Radiofrequency catheter ablation combined with spironolactone in the treatment of atrial fibrillation: A single-center randomized controlled study.

At present, the question of whether radiofrequency ablation (RFA) combined with spironolactone can reduce the levels of plasma angiotensin II (AngII) and aldosterone (ALD) in patients with atrial fibrillation (AF) and reduce the recurrence of AF has not been reported. HYPOTHESIS: The present study evaluates the effect of spironolactone as an ALD antagonist on the short-term and long-term recurrence of AF after RFA. A total of 203 patients were enrolled in the present study, with 102 patients in the spironolactone therapy group (Group PVI/SP) and 101 patients in the control group (Group PVI alone). The AngII and ALD levels and the size of the left atrium in patients with AF were observed in order to evaluate the relationship between the combination therapy of spironolactone with RFA and the success rate in AF treatment. After therapy, the levels of AngII (52.8 vs. 64.3 pg/ml, p < .001), ALD (45.7 vs. 60.6 pg/ml, p = .016), and N-terminal of B-type natriuretic peptide (NT-proBNP) (73.5 vs. 110 pg/ml, p = .016), along with the size of the left atrium (35.8 vs. 37.2 mm, p = .007), were all significantly lower in Group PVI/SP compared with Group PVI alone. The cumulative AF-free survival rate was higher in Group PVI/SP than in Group PVI alone after treatment (85.3% vs.73.3%, p = .033). In RFA combined with spironolactone treatment, spironolactone can directly antagonize the effects of ALD and AngII and the recurrence of AF and improve left ventricular function.

The Effect of the Enhanced Endpoint of Pulmonary Vein Isolation on the Long-Term Success Rate of Radiofrequency Ablation for Atrial Fibrillation.

OBJECTIVE: This study aimed to investigate whether the enhanced endpoint of pulmonary vein isolation (PVI; intravenous injection of adenosine-triphosphate [ATP] + pacing capture + supplemental ablation) after initial PVI can reduce the long-term recurrence rate of atrial fibrillation (AF) after PVI. METHODS: Patients with paroxysmal or persistent AF undergoing catheter ablation treatment were enrolled in this study and divided into three groups according to the surgical endpoint: (1) group 1 (n = 92), in which patients were observed for 30 minutes after the initial PVI and pulmonary vein-left atrium (PV-LA) electrical conduction had not recovered; (2) group 2 (n = 99), in which patients were observed for 30 minutes after the initial PVI, then intravenously injected with ATP, and PV-LA electrical conduction had not recovered; and (3) group 3 (n = 102), in which patients were observed for 30 minutes after the initial PVI, then intravenously injected with ATP + treated with ablation line pacing, and the atrium could not be captured. RESULTS: Patients were followed up for 12 months after the operation. Twenty-eight patients in group 1 (30.4%), 19 patients in group 2 (19.2%), and 10 patients in group 3 (9.8%) developed a recurrence of AF. The difference between groups 1 and 3 was statistically significant (p < 0.001). At 12 months after the operation, the thickness of the left atrium, the posterior wall of the left ventricle, and the ventricular septum of the three groups of patients were significantly thinner than before the operation. Furthermore, the left ventricular ejection fraction had increased (p < 0.05 for all), and the pulmonary artery pressure had decreased (p < 0.001). CONCLUSION: For patients with paroxysmal AF or persistent AF, the enhanced endpoint of PVI after the initial PVI can reduce the long-term recurrence rate of AF after PVI.

A Multi-directional Approach for Missing Value Estimation in Multivariate Time Series Clinical Data.

Missing values are common in clinical datasets which bring obstacles for clinical data analysis. Correctly estimating the missing parts plays a critical role in utilizing these analysis approaches. However, only limited works focus on the missing value estimation of multivariate time series (MTS) clinical data, which is one of the most challenge data types in this area. We attempt to develop a methodology (MD-MTS) with high accuracy for the missing value estimation in MTS clinical data. In MD-MTS, temporal and cross-variable information are constructed as multi-directional features for an efficient gradient boosting decision tree (LightGBM). For each patient, temporal information represents the sequential relations among the values of one variable in different time-stamps, and cross-variable information refers to the correlations among the values of different variables in a fixed time-stamp. We evaluated the estimation method performance based on the gap between the true values and the estimated values on the randomly masked parts. MD-MTS outperformed three baseline methods (3D-MICE, Amelia II and BRITS) on the ICHI challenge 2019 datasets that containing 13 time series variables. The root-mean-square error of MD-MTS, 3D-MICE, Amelia II and BRITS on offline-test dataset are 0.1717, 0.2247, 0.1900, and 0.1862, respectively. On online-test dataset, the performance for the former three methods is 0.1720, 0.2235, and 0.1927, respectively. Furthermore, MD-MTS got the first in ICHI challenge 2019 among dozens of competition models. MD-MTS provides an accurate and robust approach for estimating the missing values in MTS clinical data, which can be easily used as a preprocessing step for the downstream clinical data analysis.