,Septal Occluder ,030212 general & internal medicine ,Tamponade ,Implant ,Cardiology and Cardiovascular Medicine ,business - Abstract
Percutaneous patent foramen ovale (PFO) closure is recommended for secondary prevention of paradoxical embolism through a PFO. In the United States, two Food and Drug Administration-approved PFO closure devices are currently available, and the choice depends on operator preference and PFO anatomy. Although these devices are easy to implant, there are several potential complications. As opposed to the Amplatzer PFO Occluder, there has been no published case of atrial erosion with Gore closure devices. This report describes two cases of pericardial tamponade due to perforation of the atrial wall induced by a wire frame fracture of the Gore Helex and Cardioform devices.
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- 2019
15. Single Lead VDD pacing: an update
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Antonioli, Giovanni Enrico, Ansani, Lucia, Audoglio, Roberto, Guardigli, Gabriele, Percoco, Gianfranco, Toselli, Tiziano, Aubert, Andrè E., editor, Ector, Hugo, editor, and Stroobandt, Roland, editor
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- 1994
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16. Detection of Endo-epicardial Asynchrony in the Atrial Wall Using One-Sided Unipolar and Bipolar Electrograms
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Lisette J.M.E. van der Does, Charles Kik, Rohit K. Kharbanda, Ad J.J.C. Bogers, Paul Knops, Natasja M.S. de Groot, Roeliene Starreveld, Cardiology, and Cardiothoracic Surgery
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medicine.medical_specialty ,Pharmaceutical Science ,Fractionation ,030204 cardiovascular system & hematology ,Right atrial ,03 medical and health sciences ,Electrocardiography ,0302 clinical medicine ,Internal medicine ,Atrial Fibrillation ,mental disorders ,Genetics ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Heart Atria ,Endo-epicardial asynchrony ,Bipolar electrograms ,Genetics (clinical) ,Endocardium ,Fractionated electrograms ,Chemistry ,Atrial fibrillation ,medicine.disease ,Atrial wall ,Mapping ,One sided ,Cardiology ,cardiovascular system ,Molecular Medicine ,Original Article ,Unipolar electrograms ,Cardiology and Cardiovascular Medicine - Abstract
Graphical Abstract Endo-epicardial asynchrony (EEA) is a new mechanism possibly maintaining atrial fibrillation. We aimed to determine the sensitivity and best recording modus to detect EEA on electrograms recorded from one atrial side using electrogram fractionation. Simultaneously obtained right atrial endo- and epicardial electrograms from 22 patients demonstrating EEA were selected. Unipolar and (converted) bipolar electrograms were analyzed for presence and characteristics of fractionation corresponding to EEA. Sensitivity of presence of EEA corresponding fractionation was high in patients (86–96%) and moderately high (65–78%) for the asynchronous surface area for unipolar and bipolar electrograms equally. In bipolar electrograms, signal-to-noise ratio of EEA corresponding fractionation decreased and additional fractionation increased for electrograms recorded at the endocardium. Sensitivity of fractionation corresponding to EEA is high for both unipolar and bipolar electrograms. Unipolar electrograms are more suited for detection of EEA due to a larger signal-to-noise ratio and less disturbance of additional fractionation. Unipolar electrograms are more suited than bipolar electrograms to detect endo-epicardial asynchrony on one side of the atrial wall using electrogram fractionation. Supplementary Information The online version contains supplementary material available at 10.1007/s12265-021-10111-1.
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- 2021
17. Single-Lead Atrial Synchronous Pacing
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Furman, S., Alt, Eckhard, editor, Barold, S. Serge, editor, and Stangl, Karl, editor
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- 1993
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18. Atrial Thrombosis, Rat, Mouse, and Hamster
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Carlton, William W., Engelhardt, Jeffery A., Jones, Thomas Carlyle, editor, Mohr, Ulrich, editor, and Hunt, Ronald Duncan, editor
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- 1991
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19. The Impact of the Atrial Wall Thickness in Less Late-Gadolinium Enhancement Areas on Atrial Fibrillation Drivers in Persistent Atrial Fibrillation Patients
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Yoshiaki Watanabe, Mitsuru Takami, Kenichi Tani, Kyoko Yamamoto, Yusuke Sonoda, Kazutaka Nakasone, Takashi Ashihara, Atsushi K. Kono, Makoto Takemoto, Noriyuki Negi, Atsusuke Yatomi, Hiroyuki Takahara, Yu Izawa, Yuya Suzuki, Ken-ichi Hirata, Koji Fukuzawa, Kunihiko Kiuchi, Toshihiro Nakamura, and Jun Sakai
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medicine.medical_specialty ,business.industry ,Minimum distance ,Curve analysis ,Atrial fibrillation ,medicine.disease ,Atrial wall ,Internal medicine ,Persistent atrial fibrillation ,medicine ,Cardiology ,Late gadolinium enhancement ,cardiovascular diseases ,Phase mapping ,business ,Endocardium - Abstract
Background: Some of atrial fibrillation (AF) drivers are found in lesser late-gadolinium enhancement (LGE) areas, as well as heterogenous ones. The atrial wall thickness (AWT) has been reported to be important as a possible AF substrate. However, the AWT and degree of LGEs as an AF substrate has not been fully validated in humans. Objective: The purpose of this study was to evaluate the impact of the AWT in lesser LGE areas on AF drivers. Methods: A total of 287 segments in 15 persistent AF patients were assessed. AF drivers were defined as non-passively activated areas (NPAs), where rotational activation was frequently observed, and were detected by the novel real-time phase mapping (ExTRa Mapping). Lesser LGE areas were defined as areas with a volume ratio of the enhancement voxel of
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- 2021
20. Distances between transseptal puncture site and anatomical landmarks
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Łukasz Szumowski, Michał Orczykowski, Robert Bodalski, Dobromiła Dzwonkowska, Adam Gorlo, Jacek Kuśnierz, Jakub Baran, Paweł Derejko, Andrzej Hasiec, and Aleksander Bardyszewski
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Adult ,Male ,Cardiac Catheterization ,endocrine system ,Adolescent ,Femoral vein ,Punctures ,030204 cardiovascular system & hematology ,Radiography, Interventional ,Pulmonary vein ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,immune system diseases ,Superior vena cava ,Physiology (medical) ,Atrial Fibrillation ,Catheterization, Peripheral ,Heart Septum ,Humans ,Medicine ,030212 general & internal medicine ,Coronary sinus ,Aged ,business.industry ,virus diseases ,Mean age ,Anatomy ,Femoral Vein ,Middle Aged ,Atrial wall ,Ostium ,Fluoroscopy ,Catheter Ablation ,Female ,Anatomic Landmarks ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Right anterior - Abstract
The aim of the study was to provide quantitative data and to look for new landmarks useful during transseptal puncture (TSP) using a fluoroscopy-guided approach. METHODS AND RESULTS: A total of 104 patients at mean age 57 ± 12 years, of whom 92% underwent pulmonary vein isolation, were analysed. Before TSP catheters were placed in the coronary sinus (CS) and His bundle region. A guidewire running from femoral vein through great veins was left loose in superior vena cava. Before TSP X-ray images were taken in right anterior oblique (RAO) 45° and RAO 53° projections. Locations posterior to TSP site in RAO were described with negative values and those anterior with positive values. The measured distances in millimeters were as follows: (a) between TSP site and posterior atrial wall (RAO 45 = -21 ± 7 mm; RAO 53 = -19 ± 6 mm (b) between TSP site and free guidewire (RAO 45 = -5 ± 4 mm, RAO 53 = -3 ± 4 mm (c) between TSP site and CS ostium (RAO 45 = 9 ± 6 mm; RAO 53 = 8 ± 5 mm (d) between TSP site and His region (RAO 45 = 29 ± 8 mm; RAO 53 = 30 ± 8 mm). We observed correlations between measured distances and age, body mass index and sizes of cardiac chambers. The distance between TSP site and the line projected by the guidewire running between great veins, measured in mid-RAO projections, was very small. CONCLUSION: The distances between TSP site and standard anatomical landmarks used during TSP vary with regard to age, physique and cardiac chamber dimensions. TSP site, as assessed in mid RAO, is in direct vicinity to the line projected by a guidewire running between the great veins.
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- 2019
21. Low incidence of atrial septal defects in nonmammalian vertebrates
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Bjarke Jensen, Vincent M. Christoffels, William Joyce, David Sedmera, Martina Gregorovicova, Tobias Wang, Medical Biology, ACS - Heart failure & arrhythmias, and Amsterdam Reproduction & Development (AR&D)
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0106 biological sciences ,0301 basic medicine ,patent foramen ovale ,Septum secundum ,Hemodynamics ,heart ,Biology ,010603 evolutionary biology ,01 natural sciences ,Heart Septal Defects, Atrial ,Atrial septal defects ,Birds ,03 medical and health sciences ,evolution ,medicine ,Animals ,cardiovascular diseases ,Ecology, Evolution, Behavior and Systematics ,Atrial Septum ,Incidence ,Oxygen transport ,Reptiles ,Venous blood ,Anatomy ,medicine.disease ,Atrial wall ,030104 developmental biology ,septation ,cardiovascular system ,Patent foramen ovale ,Septum primum ,Developmental Biology - Abstract
The atrial septum enables efficient oxygen transport by separating the systemic and pulmonary venous blood returning to the heart. Only in placental mammals will the atrial septum form by the coming-together of the septum primum and the septum secundum. In up to one of four placental mammals, this complex morphogenesis is incomplete and yields patent foramen ovale. The incidence of incomplete atrial septum is unknown for groups with the septum primum only, such as birds and reptiles. We found a low incidence of incomplete atrial septum in 11 species of bird (0% of specimens) and 13 species of reptiles (3% of specimens). In reptiles, there was a trabecular interface between the atrial septum and the atrial epicardium which was without a clear boundary between left and right atrial cavities. In developing reptiles (four squamates and one crocodylian), the septum primum initiated as a sheet that acquired perforations and the trabecular interface developed late. We conclude that atrial septation from the septum primum only results in a low incidence of incompleteness. In reptiles, the atrial septum and atrial wall develop a trabecular interface, but previous studies on atrial hemodynamics suggest this interface has a very limited capacity for shunting.
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- 2019
22. Understanding AF Mechanisms Through Computational Modelling and Simulations
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Jialiu A Liang, Konstantinos N. Aronis, Natalia A. Trayanova, Shijie Zhou, and Rheeda L. Ali
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0301 basic medicine ,Valve surgery ,precision medicine ,computational modelling ,Electrophysiology and Ablation ,Atrial structure ,030204 cardiovascular system & hematology ,Atrial stretch ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Medicine ,Diseases of the circulatory (Cardiovascular) system ,personalised electrophysiology ,cardiovascular diseases ,business.industry ,Atrial fibrillation ,Atrial wall ,medicine.disease ,arrhythmia simulations ,Icd therapy ,030104 developmental biology ,RC666-701 ,Atrial fibrosis ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business ,Neuroscience ,AF mechanisms - Abstract
AF is a progressive disease of the atria, involving complex mechanisms related to its initiation, maintenance and progression. Computational modelling provides a framework for integration of experimental and clinical findings, and has emerged as an essential part of mechanistic research in AF. The authors summarise recent advancements in development of multi-scale AF models and focus on the mechanistic links between alternations in atrial structure and electrophysiology with AF. Key AF mechanisms that have been explored using atrial modelling are pulmonary vein ectopy; atrial fibrosis and fibrosis distribution; atrial wall thickness heterogeneity; atrial adipose tissue infiltration; development of repolarisation alternans; cardiac ion channel mutations; and atrial stretch with mechano-electrical feedback. They review modelling approaches that capture variability at the cohort level and provide cohort-specific mechanistic insights. The authors conclude with a summary of future perspectives, as envisioned for the contributions of atrial modelling in the mechanistic understanding of AF.
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- 2019
23. Procedural efficacy and safety of standardized, Ablation Index guided fixed 50W high power short duration pulmonary vein isolation and substrate modification using the CLOSE protocol
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Steffen Schoen, Marian Christoph, Alexander Francke, Nadja S Taha, Frank Scharfe, and Carsten Wunderlich
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Temperature monitoring ,business.industry ,medicine.medical_treatment ,medicine ,Anterior wall ,Nuclear medicine ,business ,Ablation ,Atrial wall ,Complication ,Short duration ,Substrate modification ,Pulmonary vein - Abstract
Introduction: Ablation Index guided ablation according to the CLOSE protocol is very effective in terms of chronic pulmonary vein isolation (PVI). However, the optimal RF power remains controversial. Here, we thought to investigate the efficiency and safety of an AI guided fixed circumferential 50W high power short duration (HPSD) PVI using the CLOSE protocol Methods and results: In a single-centre prospective “proof of concept” trial 40 patients underwent randomized PVI using AI guided RF ablation without oesophageal temperature monitoring. In 20 patient fixed 50W HPSD was used irrespective to the anatomical localization. 20 subjects were ablated with standard power settings (20W posterior and 40W roof and anterior wall). Additionally, 80 consecutive patients were treated according to the HPSD protocol to gather additional safety data. All patients underwent post-procedural oesophago-gastro-duodenoscopy to reveal oesophageal lesions (EDEL). The mean total procedural time was 80.3±22.5 minutes in HPSD compared to control 109.1±27.4 (p
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- 2021
24. Perforation of the atrial wall and aortic sinus after closure of an atrial septal defect with an Atriasept occluder: a case report
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Jia-Wang Ding and Zai-Qiang Zhang
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Male ,Risk ,Pulmonary and Respiratory Medicine ,Cardiac Catheterization ,medicine.medical_specialty ,Percutaneous ,Adolescent ,genetic structures ,Septal Occluder Device ,Perforation (oil well) ,lcsh:Surgery ,Case Report ,030204 cardiovascular system & hematology ,behavioral disciplines and activities ,Percutaneous intervention ,Heart Septal Defects, Atrial ,lcsh:RD78.3-87.3 ,03 medical and health sciences ,0302 clinical medicine ,Atrial and aortic erosion ,Aortic sinus ,Amplatzer septal occluder (ASO) ,medicine ,Humans ,Heart Atria ,business.industry ,High mortality ,Amplatzer Septal Occluder ,lcsh:RD1-811 ,General Medicine ,Sinus of Valsalva ,Atrial wall ,Cardiac surgery ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,lcsh:Anesthesiology ,Atrial septal defect (ASD) ,Cardiothoracic surgery ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background While the perforation of the atrial wall and aortic sinus after closure of an atrial septal defect (ASD) is rare, it’s life-threatening, with rapid progress and high mortality. To the best of our knowledge, 21 similar cases have been reported since 1976. Case presentation We report a 16-year-old male whose atrial septal defect (ASD) was closed using a 12-mm Amplatzer septal occluder (ASO). Atrial wall and aortic sinus perforation occurred 3 months after transcatheter closure, and the patient was discharged after emergency operation. He was discharged on the 12th postoperative day in good overall condition. Conclusions With this case report, we want to illustrate that although percutaneous closure of ASD is regarded as a routine procedure, we should not forget the potentially lethal complications, especially cardiac erosion. Therefore, we should carefully evaluate the risk of erosion before surgery, and careful lifelong follow-up is needed.
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- 2021
25. Atrial Wall Thickness and Risk of Hemopericardium in Elderly Women After Catheter Ablation for Atrial Fibrillation
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Jae Hyuk Lee, Hui Nam Pak, Tae Hoon Kim, Hee Jin Han, Moon Hyoung Lee, Oh Seok Kwon, Hee Tae Yu, Boyoung Joung, and Jae Sun Uhm
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,Hemopericardium ,Risk Assessment ,Pericardial Effusion ,Sex Factors ,Predictive Value of Tests ,Risk Factors ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Heart Atria ,Aged ,Retrospective Studies ,business.industry ,Incidence ,Age Factors ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Atrial wall ,Treatment Outcome ,Echocardiography ,Cardiology ,Catheter Ablation ,Female ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
26. Evaluation of accelerated motion-compensated 3d water/fat late gadolinium enhanced MR for atrial wall imaging
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Radhouene Neji, Steven Williams, Karl P. Kunze, Iain Sim, Mark D O'Neill, Pier Giorgio Masci, Michaela Schmidt, René M. Botnar, Claudia Prieto, and Camila Munoz
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Adult ,Image quality ,Gadolinium ,Respiratory motion-correction ,Biophysics ,chemistry.chemical_element ,Diaphragmatic breathing ,Contrast Media ,Inversion recovery ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,Scan time ,03 medical and health sciences ,0302 clinical medicine ,Imaging, Three-Dimensional ,Water/fat LGE ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Aged ,High rate ,Radiological and Ultrasound Technology ,business.industry ,Water ,Atrial fibrillation ,Middle Aged ,medicine.disease ,Atrial wall ,Magnetic Resonance Imaging ,chemistry ,3D atrial LGE ,business ,Nuclear medicine ,Research Article - Abstract
Objective 3D late gadolinium enhancement (LGE) imaging is a promising non-invasive technique for the assessment of atrial fibrosis. However, current techniques result in prolonged and unpredictable scan times and high rates of non-diagnostic images. The purpose of this study was to compare the performance of a recently proposed accelerated respiratory motion-compensated 3D water/fat LGE technique with conventional 3D LGE for atrial wall imaging. Materials and methods 18 patients (age: 55.7±17.1 years) with atrial fibrillation underwent conventional diaphragmatic navigator gated inversion recovery (IR)-prepared 3D LGE (dNAV) and proposed image-navigator motion-corrected water/fat IR-prepared 3D LGE (iNAV) imaging. Images were assessed for image quality and presence of fibrosis by three expert observers. The scan time for both techniques was recorded. Results Image quality scores were improved with the proposed compared to the conventional method (iNAV: 3.1 ± 1.0 vs. dNAV: 2.6 ± 1.0, p = 0.0012, with 1: Non-diagnostic to 4: Full diagnostic). Furthermore, scan time for the proposed method was significantly shorter with a 59% reduction is scan time (4.5 ± 1.2 min vs. 10.9 ± 3.9 min, p Discussion The motion-compensated water/fat LGE method enables atrial wall imaging with diagnostic quality comparable to the current conventional approach with a significantly shorter scan of about 5 min.
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- 2021
27. The role of echocardiography in predicting technical problems and complications of transvenous leads extractions procedures
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Łukasz Tułecki, Wojciech Jacheć, Andrzej Kutarski, Anna Polewczyk, Dorota Nowosielecka, and Andrzej Kleinrok
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medicine.medical_specialty ,business.industry ,Atrial wall ,Asymptomatic ,medicine.anatomical_structure ,Superior vena cava ,Internal medicine ,Cardiology ,Medicine ,In patient ,Implant ,Major complication ,medicine.symptom ,business ,Vein ,Lead (electronics) - Abstract
Introduction Transesophageal echocardiography (TEE) is a useful tool in preoperative observation of patients undergoing transvenous leads extraction (TLE) due to complications associated with implanted devices. Echocardiographic phenomena may determine the safety of the procedure. Methods and results Data from 936 transesophageal examinations (TEE) performed at a high volume center in patients awaiting TLE from 2015 to 2019 were assessed. TEE revealed a total of 1156 phenomena associated with the implanted leads in 697 (64.85%) patients, including: asymptomatic masses on endocardial leads (AMEL) (58.65%), vegetations (12,73%), fibrous tissue binding the lead to the vein or heart wall (33.76%), lead-to-lead binding sites (18.38%), excess lead loops (19.34%), intramural penetration of the lead tip (16.13%), lead-dependent tricuspid dysfunction (LDTD) (6.41%). Risk factors for technical difficulties during TLE in multivatiate analysis were: fibrous tissue binding the lead to atrial wall (OR=1.738; p
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- 2021
28. A bi-atrial statistical shape model for large-scale in silico studies of human atria: model development and application to ECG simulations
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Steffen Schuler, Claudia Nagel, Olaf Dössel, and Axel Loewe
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Signal Processing (eess.SP) ,Scale (ratio) ,Computer science ,In silico ,Atrial Appendage ,Health Informatics ,Electrocardiography ,symbols.namesake ,FOS: Electrical engineering, electronic engineering, information engineering ,Humans ,Radiology, Nuclear Medicine and imaging ,Model development ,Heart Atria ,cardiovascular diseases ,Electrical Engineering and Systems Science - Signal Processing ,Gaussian process ,Engineering & allied operations ,Models, Statistical ,Radiological and Ultrasound Technology ,Basis (linear algebra) ,business.industry ,P wave ,Pattern recognition ,Atrial wall ,Magnetic Resonance Imaging ,Computer Graphics and Computer-Aided Design ,symbols ,cardiovascular system ,Computer Vision and Pattern Recognition ,Artificial intelligence ,ddc:620 ,business - Abstract
Large-scale electrophysiological simulations to obtain electrocardiograms (ECG) carry the potential to produce extensive datasets for training of machine learning classifiers to, e.g., discriminate between different cardiac pathologies. The adoption of simulations for these purposes is limited due to a lack of ready-to-use models covering atrial anatomical variability. We built a bi-atrial statistical shape model (SSM) of the endocardial wall based on 47 segmented human CT and MRI datasets using Gaussian process morphable models. Generalization, specificity, and compactness metrics were evaluated. The SSM was applied to simulate atrial ECGs in 100 random volumetric instances. The first eigenmode of our SSM reflects a change of the total volume of both atria, the second the asymmetry between left vs. right atrial volume, the third a change in the prominence of the atrial appendages. The SSM is capable of generalizing well to unseen geometries and 95% of the total shape variance is covered by its first 24 eigenvectors. The P waves in the 12-lead ECG of 100 random instances showed a duration of 109.7 ± 12.2 ms in accordance with large cohort studies. The novel bi-atrial SSM itself as well as 100 exemplary instances with rule-based augmentation of atrial wall thickness, fiber orientation, inter-atrial bridges and tags for anatomical structures have been made publicly available. This novel, openly available bi-atrial SSM can in future be employed to generate large sets of realistic atrial geometries as a basis for in silico big data approaches.
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- 2021
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29. Abstract 16340: Atrial Wall Thickness Features Predefine Human Right Atrial Driver: Insights Gained From Novel Structural Analysis
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Aleksei Mikhailov, Megan Subr, John R. Hummel, Ning Li, Nawshin Dastagir, Vadim V. Fedorov, James Kennelly, Roshan Sharma, Bryan A. Whitson, Jichao Zhao, Aaqel Nalar, Anuradha Kalyanasundaram, and Brian J. Hansen
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Atrial fibrillation ,medicine.disease ,Ablation ,Atrial wall ,Right atrial ,Physiology (medical) ,Internal medicine ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction: Atrial fibrillation (AF) is not effectively treated in clinics due to a lack of adequate tools for identifying AF drivers as targets in ablation treatment. Recent studies revealed that 30-50% of patients with persistent AF have drivers not only in the left atrium (LA) but also in the right atrium (RA). However, the precise substrate underlying RA AF drivers remains elusive. Hypothesis: High-resolution analysis of human atrial wall 3D structure can predict the occurrence of right atrial drivers. Methods: Coronary perfused explanted human atria (N=10, 46.2±14.7 y.o.;40% female) were optically mapped with high-resolution CMOS cameras. Sustained AF was induced by fast pacing and perfusion of adenosine and/or isoproterenol. Hearts were imaged at ~170μm 3 resolution by 9.4T gadolinium-enhanced MRI (Fig. A). A coupled PDE approach was utilized to estimate the atrial wall thickness (Fig. B). Fibrosis was identified above a signal intensity threshold validated by histology; and fibrosis density was constructed for each voxel by determining the percent of neighboring fibrotic voxels within a radius of 5 voxels. Results: Optical mapping identified 9 RA drivers in 6 hearts (H1-6) and 7 LA drivers in 5 hearts (H5, 6 and 8-10, Fig. C). All 9 RA AF drivers were anchored in myobundle structure in close proximity to the crista terminalis (CT). Wall thickness distribution in RA excluding the CT was similar to that in the LA (N=10, Fig. D). Structural analysis showed that RA with AF drivers (N=6) was thicker with greater wall variation and higher fibrosis density than RA without AF drivers (N=4, Fig. E). Furthermore, RA driver regions (N=9) were thicker and varied more than other RA regions (4.64±2.86 mm vs 4.56±2.57mm, p Conclusions: For the first time, the 3D structural analysis demonstrates that structural features including atrial wall thickness and its variation near the CT can predict RA driver occurrences in human hearts and be used to improve targeted ablation.
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- 2020
30. Multimodality imaging anatomy of interatrial septum and mitral annulus
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Siew Yen Ho, Susanne Anna Schlossbauer, Jagat Narula, Vera Lucia Paiocchi, Laura Anna Leo, Francesco Faletra, University of Zurich, and Faletra, Francesco Fulvio
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business.industry ,Septum secundum ,Adipose tissue ,610 Medicine & health ,Anatomy ,030204 cardiovascular system & hematology ,Atrial wall ,11171 Cardiocentro Ticino ,2705 Cardiology and Cardiovascular Medicine ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,cardiovascular system ,Foramen ,medicine ,Septum primum ,Fossa ovalis ,cardiovascular diseases ,Mitral annulus ,business ,Cardiology and Cardiovascular Medicine ,030217 neurology & neurosurgery ,Interatrial septum - Abstract
The detailed anatomy of the interatrial septum (IAS) and mitral annulus (MA) as observed on cardiac magnetic resonance, computed tomography and two-dimensional/three-dimensional transthoracic and transesophageal echocardiography is reviewed. The IAS comprises of two components: the septum primum that is membrane-like forming the floor of the fossa ovalis (FO) and the septum secundum that is a muscular rim that surrounds the FO. The latter is an enfolding of atrial wall forming an interatrial groove. Named Waterston’s groove, it is filled with adipose tissue on the epicardial side. Thus, the safest area for transseptal puncture (TSP) is within the limits of the FO floor, which provides direct interatrial access. While crossing an intact septum is a well-established procedure, TSP is a more complex and time-consuming procedure in the presence of patent foramen ovalis, aneurysmal FO or atrial septal defect closure devices. MA comprises two distinctive segments: an anterior-straight and a posterior-curved segment. The posterior MA is a thin, discontinuous fibrous ‘string’, interspersed with adipose tissue, where four components converge: the atrial and ventricular musculature, epicardial adipose tissue and the leaflet’s hinge line. In parts of where this fibrous string is deficient or absent, the posterior leaflet is inserted directly on ventricular and atrial myocardium rendering the MA less robust and producing an ‘asymmetric’ dilation. The marked vulnerability of posterior MA to calcifications might be due to its insertion on the crest of ventricular myocardium being subject to friction injury due to the contraction and relaxation of LV.
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- 2020
31. Topographical anatomy of the right atrial appendage vestibule and its isthmuses
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Mateusz Koziej, Katarzyna Jasińska, Mateusz K. Hołda, Kamil Tyrak, Jakub Hołda, Jerzy A. Walocha, Filip Bolechała, and Katarzyna Słodowska
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animal structures ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Anatomic region ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,medicine ,Humans ,Atrial Appendage ,030212 general & internal medicine ,Heart Atria ,Annulus (mycology) ,business.industry ,Myocardium ,Anatomy ,Ablation ,Atrial wall ,medicine.anatomical_structure ,Atrial Flutter ,Vestibule ,Catheter Ablation ,Right atrium ,Gross anatomy ,Tricuspid Valve ,Cardiology and Cardiovascular Medicine ,business ,Right Atrial Appendage - Abstract
The right atrial appendage (RAA) vestibule is an area located in the right atrium between the RAA orifice and the right atrioventricular valve annulus and may be a target for invasive transcatheter procedures.We examined 200 autopsied human hearts. Three isthmuses (an inferior, a middle, and a superior isthmus) were detected. The average length of the vestibule was 67.4 ± 10.1 mm. Crevices and diverticula were observed within the vestibule in 15.3% of specimens. The isthmuses had varying heights: superior: 14.0 ± 3.4 mm, middle: 11.2 ± 3.1 mm, and inferior: 10.1 ± 2.7 mm (p .001). The superior isthmus had the thickest atrial wall (at midlevel: 16.7 ± 5.6 mm), the middle isthmus had the second thickest wall (13.5 ± 4.2 mm), and the inferior isthmus had the thinnest wall (9.3 ± 3.0 mm; p .001). This same pattern was observed when analyzing the thickness of the adipose layer (superior isthmus had a thickness of 15.4 ± 5.6 mm, middle: 11.7 ± 4.1 mm and inferior: 7.1 ± 3.1 mm; p .001). The average myocardial thickness did not vary between isthmuses (superior isthmus: 1.3 ± 0.5 mm, middle isthmus: 1.8 ± 0.8 mm, inferior isthmus: 1.6 ± 0.5 mm; p .05). Within each isthmus, there were variations in the thickness of the entire atrial wall and of the adipose layer. These were thickest near the valve annulus and thinnest near the RAA orifice (p .001). The thickness of the myocardial layer followed an inverse trend (p .001).This study was the first to describe the detailed topographical anatomy of the RAA vestibule and that of its adjoining isthmuses. The substantial variability in the structure and dimensions of the RAA isthmuses may play a role in planning interventions within this anatomic region.
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- 2020
32. Tailored ablation index for pulmonary vein isolation according to wall thickness within the ablation circle
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Shaowen Liu, Genqing Zhou, Juan Xu, Xiaoyu Wu, Yong Wei, Xiaofeng Lu, Yong Wang, and Songwen Chen
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Epicardial Mapping ,Male ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Pulmonary vein ,03 medical and health sciences ,0302 clinical medicine ,Atrial Fibrillation ,Multidetector Computed Tomography ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,Aged ,business.industry ,General Medicine ,Ablation ,Lesion depth ,Atrial wall ,Pulmonary Veins ,Catheter Ablation ,Female ,Tomography ,Cardiology and Cardiovascular Medicine ,business ,Wall thickness ,Nuclear medicine - Abstract
Background Ablation Index (AI), a novel lesion quality marker, includes contact force, time, and power of radiofrequency application, but not regional variation in wall thickness within the wide antral catheter ablation (WACA) circle. This study explored the relationships among AI target value, atrial wall thickness and gap formation within the WACA circle in patients with paroxysmal atrial fibrillation (PAF). Methods We evaluated 102 consecutive patients (mean age, 65 ± 9 years) with PAF who underwent AI-guided WACA for ipsilateral pulmonary vein isolation (PVI). Each WACA circle was subdivided into 8 segments, and overall 7143 radiofrequency applications were delivered, including 125 gaps in PVI ablation lines. For each radiofrequency tag within the ablation circle, we collected data on ablation lesion depth surrogates (time of application, delivery power, impedance drop, average contact force, force-time integral [FTI], and AI) and left atrial wall thickness measured by multi detector computer tomography scanning. Results The anterior and roof walls were the thickest segments of the ablation circle, in which 85.8% of gaps concentrated, while the posterior and inferior walls were the thinnest. Gap formation was significantly associated with FTI, AI, wall thickness, FTI/wall thickness and AI/wall thickness. AI/wall thickness had the highest predictive value for gap formation, with a cutoff of 195.6 au/mm for effective ablation. Conclusions In AI-guided PVI of PAF, AI/wall thickness by normalizing myocardial thickness variation along the WACA circle was a strong predictor of gap formation, with a target of 195.6 au/mm appearing suitable for effective ablation. This article is protected by copyright. All rights reserved.
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- 2020
33. Atrial wall thickening, fevers, and atrial fibrillation caused by immunoglobulin G4-related biatrial cardiomyopathy
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Naoki Fujimoto, Tomoyuki Fukuma, Masaki Ishiyama, and Kaoru Dohi
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medicine.medical_specialty ,Fever ,business.industry ,Cardiomyopathy ,Immunoglobulins ,Atrial fibrillation ,medicine.disease ,Atrial wall ,medicine.anatomical_structure ,Treatment Outcome ,Internal medicine ,Immunoglobulin g4 ,Atrial Fibrillation ,medicine ,Cardiology ,Catheter Ablation ,Humans ,Thickening ,Heart Atria ,Atrium (heart) ,Cardiology and Cardiovascular Medicine ,business ,Cardiomyopathies - Published
- 2020
34. 659Left atrial wall thickness evaluation during atrial fibrillation redo procedures
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Alfredo Chauca, Jordi Palet, J Carballo, D Soto, Alejandro Panaro, C Ramirez, Beatriz Jáuregui, Augusto Ordóñez, Agusti Jornet, Diego Penela, Cheryl Teres, Antonio Berruezo, David Santana, Giuliana Maldonado, and Guillermo Oller
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Left atrium ,Atrial fibrillation ,Cardiac Ablation ,Atrial wall ,Ablation ,medicine.disease ,medicine.anatomical_structure ,Physiology (medical) ,Internal medicine ,Multidetector computed tomography ,medicine ,Cardiology ,Atrium (heart) ,Cardiology and Cardiovascular Medicine ,business - Abstract
Funding Acknowledgements Dr Teres was funded by Swiss Heartrhythm Foundation Introduction pulmonary vein (PV) reconnections due to gaps on circumferential ablation lines are responsible for atrial fibrillation recurrences after catheter ablation. We sought to analyze the local left atrial wall thickness (LAWT) of PV line gaps at AF redo ablation during real-time catheter positioning. LAWT was measured on the MDCT 3D reconstruction and fused with the LA anatomy using CARTO-merge. Objective To analyze the relationship between local reconnection gaps and the LAWT during AF redo procedures. Methods Single-Center cohort study that included 41 consecutive patients referred for AF redo procedure. All patients had a MDCT prior to the ablation procedure. LAWT maps were semi-automatically computed from the MDCT as the local distance between the LA endo and epicardium. Each PV line was subdivided into 8 segments and mean LAWT was computed. During the procedure, the local gap was defined as the earliest activation site at the reconnected segment of the circumferential PV line (Figure 1A & 1B). Results 41 patients [31 (75.6%) male, age 60 ± 10 years] were included. Mean LAWT was 1.36 ± 0.20 mm. Mean PV circumferential line WT was higher in left PVs than in the right PVs 1.68 ± 0.57 vs. 1.31 ± 0.39 mm p Conclusions Reconnection points were more frequently present in the thicker segments of the PV circumferential line. The most frequently reconnected segment was the anterior carina in both right and left PVs. Atrial wall thickness maps derived from MDCT are useful to guide AF redo procedures. Abstract Figure. 1) Activation & WT map; 2) Segment WT
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- 2020
35. Right atrial catheter 'ghost' removal by cardiac surgery: A pediatric case series report
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Christian Drolet, Bruno Michon, Philippe Chetaille, Frédéric M.B. Jacques, Claire Massardier, Laurence Vaujois, Jean-Marc Côté, Christine Houde, Lamia Naccache, and Jean Perron
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medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Embolism ,Pediatric Hematology/Oncology ,Right atrial ,Fibrin ,03 medical and health sciences ,Catheters, Indwelling ,0302 clinical medicine ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Medicine ,Heart Atria ,Embolization ,Cardiac Surgical Procedures ,Child ,Tricuspid valve ,biology ,business.industry ,Lymphoma, Non-Hodgkin ,Hematology ,Precursor Cell Lymphoblastic Leukemia-Lymphoma ,Prognosis ,Atrial wall ,Cardiac surgery ,Surgery ,Catheter ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,biology.protein ,business ,030215 immunology - Abstract
Fibrin sheath formation around long-term indwelling central venous catheters is common and usually benign. Fibrin sheath can persist after catheter removal and rarely leads to complications. This is a report of three pediatric oncology patients that required cardiac surgery for cardiac embolization of a "ghost" catheter several years after catheter removal. One case required tricuspid valve replacement for complete tricuspid valve destruction and two had erosion through the atrial wall. The severity of these rare complications mandates follow-up of "ghost" catheters in pediatric oncology patients.
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- 2020
36. A new approach to the continuous monitoring of transvenous lead extraction using transesophageal echocardiography-Analysis of 936 procedures
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Łukasz Tułecki, Konrad Tomków, Wojciech Jacheć, Dorota Nowosielecka, Andrzej Kutarski, Andrzej Kleinrok, Anna Polewczyk, and Paweł Stefańczyk
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medicine.medical_specialty ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Fluoroscopy ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Lead (electronics) ,Device Removal ,Aged ,Retrospective Studies ,Aged, 80 and over ,Tricuspid valve ,medicine.diagnostic_test ,business.industry ,Continuous monitoring ,Ventricular wall ,Middle Aged ,Atrial wall ,Surgery ,Transvenous lead ,Defibrillators, Implantable ,medicine.anatomical_structure ,Tamponade ,Tricuspid Valve ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
Aims The usefulness of transesophageal echocardiographic (TEE) monitoring for transvenous lead extraction (TLE) procedures is still controversial. The purpose of the current study was to present new TEE values in detecting invisible events in fluoroscopy and preventing the development of dangerous complications. Methods From 2015 to 2019, a total of 1026 procedures were performed in single TLE center. In total, 1108 leads had been extracted with a mean lead dwell time of 115.8 ± 77.6 months. Continuous TEE was used in 936 patients with a mean age of 67.1 ± 14.4 years. Results Preprocedure examination revealed looped leads in 181 (19.3%) patients, dry cardiac perforation in 151 (16.1%), lead-to-lead adhesion in 172 (18.4%), lead adhesion to the myocardium in 317 (33.9%), and vegetations in 119 (12.7%) patients. Intra-procedural TEE demonstrated pulling on the atrial wall, ventricular wall, or tricuspid valve in 380 (40.5%), 235 (25.1%), and 78 (8.3%) patients, respectively. Acute tamponade requiring sternotomy occurred in 11 (1.1%) patients. Migration of vegetation or connective tissue fragments were seen in 69 (7.3%) and 111 (11.8%) patients, respectively. After procedure, TEE was helpful in navigating an implantation, a new lead in 97 (10.3%) patients, and removing the remnants of lead/silicone insulation in 50 (5.3%) patients. Conclusion Real time transesophageal echocardiography for the guidance of transvenous lead extraction informs the operator about the danger of manipulations close to delicate cardiac structures and whether immediate modification to the plan of lead removal is necessary in order to prevent the occurrence of unwanted events.
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- 2020
37. Influence of Gradient and Smoothness of Atrial Wall Thickness on Initiation and Maintenance of Atrial Fibrillation
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Azzolin, Luca, Luongo, Giorgio, Rocher, Sara, Rocher Ventura, Sara, Saiz, Javier, Doesse, Olaf, and Loewe, Axel
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Materials science ,Smoothness (probability theory) ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,Curvature ,Atrial wall ,030218 nuclear medicine & medical imaging ,Free wall ,TECNOLOGIA ELECTRONICA ,03 medical and health sciences ,0302 clinical medicine ,Homogeneous ,medicine ,Laplacian smoothing ,ddc:620 ,Smoothing ,Engineering & allied operations ,Biomedical engineering - Abstract
[EN] This work uses a highly detailed computational model of human atria to investigate the effect of spatial gradient and smoothing of atrial wall thickness on inducibility and maintenance of atrial fibrillation (AF) episodes. An atrial model with homogeneous thickness (HO) was used as baseline for the generation of different atrial models including either a low (LG) or high thickness gradient between left/right atrial free wall and the other regions. Since the model with high spatial gradient presented non-natural sharp edges between regions, either 1 (HG1) or 2 (HG2) Laplacian smoothing iterations were applied. Arrhythmic episodes were initiated using a rapid pacing protocol and long-living rotors were detected and tracked over time. Thresholds optimised with receiver operating characteristic analysis were used to define high gradient/curvature regions. Greater spatial gradients increased the atrial model inducibility and unveiled additional regions vulnerable to maintain AF drivers. In the models with heterogeneous wall thickness (LG, HG2 and HG1), 73.5 ± 8.7% of the long living rotors were found in areas within 1.5 mm from nodes with high thickness gradient, and 85.0 ± 3.4% in areas around high endocardial curvature. These findings promote wall thickness gradient and endocardial curvature as measures of AF vulnerability, Research supported by the European Union¿s Horizon 2020 research and innovation programme under the Marie Sk¿odowska-Curie grant agreement No.766082 (MY-ATRIA project)
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- 2020
38. Unified mechanism of local drivers in a percolation model of atrial fibrillation
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Max Falkenberg, Anthony C. Li, Alberto Ciacci, Robert Lawrence, Nicholas S. Peters, Andrew J. Ford, Kim Christensen, Rosetrees Trust, British Heart Foundation, and Imperial College Healthcare NHS Trust- BRC Funding
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Physics ,Models, Cardiovascular ,Percolation threshold ,Atrial fibrillation ,Atrial activation ,medicine.disease ,Atrial wall ,01 natural sciences ,Article ,Electrophysiological Phenomena ,010305 fluids & plasmas ,Reentrancy ,Atrial Fibrillation ,0103 physical sciences ,cardiovascular system ,medicine ,Sinus rhythm ,010306 general physics ,Neuroscience ,Endocardium ,Paroxysmal AF - Abstract
The mechanisms of atrial fibrillation (AF) are poorly understood, resulting in disappointing success rates of ablative treatment. Different mechanisms defined largely by different atrial activation patterns have been proposed and, arguably, this dispute has slowed the progress of AF research. Recent clinical evidence suggests a unifying mechanism of local drivers based on sustained re-entrant circuits in the complex atrial architecture. Here, we present a percolation inspired computational model showing spontaneous emergence of AF that strongly supports, and gives a theoretical explanation for, the clinically observed diversity of activation. We show that the difference in surface activation patterns is a direct consequence of the thickness of the discrete network of heart muscle cells through which electrical signals percolate to reach the imaged surface. The model naturally follows the clinical spectrum of AF spanning sinus rhythm, paroxysmal and persistent AF as the decoupling of myocardial cells results in the lattice approaching the percolation threshold. This allows the model to make the novel prediction that for paroxysmal AF, re-entrant circuits emerge near the endocardium, but in persistent AF they emerge deeper in the bulk of the atrial wall. If experimentally verified, this may go towards explaining the lowering ablation success rate as AF becomes more persistent.
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- 2019
39. Malleable Tin Plate Exposure System for Minimally Invasive Mitral Valve Surgery
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Akimasa Morisaki, Hiromichi Fujii, Yoshito Sakon, Yosuke Takahashi, Takashi Murakami, and Toshihiko Shibata
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Forceps ,Left atrium ,chemistry.chemical_element ,030204 cardiovascular system & hematology ,Sensitivity and Specificity ,03 medical and health sciences ,0302 clinical medicine ,Left atrial ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,cardiovascular diseases ,Atrial Septum ,business.industry ,Equipment Design ,Surgical Instruments ,equipment and supplies ,Atrial wall ,Entire mitral valve ,Surgery ,Retractor ,medicine.anatomical_structure ,Thoracotomy ,030228 respiratory system ,chemistry ,Tin ,cardiovascular system ,Mitral Valve ,Cardiology and Cardiovascular Medicine ,business ,Mitral valve surgery - Abstract
In minimally invasive mitral valve surgery, exposure in the medial left atrium is occasionally poor. A flexible exposure system for minimally invasive surgery was constructed using a tin plate (99.9% pure tin). The tin plate is very flexible and embossed to prevent slippage, and it is attached to a left atrial retractor. The folded tin plate is inserted into the left atrium via a minithoracotomy, and the plate is easily expanded using forceps, as needed. The tin plate pushes the medial atrial wall outward, which provides an excellent view of the entire mitral valve.
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- 2019
40. Primary cardiac epithelioid angiosarcoma with frond-like features: a rare and ominous radiological mimicker of benign cardiac tumors
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Yakov Elgudin, Brian Fitzsimons, Priyatharsini Nirmalanantham, Andrew Patterson, Amit Gupta, Robin Elliott, and Miroslav Sekulic
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Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,Biopsy ,Hemangiosarcoma ,Epithelioid Angiosarcoma ,030204 cardiovascular system & hematology ,Pathology and Forensic Medicine ,Resection ,Heart Neoplasms ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Biomarkers, Tumor ,medicine ,Humans ,Diagnostic Errors ,Benign neoplasms ,Cardiac Tumors ,business.industry ,Epithelioid Cells ,Myxoma ,General Medicine ,Atrial wall ,medicine.disease ,Immunohistochemistry ,Magnetic Resonance Imaging ,030104 developmental biology ,Radiological weapon ,cardiovascular system ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Most primary cardiac tumors are benign neoplasms, which generally can be differentiated from malignant neoplasms via certain radiological features. We present briefly a case of a 26-year-old man undergoing resection of a right atrial mass that based on preceding radiologic findings represent a myxoma. After pathologic examination, the lesion was determined to be an epithelioid angiosarcoma with unique frond-like architecture and multiple pedicular attachments to the atrial wall.
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- 2019
41. B-PO04-068 ESOPHAGUS-TO-POSTERIOR ATRIAL WALL RELATIONSHIP: PRE- AND INTRA-PROCEDURAL THREE-DIMENSIONAL MULTIMODALITY IMAGING FOR ESOPHAGEAL POSITION
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Agusti Jornet, David Soto-Iglesias, David Santana, Claudia Scherer, Alfredo Chauca, J T Ortiz-Perez, Cheryl Teres, Beatriz Jáuregui, Giuliana Maldonado, Antonio Berruezo, Jose-Miguel Carreno-Lineros, Carlos Ramirez-Paesano, Alejandro Panaro, Jordi Palet, Marina Huguet, Julio Carballo, Augusto Ordóñez, Guillermo Oller, and Diego Penela
- Subjects
Position (obstetrics) ,medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Physiology (medical) ,medicine ,Radiology ,Esophagus ,Cardiology and Cardiovascular Medicine ,business ,Atrial wall - Published
- 2021
42. The Impact of the Distance between the Atrial Electrode and the Atrial Wall on Atrial Undersensing in Patients with VDD Pacemakers: Long-Term Follow-Up.
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Altin, Timucin, Guldal, Muharrem, Candemir, Basar, Polat, Cegerhun, Ozdemir, Aydan O., Tulunay, Cansin, Ozdol, Cagdas, Akyurek, Omer, Karaoguz, Remzi, and Erol, Cetin
- Abstract
Aim: Atrial undersensing (AUS) in single-lead VDD pacemakers may be due to diminished P-wave amplitude secondary to local inflammation beneath the electrodes closer to atrial wall. The aim of this study was to assess the potential effect of distance between atrial electrode and atrial wall on immediate and long-term atrial sensing stability in VDD systems. Methods: A total of 275 patients with normal sinus node function who received VDD pacemakers were enrolled into the study and were followed up for a median duration of 33 months. During each control visit, a standard 12-lead electrocardiogram (ECG) was obtained and standard pacemaker function assessment was performed including testing for pacing threshold and atrioventricular synchrony. The distance between atrial electrode and atrial wall was measured from chest X-ray. Results: Of the 275 patients, AUS was detected in 59 patients. Univariate predictors of AUS were use of closely spaced bipolar ring atrial electrode (CSBR) (P = 0.01), wider atrial ring-spacing (P = 0.03), and atrial sensitivity programmed to a higher level (P = 0.001). Use of CSBR (P = 0.04) and atrial sensitivity ≥0.3 mV (P = 0.02) were observed to be the independent predictors for AUS. When the distance between atrial electrode and atrial wall was <7 mm, AUS was less with diagonally arranged bipolar ring electrodes (DABR) than it was with CSBRs (P = 0.02). Conclusions: The distance between atrial electrode and atrial wall does not appear to affect AUS incidence in VDD pacemakers. For VDD electrodes closer to atrial wall, AUS was significantly less likely in DABR-type electrodes. [ABSTRACT FROM AUTHOR]
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- 2008
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43. Development of a patient-specific atrial phantom model for planning and training of inter-atrial interventions
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João L. Vilaça, Sandro Queirós, Jan D'hooge, Pedro Morais, João Manuel R. S. Tavares, Fernando Veloso, Faculdade de Engenharia, and Universidade do Minho
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Patient-Specific Modeling ,medicine.medical_specialty ,Computer science ,Medicina Básica [Ciências Médicas] ,Computed tomography ,030204 cardiovascular system & hematology ,Surgical planning ,Imaging phantom ,Ciências Tecnológicas, Ciências médicas e da saúde ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Heart Atria ,3D - printing ,Ultrasonography ,Science & Technology ,medicine.diagnostic_test ,Phantoms, Imaging ,business.industry ,Patient - specific phantom models ,Ultrasound ,Ciências médicas e da saúde ,Inter - atrial septal wall ,Pattern recognition ,General Medicine ,Patient specific ,Atrial wall ,Surgery ,Technological sciences, Medical and Health sciences ,Ciências Médicas::Medicina Básica ,Printing, Three-Dimensional ,Medical and Health sciences ,Ultrasound compatible phantom model ,Artificial intelligence ,Cardiac atria ,Tomography, X-Ray Computed ,business ,Algorithms - Abstract
Article is accepted for publication, BackgroundSeveral authors have presented cardiac phantoms to mimic the particularities of the heart, making it suitable for medical training and surgical planning. Although the initial models were mainly focused on the ventricles, personalized phantoms of the atria were recently presented. However, such models are typically rigid, the atrial wall is not realistic and they are not compatible with ultrasound (US), being sub-optimal for planning/training of several interventions. MethodsIn this work, we propose a strategy to construct a patient-specific atrial model. Specifically, the target anatomy is generated using a computed tomography (CT) dataset and then constructed using a mold-cast approach. An accurate representation of the inter-atrial wall (IAS) was ensured during the model generation, allowing its application for IAS interventions. Two phantoms were constructed using different flexible materials (silicone and polyvinyl alcohol cryogel, PVA-C), which were then compared to assess their appropriateness for US acquisition and for the generation of complex anatomies. ResultsTwo experiments were set up to validate the proposed methodology. First, the accuracy of the manufacturing approach was assessed through the comparison between a post-production CT and the virtual references. The results proved that the silicone-based model was more accurate than the PVA-C-based one, with an error of 1.680.79, 1.36 +/- 0.94, 1.45 +/- 0.77mm for the left (LA) and right atria (RA) and IAS, respectively. Second, an US acquisition of each model was performed and the obtained images quantitatively and qualitatively assessed. Both models showed a similar performance in terms of visual evaluation, with an easy detection of the LA, RA, and the IAS. Furthermore, a moderate accuracy was obtained between the atrial surfaces extracted from the US and the ideal reference, and again a superior performance of the silicone-based model against the PVA-C phantom was observed. ConclusionsThe proposed strategy proved to be accurate and feasible for the correct generation of complex personalized atrial models., The authors acknowledge "Fundacao para a Ciencia e a Tecnologia" (FCT), in Portugal, and the European Social Found, European Union, for funding support through the "Programa Operacional Capital Humano" (POCH) in the scope of the PhD grants SFRH/BD/95438/2013 (P. Morais) and SFRH/BD/93443/2013 (S. Queiros).Authors gratefully acknowledge the funding of Projects NORTE-01-0145-FEDER-000013 and NORTE-01-0145-FEDER-000022, cofinanced by "Programa Operacional Regional do Norte" (NORTE2020), through "Fundo Europeu de Desenvolvimento Regional" (FEDER)., info:eu-repo/semantics/publishedVersion
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- 2017
44. Efficacy of 3D transoesophageal echocardiography for transcatheter device closure of atrial septal defect without balloon sizing
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Duk-Woo Park, Jung-Min Ahn, Jae-Kwan Song, Jong-Min Song, Jaeseok Bae, Ran Heo, Duk-Hyun Kang, Dae-Hee Kim, Sahmin Lee, Min Soo Cho, Jeong Yoon Jang, and Jung Ae Hong
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Adult ,Male ,Cardiac Catheterization ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Echocardiography, Three-Dimensional ,030204 cardiovascular system & hematology ,Balloon ,Transoesophageal echocardiography ,Risk Assessment ,Heart Septal Defects, Atrial ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine.artery ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Registries ,030212 general & internal medicine ,Embolization ,Procedure time ,Aorta ,business.industry ,Balloon sizing ,General Medicine ,Balloon Occlusion ,Middle Aged ,Atrial wall ,Surgery ,Treatment Outcome ,Linear Models ,Cardiology ,Female ,Patient Safety ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal ,Follow-Up Studies - Abstract
Aims Using balloon sizing to determine device size may cause complications and increase procedure time in performing transcatheter closure of atrial septal defect (ASD). We aimed to validate the clinical utility of a formula using measurements from 3D transoesophageal echocardiography (TOE) images in performing the procedure without balloon sizing. Methods and results We enrolled 248 consecutive patients with ASD in a prospective registry. In the first tier (n = 53), we determined the device size before the procedure using our formula and performed balloon sizing during the procedure to verify our decision. In the second tier (n = 195), the procedure was performed without balloon sizing. In the first tier, the estimated device size correlated well with the device size finally implanted (R = 0.961, P
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- 2017
45. Fibrosis and Atrial Fibrillation: Computerized and Optical Mapping
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Jichao Zhao, Brian J. Hansen, and Vadim V. Fedorov
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0301 basic medicine ,medicine.medical_specialty ,Conduction abnormalities ,business.industry ,Mechanism (biology) ,Atrial fibrillation ,030204 cardiovascular system & hematology ,medicine.disease ,Atrial wall ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Structural mapping ,Fibrosis ,Internal medicine ,Optical mapping ,medicine ,Cardiology ,business ,Structural imaging - Abstract
Recent studies strongly suggest that the majority of atrial fibrillation (AF) patients with diagnosed or subclinical cardiac diseases have established or even pre-existing fibrotic structural remodeling, which may lead to conduction abnormalities and reentrant activity that sustain AF. As conventional treatments fail to treat AF in far too many cases, an urgent need exists to identify specific structural arrhythmogenic fibrosis patterns, which may maintain AF, in order to identify effective ablation targets for AF treatment. However, the existing challenge is to define what exact structural remodeling within the complex 3D human atrial wall is arrhythmogenic, as well as linking arrhythmogenic fibrosis to an underlying mechanism of AF maintenance in the clinical setting. This review is focused on the role of 3D fibrosis architecture in the mechanisms of AF maintenance revealed by submillimeter, high-resolution ex-vivo imaging modalities directly of human atria, as well as from in-silico 3D computational techniques that can be able to overcome in-vivo clinical limitations. The systematic integration of functional and structural imaging ex-vivo may inform the necessary integration of electrode and structural mapping in-vivo. A holistic view of AF driver mechanisms may begin to identify the defining characteristics or "fingerprints" of reentrant AF drivers, such as 3D fibrotic architecture, in order to design optimal patient-specific ablation strategies.
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- 2017
46. Commentary: Looking beyond the atrial wall in AF-a review of 2019 and into the next decade
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P.D. Lambiase
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medicine.medical_specialty ,business.industry ,Internal medicine ,Atrial Fibrillation ,Catheter Ablation ,medicine ,Cardiology ,Humans ,Heart Atria ,Cardiology and Cardiovascular Medicine ,Atrial wall ,business - Published
- 2020
47. Ablation of scar-related reentrant atrial tachycardias with epi-to-endo bridging is less successful
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S. Bun, D.G. Latcu, B. Enache, K. Hasni, and Nadir Saoudi
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Tachycardia ,medicine.medical_specialty ,Bridging (networking) ,business.industry ,medicine.medical_treatment ,Ablation ,Atrial wall ,Antidromic ,Lesion ,Internal medicine ,medicine ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Atrial tachycardia ,Shunt (electrical) - Abstract
Background Epicardial portions of the circuit of endocardial re-entrant tachycardias are well established phenomena in the ventricles, but little is known about a similar phenomenon in post lesion atrial tachycardia (AT). Objective Higher spatial and voltage mapping capabilities may help identify extra-endocardial bridging (EEB) during tachycardia. Methods We retrospectively analysed our database of 119 pts with AT cases with ultra-high density mapping between March 2015 and March 2018. Epi-to-endo breakthrough sites were diagnosed when endocardial activation started at a discrete point before spreading radially in every available direction. PPI after transient entrainment at these sites confirmed local participation in AT. Results In 20 out of the 119 pts (mean age 70 ± 9 yrs, always with ≥ 1 prior procedures), 2 types of EEB were found. Type 1 is a “myocardial” EEB (n = 16). Subtype 1A ( Fig. 1 ) with a visible antidromic wavefront back to a line of block (n = 10) whereas in subtype 1B activation starts immediately adjacent to a usually large line of block. Type 2 implied an extra-atrial “venous” bridging, either as a “shunt” over a line of block (subtype 2A, n = 6) or by using an epicardial vein as a major part of a circuit (subtype 2B, n = 1). In presence of EEB, AT termination was 17/22 (77%), significantly lower than our historical cohort of nonEEB AT (97%, P = 0.03). The most successful strategy was targeting epi-endo breakthrough site. Conclusion Atrial EEB using either epicardial layers of the atrial wall, or extra-atrial venous structures is confirmed. Successful ablation at epi-to-endo breakthrough site proves the validity of the concept but results of ablation are inferior to nonEEB AT.
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- 2020
48. Animation of Atrial and Ventricular External Walls of a Virtual 3D Heart Based on Echocardiogram Images
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Gabriela Colares Ali Ganem, Regina Célia Coelho, and Carlos Marcelo Gurjão de Godoy
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Computational simulation ,Heartbeat ,Cardiac anatomy ,Computer science ,business.industry ,Ventricular wall ,cardiovascular system ,Computer vision ,cardiovascular diseases ,Animation ,Artificial intelligence ,Atrial wall ,business - Abstract
The advance of the three-dimensional (3D) computational simulation resulted in high-fidelity virtual heart models, which are useful for implementation in medical educational tools. These computational tools help the study of cardiac anatomy and function and are of interest to many medical professionals. As the appearance of the heart surface is relevant for the comprehension of cardiac movements, the aim of the present work was the development of an animation of the external atrial and ventricular walls, during the heartbeat in a virtual 3D heart, according to physiological data. The animation used data extracted from echocardiogram images of healthy human hearts and ECG timing. The results show that displacements of the epicardial walls measured manually and wall displacements generated by the animation were comparable. Thus, the implemented animation of the atrial and ventricular external walls of the 3D virtual heart complied with those of echocardiogram images, being useful for future implementation in cardiac teaching and (or) learning tools.
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- 2019
49. Joint Associations of Obesity and NT‐proBNP With the Incidence of Atrial Fibrillation in the ARIC Study
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Lin Y. Chen, Pamela L. Lutsey, Alvaro Alonso, Zakaria Almuwaqqat, Faye L. Norby, Elizabeth Selvin, Wesley T. O'Neal, and Elsayed Z. Soliman
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Male ,obesity ,medicine.medical_specialty ,Time Factors ,medicine.drug_class ,Arrhythmias ,030204 cardiovascular system & hematology ,brain natriuretic peptide ,Risk Assessment ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,Natriuretic Peptide, Brain ,medicine ,Natriuretic peptide ,Humans ,Arrhythmia and Electrophysiology ,cardiovascular diseases ,Prospective Studies ,030212 general & internal medicine ,Aric study ,Original Research ,2. Zero hunger ,business.industry ,Incidence ,Incidence (epidemiology) ,Atrial fibrillation ,Middle Aged ,Prognosis ,Brain natriuretic peptide ,Atrial wall ,medicine.disease ,Obesity ,Peptide Fragments ,United States ,Up-Regulation ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Body mass index ,hormones, hormone substitutes, and hormone antagonists ,Biomarkers - Abstract
Background Circulating NT ‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) levels, a well‐known indicator of atrial wall stress and remodeling, inversely correlate with body mass index. Both are strongly predictive of atrial fibrillation ( AF ). Their potential interaction in relation to incident AF, however, has not been explored. Methods and Results In total, 9556 participants of the ARIC (Atherosclerosis Risk in Communities) study who had 2 measurements of NT ‐pro BNP and no baseline AF or heart failure were followed from 1996 to 1998 through 2016 for the occurrence of incident AF . Participants were categorized as obese (body mass index ≥30) and nonobese (body mass index NT ‐pro BNP levels (using the median of 68.2 pg/ mL as the cutoff). Over a median follow‐up of 18.3 years, we identified 1806 incident cases of AF . Analysis using multivariable Cox regression models showed that obese participants with high NT ‐pro BNP levels at visit 4 had a higher adjusted risk of incident AF (hazard ratio: 3.64; 95% CI, 3.15–4.22) compared with nonobese individuals with low NT ‐pro BNP levels. The association of obesity with AF risk was not modified by NT ‐pro BNP levels ( P =0.46 for interaction). Increasing BNP among participants from 1990–1992 to 1996–1998 was associated with increased AF risk. After further adjustment for clinical risk factors and medications, results were similar. Conclusions Individuals who had both elevated body mass index and NT ‐pro BNP and were free of clinically recognized heart failure were at higher risk of AF development. Those who experienced an increase in NT ‐pro BNP levels between visits 2 and 4 were at higher risk of AF .
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- 2019
50. Topographic characteristics of the left atrial medial isthmus
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Mateusz K. Hołda, Marcin Chłosta, Filip Bolechała, Katarzyna Jasińska, Mateusz Koziej, Jakub Hołda, Katarzyna Piątek-Koziej, Paweł Kopacz, and Kamil Tyrak
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Male ,animal structures ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Left atrial ,medicine ,Cadaver ,Humans ,030212 general & internal medicine ,Heart Atria ,Oval fossa ,business.industry ,Atrial fibrillation ,General Medicine ,Anatomy ,Middle Aged ,Ablation ,medicine.disease ,Atrial wall ,Right inferior pulmonary vein ,Ostium ,medicine.anatomical_structure ,Female ,Cardiology and Cardiovascular Medicine ,business ,Interatrial septum - Abstract
BACKGROUND The purpose of this study was to provide detailed topography of the left atrial medial isthmus (situated between the right inferior pulmonary vein ostium and the medial part of the mitral annulus). METHODS Two hundred human hearts (Caucasian, 22.5% females, 48.7 ± 4.9 years old) were investigated. RESULTS The mean length of the medial isthmus was 42.4 ± 8.6 mm. Additionally, the medial isthmus line was divided by the oval fossa into three sections with equal mean lengths (upper: 14.2 ± 7.2 vs middle: 14.1 ± 6.1 vs lower: 14.9 ± 4.6 mm; P > .05). The left upper section of the atrial wall was thinner than the lower section (2.5 ± 1.1 vs 3.4 ± 1.6 mm; P
- Published
- 2019
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