| 1. |
- Ahlsson, Anders, 1962-, et al.
(författare)
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A Swedish consensus on the surgical treatment of concomitant atrial fibrillation
- 2012
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Ingår i: Scandinavian Cardiovascular Journal. - London, United Kingdom : Informa Healthcare. - 1401-7431 .- 1651-2006. ; 46:4, s. 212-218
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Forskningsöversikt (refereegranskat)abstract
- Atrial fibrillation (AF) is a common arrhythmia among patients scheduled for open heart surgery and is associated with increased morbidity and mortality. According to international guidelines, symptomatic and selected asymptomatic patients should be offered concomitant surgical AF ablation in conjunction with valvular or coronary surgery. The gold standard in AF surgery is the Cox Maze III ("cut-and-sew") procedure, with surgical incisions in both atria according to a specified pattern, in order to prevent AF reentry circuits from developing. Over 90% of patients treated with the Cox Maze III procedure are free of AF after 1 year. Recent developments in ablation technology have introduced several energy sources capable of creating nonconducting atrial wall lesions. In addition, simplified lesion patterns have been suggested, but results with these techniques have been unsatisfactory. There is a clear need for standardization in AF surgery. The Swedish Arrhythmia Surgery Group, represented by surgeons from all Swedish units for cardiothoracic surgery, has therefore reached a consensus on surgical treatment of concomitant AF. This consensus emphasizes adherence to the lesion pattern in the Cox Maze III procedure and the use of biatrial lesions in nonparoxysmal AF.
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| 2. |
- Albåge, Anders, et al.
(författare)
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Long-Term Follow-Up of Cardiac Rhythm in 320 Patients After the Cox-Maze III Procedure for Atrial Fibrillation
- 2016
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Ingår i: Annals of Thoracic Surgery. - : Elsevier BV. - 0003-4975 .- 1552-6259. ; 101:4, s. 1443-1449
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Tidskriftsartikel (refereegranskat)abstract
- Background. The Cox-maze III (CM-III) procedure is the gold standard for surgical treatment of atrial fibrillation (AF). Excellent short-term results have been reported, but long-term outcomes are lesser known. The aim was to evaluate current cardiac rhythm in a nationwide cohort of CM-III patients with very long follow-up.Methods. Perioperative characteristics were retrospectively analyzed in 536 "cut-and-sew" CM-III patients operated on from 1994 to 2009 in 4 centers. Of these, 54 patients had died and 20 were unavailable at follow-up. The remaining 462 patients received a survey concerning arrhythmia symptoms, rhythm, and medication; of these, 320 patients (69%), comprising 252 men, with a mean age of 67 years (range, 47 to 87 years), and 83% with stand-alone CM-III, returned a current 12-lead electrocardiogram. Long-term monitoring was evaluated in 40 sinus rhythm patients. Postoperative stroke/transient ischemic attack was evaluated by register analysis.Results. Mean follow-up was 111 44 months (range, 36-223 months). Electrocardiogram analysis showed sinus rhythm in 219 of 320 patients (68%), and regular supraventricular rhythm (sinus, nodal, or atrial pacing) in 262 (82%), with 75% off class I/III antiarrhythmic medication. This group had lower arrhythmia symptom scores and medication use. Rhythm outcome did not differ by gender, age, type of AF, or stand-alone vs concomitant operation. Patients with more than 10 years of follow-up had a lower rate of regular supraventricular rhythm (69% vs 91%, p = 0.02). Long-term monitoring showed freedom from AF/atrial flutter in 38 of 40 patients (95%). The incidence of stroke/transient ischemic attack was 0.37% per year (11 patients).Conclusions. In a single-moment electrocardiogram evaluation 9 years after the cut-and-sew CM-III, 82% of patients were in sinus rhythm or other regular supraventricular rhythm. These findings support a long-lasting positive effect of the CM-III procedure, which is relevant when evaluating current nonpharmacologic therapies for AF. (C) 2016 by The Society of Thoracic Surgeons
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| 3. |
- Blomström-Lundqvist, Carina, et al.
(författare)
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A randomized double-blind study of epicardial left atrial cryoablation for permanent atrial fibrillation in patients undergoing mitral valve surgery: the SWEDish Multicentre Atrial Fibrillation study (SWEDMAF).
- 2007
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Ingår i: European heart journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 28:23, s. 2902-8
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The efficacy of epicardial left atrial (LA) cryoablation in eliminating atrial fibrillation (AF) in patients undergoing mitral valve surgery (MVS) is unknown. We hypothesized that MVS combined with LA cryoablation is superior to MVS alone. METHODS AND RESULTS: Sixty-nine patients with permanent AF, included at four centres, underwent MVS with or without epicardial LA cryoablation. The primary endpoint was regained sinus rhythm. Risk factors for failed AF cryoablation were elucidated. Sixty-five out of 69 patients reached the primary endpoint. At 6 and 12 months follow-up, 73.3% of patients who underwent cryoablation had regained sinus rhythm at both follow-ups, compared with 45.7 and 42.9% of patients, respectively, who underwent MVS alone (group differences, at 6 months P = 0.024, after 12 months P = 0.013). The in-hospital complication rate was 11.4% in the MVS group and 26.5% in the cryoablation group (P = 0.110). Risk factors for failed elimination of AF by cryoablation were duration of permanent AF (P = 0.012) and presence of coronary artery disease (P = 0.047), according to multiple logistic regression analysis. CONCLUSION: This first prospective randomized study showed that combining MVS with epicardial LA cryoablation is significantly better in eliminating pre-operative permanent AF than MVS alone.
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| 4. |
- Carlsson, Camilla, et al.
(författare)
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Initial experience with a thin single segment pressure and conductance catheter for measurement of left ventricular volume
- 2001
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Ingår i: Annual Reports of the Research Reactor Institute, Kyoto University. ; , s. 103-106
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Konferensbidrag (refereegranskat)abstract
- Aims: To evaluate a thin and soft multifunctionalcatheter for the simultaneous real time monitoring of leftventricular volume and pressure with special consideration toside elTects such as interference with normal cardiacelectrophysiology.Methods and results: In four pigs, pressure and volumewere simultaneously recorded by using the thin single segmentpressure and conductance catheter. Measurements were doneunder varied cardiac conditions: at baseline, during preloadreduction and afterload Increase. Volumes were calibrated withintracardiac ultrasound measurements. During preloadreduction the pressure and volume decreased as expected. Acautious afterload increase resulted in a corresponding pressureand volume increase, the maximum of the pressure curvechanged from early to late. Both SV and EDV increased. Thevery few arrhythmias were mainly caused by surgicalinterference.Conclusion: The present study demonstrates that our thinsingle segment conductance catheter for the simultaneousmeasurement of LV volume and pressure has a performancethat warrants further development with the goal to make themethod available for human use. In particular, the catheter didnot cause any arrhythmias.
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| 5. |
- Johansson, Birgitta, et al.
(författare)
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Atrial function after left atrial epicardial cryoablation for atrial fibrillation in patients undergoing mitral valve surgery
- 2012
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Ingår i: Journal of Interventional Cardiac Electrophysiology. - : Springer Science+Business Media B.V.. - 1383-875X .- 1572-8595. ; 33:1, s. 85-91
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To explore the effects on atrial and ventricular function of restoring sinus rhythm (SR) after epicardial cryoablation and closure of the left atrial appendage (LAA) in patients with mitral valve disease and atrial fibrillation (AF) undergoing surgery.METHODS: Sixty-five patients with permanent AF were randomized to mitral valve surgery combined with left atrial epicardial cryoablation and LAA closure (ABL group, n = 30) or to mitral valve surgery alone (control group, n = 35). Two-dimensional and Doppler echocardiography were performed before and 6 months after surgery.RESULTS: At 6 months, 73% of the patients in the ABL group and 46% of the controls were in SR. Patients in SR at 6 months had a reduction in their left ventricular diastolic diameter while the left ventricular ejection fraction was unchanged. In patients remaining in AF, the left ventricular ejection fraction was lower than at baseline. The left atrial diastolic volume was reduced after surgery, more in patients with SR than AF. In patients in SR, the peak velocity during the atrial contraction and the reservoir function were lower in the ABL group than in the control group.CONCLUSIONS: In patients in SR, signs of atrial dysfunction were observed in the ABL but not the control group. Atrial dysfunction may have existed before surgery, but the difference between the groups implies that the cryoablation procedure and/or closure of the LAA might have contributed.
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| 6. |
- Källner, Göran
(författare)
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Release and effects of calcitonin gene-related peptide in myocardial ischaemia
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A proportion of sensory C-fibres is characterized by sensitivity to the pungent agent in hot peppers, capsaicin. Upon stimulation by capsaicin, co-stored peptides including calcitonin gene-related peptide (CGRP), are released from the peripheral terminals of these fibres. In addition to capsaicin, other noxious/painful stimuli and conditions such as low pH, ischaemia, nicotine and bradykinin can cause release of CGRP from capsaicin-sensitive afferent nerves. CGRP-immunoreactive nerve fibres occur throughout the cardiovascular system, including the heart where the highest amounts of CGRP have been detected along coronary arteries and in the atria. In various species and experimental models, CGRP has proven to be the most potent vasodilator yet discovered. The main objective of the present study was to investigate the release, and possible effects of CGRP in association with myocardial ischaemia. Since ischaemia-induced metabolic disturbances correlate well with ischaemia-induced myocardial acidosis, we have studied release of CGRP evoked by perfusion with low pH buffers in the isolated guinea-pig heart. This model was also used to study the possible involvement of prostacyclin (PGI2) and various ion channels in CGRP-release. Perfusion with buffer at pH 7, 6 and 5, and perfusion with lactic acid evoked a reproducible and concentration-dependent release of CGRP from the isolated heart. In addition, low pH caused formation of PGI2, which also evoked release of CGRP from the heart. Both the formation of PGI2 and the release of CGRP evoked by low pH were attenuated by cyclo-oxygenase inhibition. The outflow of CGRP caused by low pH, but not that caused by capsaicin or erogenous PGI2, was dependent on an intact endothelium. The axonal Na+ conduction blocker tetrodotoxin attenuated the release of CGRP evoked by low concentrations of capsaicin, indicating involvement of an axon reflex mechanism in the local release of CGRP. We detected common features in the outflow of CGRP evoked by capsaicin and low pH, including sensitivity to the capsaicin antagonist capsazepine, and to the blocker of N-type Ca2+-channels, [omega]-conotoxin. Cardiovascular effects of CGRP, of the CGRP antagonist CGRP(8-37) and of capsaicin pretreatment (which causes desensitization of C-fibres) in association with myocardial ischaemia and -infarction were studied in the pig in vivo. Exogenous CGRP caused a marked reduction of systemic vascular resistance. This effect was attenuated by CGRP(8-37). Local administration of CGRP augmented the myocardial hyperaemia observed after 45 minutes of occlusion of the left anterior descending coronary artery. CGRP(8-37) had no effect on post-occlusive hyperaemia. Forty-eight hours after systemic capsaicin pretreatment, myocardial levels of CGRP were decreased, and infarcted myocardium contained less CGRP than non-infarcted myocardium. Exogenous CGRP, or CGRP(8-37) had no effect on the extent of myocardial infarction. Capsaicin pretreated animals had larger myocardial infarctions than controls, indicating a protective effect of intact C-fibre activation and endogenous peptide release. In patients undergoing coronary bypass surgery without the use of cardiopulmonary bypass, 10-20 minutes of local ischaemia (as evidenced by a net production of lactate) was associated with increased levels of CGRP in coronary sinus blood. In summary, the present findings suggest that cardiac C-fibre activation and local release of CGRP observed in animal studies may function as an endogenous physiological protective response to myocardial ischaemia also in man.
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| 7. |
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| 8. |
- Söderqvist, Emil, et al.
(författare)
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The assessment of acute load and contractility changes by left ventricular pressure measurements
- 2006
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Ingår i: Physiological Measurement. - : IOP Publishing. - 0967-3334 .- 1361-6579. ; 27:12, s. 1281-1292
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to establish whether analysis of the left ventricular pressure waveform provides indicative information about cardiac load and contractility and to develop an algorithm for computer-based assessment of changes in these variables. In eight healthy standard breed anaesthetized open-chest pigs, a high frequency response guide-wire mounted pressure sensor was introduced into the left ventricle. Preload reduction was induced by vena cava occlusion, afterload increase by an i.v. injection of phenylephrine and increased contractility by an i.v. injection of adrenalin. Left ventricular pressure waveform analysis was performed by plotting the slope of the pressure curve during the systolic ejection period versus maximal systolic pressure. The analysis revealed characteristic changes in left ventricular pressure and pressure waveform and identified easily discernible reaction patterns in the slope versus maximal pressure plot, specific for each provocation. Analysis of the left ventricular waveform provides indicative information about loading conditions and contractility. The proposed algorithm can easily be implemented in pressure monitoring systems allowing real-time assessment and discrimination of acute changes in preload, afterload and myocardial performance.
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