WITHDRAWN: Enlargement of the Right Atrium - Diverticulum or Aneurysm?

The publisher regrets that this was an accidental duplication of an article that has already been published in Eur. J. Echocardiogr., 4 (2003) 223-225, . The duplicate article has therefore been withdrawn.

Hypocholesterolemic effect of ascorbic acid in maturity-onset diabetes mellitus.

A significantly lower vitamin C concentration has been found in the blood and particularly in the leukocytes of hypercholesterolemic diabetic patients than of healthy blood donors. Ascorbic acid administered in a dose of 500 mg per day for 12 months to metabolically stabilized hypercholesterolemic subjects with maturity-onset diabetes mellitus (diabetic diet without insulin or diabetic drugs) brought about a striking decline of cholesterolemia and a moderate decline of triglyceridemia. The serum lipid level in the control group given placebo remained unaltered. A daily administration of 500 mg of ascorbic acid for six months failed to affect the fasting level of serum immunoreactive insulin. It is assumed that the long-term administration of ascorbic acid to maturity-onset diabetics removed the tissue ascorbate deficiency and improved the liver ability to compensate the increased endogenous synthesis of cholesterol by its enhanced transformation to bile acids.

[Atrial fibrillation--update 2004]. / Vorhofflimmern-- Update 2004.

Atrial fibrillation is the most frequent sustained arrhythmia, especially in the elderly. Atrial fibrillation often is precipitated by underlying cardiac or noncardiac disease, but it may also occur as 'lone atrial fibrillation'. Hemodynamic impairment and thromboembolic events are leading to an important morbidity, mortality and health costs. This review-article describes the actual management of this common arrhythmia.

[Catheter ablation of atrial flutter and atrial fibrillation]. / Kathetertechnische Behandlung von Vorhofflattern und Vorhofflimmern.

Within the past 20 years, refinements in electrophysiologic mapping techniques have provided a better understanding of the pathophysiology of atrial flutter and atrial fibrillation (AF), which resulted in the development of catheter ablation techniques for this arrhythmias. Nowadays, catheter ablation has become the first line treatment of recurrent symptomatic or hemodynamically significant atrial flutter. In contrast, catheter ablation of AF is still an investigational procedure and should be restricted to patients with symptomatic AF who have been refractory to multiple antiarrhythmic drugs. In symptomatic patients with AF and an uncontrolled ventricular rate who have failed treatment with several antiarrhythmic drugs and who do not fit for primary catheter ablation of AF atrioventricular junction ablation with prior pacemaker implantation is recommended.

[Sport practice and arrhythmias]. / Sport und Arrhythmien.

Regular exercise decreases the risk of coronary artery disease by controlling risk factors. On the other hand, vigorous exertion increases the risk of sudden cardiac death in subjects with pre-existing cardiac diseases. Long term endurance sport practice may increase the incidence of atrial fibrillation, atrial flutter and sinus node dysfunction in otherwise healthy subjects.

Radiofrequency ablation of accessory pathways. Contemporary success rates and complications in 323 patients.

INTRODUCTION: 17 years ago the first radiofrequency catheter ablation of an accessory pathway (AP) was performed. The aim of this study was to describe the contemporary success rates and procedure related complication rates of radiofrequency (RF) ablation of accessory pathways (APs). In addition, the present study describes the anatomical distribution of APs according to the new nomenclature introduced by NASPE and ESC in 1999. METHODS: The analysis included all patients, who underwent RF ablation of an AP in the Heart Center Leipzig between January 2000 and December 2003. RESULTS: Over a 4 year period 336 APs were ablated in 323 patients. 201 APs (60%) presented with antegrade and retrograde conduction and showed preexcitation on ECG. For the remaining 135 APs (40%), only retrograde conduction over the AP was documented. According to the new nomenclature APs were classified as left-sided, right sided, septal and paraseptal APs. 188 APs (56%) were located on the left, 41 (12%) on the right, 64 (19%) in the paraseptal space and 31 APs (9%) presented with a septal or parahisian localization, respectively. Because of atypical course and/or characteristics 12 APs (4%) could not be classified. Ablation of all pathways were successful in 315 patients (98%). In 289 patients (89%) success was achieved within a single ablation session. The left-sided pathways had a re-intervention rate of 5%, which was significantly lower compared to the remaining localizations. The highest re-intervention rate was observed in the septal APs (23%). Complications were observed in less than 2% of all treated patients. CONCLUSIONS: 17 years after the first RF catheter ablation of an AP this therapy is established as a highly effective procedure. The success rate has improved to 98% and the complication rate has been minimized to less than 2%. The most frequent localization of APs is left posterior. Left sided APs also presented with the lowest re-intervention rate. The introduction of the new nomenclature in 1999 by NASPE and ESC has simplified the description of the exact anatomical localization of an AP.

[Tachyarrhythmias--when rapid pace is pathological]. / Tachyarrythmien--wenn Geschwindigkeit krank macht.

Tachycardias are classified as supraventricular and ventricular tachycardias. Supraventricular and ventricular tachycardias may occur as a complication of almost any underlying cardiac disease and many extracardiac causes. In addition, patients without any detectable structural heart disease may present with these arrhythmias. In this overview, we discuss the clinical presentations, the pathophysiological mechanisms and the therapeutical strategies in patients with tachyarrhythmias.

[Electrophysiological study: procedure and indications]. / Die elektrophysiologische Untersuchung: Vorgehensweise und Indikationen.

The purpose of an electrophysiological study is to verify the mechanism of arrhythmias and to decide the means of therapy for the clinical arrhythmia (pharmacological, radiofrequency catheter ablation, pacemaker-, ICD-implantation). The electrode catheters are introduced percutaneously into the right atrium, to the His-bundle, into the coronary sinus and/or into the right ventricle. By this electrode catheters the intracardiac electrograms are registered and programmed stimulation of the heart is performed. The electrical conduction properties are analysed. With stimulation manoeuvres most of the clinical tachycardias can be induced. In the first part of this overview we describe the procedure of an electrophysiological study, in the second part the indications are discussed.

Idiopathic enlargement of the right atrium: 23 year follow up of a familial cluster and their unaffected relatives.

OBJECTIVE: To evaluate the long term outcome of familial idiopathic enlargement of the right atrium (IERA) and the risk of developing this disorder among unaffected offspring. DESIGN: 23 year follow up study. PATIENTS: 14 members (eight men, mean age 54 years, range 40-78) of a pedigree with familial IERA. METHODS: All patients were examined clinically and echocardiographically in 1979 and 2002. Normal cross sectional dimensions of the right atrium were derived from echocardiographic evaluation of 100 people (47% men) with no structural or haemodynamic signs of heart disease. The 90th centile was chosen as the upper normal limit. IERA was defined as an increased right atrial long axis indexed to body surface area (RALAX(i), men > 2.6 cm/m2, women > 2.8 cm/m2) in the absence of other cardiac abnormalities. Severe IERA was defined arbitrarily as RALAX(i) > or = 4 cm/m2. RESULTS: The course of the two index patients with severe IERA diagnosed in 1979 was complicated by atrial fibrillation, systemic embolism, and symptoms of heart failure without systolic dysfunction, resulting in the death of one man (77 years old). One of two patients with initially mild forms progressed to severe IERA. All of the initially unaffected offspring (n = 9) remained asymptomatic, although four of them had developed mild IERA. CONCLUSIONS: During 23 years' follow up, severe IERA induced atrial fibrillation, systemic embolism, and symptoms of heart failure without systolic dysfunction in all cases in this family. Mild IERA seems to become manifest during middle age and may be followed by gradual progression to clinically relevant disease.

Enlargement of the right atrium--diverticulum or aneurysm?

Diverticula and aneurysms are rare congenital anomalies of the right atrium. Here, we report a case of a giant congenital diverticulum of the right atrium in a 27-year-old female and discuss the morphological characteristics distinguishing diverticula and aneurysms.

Aberrant tendinous chords with tethering of the tricuspid leaflets: a congenital anomaly causing severe tricuspid regurgitation.

OBJECTIVE: To define the entity of tricuspid regurgitation caused by tethering of the tricuspid valve leaflets by aberrant tendinous chords. DESIGN: Retrospective study. SETTING: Tertiary care centre (university teaching hospital). PATIENTS: 10 patients with unexplained severe tricuspid regurgitation. METHODS: The last 13 500 echocardiographic studies from our facility were reviewed to identify patients with severe unexplained tricuspid regurgitation. Tethering was defined by the presence of aberrant tendinous chords to the tricuspid valve leaflets limiting the mobility of the tricuspid leaflet and resulting in incomplete coaptation and apical displacement of the regurgitant jet origin. Aberrant tendinous chords were defined as those inserting at the clear zone of the tricuspid leaflet and not originating from the papillary muscle. Patients fulfilling the diagnostic criteria for Ebstein's anomaly were excluded. RESULTS: 10 patients with aberrant tendinous chords tethering one or more tricuspid valve leaflets were identified. There were short non-aberrant tendinous chords in seven patients, five of whom also had right ventricular or tricuspid annulus dilatation. CONCLUSIONS: Tethering of the tricuspid valve leaflets by aberrant tendinous chords can be the sole mechanism of congenital tricuspid regurgitation. It is often associated with short non-aberrant tendinous chords, which may develop secondary to right ventricular or tricuspid annulus dilatation. Awareness of tethering as a cause of tricuspid regurgitation may be important in planning reconstructive surgery.