Interpretation of Chinese guidelines on diagnosis and management of atrial fibrillation: Emergency management / 中国胸心血管外科临床杂志

@#The Chinese Guidelines on Diagnosis and Management of Atrial Fibrillation, jointly formulated by the Chinese Society of Cardiology, Chinese Medical Association and the Heart Rhythm Committee of Chinese Society of Biomedical Engineering, was first released on June 15, 2023. The guidelines elaborate the various aspects of atrial fibrillation management, in which emergency management of atrial fibrillation is also an integral part. This article interpreted the emergency management part in the guidelines in detail by reviewing relevant literature.

The Chinese expert recommendations on the clinical use of dronedarone / 中华内科杂志

Dronedarone, a class Ⅲ antiarrhythmic drug, is a deiodinated benzofuran derivative of amiodarone. It has similar antiarrhythmic effects with amiodarone, but much lesser adverse effects than amiodarone, particularly in those outside the heart. It is suggested to use dronedarone for the rhythm control of atrial fibrillation/flutter, for it has been shown to prevent the recurrence of atrial fibrillation/flutter and reduce rehospitalization in patients with paroxysmal or persistent atrial fibrillation/flutter. Dronedarone is not recommended for the rhythm control in patients with long-term persistent atrial fibrillation or permanent atrial fibrillation, and atrial flutter or atrial fibrillation patients with reduced ejection fraction. Liver function, electrolyte tests and an electrocardiogram should be performed before and after the drug initiation. Potential interactions with other kinds of drugs have to be taken into consideration as well.

Comparison of Rhythm and Rate Control Strategies for Stroke Occurrence in a Prospective Cohort of Atrial Fibrillation Patients

PURPOSE: Comparisons of rhythm and rate control strategies for stroke prevention in patients with atrial fibrillation (AF) are still inconclusive. We compared differences in clinical outcomes between the rhythm and rate control strategies. MATERIALS AND METHODS: The COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) registry prospectively enrolled 6000 patients who were treated for AF using real-world guideline adherence at multiple referral centers. In total, 2508 (41.8%) patients were clinically followed up for over six months. Of these, 1134 (45.2 %) patients treated by rhythm control and 1374 (54.8 %) patients treated by rate control were analyzed for clinical outcomes, including stroke and cardiovascular outcomes. RESULTS: Among all patients (age, 68±10 years; male, 62.4%), those treated with the rhythm control strategy were significantly younger, had more symptomatic paroxysmal AF, and a shorter AF duration, and were less likely to have diabetes, renal dysfunction, and heart failure, compared to those treated with the rate control strategy (CHA₂DS₂-VASc score 2.4±1.5 vs. 3.1±1.7, p < 0.001). Even though oral anticoagulation was similarly prescribed in both groups, occurrence of stroke was less likely to occur in the rhythm control strategy group (0.0% vs. 0.7%, p=0.015). Multivariate Cox hazard regression showed that only age, especially more than 75 years old, were significantly correlated with the occurrence of stroke, regardless of the strategy used for treatment. CONCLUSION: In this prospective AF cohort, compared with the rate control strategy, the rhythm control strategy was associated with fewer cardiovascular events and strokes in a short-term period.

The Mechanism of and Preventive Therapy for Stroke in Patients with Atrial Fibrillation / 대한뇌졸중학회지

Atrial fibrillation is a major cardiac cause of stroke, and a pathogenesis involving thrombus formation in patients with atrial fibrillation is well established. A strategy for rhythm control that involves catheter ablation and anticoagulation therapy is evolving. A strategy for rhythm control that restores and maintains sinus rhythm should reduce the risk of ischemic stroke that is associated with atrial fibrillation; however, this is yet to be proven in large-scale randomized controlled trials. This paper reviews the emerging role of rhythm control therapy for atrial fibrillation to prevent stroke.

Bioinformatics and expression pattern analysis of BpNOS gene in Betula platyphylla / 中草药

Objective: Nitric oxide synthase (NOS) is a kind of important NOS in organisms. The gene cloning and expression pattern analysis of NOS in plant laid the foundation for study on the biological functions of nitric oxide in plants. Methods: NOS gene in B. platyphylla was cloned by RACE technology, named BpNOS. Bioinformatics and molecular evolution analysis, abiotic stress, and signal induced of the gene were preliminarily carried out. Results: This full-length gene was 1 806 bp with the complete ORF, encoding 601 amino acids (Genebank ID: KJ197336). BpNOS was an unstable hydrophobic protein. This protein may exist signal peptide with transmembrane ability. The alpha helix, extension chain, random coil distributed throughout the protein. Molecular evolution analysis results showed that the genetic distance of BpNOS gene was closer to the gene genetic distance of grape species NOS, which indicates the relatively close relationship between them; While the genetic distance of BpNOS gene was farther from soybean and alfalfa, which explains that the relationship of them is far. The expression of BpNOS has rhythm, reached the maximum at 15: 00, 12 times as at 0: 00. The expression of BpNOS gene could be inhibited by salt, low temperature, and heavy metal cadmium stress, but in a different response pattern. The expression of BpNOS gene could be promoted by salicylic acid and exogenous NO. Conclusion: Abiotic stress could inhibit the activity of NOS. The salicylic acid and exogenous NO could be synthesized by NOS pathway to regulate endogenous NO. This paper lays a solid foundation for the further research on the metabolic regulation of NO in B. platyphylla.

Atrial fibrillation in the elderly / 老年心脏病学杂志（英文版）

Atrial fibrillation (AF) is an extremely common condition in the elderly, with increasing prevalence around the world as the population ages. AF may be associated with serious health consequences, including stroke, heart failure, and decreased quality of life, so that careful management of AF by geriatric health care providers is required. With careful attention to anticoagulation therapy, and prudent use of medications and invasive procedures to minimize symptoms, many of the adverse health consequences of AF can be prevented.