Catheter Ablation of Recurrent Paroxysmal Atrial Fibrillation: Is Gap-Closure Combining Ganglionated Plexi Ablation More Effective?

BACKGROUND: For repeat treatment with paroxysmal atrial fibrillation (PAF) recurrence, gap-closure at pulmonary vein ostia alone is not enough. Many recent studies indicated that ganglionated plexi (GPs) denervation could reduce the recurrence of AF. However, it is unclear whether the clinical outcomes of additional GP ablation plus pulmonary veins (PVs ) reisolation during a repeat procedure were associated with less recurrence in PAF patients. The purpose of this study was to evaluate if a repeat procedure of GP ablation (GPA) combining repeated procedure of pulmonary vein isolation (re-PVI), i.e., gap-closure, can offer additional benefit for patients with PAF recurrence. METHOD: A total of 123 consecutive patients with PAF recurrence who underwent success repeat procedures were retrospectively analyzed in our center (2014-2015). Note that 64 patients (group 1, GPA group) were performed with GPA plus re-PVI, while 59 patients (group 2, re-PVI group) had re-PVI (gap-closure) alone. Organized atrial tachycardias (OATs) documented or induced at the end of the procedure were all mapped and ablated. Patients were scheduled for a 12-month follow-up. Clinical presentation and outcome data for the two groups were assessed. RESULT: At the 12-month follow-up 58 of 64 patients (90.6%) in group 1 and 46 of 59 patients (78%) in group 2 remained in sinus rhythm (SR) off antiarrhythmia drugs (AADs) (P = 0.045). CONCLUSION: GPA conferred incremental benefit when performed in addition to re-PVI in patients with PAF recurrence; the GPA group yielded higher success rates than the re-PVI group.

The nitrate transporter NRT2.1 functions in the ethylene response to nitrate deficiency in Arabidopsis.

The ethylene signalling pathway is closely associated with complex environmental stresses. Previous studies have reported impact of high nitrate (HN) availability on ethylene biosynthesis and regulation of ethylene on nitrate transporter 2.1 (NRT2.1) expression. However, molecular interaction between NRT2.1 transcript levels and the ethylene signalling pathway under nitrate deficiency is still elusive. Here, we report a low nitrate (LN) treatment-induced rapid burst of ethylene production and regulated expression of ethylene signalling components CTR1, EIN3 and EIL1 in wild-type Arabidopsis thaliana (Col-0) seedlings, and enhanced ethylene response reporter EBS:GUS activity in both Col-0 and the ethylene mutants ein3-1eil1-1 and ctr1-1. LN treatment also caused up-regulation of NRT2.1 expression, which was responsible for an enhanced high-affinity nitrate uptake. Comparison of ethylene production and EBS:GUS activity between nrt1.1, nrt2.1 mutants and Col-0 indicated that this up-regulation of NRT2.1 expression caused a positive effect on ethylene biosynthesis and signalling under LN treatment. On the other hand, ethylene down-regulated NRT2.1 expression and reduced the high-affinity nitrate uptake. Together, these findings uncover a negative feedback loop between NRT2.1 expression and ethylene biosynthesis and signalling under nitrate deficiency, which may contribute to finely tuning of plant nitrate acquisition during exploring dynamic soil conditions.