Standardized Management of Acute Pulmonary Hemorrhage after Percutaneous Pulmonary Vein Intervention

Introduction:Pulmonary hemorrhage(PHm)is a life-threatening complication that can occur after catheter-based interventions in patients with pulmonary vein stenosis(PVS).Inhaled racemic epinephrine(iRE)and tra-nexamic acid(iTXA)have been used in other conditions,but a standardized approach in PVS has not been described.We aimed to describe the current management of PHm after PVS catheter-based interventions.Methods:We present a retrospective review of episodes of PHm from July 2022 to February 2024.PHm was defined as frank blood suctioned from the endotracheal tube including blood-tinged secretions and>3%decrease in saturations and/or ventilatory changes with or without acute chest X-ray changes.Each individual episode of PHm was considered a separate event.Incidence was calculated based on the total number of PVS interventions during the study period.Results:Eleven episodes of PHm were identified out of 108 PVS interventions,resulting in an incidence of 10.2%.Five(45.5%)had primary PVS,and seven(63.6%)had bilateral PVS.The median age at PHm was 23 months(3-91 months).Four episodes were treated with iRE,five with both iRE and iTXA,and two with only iTXA due to a history of suprasystemic right ventricular pressures.Median time on mechanical ventila-tion after PHm was 24 h(15-72 h)and a median ICU stay of 2 days(1-8 days).Hemostasis was achieved in all events.There were no adverse events after iTXA,however,transient hypertension was observed after iRE which was dose-related.Conclusions:The implementation of a standardized protocol for the treatment of PHm in PVS has the potential to improve procedural planning,has a wider availability of medications,and greater awareness by the providers involved,possibly leading to earlier detection of PHm and appropriate treatment.

Diagnostic Value of the Padua Score Combined with Thrombotic Biomarker Tissue Plasminogen Activator Inhibitor-1 (tPAI-1) Detection for the Risk of Deep Vein Thrombosis in Patients with Pulmonary Heart Disease

This study explores the diagnostic value of combining the Padua score with the thrombotic biomarker tissue plasminogen activator inhibitor-1(tPAI-1)for assessing the risk of deep vein thrombosis(DVT)in patients with pulmonary heart disease.These patients often exhibit symptoms similar to venous thrombosis,such as dyspnea and bilateral lower limb swelling,complicating differential diagnosis.The Padua Prediction Score assesses the risk of venous thromboembolism(VTE)in hospitalized patients,while tPAI-1,a key fibrinolytic system inhibitor,indicates a hypercoagulable state.Clinical data from hospitalized patients with cor pulmonale were retrospectively analyzed.ROC curves compared the diagnostic value of the Padua score,tPAI-1 levels,and their combined model for predicting DVT risk.Results showed that tPAI-1 levels were significantly higher in DVT patients compared to non-DVT patients.The Padua score demonstrated a sensitivity of 82.61%and a specificity of 55.26%at a cutoff value of 3.The combined model had a significantly higher AUC than the Padua score alone,indicating better discriminatory ability in diagnosing DVT risk.The combination of the Padua score and tPAI-1 detection significantly improves the accuracy of diagnosing DVT risk in patients with pulmonary heart disease,reducing missed and incorrect diagnoses.This study provides a comprehensive assessment tool for clinicians,enhancing the diagnosis and treatment of patients with cor pulmonale complicated by DVT.Future research should validate these findings in larger samples and explore additional thrombotic biomarkers to optimize the predictive model.

A Novel Mutation in FOXF1 Gene Associated with a Delayed Presentation of Alveolar Capillary Dysplasia with Misalignment of Pulmonary Veins

Alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) is a rare, fatal developmental lung disorder of neonates and infants, associated with severe persistent pulmonary hypertension unresponsive to treatment. We reported the case of a term newborn with delayed presentation of ACD/MPV and a novel mutation of FOXF1 gene that received supportive cardiopulmonary treatments, inhaled nitric oxide, oral sildenafil and nebulized iloprost with no clinical improvement. DNA sequence analysis of FOXF1 gene identified a novel heterozygous variant c.257G > C;p.R86P, in exon 1. At autopsy, lung histology showed the characteristic features of ACD/MPV. FOXF1 has been identified as one of the genes responsible for ACD/MPV associated with multiple congenital malformations. This is a report of a novel heterozygous variant c.257G > C;p.R86P, in the first exon of FOXF1, in a patient with delayed presentation of ACD/MPV.

Radiofrequency Ablation Mapping with Circumferential Catheter for Paroxys- mal Atrial Fibrillation Originating From the Pulmonary Veins

Objectives To assessed the feasibility and effectiveness of electrophysiological mapping of pulmonary veins with a circumferential 10 - electrode catheter and radiofrequency catheter ablation therapy for patients with paroxysmal atrial fibrillation. Background Standard mapping and ablation of focal sources of atrial fibrillation are associated with very long procedure times and low efficacy. Mapping and ablation pulmonary veins guide with a circular catheter could overcome these limitations. Methods 16 patients [male 11, female 5, mean age (51 ±14. 5) years] with paroxysmal atrial fibrillation refractory to antiarrhythmic drugs were included in this group. A circumferential 10 - electrode catheter was used to pulmonary vein mapping during sinus rhythm or CSd pacing to determine the origin of atrial premature contractions. When the ablative target pulmonary vein was found, the pulmonary vein potentials' distribution and activation were assessment pulmonary veins' ostial ablation was performed at the segments showing earliest activation of pulmonary vein potentials. The end point was designed: 1) elimination of pulmonary vein potential; 2) pulmonary vein potential dissociation from atrial waves; 3) atrial ectopic beats disappear. Results A total of 36 pulmonary veins were ablated, including 16 left superior, 12 right superior, 7 left inferior and 1 right inferior. 1 pulmonary vein in 2 patients was ablated, 2 pulmonary veins in 8 patients were ablated, 3 pulmonary veins were ablated in 5 patients and 4 pulmonary veins were ablated in 1 pa- tient. Procedure duration and fluoroscopy time respectively were 186. 7±63. 8 min and 51. 5±15. 0 min. During the follow-up 1-12 months, 11 patients (68. 7 % ) were free of AF without any antiarrhythmic drugs, 2 of them were reablation, effective in 3/16 (18. 7 % ) and unsuccessful in 2/16 (12. 6 % ) . 2 cases recurred with atrial premature, 1 was treated with amiodarone and the other was repeat electrophysiologi-cal mapping and ablation, 5 cases with paroxysmal a-trial fibrillation recurred, 3 of them were treated with amiodarone (2 cases) or sotalol (1 case) , one was implantled with DDDR pacemaker (having programmer of anti - atrial fibrillation), one was repeat ablation. PV's diameter in 2 of them reduced more than 50 % , but they were asymptomatic during the follow - up period. 1 case had pneumothorax complication and disappeared after 7 days. Conclusions This study suggests that careful mapping and elimination of these ectopic foci under the guide of circular catheter may have higher success rate and splendid future.

Pulmonary embolism and deep vein thrombosis caused by nitrous oxide abuse: A case report

BACKGROUND Nitrous oxide(N2O)has gained increasing popularity as a recreational drug,causing hallucinations,excitation,and psychological dependence.However,side effects have been reported in recent years.Our case report proposes a correlation among N2O,pulmonary embolism(PE),and deep vein thrombosis(DVT)and emphasizes the role of homocysteine(Hcy)in thrombotic events.CASE SUMMARY A 29-year-old man with long-term N2O abuse sought evaluation after acute chest pain.A diagnostic workup revealed PE,DVT,and hyperhomocysteinemia.The patient was successfully treated with thrombolytic and anticoagulant therapy.Moreover,his Hcy level decreased and returned to normal after Hcy-lowering therapy.CONCLUSION Chronic N2O abuse might increase the risk of PE and DVT,although there have been few studies previously.

Pulmonary vein stenosis:Etiology,diagnosis and management

Pulmonary vein stenosis(PVS) is rare condition characterized by a challenging diagnosis and unfavorable prognosis at advance stages. At present, injury from radiofrequency ablation for atrial fibrillation has become the main cause of the disease. PVS is characterized by a progressive lumen size reduction of one or more pulmonary veins that, when hemodynamically significant, may raise lobar capillary pressure leading to signs and symptoms such as shortness of breath, cough, and hemoptysis. Image techniques(transesophageal echocardiography, computed tomography, magnetic resonance and perfusion imaging) are essential to reach a final diagnosis and decide an appropriate therapy. In this regard, series from referral centers have shown that surgical and transcatheter interventions may improve prognosis. The purpose of this article is to review the etiology, assessment and management of PVS.

Impact of Pulmonary Vein Anatomy on Long-term Outcome of Cryoballoon Ablation for Atrial Fibrillation

Variant pulmonary vein anatomy （PVA） has been reported to influence the recurrence of atrial fibrillation （AF） after radiofrequency ablation. However, the effects of PVA on AF in patients undergoing cryoballoon ablation （CBA） remain unknown. The present study aimed to examine the impact of PVA on the long-term outcome of CBA for AF. A total of 78 patients （mean age 60.7±10.9 years, 64.1% males） with symptomatic and drug-refractory paroxysmal AF were enrolled in the study. Left atrium （LA） and PVA acquired at computed tomography angiography （CTA） were reconstructed with CARTO 3 SYSTEM. Patients were routinely evaluated by 24-hour Holter monitoring following CBA. Cox regression was used to detect the predictors of AF recurrence after CBA. The results showed abnormal PVA in 30 patients （38.5%） and 18 patients （23.1%） had left common PV （LCPV）. Electrical pulmonary vein isolation was achieved in all patients. After a mean follow-up of 689.5±103.8 days, it was found that patients with abnormal PVA had similar AF recurrence rate to those with normal PVA （26.7% vs. 25.0%, P=0.54）, and there was no significant difference in AF recurrence rate between LCPV patients and non-LCPV patients （33.7% vs. 23.3%, P=0.29）. Cox regression analysis showed that AF duration （72.9±9.0 vs. 42.3±43.2 months, HR 1.001; 95%CI 1.003- 1.014; P〈0.001） and cryo-applications of right-side PVs （3.0±1.6 vs. 4.7±1.7, HR 0.661; 95% CI 0.473-0.925; P=0.016） were independent predictors of freedom from AF, but PVA was not identified as a predictor of long-term success. In conclusion, the variant PVA cannot significantly influence the long-term outcome of AF patients undergoing CBA; longer AF duration and less cryo-applications of right-side PVs are associated with higher AF recurrent rate.

Segmental radiofrequency ablation of pulmonary vein ostia for patients with refractory paroxysmal atrial fibrillation using multi-slice spiral computed tomography guidance

Objective： To evaluate the safety and clinical efficacy of segmental radiofrequency ablation of pulmonary vein （PV） ostia for patients with refractory paroxysmal atrial fibrillation （AF） under multi-slice spiral computed tomography （MSCT） guidance before the procedure. Methods： A series of 58 consecutive patients with refractory paroxysmal AF were enrolled to undergo segmental radiofrequency ablation ofPV ostia. The 36 male and 22 female patients with mean age of （57.4±9.5） （32-79） years and no obvious organic heart disease. Before ablation, patients received MSCT to generate 3-dimentional image of the left atrium （LA） and proximal PVs. Patients then underwent segmental radiofrequency ablation ofPV ostia using PV circular mapping catheter manipulated several times to ensure complete isolation between PVs and LA. Results： No complications occurred during the procedure. One patient developed delayed cardiac tamponade, which was drained percutaneously. The mean follow-up time was （17.1±9.3） months. Forty-one patients （95%） experienced improved quality of life one month after the procedure. Thirty-six patients （83%） showed stable sinus rhythm, while 10 patients （23%） required additional anti-arrhythmic drugs. AF returned≥1 time in 6 （14%） patients who underwent anti-arrhythmic drug therapy, but the number of episodes was less than that before the procedure. However, one patient experienced recurrent episodes of atrial flutter. Conclusion： It is safe and effective to perform segmental radiofrequency ablation of PV ostia for patients with refractory paroxysmal AF using MSCT guidance mappening.

Pulmonary Embolism and Deep Vein Thrombosis in a Woman Taking Contraceptives and with Unhealthy Life Habit:a Case Report

QRAL contraceptives are widely used to prevent pregnancy. A number of studies have dem- onstrated the increased risk of venous throm- boembolism in women taking oral contracep-tives.1, 2 Pulmonary embolism （PE） and deep vein throm- bosis （DVT） are two clinical presentations of venous thromboembolism which share the same predisposing factors.3 This article described a female patient who taked oral contraceptives and had an unhealthy life habit de- veloped PE and DVT. CASE DESCRIPTION

Pulmonary embolism and internal jugular vein thrombosis as evocative clues of Lemierre's syndrome:A case report and review of the literature

Lemierre’s syndrome(LS)is an uncommon condition with oropharyngeal infections,internal jugular vein thrombosis,and systemic metastatic septic embolization as the main features.Fusobacterium species,a group of strictly anaerobic Gram negative rod shaped bacteria,are advocated to be the main pathogen involved.We report a case of LS complicated by pulmonary embolism and pulmonary septic emboli that mimicked a neoplastic lung condition.A Medline search revealed 173 case reports of LS associated with internal jugular vein thrombosis that documented the type of microorganism.Data confirmed high prevalence in young males with Gram negative infections(83.2%).Pulmonary embolism was reported in 8.7% of cases mainly described in subjects with Gram positive infections(OR=9.786;95%CI:2.577-37.168,P=0.001),independently of age and gender.Only four fatal cases were reported.LS is an uncommon condition that could be complicated by pulmonary embolism,especially in subjects with Gram positive infections.

Pulmonary vein isolation implemented by second-generation cryoballoon for treating hypertrophic cardiomyopathy patients with symptomatic atrial fibrillation:a case-control study

Background Atrial fibrillation(AF)is a generally acknowledged turning-point of the natural history of hypertrophic cardiomyopathy(HCM);however,data from the cryoballoon ablation(CBA)for AF in HCM patients are relatively scarce.The study aimed to evaluate the efficacy and safety of CBA in HCM patients with AF.Methods We retrospectively analyzed HCM patients among 1253 patients with symptomatic AF who underwent CBA for pulmonary vein isolation in a single center.The study analyzed the AF recurrence and assessed the CBA indexes,including nadir temperature,time-to-isolation,CBA failure,pulmonary vein potentials(PVPs),and redo procedure.Results A total of 108 patients were included(mean age:59.0±6.9 years),27 patients(25%)had HCM,with the median follow-up duration of 25.5 months.The one-year AF-free rates were 79.0%vs.63.0%(non-HCM vs.HCM),while the two-year AF-free rates were 77.8%vs.55.1%[hazard ratio(HR)=2.758,log-rank P=0.024].Patients with persistent AF had poor AF-free rates compared to those with paroxysmal AF(P<0.001).The CBA failure was the most common in the right inferior pulmonary veins,which had the lowest PVPs.Multivariate Cox regression analysis indicated that HCM and persistent AF were risk factors for AF recurrence(HR=2.74,95%CI:1.29–5.79,P=0.008;and HR=3.97,95%CI:1.85–8.54,P<0.001,respectively).Conclusions The CBA can be effectively and safely used to treat HCM patients with symptomatic AF.The freedom from AF for HCM patients after CBA is relatively low compared to that for non-HCM patients.

Modified Maze lines plus pulmonary vein isolation created by radiofrequency catheter ablation on the atrial wall to treat atrial fibrillation in elderly

Objective To evaluate the effect of modified Maze lines plus pulmonary vein (PV) isolation created by radiofrequency catheter ablation (RFCA) on atrial wall guided by a novel geometry mapping system in the treatment of elderly patients with paroxysmal atrial fibrillation (PAF). Methods After regular electrophysiological study, transseptal punctures were achieved twice with Swartz L1 and R1 sheaths. PV angiographies were conducted to evaluate their orifices and branches. A balloon electrode array catheter with 64 electrodes was put in the middle of the left atrium. Atrium geometry was constructed using Ensite 3000 Navx system. Two RFCA lesion loops and three lines (modified Maze) were created on left and right atrial walls. Each lesion point was ablated for 30 seconds with preset temperature 50 (ae) and energy 30W. The disappearance or 80% decrease of the amplitude of target atrial potential and 10 to 20(|), decrease of ablation impedance were used as an index of effective ablation. Results A total of 11 patients (7 male and 4 female, mean age, 68.7±5.1 years) were enrolled. PAF history was 7.9±4.5 years. PAF could not be prevented by mean 3.1±1.6 antiarrhythmic agents in 6.3±3.4 years. None of the patients had complications with structural heart disease or stroke. Left atrial diameter was 41.3±3.6 mm and LVEF was 59.2±3.7% on echocardiography. Two loops and three lines were completed with 67.8±13.1 (73-167) lesion points. Altogether 76-168 (89.4±15.3) lesion points were created in each patient. PAF could not be provoked by rapid burst pacing up to 600 beat per minute delivered from paroxysmal coronary sinus electrode pair.Complete PV electrical isolation was confirmed by three-dimensional activation mapping. Mean procedure time was 2.7±0.6 hours and fluoroscopy time was 17.8±9.4 minutes. Patients were discharged with oral aspirin and without antiarrhythmic agents. During follow up of 6.5±1.8 months, seven patients were PAF symptom free (63.6%). PAF attacks were decreased more than 70% in two patients (18.2%). PAF frequency did not change in another two patients (18.2%). Conclusions Ensite 3000 Navx guided modified Maze lines plus PV isolation on the atrial wall is safe and feasible in the elderly patients. It has the advantages of exact procedural endpoint, shorter X-ray exposure, fewer complications and satisfied long-term effect PAF control.

Hemoptysis secondary to pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation: A case report and literature review

Objectives: Pulmonary vein stenosis(PVS) is a known complication after radiofrequency ablation of atrial fibrillation(RAAF) and is often misdiagnosed owing to lack of awareness regarding PVS among noncardiologists.Misdiagnosis results in unnecessary treatment;therefore, greater understanding of PVS can improve the management of these patients.Methods: We report the case of a 38-year-old man with a history of RAAF who presented with massive hemoptysis.His symptoms persisted despite undergoing transcatheter bronchial artery embolization on two occasions.Results: Pulmonary computed tomography angiography revealed a completely occluded left superior pulmonary vein. Considering the patient’s history of RAAF, we diagnosed him with RAAF-induced PVS and performed left superior lobectomy after which hemoptysis did not recur.Conclusions: Unexplained massive hemoptysis should alert clinicians regarding the possibility of RAAF-induced PVS. Balloon angioplasty and stent placement are used to treat PVS;however, their efficacy is controversial considering the high recurrence rates associated with these interventions.

Increased ostial pulmonary vein diameter in congestive heart failure:a multi-slice computed tomography angiography evaluation

Background and Objectives The relationship between left atrial(LA)size and congestive heart failure(CHF)is well recognized;however,there is little information on the association of pulmonary vein(PV)diameter and CHF.The purpose of this study was to investigate the changes of PV and LA sizes in CHF patients by multislice computed tomography(MSCT)angiography using a new 64-slice scanner.Methods and Results We assessed diameters of PVs ostium and LA by 64-slice MSCT with three-dimensional reconstruction in 25 CHF patients and in 26 age-and sex-matched non-CHF controls.Compared with controls,CHF patients showed significant greater diameters of left superior pulmonary vein(LSPV)and right inferior pulmonary vein(RIPV)in both anteriorposterior(AP)and superior-inferior(SI)directions(P<0.01),significant dilation of right superior pulmonary vein(RSPV)in AP direction(P<0.05),as well as significant increase of LA transverse,AP,and SI diameters(P<0.01).Conclusion Significant dilation of PVs with simultaneous LA enlargement was demonstrated in CHF patients.This anatomic and geometric changes may participate in the perpetuation of AF.

Pulmonary vein thrombosis in a patient with polycythemia vera

Pulmonary vein thrombosis(PVT) is a rarely encountered disease entity with varied clinical presentations. It is usually associated with lung carcinoma, lung surgeries and as a complication of the radiofrequency catheter ablation procedure for atrial fibrillation. Its clinical manifestations can vary from mild hemoptysis to lung infarction with hemodynamic compromise. A 76-year-old male presented with a 2-d history of pleuritic left sided chest pain. His past medical history included polycythemia vera, atrial fibrillation, coronary artery disease, pulmonary embolism and pulmonary hypertension. Chest radiograph was normal, troponins were normal and the 12-lead electrocardiogram did not show any ischemic changes. A computerized tomography pulmonary angiogram revealed a filling defect in the left lower lobe pulmonary vein. He was treated with subcutaneous enoxaparin and his symptoms improved. This case highlights a rare etiology of chest pain and the first reported case of the association of polycythemia vera and pulmonary vein thrombosis. A high index of suspicion is required for appropriate diagnostic work up. PVT can mimic pulmonary embolism. The diagnostic work up and treatment strategies depend on acuity of presentation.

Cryoballoon pulmonary vein isolation and left atrial appendage occlusion prior to atrial septal defect closure: A case report

BACKGROUND In patients who suffer from both atrial fibrillation(AF)and atrial septal defect(ASD),cryoballoon pulmonary vein isolation(PVI),sequential left atrial appendage(LAA)occlusion and ASD closure could be a strategy for effective prevention of stroke and right heart failure.CASE SUMMARY A 65-year-old man was admitted to our institution due to recurrent episodes of palpitations and shortness of breath for 2 years,which had been worsening over the last 48 h.He had a history of AF,ASD,coronary heart disease with stent implantation and diabetes.Physical and laboratory examinations showed no abnormalities.The score of CHA2DS2VASc was 3,and HAS-BLED was 1.Echocardiography revealed a 25-mm secundum ASD.Pulmonary vein(PV)and LAA anatomy were assessed by cardiac computed tomography.PV mapping with 10-pole Lasso catheter was performed following ablation of all four PVs with complete PVI.Following the cryoballoon PVI,the patient underwent LAA occlusion under transesophageal echocardiographic monitoring.Lastly,a 34-mm JIYI ASD occlude device was implanted.A follow-up transesophageal echocardiography at 3 mo showed proper position of both devices and neither thrombi nor leakage was found.CONCLUSION Sequential cryoballoon PVI and LAA occlusion prior to ASD closure can be performed safely in AF patients with ASD.

Incidental meandering right pulmonary vein,literature review and proposed nomenclature revision

We report a case of an anomalous pulmonary vein on chest X-ray resembling a scimitar sign in an 80-year-old female undergoing investigation of syncope.Multislice computed tomography(CT) with multiplanar reformatting and maximum intensity projections demonstrated an aberrant right inferior pulmonary vein coursing inferomedially towards the diaphragm before turning superiorly and draining normally into the left atrium.The diagnosis of an incidental meandering right pulmonary vein was established.The case is used to review the literature on this rare pulmonary anomaly,including pathogenesis,its relationship with scimitar syndrome and scimitar variant,and diagnosis,with an emphasis on the role modern CT techniques can play in noninvasive diagnosis.A revision to the nomenclature of pulmonary vascular anomalies is proposed to help reduce confusion in the literature.

A three-pulmonary vein isolation approach to treat paroxysmal atrial fibrillation

Objective To investigate the safety and efficacy of a 3-pulmonary vein (PV) isolation approach in treating paroxysmal atrial fibrillation (AF). Methods Radiofrequency catheter ablation was used to eliminate PV potential in 11 patterns with frequent paroxysmal AF refractory to anti-arrhythmic agents. During sinus rhythm, PV potential was mapped in the left and right superior PVs and left inferior PV. The procedural success was defined as the elimination of PV potential in the 3 PVs. Restults PV potential was identified and abolished in a total of 24 PVs, mostly in the left and right superior PV. There was no pulmonary stenosis or other complications during or after the procedures. AF recurred in one patient after an average of 12 ± 3 month follow-up. Conclusions PV potemials were present mostly in the left or right superior PV. The 3-PVs isolation approach is safe and effective in preventing drug-resistant paroxysmal AF.

Effect of ivabradine on hyperpolarization activated cation current in canine pulmonary vein sleeve cardiomyocytes with atrial fibrillation

Objective To study the effect of ivabradine on hyperpolarization activated cation current in canine pulmonary vein(PY) sleeve cardiomyocytes with atrial fibrillation.Methods Dissociation of PVs yielded single cardiomyocytes from a Landengorff column without or with pacemaker activity from long-term rapidly atrial pacing (RAP) canines.If current was measured with the whole-cell patch-clamp technique.Results Compared with the control group,the rapidly atrial pacing canine PV cardiomyocytes had spontaneous diastolic depolarization and had larger If densities.Ivabradine (Iva,1 μM),a selective inhibitor of the If current,markedly reduced If currents in the RAP from -2.66±0.4 pA/pF to -1.58±0.1 pA/pF at the test potential of-120 mV (P＜0.01,n=12).Inhibition effect of Iva of If current showed concentration-dependent range from 0.1 to 10.0μM,with IC50 of 2.2 μ M ( 1.8-2.9 μM,95% CL).Furthermore,V1/ of steady-state activated curve was shifted from -84.3±4.9 mV to -106.9±3.4 mV and k value of steady-state activated curve was changed from 12.1+2.6 mV to 9.9±3.4 mV by the application of.1.0 μM Iva ( P＜0.01,n=12).Conclusions Our study revealed that Ivarbadine may significantly decrease If of rapidly atrial pacing pulmonary vein sleeve ceUs with atrial fibdllation.(J Geriatr Cardiol 2008;5:39-42)

Reversal of pulmonary vein remodeling after catheter ablation of atrial fibrillation

Background Pulmonary veins （PV） and the atria undergo electrical and structural remodeling in atrial fibrillation （AF）. This study aimed to determine PV and left atrial （LA） reverse remodeling after catheter ablation for AF assessed by chest computed tomography （CT）. Methods PV electrophysiologic studies and catheter ablation were performed in 63 patients （68% male; mean ± SD age： 56 ± 10 years） with symptomatic AF （49% paroxysmal, 51% persistent）. Chest CT was performed before and 3 months after catheter ablation. Results At baseline, patients with persistent AF had a greater LA volume （91 ±29 cm3 vs. 66 ± 27 cm3; P = 0.003） and mean PV ostial area （241 ＋ 43 mm2 vs. 212 ± 47 mm2; P = 0.03） than patients with paroxysmal AF. There was no significant correlation between the effective refractory period and the area of the left superior PV ostium. At 3 months of follow-up after ablation, 48 patients （76%） were AF free on or off antiarrhythmic drugs. There was a significant reduction in LA volume （77 ±31 cm3 to 70 ± 28 cm3; P 〈 0.001） and mean PV ostial area （224 ± 48 mm2 to 182 ± 43 mm2; P 〈 0.001）. Patients with persistent AF had more reduction in LA volume （11.8 ± 12.8 cm3 vs. 4.0 ± 11.2 cm3; P = 0.04） and PV ostial area （62 mm2 vs. 34 mm2; P = 0.04） than those who have paroxysmal AF. The reduction of the averaged PV ostial area was significantly correlated with the reduction of LA volume （r = 0.38, P = 0.03）. Conclusions Catheter ablation of AF improves structural remodeling ofPV ostia and left atrium. This finding is more apparent in patients with persistent AF treated by catheter ablation.