ABSTRACT
BACKGROUND@#Legg-Calvé-Perthes disease (LCPD) is still a refractory disease in children’s orthopedics. With the introduction of the concept of ‘‘osteoimmunology’’, the immune-inflammatory mechanisms between bone and immune system have become a research focus of LCPD. However, few studies have reported on the pathological role of inflammation-related receptors such as toll-like receptors (TLRs) as well as immune cells such as macrophages in LCPD. This study was for investigating the mechanism of TLR4 signaling pathway on the direction of macrophage polarization and the repair of avascular necrosis of femoral epiphysis in LCPD. @*METHODS@#With GSE57614 and GSE74089, differentially expressed genes were screened. Through enrichment analysis and protein–protein interaction network, the functions of TLR4 were explored. Furthermore, immunohistochemistry, enzyme-linked immunosorbent assay (ELISA), hematoxylin & eosin (H&E) staining, micro-CT, tartrate-resistant acid phosphatase (TRAP) dyeing and western blotting were performed for determining the influences of TAK-242 (a TLR4 inhibitor) on the repair of avascular necrosis of femoral epiphysis in rat models. @*RESULTS@#Totally 40 co-expression genes were screened as well as enriched in TLR4 signaling pathway. Immunohistochemistry and ELISA analyses certified that TLR4 facilitated macrophage polarization toward the M1 phenotype and prevented macrophage polarization toward the M2 phenotype. Besides, the results of H&E and TRAP staining, micro-CT, and western blotting showed that TAK-242 can inhibit osteoclastogenesis and promote osteogenesis. @*CONCLUSION@#Inhibition of TLR4 signaling pathway accelerated the repair of avascular necrosis of femoral epiphysis by regulating macrophage polarization in LCPD.
ABSTRACT
Objectives@#This study explored the relationship between weight control and atrial fibrillation (AF) recurrence after catheter ablation in overweight and obese patients.@*Methods@#We prospectively enrolled consecutive 333 overweight and obese patients aged 28 to 87 years old, who underwent catheter ablation for AF in Beijing Anzhen Hospital between October 2015 and February 2016. Data of patients′ characteristics, laboratory examination and treatment were collected at baseline. Each patient was followed up at 3, 6 and 12 months after ablation to collect information on weight, AF recurrence, stroke, major bleeding, hospitalization for cardiovascular reasons and death, etc. Patients were divided into weight controlled group (ΔBMI<-1 kg/m2) and weight uncontrolled group (ΔBMI≥-1 kg/m2), according to the changes in the most recent exposure BMI before AF recurrence in patients with recurrence or the BMI at 12 months′ follow-up in patients without recurrence and the BMI at baseline. Multivariate logistic regression was performed to adjust other known risk factors of AF recurrence and to explore the association between weight control and AF recurrence after catheter ablation.@*Results@#There were 54 patients in weight controlled group and 279 patients in weight uncontrolled group. There were no significant differences in age, gender, education level, left atrial size and history of hypertension between the two groups (all P>0.05). The proportion of patients using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was higher in the weight controlled group (50.0%(27/54) vs. 34.8%(97/279), P=0.034). However, there was no significant difference in the proportion of patients with obesity (33.3% (18/54) vs. 29.7% (83/279)), paroxysmal AF (59.3% (32/54) vs. 56.6% (158/279)) and AF duration less than 5 years (76.9% (40/52) vs. 65.4% (178/272)) between the weight controlled group and the uncontrolled group. During 1-year follow-up after ablation, the recurrence rate of AF was significantly lower in the weight controlled group than that in the weight uncontrolled group (14.8% (8/54) vs. 32.6%(91/279), P=0.009). Multivariable logistic regression analysis shows that weight control is independently associated with a lower postoperative AF recurrence rate (OR=0.40, 95%CI 0.18-0.90, P=0.026).@*Conclusion@#Weight control is strongly associated with a lower AF recurrence rate after catheter ablation in overweight and obese patients.
ABSTRACT
Objective To investigate associations of herpes simplex virus(HSV)infection with elevated high-sensitivity C-reactive protein(hsCRP)level and the development of atrial fibrillation(AF) in elderly individuals.Methods Through screening a total of 2,603 individuals,49 patients aged 60 years or over with AF and without structural heart diseases and known risk factors for AF were selected for data collection.Fifty-five elderly healthy control subjects were selected from a population based Chinese Arrhythmia Registry.Baseline characteristics,plasma antibody levels against HSV-1 and-2,and level of hsCRP were analyzed.Results Level of antibodies against HSV-1 was significantly higher in AF patients[(314.5±63.6)mg/L than in control subjects(216.0±50.7) mg/L,P＜0.01].Level of antibodies against HSV-2 was significantly higher in AF patients[(400.1±50.7) mg/L than in control subjects (306.3 ± 64.5) mg/L,P ＜ 0.01].Linear regression analysis demonstrated a positive correlation of plasma levels of hsCRP with both anti-HSV-1 and anti-HSV-2 IgG antibodies (r =0.291,0.188,all P ＜ 0.01).In multiple logistic regression analysis,HSV-1 and HSV-2 antibody levels were significantly associated with AF occurrence(OR =1.035 and 1.034,all P ＜0.01).The optimal cut-off point for predicting AF occurrence was 284.96 mg/L for anti-HSV-1 with sensitivity of 67.3％ and a specificity of 92.7％,and was 366.26 mg/L for anti-HSV-2 with a sensitivity of 67.3％ and a specificity of 85.5％,respectively.Conclusions The increased plasma levels of anti-HSV-1 and anti-HSV-2 antibodies are significantly associated with AF occurrence in elderly adults.
ABSTRACT
Objective The recurrence of perimitral atrial tachycardia is common after initial ablation of persistent atrial fibrillation (AF). The aim of the study is to explore a preferable ablation approach for perimitral atrial tachycardia in the redo ablation of persistent AF. Methods Seventy-four patients with perimitral atrial tachycardia after initial ablation for persistent AF were included in our study. Patients were distinguished into either the group of having ablation during tachycardia (Group A) or the group having ablation after cardioversion to sinus rhythm (Group B) according to the different ablation strategies. The procedural endpoints were pulmonary vein isolation and bidirectional conduction block of all the ablated lines. The primary endpoint of the study was freedom from atrial tachyarrhythmia recurrence during the follow-up period. Results There were statistical differences in baseline clinical data between the 2 groups. During the redo procedure, conduction recovery rate across the mitral isthmus (MI),cavotricuspid isthmus and left atial roofline were 100％, 40.5％ and 48.6％ respectively. The procedural time, fluoroscopy time, mapping time were longer in the patients of group A. During a mean follow-up of (16.9±6.3) months, 31 (72.1％) patients in group A and 21(67.7％) patients in group B maintained in sinus rhythm in the absence of antiarrhythmic durgs (P =0.771) . Conclusion In patients with perimitral atrial tachycardia after initial ablation for persistent AF,ablation in sinus rhythm is a more simplified method and as effective as ablation during tachycardia.
ABSTRACT
Objective To investigate the effect of thyroxine replacement therapy with residual subclinical hypothyroidism on the success rate of catheter ablation in elderly patients with atrial fibrillation(AF).Methods Among the consecutive patients with AF who underwent a first AF ablation in our center between 2009 and 2012,we identified 56 patients(41 paroxysmal AF,15 persistent AF)with subclinical clinical hypothyroidism after receiving thyroid hormone replacement therapy as study group.The control group consisted of 56 patients with euthyroidism and no history of thyroid dysfunction.All patients underwent catheter ablation.Results At the end of follow up,37.5%(21/56)patients were AF free after the first procedure in the study group,in comparison to 64.3%(36/56)in control group(χ2=8.655,P=0.003).Last procedure was performed in 27 patients of study group and in 15 patients of control group.After the last performed ablation,62.5%(35/56)study group patients and 80.4%(45/56)controls group patients had no recurrence(χ2=4.653,P=0.031).The major complications rate did not differ between two groups(P=0.642).Conclusions Thyroid hormone replacement therapy with residual subclinical hypothyroidism reduces catheter ablation success rate in elderly patients with atrial fibrillation.
ABSTRACT
Objective To investigate ablation characteristics of PVC/VT originating from left ventricle anterior papillary muscles.Methods This study included 10 patients of PVC/VT originating from left ventricle anterior papillary muscles from January 2015 to June 2016 in Beijing Anzhen Hospital.Electrophysiological mapping and radiofrequency ablation were completed using three-dimensional anatomical mapping system combined with three-dimensional intracardiac ultrasound technology.ECG and abaltion target diagram characteristics as well as the special anatomy were explored.Results All the 10 patients were successfully ablated and followed up for 12 months.One patient had recurrence within 12 months and no complications were recorded.The target sites localized at the tip (n =1),middle portion(n =4)or the base (n =5) of the LV-APM.Among 7 patients,the target sites were located at the anterior septal papillary muscle and in 3 patients were located in the free papillary muscle.9 patients were successfully ablated via anterograde trans-septal catheterization after the failure of retrograde approach.Premature QRS wave time were 152.80 ± 11.72 ms and 6 patients presented sharp potential at the targets during PVC/VT.Conclusions PVC/VT originating from left ventricle anterior papillary muscles have similar ECG and diagram characteristics that is different from which originating from left anterior fascicle.It is recommended to get the target via transseptalpuncure approach.Ablation target could be clearly positioned by three-dimensional intracardiac ultrasound technology.
ABSTRACT
Objective Cryoballoon ablation of pulmonary vein (PV) ostia often induces a vagal response.This prospective study was designed to assess the effectiveness of prophylactic intravenous administration of atropine on hemodynamic impairment induced by cryoballoon ablation in patients with atrial fibrillation.Methods Twenty-five patients with paroxysmal atrial fibrillation undergoing cryoballoon ablation were prospectively enrolled and assigned to either the trial group on the control group.First twelve patients (the trial group) were administered 1 mg of atropine before deflation of the cryoballoon,while the following 13 patients (the control group) were given atropine only after the onset of the hemodynamic variation (decrease in heart rate and/or blood pressure).Treatment was considered effective when the hemodynamic variations were restored.Results In the trial group,three patients with transient hypotension did not require further supportive care throughout the procedures and one patient with hypotension required supportive management.In the control group,hypotension,bradycardia and mixed bradycardia with hypotension requiring supportive care occurred in six,three,and three patients,respectively.Overall,the rate of marked vagal responses was significantly lower when prophylactic atropine was administrated (4/12 vs.12/13 patients,P ＜ 0.01).Conclusions Atropine is effective in the prevention of all types of vasovagal responses induced by cryoballoon ablation in patients with atrial fibrillation.
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the efficacy of catheter ablation in Chinese hypertrophic cardiomyopathy (HCM) patients with atrial fibrillation (AF), and to determine the risk factors of AF recurrence.</p><p><b>METHODS</b>This study enrolled 40 HCM patients with AF who underwent primary AF ablation at Beijing Anzhen Hospital from June 2005 to June 2013. Ablation strategy included bilateral pulmonary vein isolation (PVI) for paroxysmal AF (n = 27) and PVI plus left atrial roof, mitral isthmus and tricuspid isthmus linear ablations for persistent AF (n = 13). AF recurrence was followed-up by means of electrocardiography or Holter monitoring. Risk factors associated with AF recurrence were determined by a Cox regression model and the predictive power was evaluated by receiver operating characteristic (ROC) curve.</p><p><b>RESULTS</b>After (34 ± 18) months follow-up, 30% (12/40) cases remained in sinus rhythm off antiarrhythmic drug, most AF recurrence (18/28, 64.3%) occurred within 1 year post ablation. Multivariate Cox regression demonstrated that left atrial dimension (LAD, HR = 1.124, 95% CI 1.051-1.202, P = 0.001) and female gender (HR = 3.304, 95% CI 1.397-7.817, P = 0.007) were independent risk factors of AF recurrence. The cut-off value of LAD at 43.5 mm predicted AF recurrence with sensitivity of 93.5% and specificity of 60.0%. Every 1 mm enlargement in LAD was associated with an increased risk of arrhythmia recurrence (HR = 1.095, 95% CI 1.031-1.163, P = 0.003).</p><p><b>CONCLUSIONS</b>AF ablation in Chinese HCM patients is safe and feasible. However, sinus rhythm maintenance rate is low at long-time follow-up. Most of the recurrent AF occurs within 1 year post AF ablation procedure. Left atrial diameter and female gender are independent risk factors of AF recurrence.</p>
Subject(s)
Female , Humans , Male , Anti-Arrhythmia Agents , Atrial Fibrillation , Pathology , Therapeutics , Beijing , Cardiomyopathy, Hypertrophic , Catheter Ablation , Electrocardiography , Electrocardiography, Ambulatory , Heart Atria , Pulmonary Veins , ROC Curve , Recurrence , Risk Factors , Sensitivity and Specificity , Treatment OutcomeABSTRACT
Objectives To address whether menopause affects outcome of catheter ablation (CA) for atrial fibrillation (AF) by comparing the safety and long-term outcome of a single-procedure in pre-and post-menopausal women. Methods A total of 743 female patients who underwent a single CA procedure of drug-refractory AF were retrospectively analyzed. The differences in clinical presentation and outcomes of CA for AF between the pre-menopausal women (PreM group, 94 patients, 12.7%) and the post-menopausal women (PostM group, 649 patients, 87.3%) were assessed. Results The patients in the PreM group were younger (P<0.001) and less likely to have hypertension (P<0.001) and diabetes (P=0.005) than those in the PostM group. The two groups were similar with regards to the proportion of concomitant mitral valve regurgitation coronary artery disease, left atrium dimensions, and left ventricular ejection fraction. The overall rate of complica-tions related to AF ablation was similar in both groups (P=0.385). After 43 (16-108) months of follow-up, the success rate of ablation was 54.3%in the PreM group and 54.2%in the PostM group (P=0.842). The overall freedom from atrial tachyarrhythmia recurrence was simi-lar in both groups. Menopause was not found to be an independent predictive factor of the recurrence of atrial tachyarrhythmia. Conclusions The long-term outcomes of single-procedure CA for AF are similar in pre-and post-menopausal women. Results indicated that CA of AF appears to be as safe and effective in pre-menopausal women as in post-menopausal women.
ABSTRACT
Objective Identify the mechanism of induced atrial arrhythmias after pulmonary vein isolation (PVI) in patients with paroxysmal atrial ifbrillation(PAF), and investigate its long-term prognosis. Methods All patients with PAF undergoing PVI and induction test afterwards between Feburary 2010 and October 2010 were included. The induction protocol was rapid pacing initiated at cycle length of 250 ms with progressive shortening in a decrement of 10 ms down to 180 ms or refractoriness. Isoproterenol of 2-4μg/min was administrated as well. Inducibility was deifned as induction of atrial arrhythmia lasting >1 min. The mechanism of induced tachycardia was identiifed by activation mapping and entrainment mapping under the guidance of CARTO system. All patients were followed up by 36 months. Results Forty-nine atrial tachycardia were induced in 39 (19.7%) patients, including 35 organized atrial tachycardia (OAT) and 14 atrial ifbrillation (AF). The LA diameter was signiifcantly larger in inducible group than non-inducible group (39.5±6.6 mm vs. 36.7±5.2 mm, P=0.004). Macroreentry was the most common mechanism in induced OATs (28, 80.0%), and mitral isthmus was the most common critical site (20, 40.8%), followed by cavo-tricuspid isthmus (12, 24.5%), PV (6, 12.2%), LA septum (4, 8.2%), superior vena cava (3, 6.1%) and LA roof (1, 2.0%). Conclusions The most common mechanism of induced tachycardia by IV isoproterenol and rapid pacing is MI and CTI dependent after PVI in PAF patients, which can be succssefully eliminated by liner ablation, not increasing long-term recurrence rate.
ABSTRACT
Objective To observe the management and outcome of the cardiac tamponade patients during the ablation procedure using two different anticoagulation strategies. Methods All the patients developed tamponade during the ablation procedure were enrolled from January 2007 to December 2013 in our center. In group 1, warfarin was discontinued 3 to 5 days before the procedure and low molecular weight heparin (LMWH) was administered subcutaneously until ablation procedure day. In group 2, warfarin was not discontinued and the international normalized ratio INR was to maintained between 2 and 3. Results There were 27 patients (0.6%) developed cardiac tamponade out of a total 4487 patients received ablation in our center. The baseline clinical characteristics including age, left atrium, the heparin dose and ACT during the procedure had no signiifcant difference between the groups, except that the INR was higher in the group 2 (0.9±0.1 vs. 2.3±0.5, P0.999). The median hospital day was similar in the 2 groups [(9.6±3.3) d vs. (12.1±4.5) d, P=0.167]. There were no other serious complications and no hospital death. Conclusions Non-discontinuation of warfarin during peri-procedural catheter ablation of AF is not signiifcantly different to bridging with LMWH in the management and outcome of acute cardiac tamponade.
ABSTRACT
Objective To investigate the gender differences of coronary heart disease secondary prevention status in patients post percutaneous coronary intervention (PCI). Methods Patients diagnosed with coronary heart disease from 31 tertiary hospitals were enrolled for a baseline survey. Medical history and laboratory tests were taken. Analysis was done for outpatient or inpatient with the history of at least one PCI treatment. Status of smoking cessation, weight management, blood pressure < 140/90 mm Hg, low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL (2.6 mmol/L), and use of antiplatlet drugs, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB) and statins were collected and compared. Results Women (n=1151) accounted for 25.4% of all PCI patients (n=4532). Proportion of female with history of smoking was signiifcantly lower than male, but the proportion of quitting was similar between female and male, 53%(n=98) vs. 53.7%(n=1344), P=0.849. The average body mass index, mean waist circumference and proportion of overweight were higher in man than women, P=0.000. However, the proportion of abdominal obesity in women is higher than men, 75.2%vs. 52.8%, P=0.000. More female were comorbid with hypertension, hyperlipidemia and diabetes than male and the differences were signiifcant, P=0.000. Control rate of blood pressure, LDL-C and fasting glucose were lower in women than in man, the differences were 66.2% vs 73.4% for blood pressure, 47.8%vs. 57.0%for LDL-C and 57.5%vs. 62.7%for fasting glucose, P=0.000. There was no signiifcant difference in medication usage between different genders. Conclusions In patients post pecutaneous coronary intervention, female patients had more risk factors than male while risk factor control rate was lower comparing with male. Medication usage for coronary heart disease secondary prevention was similar between different genders.
ABSTRACT
OBJECTlVE To investigate the mechanism of verapamiI in the treatment of type 2 Iong QT syndrome(LQT2)using a rabbit Ieft ventricuIar myocardiaI wedge preparation. METHODS E-4031 (0.5 μmoI·L-1 )was used to induce the LQT2 modeI after rabbit Ieft ventricuIar wedge preparations were equiIibrated for 1 h,and verapamiI(0.5,1.0 and 2.5 μmoI·L-1 ,respectiveIy)was perfused in different groups. Data were coIIected for a period of 30 min starting 30 min after adding the respective drug. Transmembrane action potentiaIs of endocardiaI and epicardiaI myocardium were recorded simuItaneous-Iy at a basic cycIe Iength of 2000 ms(S1S1)together with a transmuraI ECG. The effect of verapamiI (0.5,1.0 and 2.5 μmoI·L-1 )on action potentiaI duration at 90% repoIarization(APD90 ),QT intervaI, transmuraI dispersion of repoIarization(TDR)and the deveIopment of earIy afterdepoIarization(EAD) and torsades de pointes(TdP)were evaIuated in the LQT2 myocardiaI wedge modeI. RESULTS E-4031 (0.5 μmoI·L-1 )markedIy proIonged endocardiaI and epicardiaI APD90 and QT intervaI( P﹤0.01),and dramaticaIIy increased TDR(P﹤0.01). Spontaneous or programmed eIectricaI stimuIation-induced EAD and TdP were aIso observed in the modeI. VerapamiI(0.5,1.0 and 2.5 μmoI·L-1 )dose-dependentIy abbreviated endocardiaI and epicardiaI APD90 and QT intervaI(P﹤0.01),significantIy decreased TDR(P﹤0.01),and suppressed EAD and TdP in the LQT2 modeI. Concordant but stronger effects on the eIectro-physioIogicaI properties of the LQT2 modeI were noticed when nifedipine was perfused. CONCLUSlON VerapamiI inhibits TdP in the LQT2 modeI by reducing TDR and suppressing EAD.
ABSTRACT
Objective To identify the electrophysiological charateristics and cause of ridge gap related reentry after MI ablation in atrial ifbrillation patients. Methods Activation and entrainment mapping was performed in 82 redo cases for OAT recurrence in whom MI was ablated during the index produre. Once ridge gap related reentry was conifrmed, detailed mapping was performed in MI and ridge region. In addition, in 36 cases undergoing MI ablation and fulfilling criterion for bidirectional block, differential pacing was repeated at the ridge to identify a ridge gap. Results Out of 82 redo cases for OAT recurrence in whom MI was ablated during the index produre, 7 (8.5%) was found to be ridge gap related reentry. TCL was (247.9±19.2) ms, and the left atrial endocardial activation time was (145.4±17.7) ms, accounting for (58.5±3.2)%of TCL. However, wide double potential was recorded along the previous ablated MI line where PPI was (34.3±6.6) ms longer than TCL, while PPI was signiifcantly shorter at the ridge[PPI-TCL (11.4±3.9) ms, P<0.001]. Tachycardia was terminated at the ridge in 6 cases and at the corresponding site in coronary sinus in 1 case. No recurrence was found during follow-up for (11.1±4.5) months. In addition, in 36 patients undergoing MI ablation in whom criterion of bi-directional block was fuliflled, conduction gap located at the ridge was found in 5 (13.9%) cases. Conclusions MI ridge gap related reentry is a distinctive OAT, in which the ridge was used as the critical isthmus, whereas the previous ablated MI line is not part of the reentry. MI pseudo-block due to the ridge gap may lead to this type of recurrent tachycardia.
ABSTRACT
<p><b>BACKGROUND</b>Neutrophil/lymphocyte ratio (NLR) has been proposed as a novel marker of systemic inflammation and oxidative stress. The objective of this study was to ascertain the relationship between levels of NLR and recurrence of lone atrial fibrillation (AF) after catheter ablation.</p><p><b>METHODS</b>A total of 379 lone AF patients who underwent catheter ablation were enrolled in the study. The NLR before and after catheter ablation was determined. Cox regression analyses were used to estimate the relationship between NLR and the recurrence of lone AF.</p><p><b>RESULTS</b>After a mean follow-up of (30.5 ± 5.3) months, 124 (32.7%) patients had AF recurrences. The patients who developed AF recurrence had a higher postablation NLR (post-NLR) than patients with no recurrence (5.74 ± 1.55 vs. 4.66 ± 1.27, P < 0.001). Multivariate Cox regression analysis revealed that post-NLR (hazard ratio (HR) 1.514, 95% confidence interval (CI) 1.364-1.680, P < 0.001), left atrium diameter (HR 1.035, 95% CI 1.001-1.071, P = 0.04) and body mass index (HR 1.028, 95% CI 1.002-1.054, P = 0.03) were independent predictors of AF recurrence. Using a cut-off level of 5.15, post-NLR predicted AF recurrence with a sensitivity of 73% and specificity of 67%.</p><p><b>CONCLUSIONS</b>Our results indicate that an elevated post-NLR is associated with a high rate of lone AF recurrence. A simple measurement of NLR may help us to identify high-risk patients who need pharmacologic intervention to prevent recurrence.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Atrial Fibrillation , General Surgery , Catheter Ablation , Lymphocytes , Allergy and Immunology , Neutrophils , Allergy and Immunology , Proportional Hazards ModelsABSTRACT
Objective To evaluate the clinical efficacy and safety of catheter ablation for atrial fibrillation in elderly patients.Methods From September 2008 to October 2011,a total of 420 consecutive patients undergoing catheter ablation of atrial fibrillation (AF) were selected.The patients were divided into 3 age groups:30 59 yr group (n=279),60-74 yr group (n=100),and 75-87 yr group (n =41).The effect of operation and complications during operative and postoperative periods were evaluated.Patients were followed up for at least 6 months,and the rate of atrial fibrillation reocurrence and life quality were recorded.Results Among 480 catheter ablation procedures,in 7 (1.5％) patients occurred main complications,while in 5 (1.0％) patients appeared other complications.The incidence of main complications in 3 groups were 1.1％ (3 patients),2.0％ (2 patients) and 4.9％ (2 patients) respectively,other complication rates in 3 groups were 0.7％ (2 patients),1.0％ (1 patient) and 4.9％ (2 patients) respectively and there were no differences between groups (all P＞0.05).During follow-up,the cases without AF relapse were 68.5％ (191 patients),66.0％ (66 patients) and 57.1％ (23 patients) respectively,and the patients with AF paroxysm were 21.1％ (59 patients),21.0％ (21 patients),29.3％ (12 patients) respectively,and there was no significant difference between groups (all P＞0.05).And no difference was found in improvement degree of life quality among three groups (P＞0.05).Conclusions Catheter ablation is safe and effective in elderly patients.For patients over 75 years with many types of cardiovascular diseases,catheter ablation is effective to control the relapse of AF,can significantly improve the quality of life,and has no increased risk of complications.
ABSTRACT
Objective To evaluate the feasibility of speckle-tracking echocardiography in detecting left atrial (LA) function impairment in early hypertensive (HT) patients.Methods Echocardiography was performed in 154 HT patients with LA volume index ＜28 ml/m2 and 64 age/gender-matched control subjects.LA global longitudinal strain in late diastole (Sa),systole (Ss),and total strain (Stot =Sa + Ss),strain rate in late diastole (SRa),systole (SRs),and early diastole (SRe) were measured using off-line speckle-tracking analyzing software in apical 4 chamber view.Results Both parameters reflecting LA reservoir function [Stot (23.7 ± 6.0) ％ vs (25.7 ± 5.9) ％,p =0.03 and SRs ( 1.2 ± 0.3) s- 1 vs ( 1.3 ±0.3) s-1,P =0.03]and conduit function [Ss (12.0 ± 5.1)％ vs (14.0±5.7)％,P =0.02 and SRe (1.0 ± 0.4)s- 1 vs ( 1.2 ± 0.4)s- 1,p ＜0.001 ]decreased significantly in HT group than control,while LA pump function parameters (Sa and SRa) had no differences.Ss,Stot and SRe correlated significantly with HT and HT duration.Conclusions LA phasic function are impaired in HT patients with normal LA size.Speckle tracking echocardiography is a promising tool for the early detection of LA dysfunction.
ABSTRACT
BACKGROUND:Circumferential pulmonary vein antrum ablations guided by CARTO system or integration of a computed tomographic or magnetic resonance imaging scan (CARTO-Merge) are two main locating methods.Theoretically,CARTO-Merge provides a detailed appreciation of the pulmonary vein anatomy,however,whether it can improve the safety and success of catheter ablation of atrial fibrillation remains uncertainly.OBJECTIVE:To explore the effect of CT image integration into three-dimensional (3D) electroanatomical mapping system on clinical outcomes of catheter ablation of atrial fibrillation.DESIGN,TIME AND SETTING:The randomized contrast observation was performed at Department of Cardiology of Beijing Anzhen Hospital from October 2005 to May 2007.PARTICIPANTS:A total of 93 patients with drugs refractory,paroxysmal atrial fibrillation who underwent circumferential pulmonary vein antrum ablation.METHODS:All patients underwent circumferential pulmonary vein antrum ablation using irdgated radiofreguency ablation with the endpoint of electrical isolation.Ablation was guided by 3D mapping alone in 50 patients (CARTO group) or by CT image integration in 43 patients (CARTO-Merge group).MAIN OUTCOME MEASURES:Procedure-related parameters,such as procedure duration,fluoroscopy duration,cumulative success rate and complication,were compared between the two groups.RESULTS:Pulmonary veins were isolated in all patients.After (12.6±2.9) months follow-up,73 (78.5%) patients did not have recurrence of atrial fibrillation at 3 month after the procedure.The fluoroscopy time in CARTO group was significant longer than that in CARTO-Merge group (P<0.05).The mean procedure duration,radiofrequency ablation duration,procedure-related complication and cumulative success rate were comparable between the 2 groups.CONCLUSION:Circumferential pulmonary vein antrum ablation guided by 3D mapping alone or by CT integration had similar safety and success rate in paroxysmal atrial fibrillation patients.But CT integration,which facilitated to a detailed representation of the anatomy of left atrium,is associated with reduced fluoroscopy duration.
ABSTRACT
ObjectiveAnalyzing the left atrium and pulmonary vein morphologicallv by 64 multislice spiral CT(MSCT)scan to guide the catheter ablation of Atrial fibrillation.MethodsTwo hundred and thirty-two patients(146 cases in atrial fibrillation group and 86 cases in control group)received 64 MSCT examination of the left atrium and pulmonary vein.The incidence of anatomical variation of pulmonary vein was compared between atrial fibrillation group and control group. For each group,the anatomical morphology ot every pulmonary vein and the auricle of left atrium was analyzed, the diameter of the orifice of each pulmonary vein and the size of left atrium were measured.ResultsSixty-four MSCT of left atrium and pulmonary vein could demonstrate detailed connecting type between left atrium and pulmonary Veins and the possible anatomieal variation. Anatomical variation of pulmonary vein in this study accounted for 16.8% (39/232)of total sample. For both groups,orifices of pulmonary veins appeared oval and their superoinferior diameters were larger than their anteroposterior diameters. There was significant difference in the inner diameter of left atrium between atrial fibrillation group and control group[atrial fibrillation group:(39.47±8.98)mm,control group:(36.94 ±5.49)mm,P=0.02],while there was no difference in the diameters of orifices ot puhnonary veins between two groups [ superoinferior diameters of pulmonary veins in atrial fibrillation group:left-up(18.15±1.35)mm,left-down(16.96 ±1.18)mm,right-up(17.50±
ABSTRACT
To study the effect of of lidocaine and amiodarone on the transmural heterogeneity of ventricular repolarization in isolated rabbit hearts model of sustained global ischemia and to explore the mechanisms underlying the antiarrhythmic activity of lidocaine and amiodarone, rabbits were randomly divided into 4 groups: control group, ischemia group, lidocaine group and amiodarone group. By the monophasic action potential (MAP) recording technique, MAPs of recorded across the left ventricular free wall in rabbit hearts perfused transmural dispersion of repolarization (TDR) and arrhythmic induced by ischemia. Our results showed that TDR of three myocardial layers in ischemia group were significantly lengthened after ischemia. TDR was increased from 17.5±3.9 ms to 31.2±4.6 ms at the time that concided with the onset of sustained ventricle arrhythmic. Amiodarone could decrease TDR, but lidocaine could increase TDR at initial ischemia, and no significant difference was found at other ischemia time points. 5 cases had ventriclar arrhythmia in ischemia group (62.5 %), but no case in lidocaine group (P<0.01) and only 1 case in amiodarone group had ventrilar arrhythmia (P< 0.01). No significant difference was found between amiodarone group and lidocaine group. It is concluded that TDR of of three myocardial layers increases significantly at ischemia and it is closely associated with development of ventricular arrhythmia, and amiodarone could decrease TDR, but lidocaine could increase TDR at initial ischemia and has no effects at other ischemia time points.