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ObjectiveTo retrospectively analyze the effect of modified Shugan Dingji Decoction （疏肝定悸汤） on the occurrence of endpoint events in patients with paroxysmal atrial fibrillation of liver constraint and qi stagnation. MethodsA retrospective cohort study was conducted using the electronic medical record database of Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine to screen and include patients with paroxysmal atrial fibrillation of liver constraint and qi stagnation from January 1st， 2018， to December 31th， 2021. The included patients were divided into an exposure group and a non-exposure group， each consisting of 100 cases， based on whether they received modified Shugan Dingji Decoction. General information of the patients including age， gender， body mass index， duration of illness and comorbidities， medication history， cardiac structure and function indicators such as left atrial diameter， left ventricular end-diastolic diameter， stroke volume and ejection fraction， and the occurrence of endpoint events assessed through 24-hour dynamic electrocardiography or electrocardiogram to determine the recurrence of paroxysmal atrial fibrillation were collected. Kaplan-Meier （K-M） curves and Log-Rank tests were used to conduct survival analysis on the occurrence of endpoint events in the two groups of patients. Univariate and multivariate Cox regression analyses were used to analyze the impact of various factors on entry into endpoint events. Additionally， a safety assessment was performed by comparing liver and kidney function indicators before and after treatment. ResultsIn the non-exposure group， a total of 49 cases （49.0%） experienced endpoint events， while in the exposure group， there were 26 cases （26.0%）. The Log-rank test indicated significant difference between the two groups （χ2=11.211， P=0.001）. Univariate Cox regression analysis showed that age， duration of illness， hypertension， diabetes， chronic heart failure， left atrial diameter， stroke volume， and the use of modified Shugan Dingji Decoction may be the influencing factors for the occurrence of endpoint events in patients with paroxysmal atrial fibrillation of liver constraint and qi stagnation （P＜0.05 or P＜0.01）. Multivariate Cox regression analysis showed that the risk of endpoint events in the exposure group was significantly lower than that in the non-exposure group （P＜0.01）. Patients with a duration of illness ＞12 months had a significantly higher risk of endpoint events compared to those with a duration of illness ≤12 months （P＜0.01）. Patients without concomitant hypertension had a lower risk of endpoint events compared to those with hypertension （P＜0.05）. Patients with left atrial diameter ＞40 mm had significantly higher risk of endpoint events than those with left atrial diameter ≤40 mm （P＜0.01）. There was no statistically significant difference in liver and kidney function indicators between the two groups before and after treatment （P＞0.05）. ConclusionThe use of modified Shugan Dingji Decoction is a protective factor for patients with paroxysmal atrial fibrillation of liver constraint and qi stagnation， which can help to reduce the recurrence and progression of atrial fibrillation. Long duration of illness， concomitant hypertension， and enlarged left atrial diameter are risk factors for patients to experience endpoint events.
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Abstract Aim: To analyse the potential usefulness and clinical relevance of the assessment by echocardiography with left atrial strain, based on the myocardial atrial deformation curves with speckle-tracking velocity vector imaging (VVI), in the analysis of short-form recurrent atrial extra systoles in ambulatory patients not suffering from organic cardiopathy. Methods: We designed a descriptive, prospective, and observational study including 270 patients between the ages of 18 and 75 assessed during an outpatient cardiology consultation attended due to palpitations over a period of two years. Using ambulatory electrocardiographic monitoring, we selected cases with short forms of repetitive atrial extrasystole, isolated or recurrentatrial fibrillation and a control group formed by those patients without repetitive ectopia. All patients underwent a thorough echocardiographic study during their first cardiological visit. Results: The analysis of the dynamic curves segmental deformation generated after an atrial extrasystole can reveal different points of origin of the extrasystole and detect specific anatomical alterations in the interatrial conduction at the level of the Bachmann's fascicle showing different models of electro anatomical activation possibly involved in the appearance of repetitive forms. Higher values of dyssynchrony between the septal and lateral wall and elongation in the time of interatrial electromechanical conduction could also be related to the existence of repetitive ectopic beats. Conclusions: Our ambulatory study employing the left atrial longitudinal strain, particularly in its segmental analysis, provides new insights into its the usefulness and potential clinical relevance.
Resumen Objetivo: Analizar la utilidad y relevancia clínica de la evaluación mediante ecocardiografía basada en las curvas de deformación auricular miocárdica con imágenes vectoriales de velocidad (VVI) de speckle-tracking, en el análisis de las extrasístoles auriculares recurrentes de corta duración en pacientes ambulatorios sin cardiopatía orgánica. Métodos: Se diseñó un estudio descriptivo, prospectivo y observacional que incluyó a 270 pacientes de entre 18 y 75 años evaluados durante una consulta externa de cardiología a la que acudieron por palpitaciones durante un periodo de dos años. Mediante el uso de monitorización electrocardiográfica ambulatoria, se seleccionaron casos con formas cortas de extrasistolia auricular repetitiva, fibrilación auricular aislada o repetitiva y un grupo control formado por aquellos pacientes sin ectopia repetitiva. Todos los pacientes se sometieron a un estudio ecocardiográfico exhaustivo durante su primera visita cardiológica. Resultados: El análisis de las curvas dinámicas de deformación segmentaria generadas tras un extrasístole auricular diferentes modelos de activación electroanatómica posiblemente implicados en la aparición de formas repetitivas. Valores mayores de disincronía entre la pared septal y lateral y el alargamiento en el tiempo de conducción electromecánica intraauricular pudieran también relacionarse con la existencia de latidos ectópicos repetitivos. Conclusiones: Nuestro estudio ambulatorio empleando la deformación longitudinal auricular izquierda, particularmente en su análisis segmentario, proporciona nuevas perspectivas sobre su utilidad y potencial relevancia clínica.
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Objective:To investigate the risk factors of non-valvular paroxysmal atrial fibrillation (NVPAF) with cerebral ischemic stroke(CIS) and analyze NVPAF by using left atrial automatic imaging (AFILA). Logistic regression model was established for left atrial(LA) function parameters.Methods:A total of 205 patients with NVPAF were included in the study and divided into the NVPAF group without ischemic stroke (154 patients) and the CIS group (51 patients). The clinical baseline data, blood biochemical results and AFILA ultrasound data of all patients were collected. Univariate analysis was performed to compare the above data between the two groups of patients. The independent risk factors were obtained by multivariate logistic regression analysis. Logistic regression model was compared with CHA2DS2-VASc scoring system in terms of area under ROC curve, sensitivity and specificity.Results:There were significant differences in age, CHA2DS2-VASc score, taking anticoagulant drugs, history of hypertension, diabetes and coronary heart disease, LAEF, S_R, S_CT, WBC, NEUT, HCY, UREA, NDD, NT-proBNP, Fibrinogen(Fib), Cardiac troponin I(cTnI) and NLR between the two groups (all P<0.05). The results of multifactor analysis showed that: age, hypertension, S_ CT, UREA, NLR, Fib and cTnI were independent risk factors associated with CIS in patients with paroxysmal atrial fibrillation[ OR value: 1.608 ( P=0.003), 3.821 ( P=0.019), 1.259 ( P=0.001), 1.326( P=0.001), 1.352 ( P=0.011), 1.502 ( P=0.042), 7.651( P=0.001)]. After adjusting for the age, sex and history of hypertension included in CHA2DS2-VASc score, S_CT significantly led to NVPAF complicated with stroke[ OR value 1.259 (1.095-1.447), P=0.001]. The diagnostic efficacy of Logistic regression model is better than that of CHA2DS2-VASc scoring (AUC of 0.931 vs 0.717, 95% CI: 0.896-0.967 vs 0.634-0.799, sensitivity of 0.883 vs 0.755, specificity of 0.849 vs 0.713, all P<0.001). Conclusions:Age, hypertension, S_CT, UREA, NLR, fibrinogen, cTnI are independently associated risk factors for patients with combined CIS; The diagnostic efficacy of Logistic regression model is better than that of CHA2DS2-VASc scoring model.And the sensitivity and specificity are high.
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Aims: Pulmonary vein isolation (PVI) is the treatment of choice of paroxysmal atrial fibrillation (PAF). However, radiofrequency delivery at extra-PV sites may be additionally required. We compared clinical and procedural characteristics of patients undergoing PVI alone versus adjunctive extra-PV substrate modification, at first procedure and repeat procedures for AF recurrence. Methods: 587 patients with PAF undergoing radiofrequency (RF) ablation were retrospectively included. Extra-PV ablation was performed in case of sustained AF despite PVI, or at re-do procedures without PV conduction recovery. Demographic, clinical and electrophysiological predictors of survival without reintervention were analysed in patients’ groups having undergone one (G1), two (G2) or three or more procedures (G3). Results: At baseline procedure, PV RF ablation time was shorter in G1 compared to G2/G3 whereas extraPV RF ablation time was greater in G3 compared to G1. The proportion of patients requiring PV reisolation decreased with repeat procedures. Smaller LA before procedure 1 (p1) or p2 was associated with PV reconnection at p2. Conversely larger LA before p1 was associated with extra-PV substrate modification at p2. Late re-do procedure timing (>1yr) was associated with increasing LA volume. Only longer PV and total RF time predicted poorer survival free from AF without re-intervention. Conclusion: Longer PV RF time predicted requirement for re-ablation during follow-up. Smaller LA size predicted an increased probability of PV reconnection and decreased extra-PV substrate modification at p2. LA size decreased in patients undergoing early re-intervention, whereas it increased in patients undergoing re-intervention later on suggesting ongoing remodelling or progression.
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Abstract BACKGROUND: Prevention of recurrence of stroke depends on recognition of the underlying mechanism of ischemia. OBJECTIVE: To screen patients who were hospitalized with diagnosis of acute ischemic stroke in terms of atrial fibrillation (AF) with repeated Holter electrocardiography recordings. DESIGN AND SETTING: Prospective study conducted at Konya Education and Research Hospital, Turkey. METHODS: Patients with a diagnosis of acute ischemic stroke, without atrial fibrillation on electrocardiography (ECG), were evaluated. Their age, gender, histories of previous ischemic attack, occurrences of paroxysmal atrial fibrillation (PAF) and other risks were assessed during the first week after acute ischemic stroke and one month thereafter. ECG recordings were obtained from 130 patients through 24-hour ambulatory Holter. Patients without PAF attack during the first Holter were re-evaluated. RESULTS: PAF was detected through the first Holter in 33 (25.4%) out of 130 acute ischemic stroke patients. A second Holter was planned for 97 patients: 53 (54.6%) of them could not attend due to COVID-19 pandemic; while 44 (45.3%) patients had the second Holter and, among these, 4 (9.1%) had PAF. The only parameter associated with PAF was older age. Four (10.8%) of the 37 patients with PAF had also symptomatic carotid stenosis. CONCLUSIONS: Detecting the presence of PAF by screening patients with no AF in the ECG through Holter ECG examinations is valuable in terms of changing the course of the treatment. It should be kept in mind that the possibility of accompanying PAF cannot be ruled out in the presence of other factors that pose a risk of stroke.
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Humans , Atrial Fibrillation/complications , Atrial Fibrillation/epidemiology , Stroke/complications , Ischemic Stroke , COVID-19 , Prospective Studies , Risk Factors , Electrocardiography, Ambulatory/adverse effects , PandemicsABSTRACT
Paroxysmal atrial fibrillation (pAf) is an arrhythmia that often occurs in the elderly. The quality of life often declines due to severe palpitations caused by pAf. We present a case of recurrent pAf that occurred on postoperative day 2 of coronary artery bypass grafting and pulmonary vein isolation for unstable angina pectoris and pAf. The patient was a 62-year-old man who complained of palpitations, which was consistent with pAf on the monitor ECG. During hospitalization, the patient was constantly wearing an ECG monitor. During pAf, the heart rate was around 120 bpm, and pAf could continue for up to and beyond 24 hours. Paroxysmal atrial fibrillation with strong palpitations was observed every day, even after starting beta-blockers and anticoagulants. After discharge, a Japanese Kampo medicine called shakanzoto was taken for a month, but there was no improvement. After that, it was changed to another Japanese Kampo medicine called saikokaryukotsuboreito, because abdominal examination revealed kyokyokuman (hypochondriac discomfort and distension (resistance)) and saiboki (brisk pulsation in the para-umbilical region). Palpitations quickly improved dramatically. It was speculated that not only palpitations but also pAf had been improved.
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This study aims to explore the intraventricular pressure difference (IVPD) within left ventricle in patients with paroxysmal atrial fibrillation (PAF) by using the relative pressure imaging (RPI) of vector flow mapping (VFM). Twenty patients with paroxysmal atrial fibrillation (PAF) and thirty control subjects were enrolled in the study. Systolic and diastolic IVPD derived from VFM within left ventricle and conventional echocardiographic parameters were analyzed. It was found that the B-A IVPD of left ventricle in PAF patients showed the same pattern as controls-single peak and single valley during systole and double peaks and double valleys during diastole. Basal IVPD was the main component of base to apex IVPD (B-A IVPD). The isovolumetric systolic IVPD was associated with early systolic IVPD, early systolic IVPD was associated with late systolic IVPD, and late systolic IVPD was associated with isovolumic diastolic IVPD (all
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Humans , Atrial Fibrillation/diagnostic imaging , Diastole , Heart Ventricles , Ventricular Function, Left , Ventricular PressureABSTRACT
Objective To evaluate left ventricular (LV) systolic function in patients with paroxysmal atrial fibrillation (PAF) after catheter ablation by three-dimensional speckle tracking imaging (3 D-STI). Methods A total of 35 patients with PAF who underwent catheter ablation were enrolled in this study. The participants underwent standard echocardiography and 3 D-STI three to six months before and after the operation. 30 healthy volunteers were enrolled as controls. 3 D-STI was used to obtain global longitudinal strain (GLS) , global circumferential strain (GCS) , global radial strain (GRS) , and global area strain (GAS). Results The LA and E/e' ratio in PAF group showed no significant difference before and after the operation, but were increased compared with controls.There were no significant differences between PAF group and control group in LV, left ventricular end-diastolic volume (LVEDV) , left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF) before and after the operation. Compared with control group, GLS and GAS in PAF group were significantly decreased.GAS in PAF group three to six months after catheter ablation was significantly increased. Conclusions Although with normal LVEF, LV systolic function is impaired in patients with PAF. 3 D-STI technique could sensitively reflet the decline in LV myocardial deformation and systolic function.
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Objective To evaluate the relationship between atrial synchrony and paroxysmal atrial fibrillation (PAF) in patients with sick sinus syndrome (SSS) by two-dimensional speckle tracking imaging. Methods Forty-four SSS patients who underwent echocardiographic examination at Department of Ultrasound, No. 2 Hospital of Yinzhou in Ningbo City of Zhejiang Province from January 2015 to August 2016 were enrolled, including 25 without PAF and 19 with PAF. Twenty-eight normal adults who underwent echocardiographic examination at this department at the same time were included as a normal control group. The structural and functional parameters of the left ventricle of all enrolled subjects were evaluated by echocardiographic examination. After two-dimensional speckle tracking images of the right atrium free wall, atrial septum, and left atrium free wall were obtained, the time interval from the initial point of P wave on electrocardiograph to the second negative wave of the diastolic phase in two-dimensional speckle tracking images were measured to calculate the electrical-mechanical time of the right atrium free wall (P-RA), the electrical-mechanical time of the atrial septum (P-IAS), and the electrical-mechanical time (P-LA) of the left atrium free wall. Subsequently, the parameters of atrial synchrony were calculated. Conventional echocardiographic parameters, P-RA, P-IAS, P-LA, and the parameters of atrial synchrony were compared among the three groups by one-way ANOVA, and further comparisons between any two groups were performed by the SNK-q test. The relationship between the parameters of electrical-mechanical time, parameters of atrial synchrony, and PAF were analyzed by Spearman correlation analysis. Receiver operating characteristic curve (ROC) analysis was then performed to evaluate the value of the parameters of electrical-mechanical time and parameters of atrial synchrony in predicting PAF. Results The left atrial size was significantly larger in the SSS without PAF group and SSS with PAF group than in the normal control group (q=4.18, 5.37, both P＜0.05), although there was no significant difference between the SSS without PAF group and SSS with PAF group. The P-RA and P-IAS were significantly larger in the SSS without PAF group and SSS with PAF group than in the normal control group (q=4.03, 4.10; q=4.16, 4.31, all P＜0.05), but there was no significant difference between the SSS without PAF group and SSS with PAF group. The P-LA, right atrial intra-atrial synchrony, left atrial intra-atrial synchrony, and inter-atrial synchrony showed a gradually rising trend from the normal control group to the SSS without PAF group and SSS with PAF group, and the difference between any two groups was statistically significant (q=5.18, 11.23, 4.43; q=5.25, 11.74, 4.63; q=7.38, 14.67, 4.73; q=8.01, 16.37, 6.39, all P＜0.05). Spearman correlation analysis showed that P-LA, right atrial intra-atrial synchrony, left atrial intra-atrial synchrony, and inter-atrial synchrony were significantly positively correlated with PAF in patients with SSS (r=0.61, 0.55, 0.75, 0.78, all P ＜ 0.01), and the correlation between inter-atrial synchrony and PAF was the highest. ROC analysis demonstrated the optimal threshold of P-LA for prediction of PAF was 94 ms [sensitivity: 68.42%; specificity: 76.00%; the area under the ROC curve (AUC): 0.764 (95% CI: 0.612-0.879)]; the optimal threshold of right atrial intra-atrial synchrony was 19 ms [sensitivity: 57.89%; specificity: 76.00%; AUC: 0.714 (95% CI: 0.558-0.840)];the optimal threshold of left atrial intra-atrial synchrony was 42 ms [sensitivity: 78.95%; specificity: 76.00%;AUC: 0.860 (95% CI : 0.722-0.946)]; and the optimal threshold of inter-atrial synchrony was 68 ms [sensitivity:84.21%; specificity: 84.00%; AUC: 0.859 (95% CI: 0.721-0.945)]. These results suggest that left atrial intra-atrial synchrony and inter-atrial synchronization are superior to right atrial intra-atrial synchrony in predicting PAF in patients with SSS. Conclusion Atrial electro-mechanical motion time parameters and synchrony parameters are closely related to PAF in patients with SSS, and left atrial intra-atrial synchrony and inter-atrial synchronization are the most effective parameters in predicting PAF in patients with SSS.
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Resumen Objetivo: Evaluar la seguridad y eficacia del cierre percutáneo de la orejuela izquierda en pacientes con fibrilación auricular no valvular con alto riesgo de sangrado o con contraindicación para anticoagulación oral. Métodos: Estudio prospectivo no aleatorizado en una cohorte de pacientes con fibrilación auricular con contraindicación o dificultades con anticoagulación oral y puntaje de CHA2DS2-VASc ≥ 2 y de HASBLED ≥ 2, elegibles para doble antiagregación con aspirina y clopidogrel. Resultados: Se incluyeron 53 pacientes, con edad promedio de 72,24 ± 9,22 años, de los cuales 54,72% eran hombres; 20,75% tenían fibrilación auricular paroxística, 15,1% persistente y 64,15% permanente. Además, 18,9% tenían insuficiencia cardíaca, 22,64% enfermedad coronaria, 92,45% hipertensión arterial, 41,51% eran mayores de 75 años, 18,9% eran diabéticos y 37,7% tenían enfermedad cerebrovascular previa. El promedio del puntaje de CHADS2 y CHA2DS2-VASc fue de 2,73 ± 1,34 y 4,24 ± 1,54, respectivamente. El procedimiento fue exitoso en un 98% (52/53). Sólo en un caso no fue posible implantar el dispositivo por causas anatómicas. No hubo eventos adversos serios relacionados con la implantación; durante el procedimiento se registró un episodio de derrame pericárdico leve que no requirió drenaje. En los 45 días de seguimiento, 2 pacientes (3,77%) desarrollaron enfermedad cerebrovascular y se registró un deceso por causa no cardíaca (1,89%). Conclusiones: El cierre percutáneo de la orejuela izquierda con dispositivo WATCHMAN® es un procedimiento seguro y eficaz en pacientes de alto riesgo con fibrilación auricular no valvular y contraindicación o dificultades para la anticoagulación oral.
Abstract Motivation: To assess the safety and efficacy of percutaneous left atrial appendage closure in patients with non-valvular atrial fibrillation with a high risk of bleeding or a contraindication to oral anticoagulation drugs. Methods: Prospective non-randomised study of a cohort of patients with atrial fibrillation who had a contraindication to or difficulties with oral anticoagulation, CHA2DS2-VASc ≥ 2 and HASBLED ≥ 2 scores, and who were eligible for dual antiaggregation therapy with aspirin and clopidogrel. Results: 53 patients with an average age of 72.24 ± 9.22 years were included, out of whom 54.72% were men, 20.75% had paroxysmal, 15.1% persistent and 64.15% permanent atrial fibrillation, respectively. Besides, 18.9% suffered from heart failure, 22.64% from coronary disease, 92.45% from arterial hypertension, 41.51% were over 75 years old, 18.9% were diabetic and 37.7% had a history of cerebrovascular disease. Average CHADS= y CHA=DS2-VASc scores were of 2.73 ± 1.34 and 4.24 ± 1.54 respectively. Procedure was successful in 98% of the cases (52/53). It was not possible to implant the device in only one case due to anatomical reasons. There were no severe adverse events related to the insertion; during the procedure an episode of mild pericardial effusion that did not require drainage was registered. DUring the 45-day follow up period, 2 patients (3.77%) developed a cerebrovascular disease, and there was one noncardiac death (1.89%). Conclusions: The percutaneous left atrial appendage closure with device is a safe and efficient procedure in high-risk patients with non-valvular atrial fibrillation and contraindications to or difficulties for oral anticoagulation therapy.
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Humans , Male , Aged , Atrial Fibrillation , Cerebral Arterial Diseases , Atrial AppendageABSTRACT
Objective To investigate the effect of Rivastaban tablet combined with psychological intervention after radiofrequency ablation of paroxysmal atrial fibrillation. Methods According to the random number table method, 86 patients of paroxysmal atrial fibrillation ablation were divided into the control group and the observation group. The control group was treated with Rivastaban table and routine nursing. The observation group was given psychological intervention on the basis treatment of the control group. The quality of life of two groups was evaluated by SF-36 quality of life scale, anxiety and depression symptoms of two groups were evaluated before and after the intervention. Recurrence of two groups were observed by followed-up of 6 to 12 months. Results The anxiety and depression scores of the observation group were significantly lower than those of the control group. The anxiety and depression scores of the two groups were significantly lower than those before treatment (P<0.05). The body function, physical character, social function, body pain, body emotion, vitality, mental health and overall health score of the observation group were significantly higher than those of the control group (P<0.05). The recurrence rate was 4.65% (2/43) in the observation group, which was significantly lower than (18.60%, 8/43) in the control group (χ2=4.07, P=0.04). Conclusion Radiotherapy with radiofrequency ablation of paroxysmal atrial fibrillation combined with Rivastaban tablet plus psychological intervention could help improve the mental state of patients, reduce their recurrence and improve their quality of life.
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OBJECTIVE:To investigate the effects of valsartan on related indexes of elderly patients with hypertension with paroxysmal atrial fibrillation.METHODS:A total of 128 patients with hypertension with paroxysmal atrial fibrillation were randomly divided into observation group and control group,with 64 cases in each group.Control group was given Amlodipine tablets 5-10 mg/d,once a day+Hydrochlorothiazide tablets 12.5 mg/d,once a day,orally in the morning.Observation group was additionally given Valsartan capsule 80-160 mg/d orally,once a day,in the morning.Both groups were treated for 12 weeks.The levels of Hs-CRP,IL-6 and blood pressure,LVEF,LAD,maximum P wave duration (Pmax),P wave dispersion (Pd) before and after treatment,the occurrence of ADR were observed and compared between 2 groups.RESULTS:Before treatment,there was no statistical significance in above indexes (P＞0.05).After treatment,Hs-CRP,IL-6 levels and LAD of 2 groups were significantly lower than before,and Hs-CRP,IL-6 levels in the observation group was significantly lower than the control group while LAD was higher than the control groups;LVEF was significantly higher than before,but the observation group was significantly lower than the control group,with statistical significance (P＜0.05).After treatment,SBP and DBP of 2 groups were significantly lower than before (P＜0.05),but there was no statistical significance between 2 groups (P＞0.05).Pmax and Pd in the observation group were significantly lower than before,and lower than the control group at the same time(P＜0.05),while there were no significantly of Pmax and Pd in the control group before and after treatment(P＞0.05).No obvious ADR was found in 2 groups during treatment.CONCLUSIONS:For elderly patients with hypertension with paroxysmal atrial fibrillation,valsartan shows good hypotensive effect and effectively improves serum inflammatory factor levels and cardiac function related indexes.
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Objective To investigate the effect of Rivastaban tablet combined with psychological intervention after radiofrequency ablation of paroxysmal atrial fibrillation. Methods According to the random number table method, 86 patients of paroxysmal atrial fibrillation ablation were divided into the control group and the observation group. The control group was treated with Rivastaban table and routine nursing. The observation group was given psychological intervention on the basis treatment of the control group. The quality of life of two groups was evaluated by SF-36 quality of life scale, anxiety and depression symptoms of two groups were evaluated before and after the intervention. Recurrence of two groups were observed by followed-up of 6 to 12 months. Results The anxiety and depression scores of the observation group were significantly lower than those of the control group. The anxiety and depression scores of the two groups were significantly lower than those before treatment (P<0.05). The body function, physical character, social function, body pain, body emotion, vitality, mental health and overall health score of the observation group were significantly higher than those of the control group (P<0.05). The recurrence rate was 4.65% (2/43) in the observation group, which was significantly lower than (18.60%, 8/43) in the control group (χ2=4.07, P=0.04). Conclusion Radiotherapy with radiofrequency ablation of paroxysmal atrial fibrillation combined with Rivastaban tablet plus psychological intervention could help improve the mental state of patients, reduce their recurrence and improve their quality of life.
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OBJECTIVE@#To investigate the relationship between basal ganglia cerebral infarction and paroxysmal atrial fibrillation (PAF) caused by abnormal vagus nerve tension.@*METHODS@#A total of 1483 cases of elder patients with cerebral infarction who received head CT or MRI examination during the period were enrolled, including 830 male and 613 female, with the average age as 78 years. These cases were divided into basal infarction ganglia group (n = 1045) and non-basal ganglia infarction group (n = 438) according to the anatomic site of cerebral infarction. The differences of the incidence of PAF, left atrial diameter and heart rate variability were compared between the two groups.@*RESULTS@#In basal ganglia infarction group, the incidence rate of PAF was significantly higher than that of non-basal ganglia infarction group (P 79 years basal ganglia cerebral infarction group, the incidence of PAF was significantly higher than that of non-basal ganglia infarction group (P < 0.05). There was no significant difference in the left atrial diameter between the basal ganglia infarction group and non-basal ganglia infarction group. Basal ganglia cerebral infarction patients with high PAF had higher heart rate variability than non-basal ganglia infarction group.@*CONCLUSION@#Elderly patients with basal ganglia infarction have high incidence of PAF. Sympathetic nerve damage in cerebral basal ganglia, increased vagal tension and cardiac vagal tension are the direct causes of PAF. The results indicates that the increased central vagal nerve tension mediated PAF probably is an indication of supplying sympathetic neurotransmitter or cardiac vagal denervation treatment.
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Objective To comprehensively evaluate the clinical effect of cryoballoon ablation (CBA) and radiofrequency ablation (RFA) in treating paroxysmal atrial fibrillation (PAF).Methods Computer retrieval of PubMed,EMbase,the Cochrane Library,Web of Knowledge,China national knowledge infrastructure (CNKI),Chinese Biomedical Medical Literature (CBM),China Wan Fang,China VIP,and other database to collect the randomized control trials (RCT) related to RFA and CBA treatment for PAF.The retrieval time was from the establishment of database to December 2015.The data extraction and methodological quality of the included studies were assessed by two reviewers independently.And meta-analysis was conducted by using RevMan 5.2 software.Results A total of 6 research papers (636 patients in total) were included.The results of meta-analysis showed that the incidence of phrenic nerve paralysis in CBA group was significantly higher than that in RFA group (RR=9.26,95％CI:2.17-39.63,P=0.003).No statistically significant differences in the operation time (MD=10.07,95％CI:-9.10-30.52,P=0.29),fluoroscopy time (MD=-0.18,95％CI:-8.14-7.77,P=0.96),12-month success rate (RR=0.91,95％CI:0.72-1.14,P=0.40) and the incidences of atrial tachycardia,atrial flutter,atrioventricular reentrant tachycardia existed between CBA group and RFA group (RR=0.47,95％CI:0.11-2.02,P=0.31).Conclusion For the treatment of PAF,no obvious differences in the operation time,fluoroscopy time,12-month success rate,and the incidences of atrial tachycardia,atrial flutter,atrioventricular reentrant tachycardia exist between CBA and conventional RFA,but CBA can increase the incidence of phrenic nerve paralysis.
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Objective To investigate the relationship between basal ganglia cerebral infarction and paroxysmal atrial fibrillation (PAF) caused by abnormal vagus nerve tension. Methods A total of 1 483 cases of elder patients with cerebral infarction who received head CT or MRI examination during the period were enrolled, including 830 male and 613 female, with the average age as 78 years. These cases were divided into basal infarction ganglia group (n = 1 045) and non-basal ganglia infarction group (n = 438) according to the anatomic site of cerebral infarction. The differences of the incidence of PAF, left atrial diameter and heart rate variability were compared between the two groups. Results In basal ganglia infarction group, the incidence rate of PAF was significantly higher than that of non-basal ganglia infarction group (P 79 years basal ganglia cerebral infarction group, the incidence of PAF was significantly higher than that of non-basal ganglia infarction group (P < 0.05). There was no significant difference in the left atrial diameter between the basal ganglia infarction group and non-basal ganglia infarction group. Basal ganglia cerebral infarction patients with high PAF had higher heart rate variability than non-basal ganglia infarction group. Conclusion Elderly patients with basal ganglia infarction have high incidence of PAF. Sympathetic nerve damage in cerebral basal ganglia, increased vagal tension and cardiac vagal tension are the direct causes of PAF. The results indicates that the increased central vagal nerve tension mediated PAF probably is an indication of supplying sympathetic neurotransmitter or cardiac vagal denervation treatment.
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Introduction: Paroxysmal atrial fibrillation (Paf) occurred in an inpatient who has been prescribed methadone for cancer pain in our palliative care unit, but oral administration of aprindine (antiarrhythmic agent) succeeded in defibrillation and methadone administration could be continued. Case: A 75-year-old man had developed multiple bone metastases after resection of thyroid cancer. Due to refractory cancer pain, switching from oxycodone to methadone was performed. Pain relief was achieved with methadone 40 mg/day and without QT interval prolongation. After methadone administration about 9 months, there suddenly became loss of appetite in the morning of one day. ECG examination revealed Paf onset. Aprindine 20 mg was orally administered for the purpose of defibrillation. After about 2 hours sinus rhythm was gained and later without recurrence. Conclusion: This case was considered to have the coincidental complication of paroxysmal atrial fibrillation in the course of methadone administration. If administration of antiarrhythmic agents is performed in a patient whom has been prescribed methadone, it is feared to lead to result in QT interval prolongation due to drug interactions. It is important to carefully select an agent that rarely leads to QT prolongation.
ABSTRACT
Catheter ablation has been recommended as a treatment option for paroxysmal atrial fibrillation (PAF) patients complicated with type 2 diabetes mellitus (T2DM). PAF patients with T2DM have a higher recurrence rate after catheter ablation. Prolongation of corrected QT (QTc) interval has been linked to poor outcomes in T2DM patients. Whether the abnormal QTc interval is associated with the ablation outcome in the PAF patients with T2DM remains unknown. In this study, 134 PAF patients with T2DM undergoing primary catheter ablation were retrospectively enrolled. Pre-procedural QTc interval was corrected by using the Bazett's formula. Cox proportional hazards models were constructed to assess the relationship between QTc interval and the recurrence of AF. After a 29.1-month follow-up period, 61 patients experienced atrial tachyarrhythmia recurrence. Recurrent patients had a longer QTc interval than non-recurrent patients (425.2±21.5 ms vs. 414.1±13.4 ms, P=0.002). Multivariate Cox regression analysis revealed that QTc interval [hazard ratio (HR)=1.026, 95% confidence interval (CI) 1.012-1.040, P=0.005] and left atrial diameter (LAD) (HR=1.125, 95% CI 1.062-1.192, P=0.003) were independent predictors of recurrent atrial tachyarrhythmia. Receiver operating characteristic analysis demonstrated that the cut-off value of QTc (418 ms) predicted arrhythmia recurrence with a sensitivity of 55.7% and a specificity of 69.9%. A combination of LAD and QTc was more effective than LAD alone (P<0.001) in predicting arrhythmia recurrence after the procedure. QTc interval could be used as an independent predictor of arrhythmia recurrence in T2DM patients undergoing AF ablation, thus providing a simple method to identify those patients who likely have a better outcome following the procedure.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Atrial Fibrillation , General Surgery , Catheter Ablation , Diabetes Mellitus, Type 2 , General Surgery , Electrocardiography , Heart Atria , Proportional Hazards Models , Risk Factors , Tachycardia , Treatment OutcomeABSTRACT
OBJECTIVE:To observe the effect of rosuvastatin on prognostic of patients with paroxysmal atrial fibrillation (AF) after circumferential pulmonary vein ablation. METHODS:75 patients with paroxysmal AF were divided into observa-tion group(n=39)and control group(n=36)according to the admission single. All patients underwent circumferential pulmo-nary vein ablation antiarrhythmic treatment. Control group orally received warfarin sodium,amiodarone,metoprolol,and sub-cutaneous injected low molecular weight heparin. Observation group additionally received 10 mg Rosuvastatin tablet,qd on the basic of contol group. Changes of cardiac function,inflammatory factors,lipid levels in 2 groups before and after treat-ment were observed,and follow-up results were compared. RESULTS:There was no significant difference in left atrial diame-ter and left ventricular ejection fraction in 2 groups before and after treatment (P>0.05);atrial effective refractory periods (AERP)in 2 groups significantly prolorged,and observation group prolorged more significantly than control group,the differ-ence was statistically significant(P0.05). Triglyceride and low density lipoprotein cholesterol in observation group 1 month after operation significantly decreased, HDL-C significantly increased, there were significant differences (P0.05). CONCLUSIONS:Rosuvastatin can effectively inhibit the inflammatory reaction and prolong the AERP,thereby reducing the recurrence rate of AF,with good efficacy and safety.