Atrial premature activity detected after an ischaemic stroke unveils atrial myopathy.

BACKGROUND: Recent publications suggest that left atrial (LA) myopathy is a potential source of thromboembolism, independent of atrial fibrillation. AIMS: We sought to investigate whether the presence of atrial premature activity after an ischaemic stroke is associated with LA remodelling and dysfunction, and might be a surrogate marker of LA myopathy. METHODS: After an ischaemic stroke or a transient ischaemic attack, patients without known atrial fibrillation or overt heart disease were included prospectively in the study. All patients had a standard workup, including ambulatory Holter electrocardiogram monitoring and transthoracic echocardiography. In some patients, transoesophageal echocardiography was also performed. Anatomical and functional LA remodelling were assessed using minimal and maximal volumes and LA emptying fraction in two-dimensional and three-dimensional echocardiography. Patients were separated into two groups according to the burden of atrial premature complexes (APCs), measured by Holter electrocardiography. RESULTS: Among 148 eligible patients recruited from October 2015 to May 2016, 93 were included in the group with non-frequent APCs (nf-APC:<100 APCs/24hours) and 43 in the group with frequent APCs (f-APC:>100 APCs/24hours). Twelve patients had paroxysmal atrial fibrillation, and were not included in the statistical analysis. Maximal and minimal indexed LA volumes were significantly higher in the f-APC group than in the nf-APC group (P<0.01). LA emptying fraction was worse in the f-APC group than in the nf-APC group. In addition, LA appendage emptying velocity was impaired in the f-APC group, and was correlated with LA remodelling variables, especially LA emptying fraction (r=0.621). CONCLUSIONS: After an ischaemic stroke or a transient ischaemic attack, excessive APCs are associated with LA remodelling. Thus, LA dilatation and dysfunction reflect early LA myopathy, which might itself be responsible for cardioembolic stroke.

Is radiofrequency ablation of accessory pathways always necessary? The case of a variant of Wolff-Parkinson-White syndrome.

A 16-year-old boy was referred for radiofrequency ablation of an accessory pathway. He had not experienced palpitations, but a normal electrocardiogram was a prerequisite for enrollment in a professional soccer school. The electrocardiogram showed a PR interval of 0.10 second and wide QRS complexes suggestive of an accessory pathway. The case of a variant of Wolff-Parkinson-White syndrome is discussed.

Radiofrequency ablation of atrial fibrillation: the first 100 cases in Lyon.

The aim of the study was to estimate the efficacy and complications of the first ablations of atrial fibrillation (AF) performed in a single teaching institution. The first 100 consecutive patients with symptomatic paroxysmal, persistent or permanent AF treated by application of radiofrequency in the left atrium, were included. In the patients with paroxysmal AF, success was judged as complete in 21 out of the 35 (60%). The benefit was lower in patients with persistent arrhythmia (19 out of 42, 45%). In the 23 patients with permanent AF, there were 16 failures (69%) with recurrence of AF in 10 patients the day after the procedure. There were 13 patients (13%) with minor complications.