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Objective To analyze the clinical characteristics and follow-up data of catheter ablation of recurrent atrial tachycardias (ATs) after Mini-Maze surgery,and to explore prognostic factors for recurrence.Methods 59 patients in Guangdong General Hospital with ATs post Mini-Maze and concomitant open-heart surgery from April.2010 to June.2015 were included.According to high density precise mapping,activation mapping,voltage mapping and entrainment mapping,they underwent electrophysiological study and ablation which was guided by three-dimensional mapping system.All patients were followed up regularly.We explored the prognostic factors for recurrence by the Cox regression analysis.Results There were 88 types of ATs being mappedwith mean (1.49 ± 0.75) types of ATs identified per case.Most ATs were macro-reentry ATs(67/88,76.1％)and focal ATs (20/88,22.7％),respectively.56 patients (94.9％) achieved immediate ablation success.In a mean follow-up of (30.8 ± 17.7) months,recurrences were observed in 12 patients after the first time catheter ablation.Recurrent time was 3.5 (1.3,12.0) months and the overall ablation success rate was 74.6％ (44/59).6 patients received second ablation and the achievement of freedom from arrhythmias reached 79.7％ (47/59).Multivariate analysis showed that the LA diameter was the independent predictor for recurrence (HR 1.108,95％ CI 1.002 to 1.226,P =0.045).Conclusion Catheter ablation of ATs post Mini-Maze with concomitant surgery is save and feasible.LA diameter is the independent predictor for recurrence.
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Objective:To compare diagnostic effect between coronary CT angiography (CTA) and intravascular ultra-sound (IVUS) for coronary calcified lesion .Methods:A total of 50 patients ,who were diagnosed as coronary heart disease (CHD) or suspected CHD in our hospital ,were selected .All patients received coronary CTA and IVUS ex-amination .Characteristics of coronary artery plaques and CT values of different types of plaques were observed , coronary CTA diagnostic effect was evaluated according IVUS as control .Results:There were no significant differ-ence between two methods in plaque area ,plaque burden and lumen area;CT value of calcified plaques was signifi-cantly higher than those of fibrous plaques and fatty plaques [ (725.68 ± 68.42) Hu vs .(58.12 ± 7.05) Hu ,(60.21 ± 6.78) Hu ,P<0.01 both];Sensitivity ,specificity ,accuracy ,positive predictive value and negative predictive val-ue of coronary CTA for diagnosing calcified plaques were 92. 86% ,92. 86% ,92. 86% ,81. 25% and 97. 50% respec-tively .Conclusion:Coronary CT angiography possesses higher diagnostic effect for qualitative and quantitative de-tection of coronary calcified lesions ,which can be regarded as a preferred screening method .
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Objective To observe efifcacy and safety of catheter ablation for atrial ifbrillation (AF) occurring after surgical valve replacement in patients with rheumatic heart disease (RHD). Methods A total of 23 RHD patients with atrial ifbrillation after surgical valve replacement were enrolled in this study from 2008 to 2013. The clinical characteristics, ablation strategies and successful rate were investigated. Results All the cases included 8 males and 15 females (age, 51.0 ± 9.2 years). Valves replaced were isolated mitral valves (13/23, 56.5%) and multiple valves (10/23, 43.5%). Postoperative AF after cardiac surgery was paroxysmal in 14 patients (60.9%) and nonparoxysmal in 9 cases. Nine patients (39.1%) was in sinus rhythm before cardiac surgery, 4 in paroxysmal AF and 10 in non-paroxysmal AF. The mean interval between the catheter ablation AF and the surgical intervention was (6.9±5.8) years. The postoperative AF duration was (3.1±3.2) years, left and right atrial diameters were (44.1±5.9) mm and (48.1±9.0) mm respectively, left ventricular ejection fraction was 64.0%±8.3%, the mean ablation procedure duration was (156.8±46.6) min, and lfuoroscopy exposure averaged (27.3±11.2) min. Standard pulmonary vein isolation was performed in all cases by using ipsilateral circumferential ablation technique. Additional ablation, including complex fractionated atrial electrograms, mitral and tricuspid isthmus, and left atrial roof, was applied in most of the cases. After a mean follow-up of (29.7±21.2) months (median, 24 months), 60.9%of the patients remained free of AF, 1 died, and 2 lost to follow-up. Conclusions Catheter ablation for AF is effective and safe in patients with RHD after surgical valve replacement. Stepwise ablation strategy may be better for these patients.
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Objective To investigate the level and the source of inflammatory factors in patients with paroxysmal atrial fibrillation.Methods Thirty patients with paroxysmal atrial fibrillation were selected as observation group,and 20 cases of patients with paroxysmal supraventricular tachycardia were selected as control group.The blood samples of coronary sinus,right atria,left atria and femoral vein were consecutively collected during the procedure of radiofrequency ablation.The level of tumor necrosis factor (TNF)-α,soluble tumor necrosis factor receptor-1 (sTNFR1),and interleukin(IL)-6 was detected by ELISA separately and compared between two groups.Results The level of TNF-α and IL-6 of coronary sinus,right atria,left atria and femoral vein in observation group was significantly higher than that in control group [TNF-α:(4.45 ± 1.76) ng/L vs.(0.59 ± 0.36) ng/L,(6.67 ± 1.43) ng/L vs.(0.51 ± 0.30) ng/L,(8.35 ± 2.03) ng/L vs.(0.85 ± 0.50) ng/L,(9.97 ± 2.70) ng/L vs.(0.28 ± 0.29) ng/L,P=0.000;IL-6:(2.02 ± 0.87) ng/L vs.(1.04 ± 0.63) ng/L,(1.51 ± 0.68) ng/L vs.(0.74 ± 0.26) ng/L,(2.00 ± 0.51) ng/L vs.(0.88 ± 0.35) ng/L,(1.32 ±0.47) ng/L vs.(0.48 ±0.28) ng/L,P =0.000].The level of high sensitivity C reactive protein (hs-CRP) in observation group was significantly higher than that in control group [(2.41 ± 1.35) mg/L vs.(1.10 ±0.53) mg/L,P =0.002].The level of TNF-αof left atrium in observation group was significantly higher than that of other three sites (P=0.000).The level of IL-6 in the coronary sinus and femoral vein was significantly increased,compared with that in the right atria and left atria (P ＜ 0.05).The level of sTNFR 1 in the femoral vein,right atria and coronary sinus difference was not statistically significant (P ＞ 0.05),but was significantly higher than that in the left atria(P ＜ 0.05).The level of TNF-α,IL-6 and hs-CRP was correlated with the diameter of left atrium (LAD) (P ＜ 0.01 or ＜ 0.05).The level of sTNFR1 in left atria was positively correlated with LAD,and the level of sTNFR1 in right atria was negatively correlated with LAD (P ＜ 0.01).Conclusions The level of TNF-α,IL-6 and hs-CRP is increased in patients with paroxysmal atrial fibrillation.TNF-α and IL-6 may come from the heart and is related with the enlargement of left atrium.
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Objective To evaluate left atrial function serial change after circumferential pulmonary vein ablation(CPVA)for paroxysmal atrial fibrillation using tissue Doppler echocardiography.Methods One hundred and eight patients with paroxysmal atrial fibrillation underwent CPVA guided by CARTO.Tissue Doppler imaging and conventional echocardiography were underwent 48 h before CPVA,48 h,1 month,3 month and 6 month after CPVA.Results One hundred and six patients with paroxysmal atrial fibrillation finished CPVA successfully.Compared tO 48 h pre-CPVA,left atrial diameter and volume decreased 48 h,1 month,3 month,6 month after CPVA,significant change were found at 3 month,6 month after CPVA(P＜0.05).Left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD).left ventricular ejection fraction(LVEF),mitral flow E revealed no significant change(P＞0.05).Mitral flow A decreased significantly 48 h after CPVA(P＜0.05),restored significantly after 3 month.Tissue Doppler parameter S'and E'revealed no significant change(P＞0.05)through the period,A'decreased significantly 48 h after CPVA(P＜0.05),restored significantlv after 1 month.Conclusions Left atrial diameter and volume decreased after CPVA.Left atrial active contraction function decreased shortly after CPVA(LA stunning),and restored progressively.
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Objective To identify the emergency factors associated with health-related quality of life(HRQOL)6 months after acute myocardial infarction.Methods HRQOL was assessed in 89 emergency patients 6 months after acute myocardial infarction,using the SF-36 health survey questionnaire.Multivariate linear regression analysis and analysis of covariance were applied to data analysis to identify the emergency factors associated with HRQOL.Results The sum scores of the SF-36 health survey and scores on 4 of the 8 dimensions showed negative linear correlation with age(P
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AIM: To screen and identify the differentially expressed genes in lymphocytes of patients with unstable angina in order to find the molecular mechanism of unstable angina. METHODS: Suppression subtractive hybridizations (SSH) and dot blot hybridizations were performed to screen the relatively differentially expressed genes in lymphocyte RNA between the patients with unstable angina pectoris and stable angina pectoris. The obtained expressed sequence tags (ESTs) were used as probes to perform Reverse Northern blot with forward and reverse suppression products. And the positive ESTs were performed RNA slot hybridization with unstable and stable angina group. The obtained ESTs were sequenced and analyzed using BLAST (nr) at NCBI. RESULTS: Three up-regulated ESTs in the unstable angina group, and one down-regulated EST in the stable angina group were obtained. All of them are sequences of known genes. CONCLUSION: All these ESTs may be associated with the unstablization of plaque of coronary artery in patients with unstable angina.