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| 2. |
- Roijer, Anders, et al.
(författare)
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Cardiac changes in stroke patients and controls evaluated with transoesophageal echocardiography
- 1997
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1651-2006 .- 1401-7431. ; 31:6, s. 329-337
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Tidskriftsartikel (refereegranskat)abstract
- In stroke patients several cardiac changes associated with embolism can be detected with transoesophageal echocardiography. Potential major cardiac embolic sources (e.g. atrial fibrillation, thrombi of left ventricle/atrium, vegetation, myxoma, dilated cardiomyopathy) have a causal relationship to embolism. Other changes with no certain causal relationship are regarded as potential minor cardiac embolic sources (e.g. atrial septal aneurysm, patent foramen ovale, mitral annular calcification, mitral valve prolapse, protruding atheroma of the aorta). We compared the prevalences of major and minor potential cardiac embolic sources in a stroke population with that in controls. One hundred and twenty-one patients with first-ever stroke were compared with 68 randomly selected controls. All subjects underwent magnetic resonance imaging of the brain, carotid ultrasound and transthoracic/transoesophageal echocardiography. The patients were slightly older (mean age 70.7 +/- 10.3 years) than the controls (65.5 +/- 15.5 years) (p < 0.05). Potential major cardiac embolic sources were found in 27% of the patients and in 4% of the controls (p < 0.001). The most common major potential embolic source was atrial fibrillation, detected in 22/121 patients. Fifteen of these also had spontaneous echocontrast in the left atrium. Eleven left atrial thrombi were found (four of these patients had atrial fibrillation and seven had sinus rhythm). A history of heart disease was more common in patients with a potential major cardiac embolic source or a carotid artery stenosis (77%) than in those patients without (44%) (p < 0.01). After excluding subjects with a major potential cardiac embolic source and/or carotid artery stenosis, no differences in the prevalence of minor potential cardiac embolic sources were found between patients (55%) and control subjects (47%) (p = NS). Even when subjects without a major potential cardiac embolic source or a carotid artery stenosis were categorized into three age groups (35-54, 55-74 and > 74 years) the prevalence of potential minor cardiac embolic sources did not differ between patients and controls. To conclude, major potential cardiac embolic sources are more common in an older population with first-ever stroke than in a comparable control group. However, potential minor cardiac embolic sources did not differ in prevalence in the patients compared with controls. Certain changes (e.g. atrial septal aneurysm) might have a potential embolic role in younger stroke patients but in our study no difference was found between older stroke patients and controls.
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| 3. |
- Larsson, Jörgen, et al.
(författare)
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Ultrasound enhanced thrombolysis in experimental retinal vein occlusion in the rabbit
- 1998
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Ingår i: British Journal of Ophthalmology. - 1468-2079. ; 82:12, s. 1438-1440
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To investigate if it was possible to lower the dose of streptokinase and maintain an effective thrombolysis by adding pulsed low energy ultrasound. METHODS: 53 retinal veins in 27 rabbits were occluded by rose bengal enhanced laser treatment. Six rabbits were treated with streptokinase (50,000 IU/kg), 10 rabbits were treated with a low dose of streptokinase (25,000 IU/kg), and 11 rabbits were treated with a low dose of streptokinase (25,000 IU/kg) and pulsed ultrasound during 1 hour. Fluorescein angiography was performed immediately before the thrombolytic treatment and after 12 hours. RESULTS: In the group treated with streptokinase (50,000 IU/kg) all vessels were open. In the group that was given streptokinase (25,000 IU/kg), 21% of the vessels were open. In the group that was treated with streptokinase (25,000 IU/kg) and ultrasound, 64% of the vessels were open. The difference between groups 2 and 3 is statistically significant (p = 0.011) CONCLUSION: Adding pulsed low energy ultrasound makes it possible to lower the dose of streptokinase while maintaining a good thrombolytic effect.
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| 4. |
- Hansson, Anders P, et al.
(författare)
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Right atrial free wall conduction velocity and degree of anisotropy in patients with stable sinus rhythm studied during open heart surgery
- 1998
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 19:2, s. 293-300
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Although the perpetuation of several supraventricular arrhythmias is critically dependent upon intra-atrial conduction, the literature lacks detailed information on normal values of conduction velocity and degree of anisotropy. In order to explore these factors further, we have measured conduction velocities at the right atrial free wall during sinus rhythm and during atrial pacing in four directions parallel and perpendicular to the atrioventricular groove in patients with normal atria and stable sinus rhythm. METHODS AND RESULTS: Using a Bard Cardiac Mapping System, atrial ECGs were recorded using a 3 x 4 cm electrode array with 56 equally spaced bipolar electrodes in 12 patients undergoing open heart surgery due to ischaemic heart disease or Wolf-Parkinson-White syndrome. A bipolar pen probe connected to a Medtronic 5328 stimulator was used for pacing at a 10% higher rate than sinus rhythm. The local activation times were manually set and isochronal activation maps were created for each recording. The conduction velocities were calculated from the activation maps over a distance ranging from 2.2 to 4.2 cm. The majority of the activation maps showed no signs of anisotropy; the others had less than 15% spatial inhomogeneity of conduction. Mean conduction velocity, calculated from five consecutive beats, was 88 +/- 9 cm.s-1 (mean +/- SD), ranging between 68 +/- 4 and 103 +/- 3 cm.s-1 during sinus rhythm. Mean conduction velocity during atrial pacing was 81 +/- 16 cm.s-1 at a propagation direction of 0 degree, 74 +/- 14 cm.s-1 at a 90 degrees direction, 79 +/- 12 cm.s-1 at 180 degrees and 78 +/- 20 cm.s-1 at 270 degrees, where 0 degree was parallel to the atrioventricular groove in the cranial direction and the angle increased counter-clockwise. Mean conduction velocity during sinus rhythm was significantly higher (P < 0.05) than during atrial pacing at the 90 degrees and 180 degrees directions but not compared to atrial pacing at 0 degree or 270 degrees. There was no significant difference in mean conduction velocity in different directions during atrial pacing. CONCLUSION: Although anisotropy was documented during conduction velocity in individual cases, conduction velocity was not dependent on propagation direction at the epicardial right atrial free wall in patients with stable sinus rhythm. These findings do not exclude the presence of internodal preferential pathways as these are located sub-epicardially and a marked transmural discordance in activation has previously been documented in the vicinity of such pathways.
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| 5. |
- Holm, Magnus, et al.
(författare)
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Determination of Preferable Wavelet Propagation Directions in Atrial Fibrillation
- 1993
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Konferensbidrag (refereegranskat)abstract
- M. Holm, P. Blomström, J. Brandt, R. Johansson, C. Lührs, and S. B. Olsson. Determination of preferable wavelet propagation directions in atrial fibrillation. In Erik K. Fernström Symp. Atrial Fibrillation, Lund, Sweden, June 1993.
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| 6. |
- Holm, Magnus, et al.
(författare)
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Epicardial right atrial free wall mapping in chronic atrial fibrillation. Documentation of repetitive activation with a focal spread--a hitherto unrecognised phenomenon in man
- 1997
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 18:2, s. 290-310
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous studies have shown that atrial fibrillation of recent onset in man is based on a varying number of simultaneously present activation waves reentering either themselves or each other. In the present study, right atrial activation during chronic atrial fibrillation in man was studied. METHODS AND RESULTS: In 16 patients with chronic atrial fibrillation multiple epicardial recordings of 8 s each were made at the right atrial posterior free wall and at the appendage using a 20 x 35 mm electrode array with 56 bipolar measurement points. The preferable activation pattern of each recording and the propagation direction, cycle length and conduction velocity of individual activation waves within each recording were determined. Activation was characterized by unorganised activation with several simultaneously present activation waves: inconsistent preferable activation pattern (n = 5), predominantly organised activation with either frequent episodes of uniform activation: consistent preferable activation pattern (n = 7) or frequent episodes of activation with focal spread; focal preferable activation pattern (n = 4). Random re-entry was frequently documented in recordings with the inconsistent preferable activation pattern and less frequently in recordings with the consistent and focal preferable activation pattern. Complete re-entry circuits were rarely documented. The median fibrillation cycle length was 146, 159 (P < 0.05) and 165 ms (not significant) and the mean conduction velocity during uniform activation was 64, 67 and 83 cm. s-1 (not significant) in recordings with the inconsistent, consistent and focal preferable activation pattern, respectively. CONCLUSIONS: During chronic atrial fibrillation in man, right atrial free wall activation ranges from disorganised activation with multiple co-existing activation waves to predominantly organised activation characterized by either uniform activation consistent with the presence of large re-entry circuits or repetitive activation of unknown mechanism and focal spread.
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| 7. |
- Holm, Magnus, et al.
(författare)
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Non-Invasive Assessment of the Atrial Cycle Length during Atrial Fibrillation in Man: Introducing, Validating and Illustrating a New ECG Method
- 1998
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Ingår i: Cardiovascular Research. - 1755-3245. ; 38:1, s. 69-81
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Atrial fibrillation (AF) in man has previously been shown to include a wide variety of atrial activity. Assessment of the characteristics of this arrhythmia with a commonly applicable tool may therefore be important in the choice and evaluation of different therapeutic strategies. As the AF cycle length has been shown to correlate locally with atrial refractoriness and globally with the degree of atrial organization, with, in general, shorter cycle length during apparently random AF compared to more organized AF, we have developed a new method for non-invasive assessment of the AF cycle length using the surface and the esophagus (ESO) ECG. METHODS AND RESULTS: From the frequency spectrum of the residual ECG, created by suppression of the QRST complexes, the dominant atrial cycle length (DACL) was derived. By comparison with multiple intracardiac simultaneously acquired right and left AF cycle lengths in patients with paroxysmal AF, we found that the DACL in lead V1, ranging from 130 to 185 ms, well represented a spatial average of the right AF cycle lengths, whereas the DACL in the ESO ECG, ranging from 140 to 185 ms, reflected both the right and the left AF cycle length, where the influence from each structure depended on the atrial anatomy of the individual, as determined by MRI. In patients with chronic AF, the method was capable of following changes in the AF cycle length due to administration of D,L-sotalol and 5 min of ECG recording was sufficient for the DACL to be reproducible. CONCLUSIONS: We conclude that this new non-invasive method, named 'Frequency Analysis of Fibrillatory ECG' (FAF-ECG), is capable of assessing both the magnitude and the dynamics of the atrial fibrillation cycle length in man.
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| 8. |
- Holm, Magnus, et al.
(författare)
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Non-Invasive Assessment of the Atrial Cycle Length during Chronic Atrial Fibrillation in Man
- 1996
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Ingår i: 69th Scientific Sessions of the American Heart Association, New Orleans, November 10-13, 1996; Circulation, Vol. 94, No. 8 Suppl., pp. I69, 1996.. ; 94, s. 169-169
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Konferensbidrag (refereegranskat)
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| 9. |
- Ingemansson, Max, et al.
(författare)
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Autonomic modulation of the atrial cycle length by the head up tilt test: non-invasive evaluation in patients with chronic atrial fibrillation
- 1998
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Ingår i: Heart. - 1355-6037. ; 80:1, s. 71-76
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine the effects of upright posture compared with supine position on the dominant atrial cycle length (DACL) in patients with chronic atrial fibrillation. DESIGN: The power/frequency spectrum of QRST suppressed lead V1 ECG was studied in 14 patients in the supine position and during the head up tilt table test. The DACL changes were compared with changes in heart rate and blood pressure. RESULTS: Compared with the supine position, the upright position reduced the DACL from 160 to 150 ms (p < 0.01). The DACL was increased after returning to the supine position from the upright position, from 147 to 154 ms (p < 0.01). Heart rate increased from 91 beats/min in the supine position to 106 in the upright position (p < 0.01). There was a decrease in heart rate from 109 beats/min in the upright position to 93 after returning to the supine position (p < 0.01). No significant changes were seen in systolic or diastolic blood pressure. There were indications of an inverse relation between DACL and heart rate when comparing the supine position before and after tilt with the upright position (p < 0.001). CONCLUSIONS: The sympathetic stimulation and vagal withdrawal induced by rising to upright body position are associated with a decrease in DACL during chronic atrial fibrillation. Thus a reflex increase in sympathetic discharge after induction of atrial fibrillation could favour the persistence of the arrhythmia.
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| 10. |
- Ingemansson, Max, et al.
(författare)
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Effects of magnesium and glucose, insulin, potassium (GIK) solution on the action potential parameters of guinea-pig atrial muscle
- 1998
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Ingår i: Acta Physiologica Scandinavica. - 0001-6772. ; 164:2, s. 173-179
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Tidskriftsartikel (refereegranskat)abstract
- The present paper aims to explore the effects of [Mg2+]o and glucose, insulin and K+ (GIK) on action potential parameters in guinea-pig atrial muscle. Specimens of atrial appendages were taken from guinea-pig hearts. Action potentials were recorded in isolated atrial trabeculae. Resting potential (RP) and action potential duration at 90% repolarization (APD90) were measured with conventional microelectrode techniques. [Mg2+]o at 6 and 12 mmol L-1 depolarized the RP and prolonged the APD90, whereas 4 mmol L-1 had no effect at all. Glucose alone or in combination with insulin had no effect on action potential parameters. GIK solution with supernormal [K+]o at 6 mmol L-1 depolarized the RP and decreased the APD90. Intervention with [Mg2+]o at 4 mmol L-1 in combination with GIK solution with supernormal [K+]o of 6 mmol L-1, reversibly depolarized the RP, whereas the APD90 was not significantly changed. [Mg2+]o at 12 mmol L-1 in combination with GIK solution with a physiological [K+]o of 4 mmol L-1 prolonged the APD90 whereas the RP was unaffected. [Mg2+]o at 6 and 12 mmol L-1 slightly depolarized the RP and prolonged the APD90. The action potential of normally polarized atrial muscle was not sensitive to supernormal levels of glucose alone or in combination with insulin. The effects of [Mg2+]o in combination with the GIK solutions on action potential parameters seemed to be attributable to the supernormal [Mg2+]o and [K+]o alone, while these seemed to have opposite effects on APD90.
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