Patients with prominent clockwise LR have depressed long-axis systolic velocities of the lateral wall, whereas the patients with counterclockwise LR have depressed septal wall velocities. The difference in peak amplitude of basal septal and lateral systolic velocities is predictive of LR, and in the nonischemic subgroup correlates with quantitative LV reverse remodeling at follow-up. Velocity time-based measures, including septal-lateral delay were not predictive of CRT response.

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Introduction: Inflammation has been suggested as a potential cause of AF. The specific time course and consequence of inflammation, myocardial injury and prothrombotic markers following radiofrequency (RF) ablation for AF has not been studied before.Methods: Ninety consecutive patients undergoing RF catheter ablation for AF were studied. Procedural details were recorded. High-sensitivity CRP (hs-CRP), Troponin-T, creatine kinase-MB (CKMB), fibrinogen and D-Dimer were measured at baseline, one, two, three, seven days and one month post ablation. AF recurrence was documented one, three and six months post procedure.Results: The cohort comprised 53.3% paroxysmal, 34.4% persistent and 12.2% long-standing persistent AF patients. Hs-CRP peaked and was significantly elevated at day 3 (44.29 ± 37.37 mg/L vs. 2.57 ± 2.16 mg/L, p < 0.05) post ablation compared to baseline. Troponin-T (1.61 ± 1.07 g/L vs. 0.05 ± 0.08 g/L, p < 0.05) and CKMB (10.65 ± 5.10 g/L vs. 3.21 ± 1.20 g/L) peaked at day 1 post procedure. Fibrinogen (4.71 ± 1.42 g/L vs. 3.11 ± 0.61 g/L, p < 0.05) and D-Dimer (0.58 ± 0.46 FEU vs. 0.30 ± 0.18 FEU, p < 0.05) levels were significantly elevated at one week post procedure. Increased hs-CRP, Troponin-T and CKMB elevation post ablation was significantly associated with AF recurrence within three days post procedure and increased fibrinogen elevation with AF recurrence at one month, but were not related to AF recurrence at three and six months.Conclusion: Patients undergoing RF ablation for AF exhibit an inflammatory response and myocardial injury within the first few days post ablation. Increased inflammatory response is linked to early AF recurrence but not late recurrence. Prothrombotic markers are elevated one week post ablation and explain the increased risk of thrombotic events post AF ablation.

Background : Left ventricle (LV) of cardiac resynchronization therapy (CRT) candidates often displays rotational motion in the horizontal plane, a phenomenon we named longitudinal rotation (LR). We assessed if magnitude and direction of LR affects myocardial velocity-based measures of LV dyssynchrony. Methods : In 100 CRT patients (age 64±13 yrs, 76 men) LR was assessed in the apical 4-chamber view by speckle-tracking while myocardial systolic velocities of basal septum and lateral LV wall were measured from 2-dimensional color tissue Doppler data. Patients were classified into quartiles based on their LR values. Intraventricular dyssynchrony was calculated as the absolute, while septo-lateral delay was calculated as the true difference between the time to peak systolic velocity of the septum and lateral wall. Results : LR in all quartiles except Quartile 4 had a clockwise (negative) direction when viewed in apical 4-chamber view. As quartiles increased, patients were more frequently ischemic, systolic septal velocity and septo-lateral delay decreased, while intraventricular dyssynchrony showed a U shaped relationship (Table ). While difference in peak amplitude of basal septal and lateral systolic velocities and LR correlated with end-systolic volume (ESV) decrease at follow-up in non-ischemic patients (r = 0.44 and r = 0.49, p < 0.01 for both), neither intraventrivcular dyssynchrony nor septal-lateral delay correlated with ESV decrease in either etiology. Conclusions : LR affects amplitudes and timing of myocardial velocities. While difference in peak amplitude of basal septal and lateral systolic velocities and LR predict LV reverse remodeling, time-based velocity measures do not. ICM:/DCM: ischemic/dilated cardiomyopathy; T(sep/lat): time to peak (septal/lateral) systolic velocity; S(sep/lat): peak systolic (septal/lateral) velocity; S-L delay: septo-lateral delay; Dys: intraventricular dyssynchrony; ΔESV: end-systolic volume decrease