Impact of Smoking on the Atrial Substrate Characteristics in Patients with Atrial Fibrillation

Cigarette smoking is a common health issue throughout the world. It can cause the development of various major diseases, such as chronic obstructive pulmonary disease (COPD), most cardiovascular diseases and many types of cancer. Thus, people with a tobacco habit can produce devastating health consequences for themselves. At present, there are about five million people that die annually, which can be attributed to cigarette smoking, and half of those deaths, which are mortalities from smoking, always occur in middle age. Therefore, how to reduce cigarette smoking remains the most important work to avoid the causes of health disabilities and premature death.

Patient Perspective :Sinus Node Dysfunction in Atrial Fibrillation: Cause or Effect?

Citation : Anna Kezerashvili,Andrew K. Krumerman, John D. Fisher. Sinus Node Dysfunction in Atrial Fibrillation: Cause or Effect? .JAFIB.2008 Sep;1(3): 161-169.

Sick sinus syndrome, also called Sinus node dysfunction (SSS), is a group of abnormal heart rhythms (arrhythmias) presumably caused by a malfunction of the sinus node, the heart's "natural" pacemaker. Bradycardia-tachycardia syndrome is a variant of sick sinus syndrome where atrial flutter and fibrillation alternate with prolonged periods of asystole.

SSS often coexists with Atrial Fibrillation, and in this extensive and interesting review Dr. Fisher et al., from Montefiore Medical Center and Albert Einstein College of Medicine explore the close interplay between the two conditions.

Sinus Node Dysfunction in Atrial Fibrillation: Cause or Effect?

Atrial fibrillation (AF) and sick sinus syndrome (SSS) are two conditions that frequently coexist. Despite a wealth of available knowledge, the link between these two entities is poorly understood. Whether AF is a harbinger of SSS or whether SSS predisposes to AF has been the subject of much debate. AF results in sinus node remodeling on a cellular and molecular basis that may promote SSS. However, not all patients with atrial fibrillation have SSS. Though “AF begets AF”, AF may also beget SSS; and SSS may also beget AF. Multiple studies have demonstrated that sinus node dysfunction may precede the onset of AF. This review will focus on alterations to sinus node structure and function, overdrive suppression, ion channel remodeling, and transient myocardial ischemia as possible mechanisms associated with AF induced SSS. In addition, we will review evidence suggesting that SSS, characterized by a combination of atrial extrasystoles, dispersion of excitability recovery and sinus node ischemia, may lead to AF. Additional factors common to both conditions such as aging and interstitial atrial fibrosis, may explain their coexistence. All this raises many therapeutic challenges associated with the interplay of AF and SSS.

Patient Perspective : GIANT Flutter Waves in ECG Lead V1: a Marker of Pulmonary Hypertension

Citation : James A. Reiffel. GIANT Flutter Waves in ECG Lead V1: a Marker of Pulmonary Hypertension .JAFIB.2008 Sep;1(3): 187-189.

Atrial Flutter is a common heart rhythm abnormality that may or may not be associated with problems cardiac anatomy. The current diagnosis methods with ECG do not offer direct information on the anatomical defect.

In the case report Dr. Reiffel from Section of Electrophysiology, Columbia University College of Physicians and Surgeons and The New York Presbyterian Hospital, NY reports the novel ECG pattern that may allow detection of patients with pulmonary hypertension and Atrial flutter.

Cardiac Image Registration

Long procedure time and somewhat suboptimal results hinder the widespread use of catheter ablation of complex arrhythmias such as atrial fibrillation (AF). Due to lack of contrast differentiation between the area of interest and surrounding structures in a moving organ like heart, there is a lack of proper intraprocedural guidance using current imaging techniques for ablation. Cardiac image registration is currently under investigation and is in clinical use for AF ablation. Cardiac image registration, which involves integration of two images in the context of left atrium (LA), is intermodal, with the acquired image and the real-time reference image residing in different image spaces, and involves optimization, where one image space is transformed into the other. Unlike rigid body registration, cardiac image registration is unique and challenging due to cardiac motion during the cardiac cycle and due to respiration. This review addresses the basic principles of the emerging technique of registration and the inherent limitations as they relate to cardiac imaging and registration.

GIANT Flutter Waves in ECG Lead V1: a Marker of Pulmonary Hypertension

Atrial flutter (AFl) may exist with or without underlying structural heart disease. Typical AFl presents as a “sawtooth” pattern on the ECG – with inverted flutter (F) waves in the inferior leads and upright F waves in V1. This morphology offers no direct clues as to the underlying cardiac disorder, if any. Occasionally we have encountered giant F waves, most prominently in lead V1, reaching 5 mv or more in height – sometimes exceeding the QRS voltage. The significance of this pattern has not been investigated and reported on. To determine if giant F waves in V1 provide any insight into the presence/type/absence of specific underlying cardiac pathology, the history of 6 consecutive patients with giant F waves was reviewed. Upon review, the only factor common to each patient was the presence of or history of pulmonary hypertension. Right ventricular dilation and/or dysfunction and right atrial enlargement with or without tricuspid insufficiency were present in each by echocardiography. Giant F waves appear to occur in the setting of right heart dysfunction in patients with a history of or the continued presence of pulmonary hypertension. Their detection should indicate the need for right heart evaluation.

Patient Perspective : Cardiac Image Registration

Citation : Jasbir Sra.Cardiac Image Registration .JAFIB.2008 Sep;1 (3): 145-160.

Your EP doctor uses state-of-the-art imaging techniques to evaluate and treat Atrial Fibrillation. The currently used imaging methods include Transthoracic echocardiography, Transesophageal echocardiography (or TEE), Intracardiac echocardiography (ICE), Magnetic resonance angiography, MRI and multidetector CT. 

Using these techniques it would be feasible to identify any clots (thormbi) before any procedure. Before any ablation procedure it is important to understand the anatomy of the left atrium and pulmonary vein. 

In this extensive review Dr. Jasbir Sra from Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health- Milwaukee Clinical Campus, Wisconsin discusses the advances in technology for use of imaging methods and comprehensive report on different clinical studies which have used imaging methods in patients with Atrial Fibrillation.