The electrophysiology of atrial fibrillation (AF) has always been a deep mystery in understanding this complex arrhythmia. The pathophysiological mechanisms of AF are complex and often remain unclear ...despite extensive research. Therefore, the implementation of basic science knowledge to clinical practice is challenging. After more than 20 years, pulmonary vein isolation (PVI) remains the cornerstone ablation strategy for maintaining the sinus rhythm (SR). However, there is no doubt that, in many cases, especially in persistent and long-standing persistent AF, PVI is not enough, and eventually, the restoration of SR occurs after additional intervention in the rest of the atrial myocardium. Substrate mapping is a modern challenge as it can reveal focal sources or rotational activities that may be responsible for maintaining AF. Whether these areas are actually the cause of the AF maintenance is unknown. If this really happens, then the targeted ablation may be the solution; otherwise, more rough techniques such as atrial compartmentalization may prove to be more effective. In this article, we attempt a broad review of the known pathophysiological mechanisms of AF, and we present the recent efforts of advanced technology initially to reveal the electrical impulse during AF and then to intervene effectively with ablation.
Purpose
Sleep is an essential physiologic process whose disturbances have been regarded as a risk factor in various pathophysiologic processes, including atherosclerosis and cardiovascular disease. ...Although the negative influence of short sleep duration has been well-established, recent data suggest a possible harmful effect of prolonged sleeping pattern.
Methods
In the setting of the Corinthia cross-sectional study, self-reported night sleep duration was recorded in 1752 apparently healthy individuals and was classified as normal sleep duration (NSD, 7–8 h), short sleep duration (SSD, 6–7 h), very short sleep duration (VSSD, < 6 h), and long sleep duration (LSD, > 8 h). Carotid duplex ultrasonography was performed in order to measure the mean and maximum carotid intima-media thickness (cIMT) as a non-invasive marker of atherosclerosis.
Results
Subjects with LSD and VSSD had significantly higher mean cIMT (VSSD: 1.02 ± 0.45 mm, SSD: 0.95 ± 0.35, NSD: 0.96 ± 0.38 mm, LSD: 1.07 ± 0.52 mm;
p
< 0.001) and maximum cIMT (VSSD: 1.39 ± 0.9 mm, SSD: 1.25 ± 0.71 mm, NSD: 1.23 ± 0.76 mm, LSD: 1.41 ± 0.93 mm). Following a regression analysis adjusting for known cardiovascular risk factors, individuals with LSD and VSSD had higher mean cIMT by 0.054 mm and 0.067 mm respectively compared to those with NSD.
Conclusion
A balanced sleeping duration of 6–8 h is associated with decreased mean and maximum IMT while both very short sleep duration and long sleep duration are associated with increased carotid intima-media thickness, a marker of subclinical atherosclerosis.
Non-coronary cusp (NCC) is a rare site for ventricular arrhythmias because it does not come into direct contact with the ventricular myocardium. Instead, the NCC comes in contact with the membranous ...septum near the His region. We describe a case of a young man with a ventricular ectopy who was successfully ablated in the NCC. In our case the much greater prematurity in the NCC than in the His region suggests that the arrhythmic site of origin is not in the peri-His area but most likely a myocardial extension adjoining the aortic root.
Introduction
After mitral isthmus (ΜΙ) catheter ablation, perimitral atrial flutter (PMF) circuits can be maintained due to the preservation of residual myocardial connections, even if conventional ...pacing criteria for complete MI block are apparently met (MI pseudo‐block). We aimed to study the incidence, the electrophysiological characteristics, and the long‐term outcome of these patients.
Methods
Seventy‐two consecutive patients (mean age 62.4 ± 10.2, 62.5% male) underwent MI ablation, either as part of an atrial fibrillation (AF) ablation strategy (n = 35), or to treat clinical reentrant atrial tachycardia (AT) (n = 32), or to treat AT that occurred during ablation for AF (n = 5). Ιn all patients, the electrophysiological characteristics of PMF circuits were studied by high‐density mapping.
Results
Mitral isthmus block was successfully achieved in 69/72 patients (95.6%). Five patients developed PMF after confirming MI block. In these patients, high‐density mapping during the PMF showed a breakthrough in MI with extremely low impulse conduction velocity (CV). In contrast, in usual PMF circuits that occurred after AF ablation, the lowest CV of the reentrant circuit was of significantly higher value (0.07 ± 0.02 m/s vs 0.25 ± 0.07 m/s, respectively; P < .001). Patients presented with clinical AT had better prognosis in maintaining sinus rhythm after MI ablation compared with patients presented with AF.
Conclusion
Perimitral atrial flutter with MI pseudo‐block may be present after MI ablation and has specific electrophysiological features characterized by remarkably slow CV in the MI. Thus, even after MI block is achieved, a more detailed mapping in the boundaries of the ablation line or reinduction attempts may be needed to exclude residual conduction.
This is a retrospective clinical study comprising 72 patients who underwent mitral isthmus (MI) ablation either as part of an atrial fibrillation ablation strategy, or to treat reentrant AT. The MI block was acutely achieved in 69/72 patients. However, five patients, despite showing MI block based on conventional pacing maneuvers, developed perimitral atrial flutter through a gap in previous ablation lesions with extremely low impulse conduction velocity as shown by high density mapping.
Purpose/Background/Objectives
Aortic stiffness and hemodynamics are independent predictors of adverse cardiovascular events. Transcatheter aortic valve implantation (TAVI) is growingly used in high ...surgical risk patients with aortic valve stenosis. We sought to investigate the effect of TAVI on aortic stiffness.
Methods
Fifty-five high-risk patients (mean age 79.5 ± 8.8 years, 46% males) with severe symptomatic aortic stenosis undergoing TAVI were included. Arterial stiffness was estimated through carotid-femoral pulse wave velocity (cfPWV). Measurements were conducted prior to the implantation, at discharge and 1 year post-TAVI.
Results
Prior to the implantation, cfPWV was 7.5 ± 1.4 m/s for the overall population. There was a statistically significant increase in measurements of aortic stiffness at discharge (7.5 ± 1.4 vs 8.3 ± 1.9 m/s for cfPWV with
p
= 0.043) without a statistically significant change in SBP (
p
= NS) (
Figure 1
). There was also a significant increase in cfPWV (8.7 ± 1.8 m/s) after 1 year compared to the pre-procedural assessment (
p
= 0.001). We also observed a non-significant increase in peripheral SBP at 1 year compared to SBP measurements at baseline and at discharge (153 ± 24 m/s vs 147 ± 21and 148 ± 22 m/s, respectively;
p
= 0.319) and these changes were independent of age and gender (
Figure 1
).
Conclusion
Our study shows that both shortly as well as in the long-term after TAVI subjects experience an increase in aortic stiffness that is independent of changes in SBP. These findings further elucidate the hemodynamic consequences and provide evidence of a possible long-standing repercussion of TAVI.
Figure 1
Environmental factors constitute an important but underappreciated risk factor towards the development and progression of cardiovascular disease (CVD). Environmental exposure to variable pollutants ...is implicated in the derangement or propagation of adverse pathophysiological processes linked with atherosclerosis, including genetic, hemodynamic, metabolic, oxidative and inflammation parameters. However, no data exist on environmental pollution in rural or semi-rural areas. Therefore, the purpose of the “Corinthia” study is to examine the impact of environmental pollution in indices of cardiovascular morbidity and mortality in a cross-sectional and longitudinal design. The Corinthia study began in October 2015 and is planned to recruit 1,500 individuals from different regions of Corinthia country with different environmental exposures to pollutants and different patterns of soil/ground and/or air pollution until December 2016. Baseline measurements will include lifestyle measurements, anthropometric characteristics and a comprehensive cardiovascular examination. The follow-up is planned to extend prospectively up to 10 years and this study is anticipated to provide valuable data on the distinct impact of soil and air pollution on early markers of atherosclerosis and cardiovascular disease and on the overall impact of environment pollution to cardiovascular morbidity and mortality.
Sedentary lifestyle, unlike leisure time physical activity (PA), is associated with atherosclerosis progression. Regarding the interrelationship between television watching, as a sedentary behavior ...pattern, and cardiovascular disease burden, few data exist.
In this cross-sectional epidemiological study based on 2043 inhabitants of the Corinthia region, in Greece, ultrasonography was used to measure carotid intima-media thickness (IMT) in both carotid arteries. The average (meanIMT) and maximum thickness (maxIMT) were determined as representative values of subclinical atherosclerosis. We evaluated PA using the self-reported International Physical Activity Questionnaire (IPAQ). Based on specific questions, the average hours per week spent on watching television (TV), videos or DVD was calculated for each participant.
According to TV viewing time, subjects were categorized into the low (≤7 h/week), moderate (7˃ TV hours/week ≤21) and high (˃21 h/week) TV viewing time groups. Prevalence of carotid atheromatic plaque was lower in the low TV viewing time group compared to the moderate and high TV viewing time groups (p = 0.02). TV viewing time was associated with increased carotid IMT (p = 0.03) and the prevalence of carotid atheromatic plaque (p = 0.02), even after adjustment for age, body mass index, cardiovascular risk factors or history of cardiovascular disease. Subjects in the high TV viewing time group have 80% increase odds of carotid atheromatic plaque compared to patients categorized in the low TV viewing time group (p = 0.01).
The present findings have important public health implications, providing a better understanding of the components of sedentary behavior that are associated with atherosclerotic progression.
Display omitted
•Physical activity is associated with a reduction of cardiovascular events.•Few data exist about the association of sedentary behavior with atherosclerosis.•Association between hypertension prevalence and increasing TV-viewing-time.•TV-viewing-time was associated with increased mean cIMT and carotid atheromatic plaque.•Sedentary behavior may provoke atherosclerotic progression.
Objective: Increased resting heart rate as well as increased arterial stiffness are both independent predictors of cardiovascular events and mortality. Results of previous studies have failed to ...converge concerning the association between heart rate and arterial stiffness, regardless of other potential confounders, such as age, gender and particularly blood pressure (BP). We aimed to investigate: (a) the degree of association (if any) between resting heart rate and carotid-to-femoral pulse wave velocity (PWV), the gold standard index of arterial stiffness, (b) if the relationship between heart rate and PWV is mediated by BP levels and (c) whether their association is affected by the levels of aortic stiffening. Approach: Demographic, hemodynamic, laboratory and clinical data of 1566 subjects from the cross-sectional observational 'Corinthia' study were analyzed using univariate and multivariate regression models. Mediation analysis was performed to test whether mean arterial pressure (MAP) is a significant mediator in the heart rate-PWV relationship. The total population was divided in two groups of low and high arterial stiffness according to the median PWV value (8.6 m s−1). Main results: We found that (i) there is a significant association between heart rate and PWV, regardless of other confounding factors. An increase in heart rate by 20 b.p.m. can increase PWV by 0.5 m s−1. However, this association was significant only for subjects with increased aortic stiffness (PWV > 8.6 m s−1) and not for those with PWV 8.6 m s−1. Further, (ii) heart rate-PWV association was partially mediated by MAP. Significance: Increased resting heart rate is related to increased aortic stiffness, only in subjects with stiffer aortas, regardless of BP and other risk factors and subjects' characteristics. The synergistic prognostic effect of increased arterial stiffness and elevated heart rate on target organ damage, cardiovascular events and mortality should be explored in future studies.
Abstract
Background
It has been long hypothesized that emotional factors and depression may play role in the development of cardiovascular diseases.
Aim
The aim of this study was to examine the ...association between depression, arterial stiffness and atheromatic burden in carotid arteries.
Design and methods
Corinthia study is a cross-sectional epidemiological study conducted in subjects aged 40–99 years, inhabitants of the homonym region of Greece. Intima media thickness (IMT) was measured in the left and right common carotid artery, carotid bulb and internal carotid artery. The average of the measurements (mean IMT) and the maximum IMT were determined as the representative value of carotid atherosclerosis burden. Pulse wave velocity was used to evaluate arterial stiffness. The Zung Self-Rating Depression Scale was used to evaluate depressive symptoms in subjects <65 years and the Geriatric Depression Scale in those >65 years.
Results
In this analysis, we included data from 1510 participants. In older subjects (i.e. >65 years), maximum IMT was significantly increased in subjects with depression compared to those without (1.57 ± 0.97 mm vs. 1.74 ± 1.05 mm, P = 0.04). Similarly, the prevalence of atheromatic plaques was higher in subjects with depression (46% vs. 34%, P = 0.005). In the younger subgroup (<65years), there was no difference in mean and maximum IMT. Pulse wave velocity was found higher in the presence of depression (8.35 ± 2.36m/s vs. 7.88 ± 1.77m/s, P = 0.007). No differences emerged for the rest of the variables assessed in the individual subgroups.
Conclusions
There is an age-dependent association between depression, arterial stiffness and carotid atheromatic burden highlighting the interplay between cardiovascular diseases and emotional status.
PDF
