ABSTRACT
Objective: To explore the impact of atrial fibrillation (AF) on clinical outcomes in patients with cardiac resynchronization therapy (CRT). Methods: A total of 258 arrhythmia patients who received CRT in our hospital from 2010-01 to 2014-12 were retrospectively enrolled. According to AF occurrence, the patients were divided into 2 groups: AF group,n=42 and Non-AF group,n=216. The end point events were deifned by heart failure (HF) re-admission and all-cause death (including heart transplantation). Survival curve was drawn by Kaplan-Meier method, clinical prognosis was comparedbetween 2 groups with log-rank test and the impact of AF on end point prediction was analyzed by uni- and multivariate Cox proportional-hazards regression models. Results: There were 16.3% (42/258) patients combining AF. The following indexes were statistically different between AF group and Non-AF group: patients' age, the ratios of male gender and left bundle branch block (LBBB), eGFR, blood levels of creatinine, uric acid, big endothelin-1, left atrial diameter and application of amiodarone. With the median of 22 months follow-up study, there were 33/258 (12.8%) patients died, 5 (1.9%) received heart transplantation and 72 (27.9%) with HF re-admission. Survival analysisindicated that HF re-admission rate in AF group was higher than Non-AF group (χ2=6.651,P=0.010), all cause mortality was similar between 2 groups (χ2=0.528,P=0.468). Univariate Cox proportional-hazards regression analysis showed that AF, LBBB, higher blood levels of creatinine, big endothelin-1 and large left atrium were the suspiciousrisk factors for HF re-admission; increased blood levels of creatinine, big endothelin-1 and large left atrium were thesuspiciousrisk factors for all cause death. Multivariate Cox proportional-hazards regression analysis presented that AF was not the independent risk factor for HF re-admission and all-cause death, while largeleft atrium was the independent risk factor for HF re-admission (HR=1.041, 95% CI 1.007-1.075,P=0.018); large left atrium and increased serum creatinine were the independent risk factors for all cause death (HR=1.045, 95% CI 1.001-1.091,P=0.048) and (HR=1.008, 95% CI 1.001-1.015,P=0.035) respectively. Conclusion: AF was associated with the higher rate of HF re-admission in CRT patients; while no clear evidencesupported that AF was the independent risk factor for HF re-admission and all cause death in CRT patients.
ABSTRACT
Objective: To evaluate left atrial (LA) function and synchrony in lone atrial fibrillation (LAF) patients by two-dimensional speckle tracking echocardiography (2D-STE) and to explore the predictive value of 2D-STE parameters for AF recurrence after ablation procedure. Methods: Our research included in 2 groups: LAF group,n=50 patients diagnosed in our hospital from 2013-06 to 2015-05; it was further divided into 2 subgroups as Non-LA enlargement subgroup,n=34 and LA enlargement subgroup,n=16 and Control group,n=35 healthy subjects. With sinus rhythm, 2D-STE was conducted to obtain LA peak ventricular systolic longitudinal strain (PALS), strain rate (SRs) and atrial contraction longitudinal strain (ACLS), strain rate (SRa). Standard deviation for the time to peak (TPSD) of regional strain was calculated. TPSD during ventricular systole was named as SDs and TPSD during ventriculardiastole was named asSDa. Results: Compared with Control group, LAF group had reduced PALS (28.34±8.57) vs (38.73±6.13), SRs (1.17±0.31) vs (1.57±0.25), ACLS (14.11±4.91) vs (18.86±3.57 ) and SRa (-1.41±0.58) vs (-1.90±0.30), allP<0.05; while elevated SDs (8.11±3.00) % vs (4.67±1.48) % and SDa (5.57±2.26) % vs (3.11±1.13) %, bothP<0.05. Furthermore, Compared with Control group, Non-LA enlargement subgroup had decreased PALS, SRs, ACLS and SRa, allP<0.05; while increased SDs and SDa, bothP<0.05. Logistic regression analysis indicated that compared with traditional parameters, SDs and SDa could more effectively distinguish LAF patients from normal subjects (SDs with the sensitivity 83%, speciifcity 72% and SDa with the sensitivity 81%, speciifcity 76%). Elevated SDa and SDs were the best predictors for post-operative AF recurrence (SDs with the sensitivity 80%, speciifcity 71% and SDa with the sensitivity 86%, speciifcity 79%). Conclusion: 2D-STE may detect LA dysfunction and dyssynchrony in LAF patients, abnormal parameters could be found in LAF patients without LA enlargement. SDs and SDa were the best predictors for post-operative AF recurrence.
ABSTRACT
Objective: To explore the relationship between serum level of high-sensitivity cardiac troponin T (hs-cTnT) and atrial ifbrillation (AF) occurrence in patients with stable coronary artery disease (CAD). Methods: A total of 1011 patients with stable CAD treated in our hospital from 2013-01 to 2015-09 were retrospectively studied. According to quartiles of hs-cTnT, the patients were divided into 4 groups: Group① the patients with hs-cTnT≤7ng/L, n=283, Group② hs-cTnT 7-10ng/L,n=238, Group③ hs-cTnT 10-15ng/L,n=272 and Group④ hs-cTnT>15ng/L,n=218. The relationship between hs-cTnT level and AF occurrence rate was studied; the risk factors for AF occurrence were explored by multi stepwise Logistic regression analysis. Results: There were 127/1011 (12.6%) patients combining AF and 884 (87.4%) with simple type stable CAD. AF patients had the higher serum level of hs-cTnT than non-AF patients 17.0 (12.0, 25.0) ng/L vs 10.0 (7.0, 13.0) ng/L,P Conclusion: Increased serum level of hs-cTnT was closely related to AF occurrence in patients with stable CAD.
ABSTRACT
Objective: To explore current status of antithrombotic therapy in patients with non-valvular atrial ifbrillation (NVAF) at Macau area of china via clinical data analysis. Methods: A total of 472 NVAF patients treated in Centro Hospitalar Conde de S?o Januário (CHCSJ) from 2014-01 to 2041-12 were enrolled. The patients were at the age of (73.0±10.9) years including 197 (41.7%) female and 244 (51.7%)≥75 years. The baseline condition, clinical characteristics and antithrombotic therapy were analyzed; relevant scores were calculated, CHA2DS2-VASc score≥2 was deifned as high risk of stroke and HAS-BLED score≥3 was deifned as high risk of bleeding. Results: The average CHA2DS2-VASc score was (3.4±1.8) and 389/472 (82.4%) patients with CHA2DS2-VASc scor≥2; the mean HAS-BLED score was (1.96±1.03) and 132 (28.0%) patients with HAS-BLED score≥3. There were 184 (38.9%) patients received antiplatelet therapy, 101 (21.4%) received warfarin, 156 (33.1%) received new oral anticoagulant drug and 22 patients taken both antiplatelet and anticoagulant treatments simultaneously; 53 (11.2%) patients had no antithrombotic therapy. The patients with high risk of stroke had the higher rate of anticoagulant therapy (215/472, 55.3%) and the application rate of new anticoagulant drug was higher than warfarin. Conclusion: NVAF patients had the higher risk of stroke as more than 80% with CHA2DS2-VASc score≥2 and most patients received anticoagulant therapy in Macau area. The application rate of new anticoagulant drug was higher than warfarin.
ABSTRACT
Objective: To understand the cognition status for risk factors and early symptoms of stroke via face to face questionnaire survey in 336 in-hospital patients with atrial ifbrillation (AF). Methods: A face to face questionnaire survey was conducted by uniformly trained investigators in 336 AF patients who were admitted in our hospital more than 3 days from 2014-04-01 to 2014-10-01. Results: There were 300/336 AF patients ifnished the questionnaire and among them 131 (43.7%) patients know that AF may increase the risk of stroke and 169 (56.3%) patients unknown or uncertain. There were 41.3%-79.3% patients having cognition for early symptoms of stroke and only 25.3% (76/300) patients may identify all 5 early signs of stroke. Conclusion: In our research, AF patients had poor cognition for the risk and early signs of stroke. Medical professional should intensify the propaganda and education for stroke prevention.
ABSTRACT
Objective: To observe the impact of high thoracic epidural blockade (HTEB) on atrial autonomic nerve remodeling in dogs with atrial ifbrillation (AF) induced by long-term rapid right atrial appendage pacing and to explore the effect of nerve growth factor (NGF) on atrial autonomic nerve remodeling. Methods: AF model was established by consistent rapid atrial pacing for 6 weeks. 18 experimental dogs were randomly divided into 3 groups: Sham group, the dogs had no pacing while received normal saline injection; Control group, the dogs had pacing and normal saline injection; HTEB group, the dogs had pacing and 0.5% lidocaine injection for HTEB.n=6 in each group. Atrial myocardium collagen volume fraction (CVF) was examined by Masson staining; sprouting of NGF related protein 43 (GAP43) and tyrosine hydroxylase (TH) were assessed by immunohistochemistry; protein expressions of NGF, GAP43 and TH were measured by Western blot analysis. Results: Compared with Sham group, HTEB group showed decreased CVF and sprouting of GAP43, TH,P Conclusion: Long-term rapid atrial pacing induced AF dog had inhomogeneous sprouting of atrial myocardial nerve which may cause autonomic nerve remodeling; NGF played the important role in such process. HTEB could effectively inhibit NGF up-regulation and suppress the autonomic nerve remodeling in experimental dogs.
ABSTRACT
Objective:To explore the effect of endothelin-1 on atrial ifbrosis in patients with atrial ifbrillation (AF). Methods: A total of 72 patients with thoracotomy were studied, the patients were divided into 2 groups:AF group, n=39 and Sinus rhythm (SR) group, n=33. The mRNA and protein expressions of endothelin-1 (ET-1), platelet derived growth factor-B (PDGF-B) and collagen I (COL1) in right atrial appendage (RAA) tissue were measured by RT-PCR and Western blot analysis;meanwhile, the impact of ET-1 stimulation and non-selective ET-1 receptor antagonist (sulfafurazole SIZ) on PDGF-B mRNA and protein expressions in H9c2 cells were measured. Results: ①The RAA tissue mRNA and protein expressions in AF group were higher than those in SR group, as for ET-1 (2.830 ± 2.276) vs (1.220 ± 0.887) and (0.835 ± 0.241) vs (0.286 ± 0.083), both P Conclusion: ET-1 plays an important role in AF occurrence which might be related to PDGF-B regulation.
ABSTRACT
Objective: To investigate the safety and efficacy of CARTO3 fast anatomical mapping during radiofrequency ablation in patients with paroxysmal atrial ifbrillation (PAF). Methods: A total of 120 PAF patients treated in our hospital from 2013-01 to 2015-07 were enrolled. All patients received CARTO3 system for mapping and they were randomly divided into 2 groups: Control group, the patients had selective pulmonary vein angiography, followed by conventional point by point method to reconstruct left atrial model for guiding the ablation of PFA and Treatment group, the patients had selective pulmonary vein angiography followed by fast anatomical mapping to build left atrial model for guiding the ablation of PFA; the rest operational steps such as trans-septal and circumferential pulmonary vein ablation were the same.n=60 in each group. The times of operation, X-ray exposure and the rates of success, complication occurrence were compared between 2 groups. Results: All patients were successfully completed radiofrequency ablation for PAF. Compared with Control group, Treatment group had increased modeling time (8.5 ± 3.6) min vs (5.2 ± 2.3) min, while decreased pulmonary vein ostium determing time (12.0 ± 5.6) min vs (25.0 ± 8.4) min, circumferential pulmonary vein ablation time (95.0 ± 22.0) min vs (115.0 ± 25.0) min and X-ray exposure time (15.0 ± 6.3) min vs (24.0 ±5.5) min, allP0.05. Conclusion: CARTO3 fast anatomical mapping is safe and effective for guiding radiofrequency ablation in PAF patients, it may decrease the X-ray exposure time and operation time which were important for treating the relevant patients.
ABSTRACT
Objective: To explore the occurrence rate of permanent pacemaker implantation (PPI) with relevant risk factors in patients after mechanical aortic valve replacement. Methods: A total of 1986 consecutive patients with mechanical aortic valve replacement were enrolled in this study. According to PPI conduction caused by severe arrhythmia , the patients were divided into 2 groups: PPI group,n=61 including 27 male with the average age of (53.6 ± 9.03) years and Non-PPI group,n=1925. The median follow-up time was (4.47 ± 4.36) years after valve replacement. Results: The patients in PPI group were with the elder age and higher ratio of pre-existing atrial ifbrillation (AF) than those in Non-PPI group,P1 year) was 2.22%. For PPI indications, there were 70.5% patients with high degree A-V block including 30 of AF combining long intervals, 12 of high degree A-V block, 1 of complete left bundle branch block (LBBB) and 14.8% patients with sick sinus syndrome/sinus arrest/ sinus bradycardia. Conclusion: PPI incidence was at a relative low level, the long term occurrence rate was higher than both short term and midterm; elder age, pre-existing AF could be the high risk factors for PPI requirement, and the major PPI indication was high degree AV block in clinical practice.
ABSTRACT
Objective: To evaluate the effect of catheter ablation (CA) by endpoint of left atrium (AF)- pulmonary vein (PV) with bi-directional electrical isolation in treating the patients with paroxysmal atrial fibrillation (PAF) with remote electro-cardio graphic monitoring. Methods: A total of 82 AF patients received radio frequency catheter ablation (RFCA) in our hospital and 76 PAF patients were observed. Based on circumferential pulmonary vein isolation (CPVI) judgment, the PAF patients were divided into 2 groups: Bi-directional block (BDB) group,n=20 and Entrance block (EB) group,n=56. The post-operative rhythm was followed-up by remote electro-cardio graphic monitoring and the clinical efifcacy of CA was prospectively observed. Results:①All 76 patients finished CA, 1 patient died in EB group at 4 days after operation for pulmonary embolism, the rest 75 patients were followed-up for (31±19) months. The overall success rates of single ablation procedure at 3 months and 6 months after operation were 85.33% and 77.33%; in BDB group were 95.00% and 85.00%, in EB group were 81.82% and 74.55% respectively, the result was similar between 2 groups,P>0.05.②The overall occurrence rates of arrhythmia at 1 week and 3 months after operation were 35.53% and 17.33%; in BDB group were 15.00% and 5.00%, in EB group were 42.86% and 21.82% respectively, the differences between 2 groups were at P=0.049 andP>0.05.③Remote electro-cardio graphic monitoring recorded the patients with asymptomatic atrial arrhythmia at 1 week and 3 months after operation were at 22.22% and 23.08% respectively. Conclusion:①Compared with EB group, BDB group had obviously lower occurrence rate of arrhythmia at short term after CA.②The overall success rate of single ablation procedure was similar between 2 groups which might be because less patients were studied.③Remote electro-cardio graphic monitoring has certain advantage for evaluating the occurrence of atrial arrhythmia after operation.
ABSTRACT
Objective: To observe the effects of transforming growth factor-β1 (TGF-β1) and atorvastatin on expressions of collagen type I P-Smad2, Smad4 and Smad7 in human atrial ifbroblasts, and to explore the ifbrosis and anti-ifbrosis mechanisms in human atrium. Methods: Human right atrial appendage tissue was obtained from the cardiac surgery in our hospital and the atrial ifbroblasts were isolated and cultured by generations. The effects of TGF-β1 and atorvastatin on atrial ifbroblast proliferation was detected by MTT method and the effect of TGF-β1 at (0, 0.1, 1.0, 5.0, 10.0, 20.0, 50.0) ng/ml and atorvastatin at (0, 0.1, 1.0, 10.0, 100.0) μmol/L on mRNA and protein expressions of collagen type I P-Smad2, Smad4 and Smad7 in atrial ifbroblasts were examined by RT-PCR and Western-blotting analysis respectively. Results: MTT detection presented that compared to TGF-β1 at 0 ng/ml, with the intervention of TGF-β1 at (1 and 10) ng/ml, the mRNA and protein expressions of collagen type I P-Smad2, Smad4 increased,P<0.05 and the expressions of Smad7 decreased,P<0.05. Compared to TGF-β1 at 10.0 ng/ml, with the intervention of TGF-β1 + atorvastatin at 10.0 μmol/L or with atorvastatin at 10.0 μmol/L alone, the mRNA and protein expressions of collagen type I P-Smad2, Smad4 decreased,P<0.05and expressions of Smad7 increased,P<0.05. Conclusion: TGF-β1 promotes human atrial ifbroblast proliferation and collagen type I expression, while atorvastatin inhibits such proliferation and expression, the effect might be done by affecting TGF-β1/Smads pathway in human atrial ifbroblasts.
ABSTRACT
Objective: To explore the effect of persistent atrial ifbrillation (AF) on circadian rhythm of blood pressure (BP) in patients with essential hypertension (EH). Methods: A total of 173 EH patients treated in Gansu Provincial Hospital from 2013-02 to 2014-01were studied. The patients were divided into 2 groups: EH group,n=88 and Persistent AF combining EH group,n=85. The baseline information was studied and the risk factors of persistent AF combining EH were investigated by multivariate logistic regression analysis. Results: Compared with EH group, the Persistent AF combining EH group showed decreased average daytime DBP, minimum daytime SBP, minimum daytime DBP and the average 24-hour DBP, while increased maximum nighttime SBP and the percentage of reverse dipper in DBP, allP0.05. Multivariate logistic regression analysis indicated that the maximum nighttime SBP was obviously related to persistent AF combining EH (OR=1.038, 95 CI 1.014-1.062,P=0.001). Conclusion: Persistent AF may incur daytime BP dropping, such change was not obviously observed for nighttime BP in EH patients.
ABSTRACT
Objective: To explore the feasibility with the safety at peri-operative and early post-operative periods for left atrial appendage occlusion in patients with non-valvular atrial ifbrillation (AF). Methods: A total of 17 non-valvular AF patients with transesophageal echocardiography (TEE) and CAHDS2 evaluation who received left atrial appendage occlusion in our hospital were summarized. The effect and complications during peri-operative and 1 month post-operative periods were analyzed. Results: All 17 patients had successful operation without severe complications. There were 8 patients having small amount residual shunt by TEE examination, 2 having ecchymosis near the puncture point at peri-operative period and 3 having small amount of hydropericardium by peri-cardio ultrasound examination. At the average of 45 days follow-up study, only 3 patients had small amount residual shunt, no left atrium thrombus and hydropericardium were observed. Conclusion: Left atrial appendage occlusion has the high success rate, it is safe during peri-operative and early post-operative periods in non-valvular AF patients.
ABSTRACT
Objective: To explore the risk factors in patients with chronic heart failure (CHF) combining atrial ifbrillation (AF) and to identify the predictive factors for AF recurrence after cardio version. Methods: A total of 246 CHF patients treated in our hospital were divided into 2 groups: CHF+AF (AF) group,n=71 and CHF without AF (Non-AF) group,n=175. The baseline information was recorded. The risk factors for AF occurrence were screened by Logistic regression analysis. There were 66 AF patients with successful cardio verse and they were followed-up for 18 months, the predictors for AF recurrence were studied by Cox regression analysis. Results: The baseline information showed that age, CHF duration, left atria diameter (LAD), the levels of BNP, uric acid and serum creatinine in AF group were all higher than those in Non-AF group, allP<0.05. Logistic regression analysis presented that age (RR=1.89, 95% CI 1.08-3.31,P<0.05), CHF duration (RR=1.35, 95% CI 1.05-1.74,P<0.05), BNP level (RR=1.82, 95% CI 1.30-2.53,P<0.01), LAD (RR=1.51, 95% CI 1.09-2.08,P<0.05) were the risk factors for AF occurrence. Cox regression analysis indicated that BNP level (RR=1.30, 95% CI 1.09-1.54,P<0.01) and LAD (RR=1.74, 95% CI 1.30-2.34, P<0.01) were the predictors for AF recurrence. Conclusion: The elder age, longer CHF duration, increased BNP level and LAD were the risk factors for AF occurrence in CHF patients. The increased BNP level and LAD were the objective predictors for AF recurrence after cardio version.
ABSTRACT
Objective: To analyze the clinical characteristics and current treating status from atrial ifbrillation (AF) patients with different gender in 20 emergency departments. Methods: A total of 2015 consecutive AF patients from 20 emergency departments nationwide from 2008-11 to 2011-10 were retrospectively investigated. The patients were divided into 2 groups: Female group,n=1104 and Male group,n=911. The baseline clinical characteristics and current treating status were compared between groups, the risk of stroke in non-valvular atrial ifbrillation (NVAF) patients was evaluated by CHADS2 score and the factors affecting walfarin application were studied by Logistic regression analysis. Results: Compared with Male group, Female group had the elder age (69.11 ± 12.96) years vs (67.67 ± 13.63) years,P=0.015, lower body mass index (BMI) (23.24 ± 3.73) kg/m2 vs (23.89 ± 3.47) kg/m2,P=0.000, more patients combining with heart failure (39.7% vs 34.6%,P=0.019), more patients with valvular heart disease (26.6% vs 12.4%,P=0.000). In contrast, Male group had more smokers (41.4% vs 5.1%,P=0.000), more patients combining with coronary artery disease (45.1% vs 39.1%,P=0.007) and more patients with previous history of myocardial infarction (9.5% vs 5.5%,P=0.001). The average CHADS2 score was higher in Female group than Male group (2.0 ± 1.4) vs (1.8 ± 1.4),P=0.008 and the proportion of patients with CHADS2 score ≥2 was higher in Female group than Male group (58.0% vs 51%,P=0.005). There were 407 patients of valvular heart disease with AF and 167 (41%) of them received walfarin treatment including 119 female and 48 male,P=0.713; 1608 NVAF patients with CHADS2 score≥ 2 and 105 of them received anticoagulation therapy including 54 female and 51 male,P=0.636. Conclusion: The clinical characteristics and current treating status are different by gender from AF patients in 20 emergency departments in China.
ABSTRACT
Objective: To investigate the impact of thyroid hormone on atrial ifbrillation (AF) prevalence in patients with chronic heart failure (CHF). Methods: A total of 322 non-valvular heart disease CHF patients treated in our hospital from 2011-0-01 to 2012-10-01 were retrospectively studied. Based on previous history and the ECG at admission, the patients were divided into 2 groups: AF group,n=187 and Sinus rhythm group,n=135. The proifle of serum levels of free thyroxine (FT4), free triiodothyronine (FT3), hyroid stimulating hormone (TSH) and LDL-C were examined within 24 hours of admission; 12 lead ECG and echocardiography were conducted to analyze the related factor for AF occurrence. Results: Compared with Sinus rhythm group, AF group had increased FT4 level as 14.52 (12.74, 15.85) pmol/L vs 13.11 (11.68, 14.85) pmol/L,P Conclusion: High serum level of FT4 may increase the risk AF occurrence in CHF patients.
ABSTRACT
Objective: To analyze the risk factors of ischemic stroke prevalence in elder patients with non-valvular atrial ifbrillation (AF). Methods: A total of 180 AF patients treated in our hospital from 2010-01 to 2014-12 were retrospectively studied. The diagnosis of ischemic stroke was conifrmed by CT/MRI, and the patients were divided into 2 groups: AF with ischemic stroke group,n=120 and AF alone group,n=60. The CHA2DS2-VASc score, CHADS2 score, plasma levels of homocysteine (HCY), ifbrinogen (FIB), left atrial diameter (LAD), blood lipid proifle and renal function were examined and compared between 2 groups. Results: There were signiifcant differences on CHA2DS2-VASc score, CHADS2 score, HCY, FIB and LAD between AF with ischemic stroke group and AF alone group,P Conclusion: The CHA2DS2-VASc score and CHADS2 score system combining with plasma levels of HCY, FIB and LAD have the important clinical predictive value for the occurrence of ischemic stroke in elder patients with AF. CHA2DS2-VASc score is more appropriate for screening the low-risk patients, and CHADS2 score is rather appropriate for screening the high-risk patients.
ABSTRACT
Objective: To explore the correlation between antithrombotic strategy and its prognostic value in coronary artery disease (CAD) patients combining with atrial ifbrillation (AF) after percutaneous coronary intervention (PCI). Methods: A total of 570 CAD patients with AF received PCI in our hospital from 2012-01 to 2013-12 were retrospectively analyzed by CHADS2 and HAS-BLED Score system. According to CHADS2 Results: Compared with Low risk of stroke group, the patients in High risk of stroke group had the worse prognosis and higher rate of MACCE occurrence,P0.05. The major bleeding events in patients with warfarin were a little higher than those without warfarin,P>0.05. The minor bleeding events were increased in both Low risk stroke group asP Conclusion: Warfarin medication may obviously decrease the occurrence rates of MACCE and ischemic events in high risk of stroke patients, while in low risk patients, warfarin could not further decrease the occurrence of MACCE and ischemic events. Warfarin could increase the risk for minor bleeding in both low risk and high risk of stroke in CAD patients combining with AF after PCI.
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.