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Objective: To evaluate the safety and efficacy of catheter ablation in patients with new-onset atrial arrhythmia after surgical excision of left atrial myxoma. Methods: Nine patients with new onset atrial arrhythmia and a prior history of left atrial myxoma, who received surgical myxoma excision and catheter ablation between September 2014 and November 2019, were included in the present study. Baseline characteristics, procedural parameters during catheter ablation, severe perioperative adverse events, recurrence rate of arrhythmia and clinical prognosis were analyzed. Kaplan Meier survival analysis was used to define the maintenance rate of sinus rhythm after catheter ablation in this patient cohort. Results: Nine patients were included. The average age was (55.8 ± 9.1) years old (3 male), there were 3 patients (3/9) with paroxysmal atrial fibrillation (PAF) and 6 patients (6/9) with atrial flutter or atrial tachycardia (AFL or AT). Ablation was successful in all patients, there were no perioperative complications such as stroke, pericardial effusion, cardiac tamponade, vascular complications or massive hemorrhage. During a mean follow-up time of 40.0 (27.5, 55.5) months, sinus rhythm was maintained in six patients (6/9) after the initial catheter ablation. The overall sinus rhythm maintenance rate was 2/3. In addition, 1 out of the 3 AF patients (1/3) developed recurrence of AF at 3 month after ablation, and 2 out of the 6 AFL or AT patients (2/6) developed late recurrence of AF or AFL (19 months and 29 months after ablation), two out of three patients with recurrent AFs or AFL received repeated catheter ablation and one patient remained sinus rhythm post repeat ablation. Meanwhile, there was no recurrence of atrial myxoma, no death, stroke, acute myocardial infarction and other events during the entire follow-up period. Conclusions: Catheter ablation is a safe and feasible therapeutic option for patients with new-onset atrial arrhythmia after surgical excision of left atrial myxoma.
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Background@#Perioperative and median-term follow-up outcomes have not been compared among procedures using radiofrequency ablation devices for permanent atrial fibrillation with concomitant rheumatic valve disease. We compared the sinus rhythm restoration efficacy of "non-irrigation" ablation forceps and an "irrigation" ablation device in patients with rheumatic valve disease undergoing a modified Cox maze radiofrequency ablation procedure due to permanent atrial fibrillation.@*Methods@#Data of 278 patients with rheumatic valve disease from the Cardiac Surgery Department of Sichuan Provincial People’s Hospital who underwent the modified Cox maze radiofrequency ablation procedure between May 2013 and May 2017 were reviewed. The procedure was performed using "non-irrigation" ablation forceps (AtriCure, group A) in 149 patients and an "irrigation" ablation device (Medtronic, group M) in 129 patients. Data were collected prospectively, and follow-up was documented and compared between the groups.@*Results@#The radiofrequency procedure duration was 28.9 ± 3.8 min in group A and 29.5 ± 2.8 min in group M (t = 1.623, P = 0.106). The predicted radiofrequency time to the left atrium diameter was (Ya = 0.4964 X + 0.3762, R2 = 0.74) in group A and (Ym = 0.4331 X + 4.3563, R2 = 0.8435) in group M. The sinus rhythm (SR) conversion rate without use of anti-arrhythmic drugs was similarly good in groups A and M, with 75.2%, 72.5%, and 70.5% vs. 73.6%, 71.3%, and 69.8% at discharge, 6 and 12 months, respectively (F = 0.084, F = 0.046, F = 0.046, P > 0.05, respectively).@*Conclusion@#Two types of radiofrequency ablation devices characteristic of "non-irrigation" and "irrigation" bipolar ablation forceps were similarly efficient at SR restoration.
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@#Objective Through analyzing BKCa channel expression in atrial fibroblasts in patients with sinus rhythm and atrial fibrillation (AF), to explore the mechanism of myocardial fibrosis and provide new therapeutic strategies for the treatment and reversal of AF structure reconstruction. Methods We selected 10 patients of rheumatic heart valvular disease who underwent valve replacement surgery. They were 5 patients with sinus rhythm (a sinus rhythm group, 2 males and 3 females with an average age of 49.1±8.3 years) and 5 with AF (an AF group, 3 males and 2 females with an average age of 50.3±5.8 years). About 100 mg tissue was obtained from the right auricula dextra, and the atrial fibroblasts were cultured by tissue block adherence method, and the expression of BKCa channel genes and proteins in cultured fibroblasts was detected by quantitative real-time polymerase chain reaction (qRT-PCR) and western blotting methods. Results (1) The general data of 10 patients between the AF group and the sinus rhythm group were compared. There was no significant difference between the two groups in age (t=1.21, P=0.67) and sex (t=2.56, P=0.75). There was statistical difference in the left atrial diameter and the right atrium diameter between the two groups (t=19.45, P=0.01; t=23.52, P=0.06); (2) the mRNA expression of BKCa subunit was detected by qRT-PCR method, and there was no significant difference in the mRNA expression of BKCa α and BKCa β1 between the two groups (t=3.14, P=0.79; t=2.88, P=0.69); (3) the expression of BKCa protein was detected by western blotting method, and there was no significant difference in the protein expression of BKCa α and BKCa β1 between the two groups (t=0.55, P=0.31; t=0.73, P=0.46). Conclusion BKCa pathway may not be involved in the pathogenesis and maintenance of AF, but it may play an important role in the process of myocardial fibrosis.
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OBJECTIVE:To compare therapeutic efficacy and safety of nifedipine and atenolol in the treatment of moderate mitral stenosis in sinus rhythm rheumatic heart disease.METHODS:In retrospective analysis,a total of 108 patients with moderate mitral stenosis in sinus rhythm rheumatic heart disease were divided into nifedipine group (54 cases) and atenolol group (54 cases)according to therapeutic regimen.Based on routine treatment,nifedipine group was given Nifedipine sustained-release tablet (Ⅰ)20 mg orally,once a day.Atenolol group was given Atenolol tablet 50 mg orally,once a day.Both groups received treatment for 8 weeks.Clinical efficacies as well as resting heart rate,cardiac function indexes (LVESV,LVEDV,LVET,LVEF,LVMI,E/A),BNP and hs-CRP levels,6 min walking distance,the occurrence of ADR before and after treatment were observed in 2 groups.RESULTS:There was no statistical significance in total response rate and the incidence of ADR between 2 groups (P＞0.05).Before treatment,there was no statistical significance in the levels of resting heart rate,cardiac function indexes,BNP and hs-CRP,6 min walking distance between 2 group (P＞0.05).After treatment,resting heart rate,LVMI,BNP and hs-CRP levels of 2 groups were significantly lower than before treatment,and LVMI,BNP and hs-CRP levels of nifedipine group were significantly lower than those of atenolol group;LVESV,LVEDV,LVET,LVEF,E/A and 6 min walking distance of 2 groups were significantly higher or longer than before treatment,and LVESV,LVET,LVEF,E/A and 6 min walking distance of nifedipine group were significantly higher than those of atenolol group;there was statistical significance (P＜0.05 or P＜0.01).There was no statistical significance in resting heart rate and LVEDV between 2 groups (P＞0.05).CONCLUSIONS:Based on routine treatment,nifedipine is similar to atenolol for moderate mitral stenosis in sinus rhythm rheumatic heart disease in therapeutic efficacy and safety.But nifedipine is better than atenolol in improving cardiac function,neuroendocrine factor levels and exercise ability.
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OBJECTIVE:To compare therapeutic efficacy and safety of nifedipine and atenolol in the treatment of moderate mitral stenosis in sinus rhythm rheumatic heart disease.METHODS:In retrospective analysis,a total of 108 patients with moderate mitral stenosis in sinus rhythm rheumatic heart disease were divided into nifedipine group (54 cases) and atenolol group (54 cases)according to therapeutic regimen.Based on routine treatment,nifedipine group was given Nifedipine sustained-release tablet (Ⅰ)20 mg orally,once a day.Atenolol group was given Atenolol tablet 50 mg orally,once a day.Both groups received treatment for 8 weeks.Clinical efficacies as well as resting heart rate,cardiac function indexes (LVESV,LVEDV,LVET,LVEF,LVMI,E/A),BNP and hs-CRP levels,6 min walking distance,the occurrence of ADR before and after treatment were observed in 2 groups.RESULTS:There was no statistical significance in total response rate and the incidence of ADR between 2 groups (P＞0.05).Before treatment,there was no statistical significance in the levels of resting heart rate,cardiac function indexes,BNP and hs-CRP,6 min walking distance between 2 group (P＞0.05).After treatment,resting heart rate,LVMI,BNP and hs-CRP levels of 2 groups were significantly lower than before treatment,and LVMI,BNP and hs-CRP levels of nifedipine group were significantly lower than those of atenolol group;LVESV,LVEDV,LVET,LVEF,E/A and 6 min walking distance of 2 groups were significantly higher or longer than before treatment,and LVESV,LVET,LVEF,E/A and 6 min walking distance of nifedipine group were significantly higher than those of atenolol group;there was statistical significance (P＜0.05 or P＜0.01).There was no statistical significance in resting heart rate and LVEDV between 2 groups (P＞0.05).CONCLUSIONS:Based on routine treatment,nifedipine is similar to atenolol for moderate mitral stenosis in sinus rhythm rheumatic heart disease in therapeutic efficacy and safety.But nifedipine is better than atenolol in improving cardiac function,neuroendocrine factor levels and exercise ability.
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Aims: To study the levels of interleukin-8 (IL-8) in patients with paroxysmal atrial fibrillation (occurred in <48 hours) and track the changes after restoration of sinus rhythm. Study Design: Prospective. Place and Duration of Study: The study was conducted in the Intensive Cardiology Department of the First Cardiology Clinic at the University Hospital "St. Marina "- Varna for the period October 2010 – May 2012. Methodology: We included 51 patients (26 men, 25 women; mean age 59.84±1.60 years) with paroxysmal atrial fibrillation and 52 controls (26 men, 26 women; 59.50±1.46 years) with no history of atrial fibrillation. The two groups matched by age, gender and clinical characteristics. Patients’ plasma concentrations of IL-8 were measured three times: immediately after admission to the ward (baseline values), twenty-four hours and twenty-eight days after rhythm restoration. In the control group the indicator was tested once. IL-8 was measured using an ELISA kit. In all patients the arrhythmia episode was discontinued by the administration of propafenone. Results: All patients were hospitalized between the second and the twenty-fourth hour after the onset of the arrhythmia, and most frequently in the fifth hour (10 of all 51 patients). Baseline values of IL-8 were increased compared to those of the controls (77.38±3.78 vs 32.18±1.54 pg/mL, p <0.001). Twenty-four hours after restoration of sinus rhythm, IL-8 concentrations were still significantly higher (65.33±3.29 vs 32.18±1.54 pg/mL, p <0.001). On the twenty-eighth day there was no significant difference (28.07±1.68 vs 32.18±1.54 pg/mL, p = 0.07). Conclusion: Plasma concentrations of IL-8 are significantly elevated in the early hours of the clinical manifestation of paroxysmal atrial fibrillation as well as after the arrhythmia discontinuation. Their restoration occurs slowly over time. The established specific dynamics in IL-8 concentrations suggests a close relationship between paroxysmal atrial fibrillation and inflammation.
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Objective: To explore the advantage of RR-Lorenz plot (RR-LP) in analyzing the patients of sinus rhythm with long RR interval. Methods: A total of 308 RR-LP patients with long RR interval were retrospectively studied. The patients were divided into 7 groups according to the type of long RR intervals. ① Sinus bradycardia with arrhythmia group, n=63,②Repeated transient sinus arrest group, n=16, ③Ⅱ° sino-atrial block group, n=14, ④Ⅱ° atrial ventricular block (Ⅱ° AVB) group, n=47, ⑤ Un-passed atrial premature beats (APB) group, n=28, ⑥ Atrial premature beats group, n=72 and ⑦ Premature ventricular beats group, n=68. We analyzed the patients of RR interval greater than 1500 ms with ambulatory electrocardiogram record. Results: ①RR-LP of sinus bradycardia with arrhythmia group showed a single distributing area with 1500 ms for the origin of transverse and longitudinal axis with B line slope at 1, tilt angle of 45°.②RR-LP of repeated transient sinus arrest,Ⅱ° sino-atrial block,Ⅱ° AVB and APB groups showed special four distributing areas with B line slope at (0.51 ± 0.01), tilt angle of (23.04 ± 0.50) °, B line slope at 0.6, tilt angle of (27°), B line slope at (0.57 ± 0.21), tilt angle of (25.69 ± 9.59)° and B line slope at (0.50 ± 0.01), tilt angle of (22.59 ± 0.54) ° respectively.③RR-LP of premature beats groups showed special four regional distributing areas, B line slope for atrial premature beats was at (0.38 ± 0.12), tilt angle of (17.06 ± 5.22) ° and B line slope for ventricular premature beats was at (0.07 ± 0.05), tilt angle of (3.02 ± 2.39) °. Conclusion: RR-LP in patients of sinus rhythm with long RR interval had speciifc morphology and distribution features, the local abnormality could be found in a plane via all RR intervals which provided a differential diagnosis for repeated occurrence of short RR interval.
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Objective To define the incidence and perioperative risk factors of new-onset atrial fibrillation for patients with preoperative sinus rhythm after successful mitral valve replacement.Methods Retrospective analysis was performed on 586 patients with preoperative sinus rhythm who underwent successful mitral valve replacement in our hospital from 1998 to 2008.The cases were classified into postoperative atrial fibrillation (AF group) or postoperative sinus rhythm (SR group).Twenty-nine risk factors including clinical and echocardiography data were selected into univariate analysis by using student' s t test or chi-squared test according to the data type.The factors with a value of P ＜ 0.1 in univariate analysis were assessed by multivariate logistic regression.A value of P ＜ 0.05 (two-sided) was considered to be statistically significant in multivariate logistic regression. ResultsOne hundred and eighteen patients had atrial fibrillation postoperatively. The incidence was 20.1％.Univariate analysis revealed that the factors including age,chronic lung disease,left ventricular mass,left atrial volume,right atrial volume,tricuspid valve regurgitation,heart failure,valvular pathology,postoperative prosthetic mitral effective orifice area index,postoperative mechanical ventilation time,serum levels of potassium and magnesium significantly increased the risk of postoperative atrial fibrillation.However,in multivariate logistic regression,age,left atrial volume and postoperative prosthetic mitral valve effective orifice area index and serum of potassium had significant statistically significances between AF group and SR group.Conclusion Age,left atrial volume,postoperative prosthetic valve effective orifice area index and serum of potassium were significant predictors of postoperative new-onset atrial fibrillation for patients with preoperative sinus rhythm after mitral valve replacement.
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2.5ms, then the R-R interphase is normal, meaning that the rhythm is decreasing gradually after the premature ventricular complex; If TS
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BACKGROUND: To evaluate the influence of changes in mitral valve area (MVA) and left atrial pressure on pulmonary vein flow (PVF) we analyzed PVF with transesophageal echocardiography (TEE) before, after and one-year after percutaneous mitral valvuloplasty (PMV) in patients with mitral stenosis (MS) in sinus rhythm. METHODS: PMV was guided with TEE. Follow-up TEE was done about one year after PMV. MVA and transmitral mean gradient (TMG) were measured. Systolic velocity (S), diastolic velocity (D), atrial reversal velocity (AR), their time-velocity integral (S-TVI, D-TVI, AR-TVI) and their ratio (S/D ratio, S-TVI/D-TVI ratio were evaluated. RESULTS: The number of patients was twenty-two (F:20). The age was 39+/-9 years (range:26-64). Follow-up duration was 16+/-6 months (range:7-28). MVA increased from 0.9+/-0.2 cm2 to 1.9+/-0.3 cm2 after PMV and decreased to 1.7+/-0.3 cm2 on follow-up TEE significantly. TMG decreased from 15.4+/-4.3 mmHg to 5.5+/-1.9 mmHg after PMV and was 6.2+/-2.4 mmHg on follow-up. S increased significantly on follow-up at both pulmonary vein (PV). D increased on follow-up at left PV. S/D ratio increased on follow-up at both PV. AR increased on follow-up at both PV. S-TVI increased after PMV at left PV and increased on follow-up at both PV. D-TVI had no change. S-TVI/D-TVI ratio increased on follow-up at left PV. AR-TVI increased on follow-up at right PV. CONCLUSIONS: The main changes after PMV in patients with MS in sinus rhythm were increasing tendency in S, S-TVI, S/D ratio, S-TVI/D-TVI ratio and AR. And these changes were statistically significant on follow-up TEE rather than immediately after PMV.