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Gurbuz AS, Ozturk S, Kilicgedik A, Akgun T, Kalkan ME, Demir S, Efe SC, Acar RD, Akcakoyun M, Kirma C. Effects of atrial electromechanical delay and ventriculoatrial conduction over the atrial functions in patients with frequent extrasystole and preserved ejection fraction. Pacing Clin Electrophysiol 2019; 42:321-326. [PMID: 30653680 DOI: 10.1111/pace.13606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 12/01/2018] [Accepted: 01/04/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The deterioration of left atrial and ventricular functions was demonstrated in patients with frequent ventricular extrasystole (fVES). The exact pathophysiology of left atrial dysfunction in patients with fVES is unclear. Retrograde ventriculoatrial conduction (VAC) often accompanies fVES, which may contribute to atrial dysfunction. We investigated whether atrial electromechanical delay and VAC are related to these atrial functions in patients with frequent right ventricular outflow tract (RVOT) VES and preserved ejection fraction (pEF). METHODS This study included 21 patients with pEF (eight males, 48 ± 11 years), who had experienced more than 10 000 RVOT-VES during 24-h Holter monitoring and had undergone electrophysiological study/ablation. The study also included 20 healthy age- and sex-matched control subjects. Transthoracic echocardiography was performed on all of the subjects. Atrial conduction time was obtained by using tissue Doppler imaging. Strain analysis was performed with two-dimensional speckle tracking echocardiography. RESULTS The peak atrial longitudinal strain was significantly impaired in patients with fVES (P = 0.01). In addition, although the interatrial and left atrial conduction delay times were significantly different between each group (P < 0.001, P < 0.001), the right atrial conduction delay times were similar. When patients with fVES were divided into groups depending on the existence of retrograde VAC, atrial deformation parameters and conduction delay time did not significantly differ between either group. CONCLUSION Frequent RVOT-VES causes left atrial dysfunction. This information is obtained through strain analyses and recordings of left atrial conduction times in patients with pEF. Regardless, retrograde VAC is not related to atrial dysfunction.
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Affiliation(s)
- Ahmet Seyfeddin Gurbuz
- Department of Cardiology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Semi Ozturk
- Department of Cardiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Alev Kilicgedik
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Taylan Akgun
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Emin Kalkan
- Department of Cardiology, Mehmet Akif Ersoy Thorax and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Serdar Demir
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Suleyman Cagan Efe
- Department of Cardiology, Istanbul Training and Research Hospital, Turkey
| | - Rezzan Deniz Acar
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | | | - Cevat Kirma
- Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey
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Cismaru G, Gusetu G, Muresan L, Rosu R, Andronache M, Matuz R, Puiu M, Mester P, Miclaus M, Pop D, Mircea PA, Zdrenghea D. Recovery of Ventriculo-Atrial Conduction after Adrenaline in Patients Implanted with Pacemakers. Pacing Clin Electrophysiol 2015; 38:857-63. [PMID: 25850362 DOI: 10.1111/pace.12641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 03/15/2015] [Accepted: 03/29/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ventriculo-atrial (VA) conduction can have negative consequences for patients with implanted pacemakers and defibrillators. There is concern whether impaired VA conduction could recover during stressful situations. Although the influence of isoproterenol and atropine are well established, the effect of adrenaline has not been studied systematically. The objective of this study was to determine if adrenaline can facilitate recovery of VA conduction in patients implanted with pacemakers. METHODS A prospective study was conducted on 61 consecutive patients during a 4-month period (April-July 2014). The presence of VA conduction was assessed during the pacemaker implantation procedure. In case of an impaired VA conduction, adrenaline infusio was used as a stress surrogate to test conduction recovery. RESULTS The indications for pacemaker implantation were: sinus node dysfunction in 18 patients, atrioventricular (AV) block in 40 patients, binodal dysfunction (sinus node+ AV node) in two patients and other (carotid sinus syndrome) in one patient. In the basal state, 15/61 (24.6%) presented spontaneous VA conduction and 46/61 (75.4%) had no VA conduction. After administration of adrenaline, there was VA conduction recovery in 5/46 (10.9%) patients. CONCLUSIONS Adrenaline infusion produced recovery of VA conduction in 10.9% of patients with absent VA conduction in a basal state. Recovery of VA conduction during physiological or pathological stresses could be responsible for the pacemaker syndrome, PMT episodes, or certain implantable cardiac defibrillator detection issues.
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Affiliation(s)
- Gabriel Cismaru
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Gabriel Gusetu
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Lucian Muresan
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Radu Rosu
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Marius Andronache
- CHU de Nancy, Department of Cardiology, University Hospital Nancy, France
| | - Roxana Matuz
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Mihai Puiu
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Petru Mester
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Maria Miclaus
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Dana Pop
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Petru Adrian Mircea
- Department of Gastroenterology, Medical Clinic No 1, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
| | - Dumitru Zdrenghea
- Department of Cardiology, Rehabilitation Hospital, University of Medicine and Pharmacy "IuliuHatieganu," Cluj-Napoca, Romania
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