1/104. Left ventricular ischemia due to coronary stenosis as an unexpected treatable cause of paroxysmal atrial fibrillation.We present a patient with exercise-induced paroxysmal atrial fibrillation who was eventually scheduled for a Cox-maze operation due to persistence of his complaints of fatigue, impaired exercise tolerance, and predominantly exercise-related irregular palpitations despite treatment with several antiarrhythmic drugs. A preoperative exercise stress test without antiarrhythmic or negative chronotropic drugs, however, showed clear evidence of myocardial ischemia. After coronary angioplasty of a significant stenosis in the left anterior descending artery, there was no recurrence of atrial fibrillation during a follow-up of 7 months.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
2/104. Reproducibility of spontaneous initiations of atrial fibrillation.INTRODUCTION: It has been suggested that some atrial regions may play a role in the maintenance of atrial fibrillation (AF), whereas little is known about the presence of critical areas for the initiation of AF. It is conceivable that the identification of such critical areas may lead to more localized and selective strategies of ablative therapy. methods AND RESULTS: A patient suffering from paroxysmal AF was extensively mapped in both the atria with a multielectrode basket catheter in right atrium and two decapolar catheters placed in the coronary sinus and along the left septum. During the mapping, seven identical patterns of initiation of AF were recorded. AF was initiated by an atrial premature beat (APB) arising from the superior right septum, followed by a reentrant beat originating from the same area that slowly propagated through the atria and resulted in late activation of the right lateral wall. During sinus rhythm, the majority of the electrograms were single potentials, whereas during the APB, and particularly during the first atrial reentrant beat, a high percentage of fragmented complexes was present, mainly located in the right superior septum. These fragmented complexes were present in the same sites in each initiating episode and remarkably, they showed an almost identical morphology. CONCLUSION: This case suggests that in some patients the initiation of AF could be caused by reentrant circuits localized in specific atrial regions and the reentrant circuits could be identical in the different episodes of AF. This highlights the importance of increasing our understanding of the mechanisms of the initiation of AF so that we can identify any critical area involved in the genesis of AF where selective RF lesions may be effective in curing this arrhythmia.- - - - - - - - - - ranking = 0.2keywords = coronary (Clic here for more details about this article) |
3/104. Practice variability in management of transient ischemic attacks.To define practice patterns in the management of transient ischemic attacks (TIAs), we surveyed practicing neurologists attending an educational conference in san francisco, evaluating management decisions in 2 TIA case vignettes. In a vignette describing a hemispheric TIA 1 day prior with ipsilateral bruit, 53% chose admission, 47% elected an outpatient work-up, 28% treated with intravenous heparin and 70% chose aspirin, reflecting the disagreement about medical management of carotid stenosis in the literature. There was more agreement in the second case, a posterior circulation TIA 1 day prior with atrial fibrillation, in which 84% chose hospital admission, 74% chose intravenous heparin and 90% treated with some form of anticoagulation. There are areas of important practice variability in the management of TIAs. Further research is justified to guide patient care decisions in TIA patients.- - - - - - - - - - ranking = 0.0013378542872168keywords = circulation (Clic here for more details about this article) |
4/104. Cardiogenic shock due to coronary narrowings one day after a MAZE III procedure.A MAZE III procedure was performed on a patient with a small body surface area. On the first postoperative day, the patient developed severe dysfunction of the left ventricle, due to significant narrowings of the right and circumflex coronary arteries in the areas that were cryoablated during the MAZE III procedure. The coronary narrowings were treated by percutaneous transluminal coronary angioplasty (PTCA). At discharge the coronary anatomy was normal again with an almost normal left ventricular function.- - - - - - - - - - ranking = 1.6keywords = coronary (Clic here for more details about this article) |
5/104. procainamide-induced postoperative pyrexia.procainamide is an effective antiarrhythmic that is often used to convert atrial fibrillation to normal sinus rhythm. A side effect of procainamide, rarely reported in the surgical literature, is pyrexia. The pyrexia is a manifestation of an allergic response to this medication. If unrecognized, procainamide-induced pyrexia can lead to unnecessary testing, hospitalization, and treatment. We present a case of a post-coronary artery bypass surgery patient who repeatedly displayed pyrexia when reexposed to procainamide indicating an allergic response to this drug.- - - - - - - - - - ranking = 0.2keywords = coronary (Clic here for more details about this article) |
6/104. atrial fibrillation following cardiac surgery.Atrial arrhythmias are the most common complication of cardiac surgeries, occurring in 30% of patients undergoing coronary revascularization and 60% of patients having valvular surgeries. The most frequently occurring atrial arrhythmia, atrial fibrillation (AF), not only causes uncomfortable palpitations, but has also been shown to increase postoperative hospital length of stay and morbidity, including hemodynamic compromise and stroke. Both the frequency and the potential consequences of AF make prevention and early intervention important aspects in the postoperative care of cardiac surgery patients.- - - - - - - - - - ranking = 0.2keywords = coronary (Clic here for more details about this article) |
7/104. Surgical repair of right-atrial aneurysm.atrial fibrillation and embolic events are the most common clinical symptoms of congenital right- or left-atrial aneurysms. We report an a case of righ-atrial aneurysm, in a patient with typical history of atrial fibrillation and history of stroke. The aneurysm was resected, but the patient suffered from acute embolic occlusion of the left anterior descending coronary artery on the fourth postoperative day despite of systemic heparinization with 300 IU/kg bw per 24 hours.- - - - - - - - - - ranking = 0.2keywords = coronary (Clic here for more details about this article) |
8/104. dissection of the coronary sinus secondary to pacemaker lead manipulation.We report a 64-year-old man with atrial fibrillation and impaired left ventricular function in whom pacemaker lead manipulation during biatrial pacemaker lead removal and biventricular pacemaker lead insertion caused coronary sinus dissection. After further manipulation of the biventricular pacing lead, the true lumen of the coronary sinus could be entered and satisfactory left ventricular pacing undertaken. The dissection was managed conservatively without long-term sequelae.- - - - - - - - - - ranking = 1.2keywords = coronary (Clic here for more details about this article) |
9/104. Gemcitabine-induced atrial fibrillation: a hitherto unreported manifestation of drug toxicity.BACKGROUND: Gemcitabine is an antimetabolic drug for solid tumors. Although its pharmacokinetics as well as its side-effects are well known, paroxysmal atrial fibrillation associated to the administration of this drug has not yet been described. patients AND methods: We describe the case of a 78-year-old man with pancreatic adenocarcinoma who presented repeated paroxysmal atrial fibrillation episodes 18-24 hours after every gemcitabine infusion which resolved with antiarrhythmic drugs. This clinical history was positive for a remote brief episode of atrial fibrillation, which resolved spontaneously, and the patient had no predisposing factors for supraventricular arrhythmias (systemic hypertension, diabetes or coronary artery disease). RESULTS: Cardiac work-up revealed only a mild mitral-valve prolapse and complete right bundle branch block. During the arrhythmia episodes no other precipitating factors were reported. The close temporal relationship of the arrhythmia to drug administration and the recurrence of arrhythmia upon rechallenge allowed to hypothesize an intrinsic pro-arrhythmic effect of gemcitabine or its metabolite 2',2'-difluorodeoxyuridine. CONCLUSIONS: The occurrence of atrial fibrillation during the administration of gemcitabine may be considered as a cardiac arrhythmia drug-related toxicity. This side-effect of gemcitabine infusion is a previously unreported sign of drug toxicity; therefore, a high level of awareness to this problem is warranted when this drug is administered.- - - - - - - - - - ranking = 0.2keywords = coronary (Clic here for more details about this article) |
10/104. Congenital malformations of the right atrium and the coronary sinus: an analysis based on 103 cases reported in the literature and two additional cases.STUDY OBJECTIVES: Congenital malformations of the right atrium (RA) and the coronary sinus (CS) are rare, and only sporadic cases have been reported. Little is known about the clinical relevance of this disorder. We report on two patients, one with a giant RA diverticulum, the other with a diverticulum of the CS, and review 103 cases of such malformations that have been reported previously. DESIGN: A medline search was performed to collect all cases of congenital malformations of the RA and the CS reported in the literature between 1955 and 1998. Cases were classified into the following categories: (1) congenital enlargement of the RA; (2) single diverticulum of the RA; (3) multiple diverticula of the RA; and (4) diverticulum of the CS. Clinical presentation and outcome of the different types of malformations were analyzed. RESULTS: The patients most frequently presenting with symptoms were those with diverticula of the CS (n = 28) followed by those with single diverticula of the RA (n = 13), multiple diverticula (n = 4), and congenital enlargements of the RA (n = 60). The percentages of symptomatic patients were 93, 84, 75, and 53%, respectively. Symptoms were frequently caused by arrhythmias. Supraventricular tachycardia (SVT) was found in 42 of the patients (40%) and was most common in patients with diverticula of the CS (24 of 28 patients) and multiple atrial diverticula (3 of 4 patients). Sudden cardiac death was reported more frequently in patients with diverticula of the CS (18%) compared to those with congenital enlargement of the RA (5%) or single or multiple diverticula of the RA (6%). All seven patients with diverticula of the CS who were not treated with catheter or surgical ablation eventually died. CONCLUSION: Congenital malformations of the RA and the CS frequently are associated with arrhythmias. SVT and sudden cardiac death have been reported in a significant percentage of patients with diverticula of the CS.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
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