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ABSTRACT Arterial stiffness has been investigated as part of the physiopathology of arterial hypertension since the 1970s. Its role in increasing the "pulsatile load" imposed over the Left Ventricle (LV) has been intensely studied recently and has helped in understanding the mechanisms of Atrial Fibrillation (AF) in hypertensive patients. This paper aims to review the main evidence on this issue and establish possible mechanisms involved in the development of AF in patients with arterial stiffness. A PubMed search was performed, and selected articles were searched for references focusing on this topic. In the long term, lower blood pressure levels allow for arterial wall remodeling, leading to a lower stiffness index. To this day, however, there are no available treatments that directly promote the lowering of arterial wall stiffness. Most classes of anti-hypertensive drugs ‒ with stronger evidence for beta-blockers and diuretics ‒ could be effective in reducing arterial stiffness. There is strong evidence demonstrating an association between arterial stiffness and AF. New studies focusing on arterial stiffness and pre-fibrillatory stages would strengthen this causality relation.
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Objective To investigate the correlation of atrial arrhythmia with V1 lead P wave terminal potential (PTFV1) and left atrial diameter (LAD) in patients with obstructive sleep apnea syndrome (OSAS). Methods A total of 247 suspected OSAS patients, firstly hospitalized in Snoring Department of Gansu Provincial People's Hospital from Sep. 2017 to Apr. 2019, were included, and divided into four groups according to the apnea hypopnea index (AHI): AHI<5 as the control group (n=22), 5≤AHI<15 as the mild OSAS group (n=37), 15≤AHI<30 as the moderate OSAS group (n=46), and AHI≥30 as the severe OSAS group (n=142). Polysomnography (PSG) were collected, the incidence of atrial arrhythmia was observed by 24-h dynamic electrocardiogram, LAD was measured by echocardiography, and PTFV1 was measured by 12-lead electrocardiogram. The incidence of atrial arrhythmia in each group was compared, and the correlation between the occurrence of atrial arrhythmia and PTFV1 and LAD was analyzed. Results The incidences of atrial arrhythmia in the mild, moderate and severe group (16.2%, 23.9% and 17.6%, respectively) were significantly higher than that in the control group (0, P<0.05), but no significant difference existed among the mild, moderate and severe group. PTFV1 was positively associated with the incidence of atrial arrhythmia in patients with OSAS (r=0.394, P<0.01). LAD was positively correlated with the incidence of atrial arrhythmia in patients with OSAS (r=0.235, P<0.01). Conclusion The occurrence of atrial arrhythmia in OSAS patients is associated with the abnormal increase of PTFV1 and LAD, which indicates that the occurrence of atrial arrhythmia in OSAS patients is related to the electrical and structural remodeling of the left atrium.
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Objective To explore the predictive value of P wave dispersion (Pd) and maximum P wave duration (Pmax) of 12 lead ECG in patients with atrial arrhythmia.Methods51 cases of atrial arrhythmia group from October 2013 to April 2015 in Jiashan County First People's Hospital, patients with frequent atrial premature atrial tachycardia, were examined for the determination of P wave dispersion by 12 lead electrocardiograms (Pd) and maximum P wave duration (Pmax), and 53 healthy persons (control group) were compared.ResultsAtrial arrhythmia group Pd and Pmax were significantly higher than the control group, the rate is Pmax=100ms with Pd=40ms high prediction of atrial arrhythmia sensitivity, specificity and diagnostic, Pd=40ms=100ms combined with Pmax diagnosis, the sensitivity increased, but the specificity and diagnostic rate of decline.ConclusionPd is an effective index to predict atrial arrhythmias, and the combined detection of Pd and Pmax can improve the diagnostic sensitivity.
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Objective To investigate the effective therapic methods of the perioperative vasovagal reflex(RV)in patients with atrial arrhythmias(AAs)underwent by catheter ablation .Methods The clinical data in the patients with atrial arrhythmias(AAs) complicated by vasovagal reflex(RV)were retrospectively analyzed during the perioperative procedure of catheter ablation guided by three dimensional mapping system CARTO ;the clinical data were compared between patients with RV and without RV .Results A total of 535 patients with AAs underwent catheter ablation guided by three dimensional mapping system were collected from Janu‐ary 2010 to December 2012 ,and 35 cases of intraoperative RV were found .Compared by patients without RV ,the patients with RV had more elderly cases and the cases of hypertension ,coronary heart disease and diabetes .The RV occurrence was also associated with the fasting ,painful stimuli ,operation time and skill .Conclusion The perioperative RV often is occurred in the cases of high risk and have the precipitating factors ,and the good prognosis could be obtained by the detect and treatment as early as possible .
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Objective To investigate the incidence, causes, management and prognosis of atrial fibrillation (AF) after operation of esophagus cancer(EC)and lung cancer(LC). Methods The patients of postoperative AF following EC and LC surgery between December 2004 and May 2006 were taken into EC group and LC group. Results AF occurred in 27 patients ( 11.2%) of EC and in 18 patients (5.6%) of LC. The duration of operating and the level of urine catecholamine within the first two days after operation in the EC group were higher than those of the LC group (P0.05). All patients had been cured. Conclusions The EC predominate over the LC in the incidence of AF after operation; the early medicine treatment needs to be advisable to patients, and the patients of LC can be treated with removing causes at first.