Importance of Atrial Contraction in Hypertrophic Obstructive Cardiomyopathy: Implications for Pacing Therapy

Recurrent unilateral pleural effusion in a hypertrophic cardiomyopathy patient secondary to atrial arrhythmias and the role of radiofrequency ablation

Heart failure (HF) is a common cause of pleural effusion. Atrial tachyarrhythmias (ATa) can precipitate HF. ATa precipitating unilateral pleural effusion (PLE) has not been reported. We report a case of ATa in a patient with hypertrophic cardiomyopathy with recurrent unilateral rightsided PLE and resolution of effusion with catheter ablation of the arrhythmia.

Intra- and interatrial conduction delay: implications for cardiac pacing

Atrial conduction disorders are frequent in elderly subjects and/or those with structural heart diseases, mainly mitral valve disease, hyperthrophic cardiomyopathies, and hypertension. The resultant electrophysiological and electromechanical abnormalities are associated with a higher risk of paroxysmal or persistent atrial tachyarrhythmias, either atrial fibrillation, typical or atypical flutter or other forms of atrial tachycardias. Such an association is not fortuitous because intra- and interatrial conduction abnormalities delays disrupt (spatial and temporal dispersion) electrical activation, thus promoting the initiation and perpetuation of reentrant circuits. Preventive therapeutic interventions induce variable, sometimes paradoxical effects as with the proarrhythmic effect of class I antiarrhythmic drugs. Similarly, atrial pacing may promote proarrhythmias or an antiarrhythmic effect according to the pacing site(s) and mode. Multisite atrial pacing was conceived to correct, as much as possible, abnormal activation induced by spontaneous intra- or interatrial conduction disorders or by single site atrial pacing, which are situations responsible for commonly refractory arrhythmias. Atrial electrical resynchronization can also be used to correct mechanical abnormalities like left heart AV dyssynchrony resulting from intraatrial conduction delays.