[Syncope of uncertain cause and sudden cardiac death in young patients].
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
R Schimpf
Publications and source records attributed to R Schimpf.
[Primary electrical heart disease in adulthood--electrophysiological findings and therapy].
Sudden cardiac death accounts for 100,000 victims in Germany per year. Predominantly, patients with structural heart disease such as coronary artery disease or dilated cardiomyopathy are affected. However, approximately 5-10% of sudden deaths hit patients without structural disease of the heart. The proportion of young patients (< 40 years of age) in this group is even higher (10-20%). In younger patients significantly more diseases like hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia and primary electrical diseases of the heart could be observed such as long QT syndrome, short QT syndrome, Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia. The primary electrical diseases are different concerning their electrocardiographical pattern, clinical triggers of arrhythmias, results of invasive diagnostics and therapy. Meanwhile, molecular genetic screening can reveal specific mutations of ion channels and can identify consecutive functional defects. The significance of programmed ventricular stimulation is at present unclear concerning risk stratification in patients with Brugada syndrome and short QT syndrome and of no significance in long QT syndrome and catecholaminergic polymorphic ventricular tachycardias. The implantable cardioverter defibrillator is the therapy of choice in most symptomatic patients. With increasing knowledge as a result of sophisticated molecular genetic screening, identification of underlying ion channel defects and new details of the mechanisms of arrhythmogenesis, a potential genotype-guided therapy will gain more importance in the future.
Adult↗
[Magnetic resonance imaging of the brain in patients with cardiac pacemakers. Experimental and clinical investigations at 1.5 Tesla].
PURPOSE: In-vitro and In-vivo evaluation of feasibility and safety of MRI of the brain at 1.5 T in patients with implanted pacemakers (PM). MATERIALS AND METHODS: 24 PM models and 45 PM electrodes were tested In-vitro with respect to translational forces, heating of PM leads, behaviour of reed switch (activated vs. deactivated) and function at a 1.5 T MRI-system (actively shielded, maximum field gradient: 30 mT/m; rise time: 150 T/m/s). Based on these results, 63 MRI examinations in 45 patients with implanted PM were performed. Prior to MRI the PM were re-programmed in an asynchronous mode. The maximum SAR of MRI-sequences was limited to 1.2 W/kg. Continuous monitoring of ECG and pulse oximetry was performed during MRI. PM inquiry was performed prior to MRI, immediately after MRI and -- to assess long-term damages -- three months after the MRI exams, including determination of stimulation thresholds to assess potential thermal myocardial injuries at the lead tips. RESULTS: Translational forces (F (max) < or = 560 mN) and temperature increase (DeltaT (max) < or = 2.98 degrees C) were in a range which does not represent a safety concern from a biophysical point of view. No changes to the programmed parameters of the PM or damage of PM components were observed neither In-vitro (n = 0/24) nor In-vivo (n = 0/63). Despite the strong magnetic field, the reed switch remained deactivated in 54 % (13/24) of the cases during In-vitro simulated MRI exams of the brain. All patient studies (n = 63/63) could be completed without any complications. Atrial and ventricular stimulation thresholds (expressed as pulse duration at 2-fold rheobase) did not change significantly immediately post-MRI nor in the 3 months follow-up (pre-MRI: 0.17 ms +/- 0.13 ms, post-MRI: 0.18 ms +/- 0.14 ms, 3 months follow-up: 0.17 ms +/- 0.12 ms). CONCLUSION: MRI of the brain at 1.5 Tesla can be safely performed in carefully selected clinical circumstances when appropriate strategies are used (re-programming the PM to an asynchronous mode, continuous monitoring of ECG and pulse oximetry, limiting the SAR value of the MRI sequences, cardiological stand-by). Based on these studies, implanted PM should not longer be regarded as an absolute contraindication for MRI at 1.5 T.
Burns, Electric↗
Incidence and electrophysiological characteristics of spontaneous ventricular tachyarrhythmias in high risk coronary patients and prophylactic implantation of a defibrillator.
OBJECTIVES: To assess the incidence and electrophysiological characteristics of spontaneous ventricular tachyarrhythmias after implantable cardioverter-defibrillator (ICD) implantation for primary prevention. DESIGN: Prospective observational study. PATIENTS: 41 consecutive patients, who fulfilled MADIT (multicenter automatic defibrillator implantation trial) I criteria, except for suppressibility by procainamide, and who received a prophylactic ICD. INTERVENTIONS: Subpectoral implantation of an ICD. MAIN OUTCOME MEASURES: Incidence of ventricular tachyarrhythmias and their electrophysiological characteristics with respect to timing of the arrhythmia, tachyarrhythmia cycle length, mode of termination, and clinical relevance. RESULTS: During a mean (SD) follow up of 30 (21) months 18 of 41 (43.9%) patients experienced 142 appropriate ICD treatments. The mean (SD) time to first event was 9.6 (15.1) months. One patient had ventricular fibrillation (VF), 12 patients ventricular tachycardia (VT), and five both VT and VF. The mean (SD) cycle length of monomorphic VT was 306 (42) ms. Of 142 episodes, 117 (82.3%) were terminated by antitachycardia pacing and another 25 (17.6%) by ICD discharges. Cumulative survival of hypothetical death, defined as treated VT with a cycle length < 260 ms or VF, was 83.2% after one year and 78.4% after two years. CONCLUSIONS: Patients with a left ventricular ejection fraction < 35%, a history of myocardial infarction, non-sustained VT, and inducible VT/VF are at high risk of VT/VF early after implantation. Therefore, implantation of a tiered treatment defibrillator seems to be justified.
Aged↗
Amiodarone-associated "torsade de pointes". Relevance of concomitant cardiovascular medication in a patient with atrial fibrillation and structural heart disease.
A 69 year old female with history of coronary heart disease, myocardial infarction and paroxysmal atrial fibrillation suffered from occipital apoplexy. Under treatment with amiodarone 600 mg daily and concomitant medication with beta-acetyldigoxine (0.1 mg daily) and bisoprolole (1.25 mg daily), significant QT-prolongation (max. 700 ms; QTc: 614 ms) could be documented. Out of normofrequent sinus rhythm but as well out of bradycardia, the patient developed repetitive short-lasting "torsade de pointes" tachycardias (320 bpm) which terminated spontaneously. Serum electrolytes, plasma levels of digoxine (1.76 ng/ml) and amiodarone (1.9 mcg/ml) were within therapeutic range. This case report is the first to describe induction of amiodarone-associated "torsade de pointes" tachycardia during concomitant beta-blocker and digitalis medication in a patient with atrial fibrillation and structural heart disease. This points towards an elevated risk for proarrhythmia under this triple therapy.
Acetyldigoxins↗
Potential device interaction of a dual chamber implantable cardioverter defibrillator in a patient with continuous spinal cord stimulation.
Spinal cord or thalamic deep brain stimulation with a pacemaker is becoming more important in the treatment of drug refractory pain due to peripheral vascular disease, angina pectoris and intractable tremor in patients with neurologic disorders such as Parkinson's disease. An additional indication for a cardiac pacemaker or implantable cardioverter defibrillator raises concerns about possible interactions between the implanted electrical devices. We report on a patient with existing spinal cord stimulation who survived sudden cardiac death and received a dual chamber cardioverter defibrillator capable of delivering tiered therapies in both the atrium and ventricle.
Aged↗
[Cardiac resynchronization therapy by biventricular pacing. How many patients with left ventricular dysfunction are eligible?].
BACKGROUND AND OBJECTIVE: Cardiac resynchronization therapy by multisite biventricular pacing presents an additive therapeutic option in the treatment of severe congestive heart failure. The objective of the study was to evaluate how many patients with left ventricular dysfunction may potentially benefit from this therapy. METHODS: A total of 975 patients were screened for the prevalence of left ventricular dysfunction. Patients with a left ventricular ejection fraction (LVEF) <45 % were included into the investigation. Potential benefit of biventricular pacing was presumed in the presence of: LVEF < 35 %, severe heart failure (NHYA class III or IV), intrinsic left bundle branch block pattern with QRS interval > 150 ms and the absence of atrial fibrillation in the last 3 months before study inclusion. RESULTS: In 203 patients (168 male, 35 female, mean age: 64 +/- 11) an LVEF <45 % was found. A total of 12 of these patients (6 %) or 12 of 113 patients (11 %) with an LVEF <35 % were identified as appropiate candidates for biventricular resynchronization therapy. CONCLUSIONS: Cardiac biventricular pacing currently serves as a therapeutic option for a relatively small subgroup of patients with left ventricular dysfunction. Focusing on estimations that the incidence of heart failure in Germany amounts to more than 100.000 cases per year our results suggest that after all more than 6.000 patients per year may potentially benefit from electric resynchronization therapy. This number may increase substantially if prospective studies can prove that patients with heart failure and atrial fibrillation or left ventricular conduction delay due to univentricular pacing also benefit from cardiac resynchronization therapy.
Aged↗
Decremental intravenous pulse propagation during extrastimulus pacing: relevance for catheter ablation of focal atrial fibrillation.
We report a case study demonstrating delayed circumferential intrapulmonary-venous conduction characteristics during coronary sinus extrastimulus pacing. This phenomenon allowed the unmasking and discrimination of a localized left atrial to PV breakthrough from secondarily activated PV muscle in a common left-sided PV ostium. Thus, this pacing manoeuvre may serve to guide RF delivery in the treatment of focal AF.
Atrial Fibrillation↗
[A new dual-chamber defibrillation system: duration, frequency and circadian variation of recurrent supraventricular tachyarrhythmias].
BACKGROUND: The treatment of concomitant atrial tachyarrhythmias in patients with malignant ventricular tachyarrhythmias is a major challenge for new defibrillator devices. Atrial fibrillation is not only responsible for inappropriate ventricular therapies, but also reduced left ventricular performance, especially in patients with heart failure and severely depressed left ventricular function. Furthermore, it is a strong risk factor for the development of thromboembolism. NEW SYSTEM: A new dual-chamber implantable defibrillator is capable of tiered atrial therapies for both regular and irregular atrial tachyarrhythmias. In first investigations a high sensitivity and specificity could be shown as well as a promising therapy efficacy of atrial antitachycardia ramp and burst pacing for the treatment of atrial tachycardias. Atrial ramp pacing has shown to be successful for regular atrial tachyarrhythmias in up to 60 to 70% of all episodes. The results have supported a programming of a high first shock energy for treatment of atrial fibrillation. The incidence of atrial fibrillation in patients with a history of atrial fibrillation or without is much higher in the present investigated patient populations than expected. CONCLUSION: The more complicated and subtle new dual-chamber detection algorithm has proven to be safe and effective both for the detection of ventricular tachycardia but also in terms of an increase of specificity and a reduction of inappropriate ventricular therapies for atrial tachyarrhythmias.
Atrial Fibrillation↗
Algorithms for better arrhythmia discrimination in implantable cardioverter defibrillators.
The discrimination of concomitant atrial tachyarrhythmias and sinus tachycardias in patients with malignant ventricular tachyarrhythmias is a major challenge for new defibrillator devices. Different algorithms have now been established to distinguish between atrial and ventricular tachyarrhythmias. Furthermore, new dual-chamber implantable defibrillators are capable of tiered atrial therapies for both regular and irregular atrial and ventricular tachyarrhythmias. The increasingly complex and subtle dual-chamber detection algorithms have proven to be safe and effective for the detection of ventricular tachycardia, and also in terms of an increase in specificity and a reduction in inappropriate ventricular therapies for supraventricular tachyarrhythmias. Stable electrode position, and a continuous and correct atrial signal quality, are prerequisites for atrial therapies and algorithms for arrhythmia discrimination.
Algorithms↗
Prevalence of left atrial chamber and appendage thrombi in patients with atrial flutter and its clinical significance.
OBJECTIVES: The study was done to assess the prevalence of left atrial (LA) chamber and appendage thrombi in patients with atrial flutter (AFl) scheduled for electrophysiologic study (EPS), to evaluate the prevalence of thromboembolic complications after transesophageal echocardiographic (TEE)-guided restoration of sinus rhythm and to evaluate clinical risk factors for a thrombogenic milieu. BACKGROUND: Recent studies showed controversial results on the prevalence of atrial thrombi and the risk of thromboembolism after restoring sinus rhythm in patients with AFl. METHODS: Between 1995 and 1999, patients with AFl who were scheduled for EPS were included in the study. After transesophageal assessment of the left atrial appendage and exclusion of thrombi, an effective anticoagulation was initiated and patients underwent EPS within 24 h. RESULTS: We performed 202 EPSs (radiofrequency catheter ablation, n = 122; overdrive stimulation, n = 64; electrical cardioversion, n = 16) in 139 consecutive patients with AFl. Fifteen patients with a thrombogenic milieu were identified. All of them had paroxysmal atrial fibrillation (AF). Transesophageal echocardiography revealed LA thrombi in two cases (1%). After EPS no thromboembolic complications were observed. Diabetes mellitus, arterial hypertension and a decreased left ventricular ejection fraction were found to be independent risk factors associated with a thrombogenic milieu. CONCLUSIONS: The findings of a low prevalence of LA appendage thrombi (1%) in patients with AFl and a close correlation between a history of previous embolism and paroxysmal AF support the current guidelines that patients with pure AFl do not require anticoagulation therapy, whereas patients with AFl and paroxysmal AF should receive anticoagulation therapy. In addition, the presence of clinical risk factors should alert the physician to an increased likelihood for a thrombogenic milieu.
Aged↗
Interference with cardiac pacemakers by magnetic resonance imaging: are there irreversible changes at 0.5 Tesla?
The safety and feasibility of magnetic resonance imaging (MRI) in patients with cardiac pacemakers is an issue of gaining significance. The effect of MRI on patients' pacemaker systems has only been analyzed retrospectively in some case reports. Therefore, this study prospectively investigated if MRI causes irreversible changes in patients' pacemaker systems. The effect of MRI at 0.5 Tesla on sensing and stimulation thresholds, lead impedance and battery voltage, current, and impedance was estimated during 34 MRI examinations in 32 patients with implanted pacemakers. After measurements at baseline and with documentation of intrinsic rhythm and modification of the pacing mode, patients underwent MRI. The rest of the function time of the pacemaker was calculated. Measurements were again performed after 99.5 +/- 29.6 minutes (mean +/- SD), immediately after MRI examination, and 3 months later. Lead impedance and sensing and stimulation thresholds did not change after MRI. Battery voltage decreased immediately after MRI and recovered 3 months later. Battery current and impedance tended to increase. The calculated rest of function time did not change immediately after MRI. MRI affected neither pacemaker programmed data, nor the ability to interrogate, program, or use telemetry. Surprisingly, in the gantry of the scanner, temporary deactivation of the reed switch occurred in 12 of 32 patients when positioned in the center of the magnetic field. Missing activation of the reed switch through the static magnetic field at 0.5 Tesla is not unusual. MRI at 0.5 Tesla does not cause irreversible changes in patients' pacemaker systems.
Contraindications↗
[Transthoracic echocardiography in endocarditis: a comparison of conventional and harmonic echocardiography].
BACKGROUND AND OBJECTIVE: Compared with conventional echocardiography (CEC) harmonic imaging (HEC) provides better resolution of the endocardial line and valvular apparatus. This prospective study was undertaken to compare the value of harmonic and conventional transthoracic echocardiography in endocarditis and compare them with standard transoesophageal echocardiography (TOE) and operative findings. PATIENTS AND METHOD: Conventional and harmonic echocardiographic imaging was compared in 30 patients (aged 58 +/- 17 years; 19 males and 11 females) with endocarditis clinically judged to require surgical intervention. The results of both methods were then compared with those of standard TOE and the intraoperative findings. RESULTS: Intraoperatively 15 floating structures, 9 abscesses and 5 perforations were demonstrated. Transoesophageal echocardiography was better than the standard method in diagnosing floating structures and detecting abscesses (15 vs. 10 vegetations, p < 0.05; 7 vs. 5 abscesses, p = 0.05). TOE was better than either method in the diagnosis of abscess. CONCLUSION: Harmonic transthoracic echocardiography is better than the conventional mode in diagnosing complications of endocarditis.
Abscess↗
Clinical experience with implantable atrial and combined atrioventricular defibrillators.
UNLABELLED: The high prevalence of atrial fibrillation (AF) and its clinical complications, the poor efficacy of medical therapy for preventing recurrences, and dissatisfaction with alternative modes of therapy stimulated interest in implantable atrial and combined atrioventricular defibrillators. In a multicenter study, the safety and efficacy of a stand alone implantable atrial defibrillator, the Metrix system, were evaluated. The device was implanted in 51 patients with highly symptomatic episodes of AF refractory to pharmacological treatment. During a follow-up of 9 months, 96% of 227 spontaneous AF episodes were successfully converted to sinus rhythm in 41 patients. In 62 episodes (27%), several shocks and/or additional drug treatment were required to maintain stable sinus rhythm because of early recurrences of AF. A total of 3719 shocks were delivered and no induction of ventricular proarrhythmia or inaccurately synchronized shocks occurred. The AF detection algorithm exhibited a 100% specificity for the recognition of sinus rhythm and a 92.3% sensitivity for the detection of AF. The combined atrioventricular defibrillator, Jewel AF 7250, was evaluated in a multicenter, randomized, cross-over trial. The primary study objectives included: overall safety as determined by complications-free survival at 6 months, efficacy of tiered atrial pacing and defibrillation therapies for termination of spontaneous atrial tachycardias (AT) and AF, and relative sensitivity of a new dual-chamber detection algorithm. The device was implanted in 211 patients with either a history of ventricular tachyarrhythmias (VT/VF) alone or with a history of both AT/AF and VT/VF. During a mean follow-up of 4.5 months, it has been shown that the Jewel AF is safe and effective in treating atrial and ventricular tachyarrhythmias. Pace termination of 85% of AT episodes were achieved with painless delivery of antitachycardia pacing; additional 35% of AT episodes were terminated by high frequency burst pacing. CONCLUSIONS: The stand alone implantable atrial defibrillator may be safe and clinically useful in selected patients for the treatment of highly symptomatic, drug resistant recurrences of AF. The combined atrioventricular defibrillator may be particularly indicated in patients presenting with both a history of atrial and ventricular tachyarrhythmias.
Aged↗
Comparison of spontaneous atrial fibrillation electrogram potentials with the P-wave electrogram amplitude in dual chamber pacing with unipolar atrial sensing.
AIMS: Although bipolar sensing is recommended and desirable in patients with dual chamber pacemakers (DDD) and intermittent atrial fibrillation (AF) it is a clinical reality that some patients who are given unipolar atrial leads without a prior history of AF may develop intermittent AF during follow-up. It was therefore the purpose of this prospective study to compare the electrogram amplitudes of AF potentials with sinus rhythm P-wave potentials as a relevant factor for appropriate mode switching in dual chamber pacing with unipolar atrial sensing. METHODS AND RESULTS: Forty-two patients with dual chamber pacemakers, unipolar atrial leads and intermittent AF were studied. Aside from measuring the P-wave potential, it was possible in 14 patients (4 women, 10 men; mean age: 61.8 (+/- 13.3) years) additionally to document spontaneous AF electrogram potentials using pacemaker telemetry. A prospective survey study was performed including a 6 month follow-up period with an outpatient clinic visit every 2-3 weeks. The mean P-wave electrogram amplitude was 3.4 (+/- 1.8) mV (range: 1.4-7.4) compared with the mean amplitude during AF of 2.04 (+/- 1.26) mV (range: 0.8-5.2 mV) indicating a significant attenuation of 40% during AF (P < 0.0001). A linear correlation regression analysis revealed that there was a significant correlation between the P-wave and the AF amplitude (P < 0.0001), with a correlation coefficient of r = 0.867. CONCLUSION: Once it is known that a substantial reduction exists in electrogram amplitude, compared with the P wave electrogram potential, an estimate can be made of whether AF potentials will be sensed, if the programming of atrial sensitivity is congruent with the P-wave characteristics and the presence or absence of myopotential triggering.
Atrial Fibrillation↗
Incidence of left atrial thrombi in patients in sinus rhythm and with a recent neurologic deficit.
OBJECTIVES: We sought to determine the incidence of left atrial (LA) thrombi in patients in sinus rhythm (SR) and with a recent neurologic deficit and to analyze the relation between LA thrombi and LA chamber and appendage function in patients in SR. METHODS: A prospective study was conducted in 869 consecutive patients. The study group consisted of 583 patients in SR (67%). The remaining 286 patients had atrial fibrillation (AF) and served as controls (33%). RESULTS: The incidence of LA thrombi was significantly higher in patients with AF (n = 39 [14%]) compared with patients in SR (n = 6 [1%]; P <.001). Three of 6 patients with thrombi in SR had mitral stenosis, 1 patient had aortic stenosis, 1 patient had coronary artery disease, and another patient had a cardiomyopathy. Of the patients with detected thrombi, those in SR did not receive anticoagulation, whereas those with AF did in 18 cases. Patients with thrombi in SR and with AF did not significantly differ in LA diameter (5.1 +/- 0.8 cm vs 4.8 +/- 0.7 cm; 95% confidence interval [CI], -0.78 to 0.45), left ventricular ejection fraction (46% +/- 13% vs 42% +/- 15%; 95% CI, -18.7 to 7.4), LA appendage area (5.8 +/- 2.7 cm(2) vs 6.7 +/- 3.2 cm(2); 95% CI, -1.9 to 3.6), peak emptying velocity of the LA appendage (0.19 +/- 0.08 m/s vs 0.17 +/- 0.07 m/s; 95% CI, -0.08 to 0.04), or LA spontaneous echo contrast (3. 5 +/- 0.6 vs 3.9 +/- 0.5; 95% CI, -0.06 to 0.45). CONCLUSIONS: LA appendage thrombi are an infrequent cause of thromboembolism in patients in SR and are associated either with mitral valve disease or LA chamber and appendage dysfunction. Routine transesophageal echocardiography for the exclusion of LA thrombi is not recommended in patients in SR without underlying heart disease and normal LA function as assessed by transthoracic echocardiography.
Aortic Valve Stenosis↗
Right atrial appendage thrombosis in atrial fibrillation: its frequency and its clinical predictors.
This study assesses the incidence of right atrial (RA) chamber and appendage thrombosis in patients with atrial fibrillation (AF) in relation to RA appendage morphology and function. Transthoracic and multiplane transesophageal echocardiography were performed in 102 patients with AF to assess the incidence of RA and left atrial (LA) thrombi and spontaneous echo contrast. Both right and left ventricular sizes, atrial chamber and appendage sizes and function were measured. Twenty-two patients in sinus rhythm served as the control group (SR). Complete visualization of the RA appendage was feasible in 90 patients with AF. Patients with AF had lower tricuspid annular excursion (p = 0.008) and larger RA chamber area (p = 0.0001) than patients in SR. In addition, RA appendage areas were larger (p <0.05) and RA ejection fraction and peak emptying velocities (both p <0.0001) were lower in patients with AF patients than in those in SR. Equivalent differences were found for the LA appendage. Six thrombi were found in the RA appendage and 11 thrombi in the LA appendage in AF patients. Spontaneous echo contrast was found in 57% and 66% in the right atrium and in the left atrium, respectively. AF patients with RA appendage thrombi had a larger RA area (p = 0.0001), and lower RA appendage ejection fraction and emptying velocities (both p = 0.0001) than patients without thrombi. Spontaneous echo contrast was detected in all patients with thrombi. Spontaneous echo contrast was the only independent predictor of RA (p = 0.03) and LA appendage thrombosis (p = 0.036). In conclusion, multiplane transesophageal echocardiography allows the assessment of RA appendage morphology and function. RA spontaneous echo contrast is the only independent predictor of RA appendage thrombosis.
Adult↗
Hemodynamic and cardiorespiratory function following internal atrial defibrillation for chronic atrial fibrillation.
Internal atrial defibrillation (IAD) is able to restore sinus rhythm in patients with chronic atrial fibrillation (AF) and failed external electrical and/or pharmacologic cardioversion. To assess whether cardiorespiratory and hemodynamic function improve after IAD, 35 patients were prospectively investigated during constant workload exercise by spiroergometry and Doppler echocardiography before IAD, and 1 day and 1 month after IAD. Oxygen uptake kinetics, ventilation, left atrial mechanical function, and pulmonary artery pressure were determined simultaneously at rest and during steady state. During the serial follow-up, 20 patients maintained sinus rhythm. The time interval for achieving the steady state (146 +/- 53 vs 132 +/- 42 seconds; p = 0.5) and the oxygen deficit (645 +/- 190 vs 670 +/- 174 ml; p = 0.7) were not different before and 1 day after IAD, but decreased significantly after 1 month (98 +/- 16 seconds, p = 0.01 and 487 +/- 72 ml, p = 0.02). Exercise pulmonary artery systolic pressures were 38 +/- 13 mm Hg before IAD, increased significantly to 46 +/- 11 mm Hg on day 1 (p = 0.03), and decreased below baseline values at 1 month to 31 +/- 12 mm Hg (p = 0.07). Peak A-wave velocities increased from 0.51 +/- 0.1 m/s after 1 day to 0.67 +/- 0.2 m/s after 1 month (p = 0.03). Restoration of sinus rhythm in patients with AF resistant to external electrical and/or pharmacologic cardioversion improves hemodynamic and cardiorespiratory function at daily activity exercise levels.
Atrial Fibrillation↗