Circulation. Arrhythmia and electrophysiology
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Circ Arrhythm Electrophysiol · Oct 2011
Influence of race on atrial fibrillation after cardiac surgery.
Despite having fewer risk factors for atrial fibrillation (AF), white patients have a greater prevalence of AF in the community than black patients, and a genetic basis has been postulated. However, it is unknown whether occurrence of new-onset AF after cardiac surgery is different in white versus black patients, and secondarily, other non-Caucasian patients. ⋯ White patients had a markedly higher risk of postoperative AF than black and other non-Caucasian patients. The cause for racial differences of arrhythmic risk is unknown, but a genetic predisposition is plausible. Our results have implications for risk stratification and mechanistic understanding of postoperative AF.
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Circ Arrhythm Electrophysiol · Oct 2011
Outcomes of cardiac perforation complicating catheter ablation of ventricular arrhythmias.
Cardiac perforation is a recognized complication of catheter ablation procedures, most commonly encountered during ablation of atrial fibrillation. The study aims to investigate the incidence, management, and hospital outcomes of cardiac perforation complicating catheter ablation for ventricular arrhythmias. ⋯ Ventricular perforation and tamponade occurs in 1% of ventricular ablation procedures and in this series, occurred only in patients without a history of prior cardiac surgery. More than half the patients required surgical repair. Perforation is often associated with steam pops and emergent surgical repair is often required when perforation occurs after a steam pop.
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Circ Arrhythm Electrophysiol · Oct 2011
Very low risk of thromboembolic events in patients undergoing successful catheter ablation of atrial fibrillation with a CHADS2 score ≤3: a long-term outcome study.
Long-term cessation of oral anticoagulation (OAC) after catheter ablation of atrial fibrillation (AF) has been deemed controversial. The safety of this management strategy in patients without recurrent AF and with historically elevated risks for thromboembolism remains largely unknown. In this study, we sought to evaluate the long-term results of OAC cessation after successful catheter ablation of AF. ⋯ No significant thromboembolic-related morbidity is observed when AADs and OAC are discontinued after successful catheter ablation of AF in patients with a CHADS(2) score ≤3 who are maintained on antiplatelet therapy during long-term follow-up.
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Circ Arrhythm Electrophysiol · Oct 2011
Iron overload decreases CaV1.3-dependent L-type Ca2+ currents leading to bradycardia, altered electrical conduction, and atrial fibrillation.
Chronic iron overload (CIO) is associated with blood disorders such as thalassemias and hemochromatosis. A major prognostic indicator of survival in patients with CIO is iron-mediated cardiomyopathy characterized by contractile dysfunction and electrical disturbances, including slow heart rate (bradycardia) and heart block. ⋯ Our results demonstrate that CIO selectively reduces Ca(V)1.3-mediated I(Ca,L), leading to bradycardia, slowing of electrical conduction, and atrial fibrillation as seen in patients with iron overload.
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Circ Arrhythm Electrophysiol · Aug 2011
Comparative StudyDifferences in repeating patterns of complex fractionated left atrial electrograms in longstanding persistent atrial fibrillation as compared with paroxysmal atrial fibrillation.
Complex fractionated atrial electrograms (CFAE) are morphologically more uniform in persistent longstanding as compared with paroxysmal atrial fibrillation (AF). It was hypothesized that this may result from a greater degree of repetitiveness in CFAE patterns at disparate left atrial (LA) sites in longstanding AF. ⋯ In paroxysmal AF, CFAE repetitiveness is low and randomness high outside the PVs, particularly the left superior PV. As evolution to persistent longstanding AF occurs, CFAE repetitiveness becomes more uniformly distributed at disparate sites, possibly signifying an increasing number of drivers from remote PVs.