Bilirubin Elevation During Hospitalization Post Radiofrequency Catheter Ablation of Persistent Atrial Fibrillation: Variation Trend, Related Factors, and Relevance to 1-Year Recurrence.

Background: The role of total bilirubin (TBIL) in cardiovascular disease has been increasingly recognized in recent decades. Studies have shown a correlation between total bilirubin levels and the prognosis of patients after heart surgery. This study aimed to investigate the clinical significance of bilirubin elevation in persistent atrial fibrillation (PAF) patients who received radiofrequency catheter ablation (RFCA). Methods and Results: A total of 184 patients with PAF who received RFCA were retrospectively studied. Laboratory examinations and demographic data were analyzed to identify independent predictors of TBIL elevation. The relationship between TBIL and prognosis was further investigated. Our results indicated that TBIL increased significantly after RFCA. Multiple linear regression analysis showed that TBIL elevation owned a negative correlation with the percentile of low voltage areas (LVAs) in left atria (ß=-0.490, P<0.001). In contrast, a positive correlation was observed with the white blood cell (WBC) ratio (ß=0.153, P=0.042) and left atrial diameter (LAD) (ß=0.232, P=0.025). It was found that postoperative TBIL levels increased and then gradually decreased to baseline within 5 days without intervention. The bilirubin ratio <1.211 indicated the possibility of 1-year AF recurrence after ablation with a predictive value of 0.743 (specificity = 75.00%, sensitivity = 66.67%). Conclusion: Bilirubin elevation post PAF RFCA was a common phenomenon and was associated with 1-year recurrence of AF in PAF patients after RFCA.

Electrocardiographic Characteristics of Ventricular Arrhythmias Originating from Different Areas Adjacent to the Mitral Annulus.

BACKGROUND: This study aimed to explore the electrocardiographic (ECG) characteristics of ventricular arrhythmias (VAs) arising from epicardial and endocardial areas adjacent to the mitral annulus (MA). METHODS: This study involved 283 patients with MA-VAs who received radiofrequency catheter ablation at the center. The ECG characteristics of these patients were analyzed retrospectively. RESULTS: The origin of MA-VAs was judged based on the ECG variables. Among all MA-VAs, intrinsicoid deflection time (IDT) > 77 ms or maximum deflection index (MDI) > 0.505 predicted the VAs arising from the epicardium (sensitivity of 70.20% and 73.51%, specificity of 94.70% and 82.58%, positive predictive value (PPV) of 93.81% and 82.84%, and negative predictive value (NPV) of 73.53% and 73.15%). Among all epicardial MA-VAs, the RV1/RV2 ratio > 0.87 predicted the VAs originating from the epicardial anteroseptal wall adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 62.86%, 98.06%, 91.67%, and 88.60%, respectively. Among all endocardial MA-VAs, Q(q)R(r) morphology in lead V1 predicted the VAs arising from the endocardial septal wall adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 92.98%, 100%, 100%, and 94.94%, respectively. Among all endocardial septal MA-VAs, a predominant positive wave in lead II and a predominant negative wave in lead III predicted the VAs arising from the endocardial midseptal portion adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 86.04%, 100%, 100%, and 70.00%, respectively. CONCLUSION: the ECG characteristics of VAs from the different sites adjacent to the MA can enable judging the arrhythmia's origin and designing the ablation plan accordingly.

Idiopathic Ventricular Arrhythmias Originating from Different Portions of the Coronary Venous System: Prevalence, Electrocardiographic Characteristics, Catheter Ablation, and Complications.

(1) Background: To determine the prevalence, electrocardiographic characteristics, mapping, and ablation of IVAs arising from the CVS. (2) Methods: Detailed activation and pace mapping of the CVS IVAs was performed before attempted radiofrequency ablation (RFCA). (3) Results: The IVAs originating from the vicinity of the CVS represented approximately 5.27% (164/3113) of all IVAs; 94.51% (155/164) cases were accessed at the earliest identified site and 83.54% (137/164) IVAs were successfully ablated. The main coronary vein group had a relatively short procedure time, short fluoroscopy time, fewer radiofrequency lesions prior to success, and less Swartz sheath support. IVAs originating from the CVS had distinct ECG characteristics: Rs, RS or rS (with s or S) wave in lead V1 indicate the Vas arising from the proximal portion of the anterior interventricular vein (AIV) and summit-CV; Rs (with s or S) wave in leads V5−V6 indicate the Vas arising from the adjacent regions of the distal great cardiac vein 1 (DGCV1); positive wave (R, Rs or r) In lead I indicate the VAs ori"inat'ng from Summit-CV and posterior wall subgroup (including middle cardiac vein [MCV], posterior lateral vein [PLV], coronary sinus [CS]). Compared with the IVAs originating from the endocardial mitral annulus, a PdW > 45 ms, an IDT > 74 ms, and an MDI > 0.50 indicate a CVS origin of the IVAs. The common peri-procedure complications were CV dissection (6.45%, 10/155), CV rupture (1.29%, 2/155), coronary artery spasm (1.29%, 2/155), coronary artery stenosis (0.65%, 1/155), pericardial effusion (0.65%, 1/155) and tamponade (1.29%, 2/155). Stenosis of coronary arteries was not observed at the adjacent ablation site in the CVS during follow-up. (4) Conclusions: vAs arising from the CVS are not a rare phenomenon. Several ECG and procedure characteristics could help regionalize, map, and ablate the origin of IVAs from different portions of the CVS. RFCA within the CVS was relatively effective and safe.