Clinical Significance of Additional Ablation of Atrial Premature Beats after Catheter Ablation for Atrial Fibrillation

PURPOSE: The clinical significance of post-procedural atrial premature beats immediately after catheter ablation for atrial fibrillation (AF) has not been clearly determined. We hypothesized that the provocation of immediate recurrence of atrial premature beats (IRAPB) and additional ablation improves the clinical outcome of AF ablation. MATERIALS AND METHODS: We enrolled 200 patients with AF (76.5% males; 57.4+/-11.1 years old; 64.3% paroxysmal AF) who underwent catheter ablation. Post-procedure IRAPB was defined as frequent atrial premature beats (> or =6/min) under isoproterenol infusion (5 microg/min), monitored for 10 min after internal cardioversion, and we ablated mappable IRAPBs. Post-procedural IRAPB provocations were conducted in 100 patients. We compared the patients who showed IRAPB with those who did not. We also compared the IRAPB provocation group with 100 age-, sex-, and AF-type-matched patients who completed ablation without provocation (No-Test group). RESULTS: 1) Among the post-procedural IRAPB provocation group, 33% showed IRAPB and required additional ablation with a longer procedure time (p=0.001) than those without IRAPB, without increasing the complication rate. 2) During 18.0+/-6.6 months of follow-up, the patients who showed IRAPB had a worse clinical recurrence rate than those who did not (27.3% vs. 9.0%; p=0.016), in spite of additional IRAPB ablation. 3) However, the clinical recurrence rate was significantly lower in the IRAPB provocation group (15.0%) than in the No-Test group (28.0%; p=0.025) without lengthening of the procedure time or raising complication rate. CONCLUSION: The presence of post-procedural IRAPB was associated with a higher recurrence rate after AF ablation. However, IRAPB provocation and additional ablation might facilitate a better clinical outcome. A further prospective randomized study is warranted.

Efficacy of Yixinshu Capsule in treatment of premature beats / 中成药

AIM:To find a new way of treating premature beats(PB) to evaluate the efficacy and safety of Yi-(xinshu) Capsule(Radix et Rhizoma Ginseng,Radix et Rhizoma Salviae miltiorrhizae,Radix Ophiopogonis,Radix Astragali,etc.) METHODS:Randomized,controlled clinical study were conducted in 60 patients with atrial premature beats(APB),and 60 patients with premature ventricular beats(PVB).APB patients were randomly divided into two groups:Yixinshu Capsule plus Isoptin(study group,n=30) and Isoptin group(control group,n=30).PVB patients:Yixinshu Capsule plus Mexiletine(study group,n=30) and Mexiletine group(control group,n=30).Those patients were treated for four weeks.We used 24 h Holter to monitor the times of PB and myocardial ischemia in before and after treatment.RESULTS:In the study group and control group,the times of APB and PVB were decreased obviously after 4 weeks treatment(P