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- Brugada, Josep, et al.
(författare)
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Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population : EHRA and AEPC-Arrhythmia Working Group joint consensus statement
- 2013
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Ingår i: Europace. - : Oxford University Press (OUP). - 1099-5129 .- 1532-2092. ; 15:9, s. 1337-1382
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Tidskriftsartikel (refereegranskat)abstract
- In children with structurally normal hearts, the mechanisms of arrhythmias are usually the same as in the adult patient. Some arrhythmias are particularly associated with young age and very rarely seen in adult patients. Arrhythmias in structural heart disease may be associated either with the underlying abnormality or result from surgical intervention. Chronic haemodynamic stress of congenital heart disease (CHD) might create an electrophysiological and anatomic substrate highly favourable for re-entrant arrhythmias.As a general rule, prescription of antiarrhythmic drugs requires a clear diagnosis with electrocardiographic documentation of a given arrhythmia. Risk-benefit analysis of drug therapy should be considered when facing an arrhythmia in a child. Prophylactic antiarrhythmic drug therapy is given only to protect the child from recurrent supraventricular tachycardia during this time span until the disease will eventually cease spontaneously. In the last decades, radiofrequency catheter ablation is progressively used as curative therapy for tachyarrhythmias in children and patients with or without CHD. Even in young children, procedures can be performed with high success rates and low complication rates as shown by several retrospective and prospective paediatric multi-centre studies. Three-dimensional mapping and non-fluoroscopic navigation techniques and enhanced catheter technology have further improved safety and efficacy even in CHD patients with complex arrhythmias.During last decades, cardiac devices (pacemakers and implantable cardiac defibrillator) have developed rapidly. The pacing generator size has diminished and the pacing leads have become progressively thinner. These developments have made application of cardiac pacing in children easier although no dedicated paediatric pacing systems exist.
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- Platonov, Pyotr, et al.
(författare)
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Left Atrial Posterior Wall Thickness in Patients with and without Atrial Fibrillation: Data from 298 Consecutive Autopsies.
- 2008
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Ingår i: Journal of Cardiovascular Electrophysiology. - : Wiley. - 1540-8167 .- 1045-3873. ; 19:7, s. 689-692
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Radiofrequency ablation of atrial fibrillation (AF) is associated with energy delivery on the posterior left atrial (LA) wall with small but significant risk of life-threatening complications. Anatomy of LA walls has been described, but wall thickness in patients with AF has not been studied systematically. The aim of the present study was to describe LA posterior wall thickness in patients with and without history of AF. Methods and Results: Heart mass and LA wall thickness was measured during 298 consecutive autopsies (142 male, age 61 +/- 17 years). LA posterior wall was measured at three levels: between the superior pulmonary veins (SPV), in the center of the posterior LA wall (CPV), and between the inferior pulmonary veins (IPV). Information about AF history was obtained from medical records. Fifty-nine subjects (20%) had documented AF. They were older than subjects without AF (74 +/- 10 years vs 58 +/- 17 years, P < 0.0001) and had greater heart mass (522 +/- 114 g vs 389 +/- 99 g, P < 0.0001). LA posterior wall thickness increased from the most superior to the most inferior measured level (2.3 +/- 0.9 mm vs 2.5 +/- 1.0 mm vs 2.9 +/- 1.3 mm for SPV, CPV, and IPV, respectively; P < 0.001). Subjects with AF history had thinner LA posterior wall at CPV and IPV compared with those without AF. Conclusions: LA posterior wall thickness is described on a large series of consecutive autopsies. LA posterior wall is found to be generally thinner in patients with history of AF. Study results have clinical implications for understanding complication risk and improvement of safety of AF ablation procedures.
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- Platonov, Pyotr, et al.
(författare)
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Structural abnormalities in atrial walls are associated with presence and persistency of atrial fibrillation but not with age.
- 2011
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097. ; 58:21, s. 2225-2232
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The purpose of this study was to assess the association between structural changes in human atria, age, and history of atrial fibrillation (AF). BACKGROUND: Development of fibrosis in atrial walls is associated with deterioration of atrial conduction and predisposes to AF in experiment. Human data, however, are scarce, and whether fibrosis is a cause or consequence of AF is not known. METHODS: Medical records for consecutive autopsies were checked for AF history and duration. Atrial specimens from 30 patients (ages 64 ± 12 years) were collected in 3 equal age-matched groups as patients without AF history, with paroxysmal AF, or with permanent AF. Tissue samples were obtained at the level of superior pulmonary veins, inferior pulmonary veins, center of posterior left atrial wall, terminal crest, and Bachmann's bundle. Histology sections were assessed for extent of fibrosis, fatty tissues, and inflammatory infiltration at each location. RESULTS: No correlation was observed between age and fibrosis at any location. Fibrosis extent and fatty infiltration were twofold to threefold higher at all locations in patients with history of AF and correlated with lymphomononuclear infiltration. Patients with permanent AF had greater fibrosis extent than did patients with paroxysmal AF. CONCLUSIONS: In post-mortem material, structural changes in the atria were not associated with age, but were significantly correlated with presence of AF and its severity. Our findings suggest that age-related changes per se are unlikely to be the sole cause of advanced fibrosis underlying AF.
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- Platonov, Pyotr, et al.
(författare)
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Substrates for intra-atrial and interatrial conduction in the atrial septum: anatomical study on 84 human hearts.
- 2008
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Ingår i: Heart Rhythm. - : Elsevier BV. - 1547-5271. ; 5:8, s. 1189-1195
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Technical developments in the management of atrial arrhythmias revived interest into the detailed knowledge of atrial anatomy. The atrial septum (AS), known for its complex structure, has been particularly difficult to study, and our knowledge of the muscular bundles providing routes for intra-atrial and interatrial conduction within the AS remains limited. OBJECTIVE: The purpose of this study was to describe myocardial arrangement within the AS and adjacent parts of atrial walls for delineation of possible substrates for interatrial and intra-atrial conduction. METHODS: Human heart specimens from 84 postmortem studies were studied using conventional morphometric assessment, blunt dissection, and light microscopy of serial histological sections of AS. RESULTS: Interatrial muscular connections are present anteriorly, posteriorly between right pulmonary veins, and inferiorly between the coronary sinus and the right inferior pulmonary vein. The inferior connections can be more prominent than the Bachmann bundle. Atrial musculature in the fossa ovalis consists of muscular bands isolated by fatty tissue from the endocardium of the right and left atrium. They are arranged along the anterior-posterior axis and have connections with left atrial myocardium. Myocardial fascicles in the posterior-inferior and superior portions of the muscular rim of fossa ovalis originate on the right atrial side and can be traced toward the atrioventricular node. CONCLUSION: The general myocardial arrangement in the AS and adjacent regions of atrial walls are important for understanding propagation of atrial activation for selection of the optimal treatment strategy.
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