Atrial and ventricular cardiomyopathy associated with premature atrial contractions: Speckle-tracking echocardiography demonstrates reversibility following successful ablation

Figures

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  Figure 1. Electrocardiograms (ECG) of the ectopic beats. A: Monitored ECG 2 years prior to patient’s visit. B, C: Twelve-lead ECG showing sinus rhythm with ectopic beats (B) and premature atrial complexes (PAC; C) with or without different degrees of aberrancy.

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  Figure 2. Catheter ablation of premature atrial complexes (PACs). A: Intracardiac electrogram showing the earliest local atrial signals during short runs of PACs. B: The earliest site is noted in the right inferior pulmonary vein (RIPV) near the carina (red spot). C: A radiofrequency application at the earliest site resulted in the elimination of all PACs. Subscripts d, m, and p indicate the distal, mid, and proximal electrode pairs of the relevant catheter. ABL = ablation catheter; CS = coronary sinus; IVC = Inferior vena cava, LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; PA = posterior-anterior; RA = right atrium; RAO = right anterior oblique; RSPV = right superior pulmonary vein; SVC = superior vena cava.

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  Figure 3. Difference in the left ventricle (LV) and left atrium (LA) function using speckle-tracking strain imaging before and 5 months after ablation. A, B: Comparisons of the LV function quantified by 2-dimensional (2D) speckle-tracking imaging (EchoPAC; GE Healthcare, Horten, Norway) between that before (A) and that 5 months after the PAC ablation (B), which was obtained from the apical 2-chamber view. The global LV longitudinal strain was assessed by measuring the average of the peak longitudinal strain across 18 segments obtained from the apical 2-chamber, 3-chamber, and 4-chamber views, respectively, at a frame rate of ≥70 frames per second. The intraventricular dyssynchrony was defined as the difference in the time-to-peak of the earliest and latest activated segments among the 6 segments for each view. C, D: Comparisons of the LA function quantified by 2D speckle-tracking imaging between that before (C) and that 5 months after the PAC ablation (D), which was obtained from the apical 2-chamber view. The global LA reservoir strain, contractile strain (averaged across 12 segments: apical 4- and 2-chamber views), and intra-atrial dyssynchrony were obtained by the same methods used for…