Electrical remodelling of the left and right atria due to rheumatic mitral stenosis
Identifieur interne : 004233 ( Main/Exploration ); précédent : 004232; suivant : 004234Electrical remodelling of the left and right atria due to rheumatic mitral stenosis
Auteurs : Bobby John [Australie, Inde] ; Martin K. Stiles [Australie] ; Pawel Kuklik [Australie] ; Sunil T. Chandy [Inde] ; Glenn D. Young [Australie] ; Lorraine Mackenzie [Australie] ; Lukasz Szumowski [Pologne] ; George Joseph [Inde] ; Jacob Jose [Inde] ; Stephen G. Worthley [Australie] ; Jonathan M. Kalman [Australie] ; Prashanthan Sanders [Australie]Source :
- European Heart Journal [ 0195-668X ] ; 2008-09.
Abstract
Aims To characterize the atrial remodelling in mitral stenosis (MS). Methods and results Twenty-four patients with severe MS undergoing commissurotomy and 24 controls were studied. Electrophysiological evaluation was performed in 12 patients in each group by positioning multi-electrode catheters in both atria to determine the following: effective refractory period (ERP) at 10 sites at 600 and 450 ms; conduction time; conduction delay at the crista terminalis (CT); and vulnerability for atrial fibrillation (AF). P-wave duration (PWD) was determined on the surface ECG. In the remaining 12 patients in each group, electroanatomic maps of both atria were created to determine conduction velocity and identify regions of low voltage and electrical silence. Patients with MS had larger left atria (LA) (P < 0.0001); prolonged PWD (P = 0.0007); prolonged ERP in both LA (P < 0.0001) and right atria (RA) (P < 0.0001); reduced conduction velocity in the LA (P = 0.009) and RA (P < 0.0001); greater number (P < 0.0001) and duration (P< 0.0001) of bipoles along the CT with delayed conduction; lower atrial voltage in the LA (P < 0.0001) and RA (P < 0.0001); and more frequent electrical scar (P = 0.001) compared with controls. Five of twelve with MS and none of the controls developed AF with extra-stimulus (P = 0.02). Conclusion Atrial remodelling in MS is characterized by LA enlargement, loss of myocardium, and scarring associated with widespread and site-specific conduction abnormalities and no change or an increase in ERP. These abnormalities were associated with a heightened inducibility of AF.
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DOI: 10.1093/eurheartj/ehn329
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Young</name></author><author><name sortKey="Mackenzie, Lorraine" sort="Mackenzie, Lorraine" uniqKey="Mackenzie L" first="Lorraine" last="Mackenzie">Lorraine Mackenzie</name></author><author><name sortKey="Szumowski, Lukasz" sort="Szumowski, Lukasz" uniqKey="Szumowski L" first="Lukasz" last="Szumowski">Lukasz Szumowski</name></author><author><name sortKey="Joseph, George" sort="Joseph, George" uniqKey="Joseph G" first="George" last="Joseph">George Joseph</name></author><author><name sortKey="Jose, Jacob" sort="Jose, Jacob" uniqKey="Jose J" first="Jacob" last="Jose">Jacob Jose</name></author><author><name sortKey="Worthley, Stephen G" sort="Worthley, Stephen G" uniqKey="Worthley S" first="Stephen G." last="Worthley">Stephen G. Worthley</name></author><author><name sortKey="Kalman, Jonathan M" sort="Kalman, Jonathan M" uniqKey="Kalman J" first="Jonathan M." last="Kalman">Jonathan M. 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Stiles</name><affiliation wicri:level="1"><country xml:lang="fr">Australie</country><wicri:regionArea>Cardiovascular Research Center, Department of Cardiology, Royal Adelaide Hospital and the Disciplines of Medicine and Physiology, University of Adelaide, Adelaide</wicri:regionArea><wicri:noRegion>Adelaide</wicri:noRegion></affiliation></author><author><name sortKey="Kuklik, Pawel" sort="Kuklik, Pawel" uniqKey="Kuklik P" first="Pawel" last="Kuklik">Pawel Kuklik</name><affiliation wicri:level="1"><country xml:lang="fr">Australie</country><wicri:regionArea>Cardiovascular Research Center, Department of Cardiology, Royal Adelaide Hospital and the Disciplines of Medicine and Physiology, University of Adelaide, Adelaide</wicri:regionArea><wicri:noRegion>Adelaide</wicri:noRegion></affiliation></author><author><name sortKey="Chandy, Sunil T" sort="Chandy, Sunil T" uniqKey="Chandy S" first="Sunil T." last="Chandy">Sunil T. Chandy</name><affiliation wicri:level="1"><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Cardiology, Christian Medical College, Vellore</wicri:regionArea><wicri:noRegion>Vellore</wicri:noRegion></affiliation></author><author><name sortKey="Young, Glenn D" sort="Young, Glenn D" uniqKey="Young G" first="Glenn D." last="Young">Glenn D. Young</name><affiliation wicri:level="1"><country xml:lang="fr">Australie</country><wicri:regionArea>Cardiovascular Research Center, Department of Cardiology, Royal Adelaide Hospital and the Disciplines of Medicine and Physiology, University of Adelaide, Adelaide</wicri:regionArea><wicri:noRegion>Adelaide</wicri:noRegion></affiliation></author><author><name sortKey="Mackenzie, Lorraine" sort="Mackenzie, Lorraine" uniqKey="Mackenzie L" first="Lorraine" last="Mackenzie">Lorraine Mackenzie</name><affiliation wicri:level="1"><country xml:lang="fr">Australie</country><wicri:regionArea>Cardiovascular Research Center, Department of Cardiology, Royal Adelaide Hospital and the Disciplines of Medicine and Physiology, University of Adelaide, Adelaide</wicri:regionArea><wicri:noRegion>Adelaide</wicri:noRegion></affiliation></author><author><name sortKey="Szumowski, Lukasz" sort="Szumowski, Lukasz" uniqKey="Szumowski L" first="Lukasz" last="Szumowski">Lukasz Szumowski</name><affiliation wicri:level="1"><country xml:lang="fr">Pologne</country><wicri:regionArea>Institute of Cardiology, Warsaw</wicri:regionArea><wicri:noRegion>Warsaw</wicri:noRegion></affiliation></author><author><name sortKey="Joseph, George" sort="Joseph, George" uniqKey="Joseph G" first="George" last="Joseph">George Joseph</name><affiliation wicri:level="1"><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Cardiology, Christian Medical College, Vellore</wicri:regionArea><wicri:noRegion>Vellore</wicri:noRegion></affiliation></author><author><name sortKey="Jose, Jacob" sort="Jose, Jacob" uniqKey="Jose J" first="Jacob" last="Jose">Jacob Jose</name><affiliation wicri:level="1"><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Cardiology, Christian Medical College, Vellore</wicri:regionArea><wicri:noRegion>Vellore</wicri:noRegion></affiliation></author><author><name sortKey="Worthley, Stephen G" sort="Worthley, Stephen G" uniqKey="Worthley S" first="Stephen G." last="Worthley">Stephen G. Worthley</name><affiliation wicri:level="1"><country xml:lang="fr">Australie</country><wicri:regionArea>Cardiovascular Research Center, Department of Cardiology, Royal Adelaide Hospital and the Disciplines of Medicine and Physiology, University of Adelaide, Adelaide</wicri:regionArea><wicri:noRegion>Adelaide</wicri:noRegion></affiliation></author><author><name sortKey="Kalman, Jonathan M" sort="Kalman, Jonathan M" uniqKey="Kalman J" first="Jonathan M." last="Kalman">Jonathan M. Kalman</name><affiliation wicri:level="4"><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Victoria</wicri:regionArea><orgName type="university">Université de Melbourne</orgName><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation></author><author><name sortKey="Sanders, Prashanthan" sort="Sanders, Prashanthan" uniqKey="Sanders P" first="Prashanthan" last="Sanders">Prashanthan Sanders</name><affiliation wicri:level="1"><country xml:lang="fr">Australie</country><wicri:regionArea>Cardiovascular Research Center, Department of Cardiology, Royal Adelaide Hospital and the Disciplines of Medicine and Physiology, University of Adelaide, Adelaide</wicri:regionArea><wicri:noRegion>Adelaide</wicri:noRegion></affiliation><affiliation wicri:level="1"><country wicri:rule="url">Australie</country></affiliation><affiliation><wicri:noCountry code="syntax">???</wicri:noCountry></affiliation><affiliation wicri:level="1"><country wicri:rule="url">Australie</country></affiliation></author></analytic><monogr></monogr><series><title level="j">European Heart Journal</title><idno type="ISSN">0195-668X</idno><idno type="eISSN">1522-9645</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2008-09">2008-09</date><biblScope unit="volume">29</biblScope><biblScope unit="issue">18</biblScope><biblScope unit="page" from="2234">2234</biblScope><biblScope unit="page" to="2243">2243</biblScope></imprint><idno type="ISSN">0195-668X</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0195-668X</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Aims To characterize the atrial remodelling in mitral stenosis (MS). Methods and results Twenty-four patients with severe MS undergoing commissurotomy and 24 controls were studied. Electrophysiological evaluation was performed in 12 patients in each group by positioning multi-electrode catheters in both atria to determine the following: effective refractory period (ERP) at 10 sites at 600 and 450 ms; conduction time; conduction delay at the crista terminalis (CT); and vulnerability for atrial fibrillation (AF). P-wave duration (PWD) was determined on the surface ECG. In the remaining 12 patients in each group, electroanatomic maps of both atria were created to determine conduction velocity and identify regions of low voltage and electrical silence. Patients with MS had larger left atria (LA) (P < 0.0001); prolonged PWD (P = 0.0007); prolonged ERP in both LA (P < 0.0001) and right atria (RA) (P < 0.0001); reduced conduction velocity in the LA (P = 0.009) and RA (P < 0.0001); greater number (P < 0.0001) and duration (P< 0.0001) of bipoles along the CT with delayed conduction; lower atrial voltage in the LA (P < 0.0001) and RA (P < 0.0001); and more frequent electrical scar (P = 0.001) compared with controls. Five of twelve with MS and none of the controls developed AF with extra-stimulus (P = 0.02). Conclusion Atrial remodelling in MS is characterized by LA enlargement, loss of myocardium, and scarring associated with widespread and site-specific conduction abnormalities and no change or an increase in ERP. These abnormalities were associated with a heightened inducibility of AF.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Inde</li><li>Pologne</li></country><region><li>Victoria (État)</li></region><settlement><li>Melbourne</li></settlement><orgName><li>Université de Melbourne</li></orgName></list><tree><country name="Australie"><noRegion><name sortKey="John, Bobby" sort="John, Bobby" uniqKey="John B" first="Bobby" last="John">Bobby John</name></noRegion><name sortKey="Kalman, Jonathan M" sort="Kalman, Jonathan M" uniqKey="Kalman J" first="Jonathan M." last="Kalman">Jonathan M. Kalman</name><name sortKey="Kuklik, Pawel" sort="Kuklik, Pawel" uniqKey="Kuklik P" first="Pawel" last="Kuklik">Pawel Kuklik</name><name sortKey="Mackenzie, Lorraine" sort="Mackenzie, Lorraine" uniqKey="Mackenzie L" first="Lorraine" last="Mackenzie">Lorraine Mackenzie</name><name sortKey="Sanders, Prashanthan" sort="Sanders, Prashanthan" uniqKey="Sanders P" first="Prashanthan" last="Sanders">Prashanthan Sanders</name><name sortKey="Sanders, Prashanthan" sort="Sanders, Prashanthan" uniqKey="Sanders P" first="Prashanthan" last="Sanders">Prashanthan Sanders</name><name sortKey="Sanders, Prashanthan" sort="Sanders, Prashanthan" uniqKey="Sanders P" first="Prashanthan" last="Sanders">Prashanthan Sanders</name><name sortKey="Stiles, Martin K" sort="Stiles, Martin K" uniqKey="Stiles M" first="Martin K." last="Stiles">Martin K. Stiles</name><name sortKey="Worthley, Stephen G" sort="Worthley, Stephen G" uniqKey="Worthley S" first="Stephen G." last="Worthley">Stephen G. Worthley</name><name sortKey="Young, Glenn D" sort="Young, Glenn D" uniqKey="Young G" first="Glenn D." last="Young">Glenn D. Young</name></country><country name="Inde"><noRegion><name sortKey="John, Bobby" sort="John, Bobby" uniqKey="John B" first="Bobby" last="John">Bobby John</name></noRegion><name sortKey="Chandy, Sunil T" sort="Chandy, Sunil T" uniqKey="Chandy S" first="Sunil T." last="Chandy">Sunil T. Chandy</name><name sortKey="Jose, Jacob" sort="Jose, Jacob" uniqKey="Jose J" first="Jacob" last="Jose">Jacob Jose</name><name sortKey="Joseph, George" sort="Joseph, George" uniqKey="Joseph G" first="George" last="Joseph">George Joseph</name></country><country name="Pologne"><noRegion><name sortKey="Szumowski, Lukasz" sort="Szumowski, Lukasz" uniqKey="Szumowski L" first="Lukasz" last="Szumowski">Lukasz Szumowski</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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