ABSTRACT
Objective To evaluate the application of real-time three-dimensional transesophogeal echocardiography(RT-3D TEE)in percutaneous left atrial appendage closure and its follow-up in patients with non-valvular atrial fibrillation.Methods Fifteen patients including 6 males and 9 females were refractory to percutaneous closure of left atrial appendage.The morphology of the left atrial appendage (LAA)in those patients was evaluated by RT-3D TEE.Combined with two-dimensional transesophogeal echocardiography(2D-TEE),RT-3D TEE was performed during the procedure of LAA occlusion,including the measurement of left atrial appendage,the selection of occluder,the puncture of atrial septal,the delivery and release of occlusive device.Finally,it was also used immediately to evaluate the effect of blocking and complications after the operation.The closure effect and related complication were also evaluated by RT-3D TEE at 3 months and 1 2 months followed up,respectively.Results Fifteen patients were successfully undergone the LAA closure procedures with LAmbre TM device.The dimension of LAA landing zone was (21.60±4.08)mm,the measurement of cardiac angiography(CAG)during the procedure was(20.91 ± 3.93)mm and finally the fixed plate size of LAmbreTMdevice was(26.13±4.69)mm.Correlation between the measurements by RT-3D TEE and selective angiography was significant(r =0.84,P =0.0001). Bland-Altman plot showed that 86.67% of plots were among limits of agreement.The width of the flow jet was <3 mm near the LAA closure device in 2 patients immediately after the procedure.At the 3 months and 1 2 months follow-up,the LAA closures had good morphology,fixed position,and no thrombus formation on the surface.There was still slight flow j et near the closure device in 2 patients at that time. Conclusions RT-3D TEE plays an important role in the procedure of left atrial appendage closure and its follow-up.There is better correlation and consistency between the measurements by RT-3D TEE and CAG.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the association between CHADS2 score and long-term ( ≥ 3 years) outcomes post catheter ablation in patients with atrial fibrillation (AF).</p><p><b>METHODS</b>AF patients who received single catheter ablation in our hospital from January 2004 to March 2009 in our department were included and patients received regular follow-up. AF recurrence was defined as the occurrence of atrial arrhythmias (AF, atrial flutter and atrial tachycardia) recorded by electrocardiogram monitor ( ≥ 30 seconds) after ablation during follow-up period (after 3 months blanking period). The relationship between baseline clinical and echocardiographic characteristics and the time to recurrence during follow-up was evaluated using Cox multivariate analysis.</p><p><b>RESULTS</b>A total of 280 patients who received single catheter ablation procedure were included in the study, 3 patients died and there were 50 patients lost to follow-up. A total of 227 patients with AF (163 paroxysmal and 64 non-paroxysmal ) were enrolled in the final analysis. During a median follow-up of 51 months (41-56 months), 109 patients experienced AF recurrences and the recurrence rate after catheter ablation ( ≥ 3 years) was 48.0% (109/227). Cox multivariate analysis showed that the high CHADS2 score (HR: 1.417, 95%CI 1.194-1.682, P < 0.001) and AF non-termination during ablation (HR: 2.077, 95%CI 1.380-3.126, P = 0.043) were risk factors of AF recurrence. AF recurrence rates in the termination and non-termination group were 41.0% (75/183) and 77.3% (34/44), respectively. In the AF termination group, the recurrence rates and the median recurrence free time in patients with CHADS2 score ≥ 3 were 80.0% (12/15) and 1 year, respectively. In the non-AF termination group, the recurrence rates in patients with CHADS2 score = 0, CHADS2 score = 1-2 and CHADS2 score ≥ 3 were 60.0% (6/10), 77.8% (21/27) and 100% (7/7), respectively; the median recurrence free time of patients with CHADS2 score = 0, CHADS2 score = 1-2 and CHADS2 score ≥ 3 were 30 months, 12 months and 6 months, respectively.</p><p><b>CONCLUSIONS</b>CHADS2 score is a predictor of AF recurrences after catheter ablation. Patients with high CHADS2 score is associated with higher risk of long-term ( ≥ 3 years) AF recurrences.</p>