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JACC Clin Electrophysiol ; 6(1): 21-30, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31971902


OBJECTIVE: This study sought to investigate incidence of left atrial appendage (LAA) triggers of atrial fibrillation (AF) and/or organized atrial tachycardias (OAT) in patients undergoing AF ablation and to evaluate outcomes after ablation. BACKGROUND: Although LAA isolation is being increasingly performed during AF ablation, the true incidence of LAA triggers for AF remains unclear. METHODS: All patients with LAA triggers of AF and/or OAT during AF ablation from 2001 to 2017 were included. LAA triggers were defined as atrial premature depolarizations from the LAA, which initiated sustained AF and/or OAT. RESULTS: Out of 7,129 patients undergoing AF ablation over 16 years, LAA triggers were observed in 21 (0.3%) subjects (age 60 ± 9 years; 57% males; 52% persistent AF). Twenty (95%) patients were undergoing repeat ablation. The LAA was the only nonpulmonary vein trigger in 3 patients; the remaining 18 patients had both LAA and other nonpulmonary vein triggers. LAA triggers were eliminated in all patients (focal ablation in 19 patients; LAA isolation in 2 patients). Twelve months after ablation, 47.6% remained free from recurrent arrhythmia. After overall follow-up of 5.0 ± 3.6 years (median: 3.7 years; interquartile range: 1.4 to 8.9 years), 38.1% were arrhythmia-free. All 3 patients with triggers limited to the LAA remained free of AF recurrence. One patient undergoing LAA isolation developed LAA thrombus during follow-up. CONCLUSIONS: The incidence of true LAA triggers is very low (0.3%). Most patients with LAA triggers have additional nonpulmonary vein triggers, and despite elimination of LAA triggers, long-term arrhythmia recurrence rates remain high. Potential risks of empiric LAA isolation during AF ablation (especially first-time AF ablation) may outweigh benefits.

Can J Cardiol ; 34(3): 252-261, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29395705


BACKGROUND: Intracardiac thrombi arising in the left atrial appendage (LAA) are the principal cause of stroke in nonvalvular atrial fibrillation (AF). Predicting the presence of LAA thrombi is of vital importance in stratifying patients that would need further LAA imaging prior to cardioversion or AF ablation. METHODS: We comprehensively searched PubMed from its inception to November 2017 for randomized controlled trials, cohort and case control studies, as well as for case series on LAA thrombi risk factors, imaging, prevention, and anticoagulation management in atrial fibrillation. RESULTS: A systematic review of the literature identified 106 articles that investigated the presence of LAA thrombi in AF patients. We classified the articles according to topic and reported on: (1) risk factors; (2) diagnostic imaging modalities; (3) prevention strategies before cardioversion; (4) prevention strategies before AF ablation; and (5) management of detected LAA thrombi. CONCLUSIONS: Integration of clinical, biomarker, and imaging risk factors can improve overall prediction for the presence of LAA thrombi, translating into improved patient selection for imaging. The gold standard for the diagnosis of LAA thrombi remains transesophageal echocardiography, although intracardiac ultrasound, cardiac computed tomography, and cardiovascular magnetic imaging are promising alternative modalities. When LAA thrombi are discovered, the treatment regimen remains variable, although direct oral anticoagulants might have efficacy similar to vitamin K antagonists. Future trials will help further elucidate direct oral anticoagulant use for the treatment of LAA thrombi.

Anticoagulantes/administração & dosagem , Apêndice Atrial/patologia , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/terapia , Ablação por Cateter/métodos , Trombose/terapia , Idoso , Apêndice Atrial/cirurgia , Fibrilação Atrial/complicações , Fibrilação Atrial/mortalidade , Ecocardiografia Transesofagiana/métodos , Cardioversão Elétrica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Taxa de Sobrevida , Trombose/diagnóstico por imagem , Trombose/etiologia , Trombose/mortalidade , Resultado do Tratamento
Int J Cardiol ; 195: 98-103, 2015 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-26025867


Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice and is associated with major morbidity and mortality. AF prevalence has been projected to increase in the coming decades and is expected to affect over 7.5 million Americans by the year 2050. There is growing evidence that obesity represents an important risk factor for new onset AF, with each increment in BMI associated with a 3-8% higher risk for new-onset of AF, independent of other conventional AF risk factors such as age, hypertension and heart failure. Several recent studies have also reported that obesity is also a risk factor for AF severity & chronicity. Although obesity may impact AF incidence via several mechanisms, a relation between local pericardial fat depots surrounding the heart and AF has been recently described which may have important pathophysiological implications. Pericardial fat represents one of several localized, fat depots, with unique properties due to its contiguity with cardiac structures and its shared blood supply with the heart microcirculation. Pericardial fat is also highly metabolically active and is an important source of several adipokines and cytokines. Importantly, pericardial fat appears to be more closely linked with metabolic risk than indices of systemic obesity such as BMI or waist circumference. Therefore, pericardial fat may partially explain the increased risk of AF seen in obesity and may promote AF arrhythmogenesis by local mechanisms. In this article, we review the characteristics of pericardial fat, the evidence of an association between pericardial fat and AF and the potential mechanisms for this association. We also summarize the evidence from several recent reports that have linked pericardial fat to AF prevalence, severity as well as outcome after AF ablation. We also briefly review whether interventions targeting pericardial fat could reduce AF incidence and recurrence.

Tecido Adiposo , Fibrilação Atrial , Obesidade , Pericárdio , Tecido Adiposo/metabolismo , Tecido Adiposo/patologia , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Fibrilação Atrial/metabolismo , Fibrilação Atrial/patologia , Fibrilação Atrial/cirurgia , Índice de Massa Corporal , Ablação por Cateter/métodos , Humanos , Obesidade/complicações , Obesidade/diagnóstico , Obesidade/metabolismo , Pericárdio/metabolismo , Pericárdio/patologia , Fatores de Risco
Sultan Qaboos Univ Med J ; 9(2): 167-9, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21509295


Neurofibromatosis type 1 (NF-1) is an autosomal dominant, hereditary, neurocutaneous syndrome that may, primarily or secondarily, affect different organs or systems of the body including the cardiovascular system. The most common vascular abnormality in patients with NF-1 is renal artery stenosis. Here we report the case of a middle-aged gentleman who presented at Sultan Qaboos University Hospital, Oman, with end stage renal disease and severe hypertension and was diagnosed to have NF-1 with bilateral renal artery stenosis. He was started on renal replacement therapy.