Background Recently there has been a great deal of interest in the role of serum uric acid （SUA） in atrial fibrillation （AF）. The objective of this study was to establish whether there is a relationship between le...Background Recently there has been a great deal of interest in the role of serum uric acid （SUA） in atrial fibrillation （AF）. The objective of this study was to establish whether there is a relationship between levels of SUA and recurrence of paroxysmal AF after catheter ablation. Methods Three hundred and thirty patients diagnosed with paroxysmal AF were analyzed. Patients were categorized into quartiles on the basis of their pre-operative SUA measurement and follow-up, and Kaplan-Meier estimation with a Log-rank test was used for the analysis of the influence of SUA on the recurrence of AF. Pre-procedural clinical variables were correlated with the clinical outcome after ablation using multivariate Logistic analysis. A Cox proportional hazards model was used to estimate the relationship between SUA and the recurrence of AF. Results After a mean follow-up of （9.341＋3.667） （range 3.0-16.3） months, recurrence rates from the lowest SUA quartile to the highest SUA quartile were 16.0%, 26.4%, 28.3%, and 29.3% respectively （P=0.014）. After adjustment for gender, body mass index （BMI）, hypertension, serum levels of high sensitivity C-reactive protein （hsCRP）, triglyceride （TG）, left atrial diameter （LA）, estimated glomerular filtration rate （eGFR）, and SUA, there was an increased risk of recurrence in subjects in the highest SUA quartile compared with those in the lowest quartile （hazard ratio 2.804, 95% confidence interval 1.466-5.362, P=0.002）. Following multivariate Logistical analysis, SUA was found to be an independent predictor of recurrence （hazard ratio 1.613, 95% confidence interval 1.601-1.625, P=0.014）. Conclusion In a retrospective study of patients with paroxysmal AF undergoing catheter ablation, elevated preoperative SUA levels were associated with a hiaher rate of recurrence of AF.展开更多
Background The optimal endpoint for catheter ablation of persistent atrial fibrillation （AF） remains ambiguous. This study investigated the impact of AF termination as a procedural endpoint and the termination mode ...Background The optimal endpoint for catheter ablation of persistent atrial fibrillation （AF） remains ambiguous. This study investigated the impact of AF termination as a procedural endpoint and the termination mode on long-term clinical outcome. Methods Two hundred and ninety-three patients who underwent stepwise ablation for persistent AF were categorized into the AF termination by ablation group and into the electrical cardioversion （CV） group. Subgroups were also analyzed based on different termination modes. Follow-up assessment included early recurrence and sinus rhythm （SR） maintenance. Results During initial ablation, 33 patients （11.3%） were directly converted to SR, 166 patients （56.7%） were converted to atrial tachycardia （AT） that subsequently restored SR with further ablation in 98 patients （33.4%）, and a total of 162 patients （55.3%） underwent cardioversion due to persistent atrial arrhythmias. Comparison between termination by ablation and termination by cardioversion in patients exhibiting AF or AT revealed that no significant difference was observed in early recurrence （38.2% vs. 43.8%, P=0.328） and SR maintenance （67.2% vs. 59.8%, P=0.198） during the （23±7） months follow-up. Even after repeat ablation, the SR maintenance continued to exhibit no statistical difference in above two groups （72.5% vs. 70.4%, P=0.686）. Further analysis of subgroups, however, demonstrated that patients with AF terminated directly to SR experienced better clinical outcomes than other subgroups （P 〈0.05）. Furthermore, atrial arrhythmias present during ablation have been implicated in prediction of recurrence mode： AF or AT （P 〈0.05）. Conclusions Termination as a procedural endpoint is not associated with favorable long-term SR maintenance in persistent AF. AF methods that convert arrhythmia directly to SR have, however, been linked with improved clinical outcomes, although conversions to AT may not be correlated. Atrial arrhythmias observed during the ablation may be used to predict the recurrence mode.展开更多
Background HATCH score is an established predictor of progression from paroxysmal to persistent atrial fibrillation （AF）. The purpose of this study was to determine if HATCH score could predict recurrence after cath...Background HATCH score is an established predictor of progression from paroxysmal to persistent atrial fibrillation （AF）. The purpose of this study was to determine if HATCH score could predict recurrence after catheter ablation of AF. Methods The data of 488 consecutive paroxysmal AF patients who underwent an index circumferential pulmonary veins （PV） ablation were retrospectively analyzed. Of these patients, 250 （51.2%） patients had HATCH score=0, 185 （37.9%） patients had HATCH score=l, and 53 （10.9%） patients had HATCH score 〉2 （28 patients had HATCH score=2, 23 patients had HATCH score=3, and 2 patients had HATCH score=4）. Results The patients with HATCH score 〉2 had significantly larger left atrium size, the largest left ventricular end systolic diameter, and the lowest ejection fraction. After a mean follow-up of （823＋532） days, the recurrence rates were 36.4%, 37.8% and 28.3% from the HATCH score=0, HATCH score=l to HATCH score 〉2 categories （P=0.498）. Univariate analysis revealed that left atrium size, body mass index, and failure of PV isolation were predictors of AF recurrence. After adjustment for body mass index, left atrial size and PV isolation, the HATCH score was not an independent predictor of recurrence （HR=0.92, 95% confidence interval=0.76-1.12, P=0.406） in multivariate analysis. Conclusion HATCH score has no value in prediction of AF recurrence after catheter ablation.展开更多
Background It is unclear whether a history of paroxysmal atrial fibrillation （PAF） would impact the effect of catheter ablation on persistent atrial fibrillation （AF）. This study aimed to compare the effect of cat...Background It is unclear whether a history of paroxysmal atrial fibrillation （PAF） would impact the effect of catheter ablation on persistent atrial fibrillation （AF）. This study aimed to compare the effect of catheter ablation on persistent AF with and without a history of PAF. Methods One hundred and eighty-three patients underwent catheter ablation of persistent AF lasting for 〉1 month and were reviewed. Patients were divided into two groups according to whether they had a history of PAF or not. Group I consisted of persistent AF patients with a history of PAF, and group II consisted of persistent AF patients without such a history. All patients received catheter ablation focused on pulmonary vein isolation and were observed for arrhythmia recurrences, which were defined as documented episodes of AF or atrial tachycardia after a blanking period of 3 months. Results One hundred and three patients （60.9%） in group I and sixty-six patients （39.1%） in group II were successfully followed and included in analysis. There were no significant differences in clinical and echocardiographic characteristics between both groups except for a younger age and more male patients in group II. After （15.5±10.7） months of follow-up, 59 （57.3%） patients in group I and 49 （74.2%） patients in group II maintained sinus rhythm free of anti-arrhythmia drugs （P=0.025）. Multivariate analyses found left atrial anteroposterior diameter （P=0.006） and persistent AF with a history of PAF （OR 1.792, 95% CI 1.019-3.152; P=0.043） as the only independent statistical predictors of arrhythmia recurrences. Conclusion The arrhythmia recurrence rate of catheter ablation based on pulmonary vein isolation in persistent AF with a history of PAF was hiQher than those without a history of PAF展开更多
Catheter ablation of atrial fibrillation （AF） has been ,increased dramatically recently. However, it is an unpleasant procedure with intolerable pain without sedation. Propofol and fentanyl/midazolam have been widel...Catheter ablation of atrial fibrillation （AF） has been ,increased dramatically recently. However, it is an unpleasant procedure with intolerable pain without sedation. Propofol and fentanyl/midazolam have been widely used in painful clinical examination and cardiovascular procedures with established safety and efficacy. Propofol, alfentanyl and midazolam were administrated for catheter ablation in some electrophysiological labs for a less painful procedure. However, there is few published work on the sedation regimen for catheter ablation of AF.展开更多
Background Previous studies have investigated the technique of linear ablation at the mitral isthmus （MI） in patients with idopathic atrial fibrillation （AF）, but MI ablation in patients with prosthetic natural mi...Background Previous studies have investigated the technique of linear ablation at the mitral isthmus （MI） in patients with idopathic atrial fibrillation （AF）, but MI ablation in patients with prosthetic natural mitral valves （MVs） was not described in detail. Present study sought to summarize our initial experience of ablating MI in patients with prosthetic MVs Methods Patients with drug refractory AF and prosthetic MVs were eligible for this study, and the patients with natural MVs but received MI ablation served as control group. Left atrium （LA） mapping and ablation was carried out guided by CARTO system. The anatomy of MI was assessed via computer topography scan. Results During the study period, a consecutive of 19 patients （male/female=12/7, mean age of （48±6） years） with prosthetic MVs （16 with metal valves, 3 with biologic valves） entered for AF ablation, other 35 patients served as control group. In study group, mapping along MI documented lower voltages （（2.0±1.0） vs. （3.1±1.3） mV, P=-0.002）, more fragmented potentials （19/19 vs. 20/15, P 〈0.001 ）, and higher impedance （（132±34） vs. （110±20） Ω, P=0.004）. After initial ablation, more residual gaps along the MI lesions were found in study group （2.4±0.4 vs. 1.7±0.3, P 〈0.001）. The mean length of MI （（6.2±3.3） vs. （7.1±2.3） cm, P=-0.25） was comparable between 2 groups, but the MI in study group was much thicker （（3.1±1.8） vs. （2.1±1.07） cm, P=0.01） and all were found as pouch type （19/19 vs. 2/35, P 〈0.001）. The follow-up results were comparable （65.1% vs. 72.3%, P=-0.30）. Conclusion For patients with prosthetic MVs, linear ablation at MI could be successfully carried out despite anatomical and pathological changes.展开更多
Background When performing superior vena cava isolation, the major concerns are inadvertent ablation on sinus node and right phrenic nerve. However, little is known about the spatial relationship of electrical connect...Background When performing superior vena cava isolation, the major concerns are inadvertent ablation on sinus node and right phrenic nerve. However, little is known about the spatial relationship of electrical connections between superior vena cava and right atrium with the sinus node and phrenic nerve locations among individual patients.Methods We studied 87 patients （male/female 60/27, mean age of （51±9） years） with atrial fibrillation. Before superior vena cava isolation, the sinus node site was defined by right atrium activation mapping during sinus rhythm and the right phrenic nerve site was localized via pacing manoeuvre. Superior vena cava was isolated by ablation at the electrical connection under the guidance of circular mapping catheter. The sites of sinus node, phrenic nerve and electrical connections were noted. Continuous variables were compared using Student＇s t test. A P value 〈0.05 was considered statistically significant.Results Right atrium activation mapping revealed that the sinus node located at the anterior lateral segment of superior vena cava-right atrium junction in all patients. In 82 patients with detectable diaphragmatic stimulations, the phrenic nerve sites were predominantly at the lateral segment （70/82） with anterior lateral and anterior segments for a few patients. A total of 165 electrical connections were located among all 87 patients, and this averaged 1.8±0.6 （1-3） per patient. The anterior septum （72 patients （43.6%））, the anterior wall （40 （24.2%））, and the posterior septum （35 （35.4%）） of superior vena cava-right atrium junction were the electrical connection regular sites. Superior vena cava was isolated in all patients. Two patients developed sinus bradycardia, with 3 mild superior vena cava stenosis and 2 phrenic nerve palsy.Conclusions The sinus node, phrenic nerve and electrical connection sites were distributed along the superior vena cava-right atrium junctions at expected locations for most patients. The electrical connections were separated from the sinus node and phrenic nerve sites. With the activation mapping of right atrium and pacing along superior vena cava-right atrium junctions, the sinus node and phrenic nerve were localized and superior vena cava isolated in most patients.展开更多
The present report demonstrates two cases of transient inferior ST-segment elevation accompanied by profound hypotension and bradycardia immediately after transseptal puncture for catheter ablation of atrial fibrillat...The present report demonstrates two cases of transient inferior ST-segment elevation accompanied by profound hypotension and bradycardia immediately after transseptal puncture for catheter ablation of atrial fibrillation. This rare complication of transseptal puncture was resolved quickly within several minutes. The most likely mechanism of this phenomenon is coronary vasospasm, although coronary embolism can not be ruled out completely. This complication is characterized as follows： （1） The right coronary artery might be the most likely involved vessel and therefore myocardial ischemia usually occurs in the inferior wall of left ventricular; （2） Reflex hypotension and bradycardia by the Bezold-Jarisch reflex secondary to inferior ischemia often occur at the same time. Though it appears to be a transient and completely reversible phenomenon, there are still potential life-threatening risks because of myocardial ischemia and profound haemodynamic instability. Clinical cardioloaists should be aware of this rare comolication and orooerlv deal with it.展开更多
基金This study was supported by grants from the Beijing Postdoctoral Work Foundation （No. 2012ZZ-40 and 2011ZZ-04）, National Science Foundation Council of China （No. 30971239 and 81070147）, and the Beijing Natural Science Foundation （No. 7101004）. Beijing Municipal Science ＆ Technology Commission （No. DI 1110700300000）.
文摘Background Recently there has been a great deal of interest in the role of serum uric acid （SUA） in atrial fibrillation （AF）. The objective of this study was to establish whether there is a relationship between levels of SUA and recurrence of paroxysmal AF after catheter ablation. Methods Three hundred and thirty patients diagnosed with paroxysmal AF were analyzed. Patients were categorized into quartiles on the basis of their pre-operative SUA measurement and follow-up, and Kaplan-Meier estimation with a Log-rank test was used for the analysis of the influence of SUA on the recurrence of AF. Pre-procedural clinical variables were correlated with the clinical outcome after ablation using multivariate Logistic analysis. A Cox proportional hazards model was used to estimate the relationship between SUA and the recurrence of AF. Results After a mean follow-up of （9.341＋3.667） （range 3.0-16.3） months, recurrence rates from the lowest SUA quartile to the highest SUA quartile were 16.0%, 26.4%, 28.3%, and 29.3% respectively （P=0.014）. After adjustment for gender, body mass index （BMI）, hypertension, serum levels of high sensitivity C-reactive protein （hsCRP）, triglyceride （TG）, left atrial diameter （LA）, estimated glomerular filtration rate （eGFR）, and SUA, there was an increased risk of recurrence in subjects in the highest SUA quartile compared with those in the lowest quartile （hazard ratio 2.804, 95% confidence interval 1.466-5.362, P=0.002）. Following multivariate Logistical analysis, SUA was found to be an independent predictor of recurrence （hazard ratio 1.613, 95% confidence interval 1.601-1.625, P=0.014）. Conclusion In a retrospective study of patients with paroxysmal AF undergoing catheter ablation, elevated preoperative SUA levels were associated with a hiaher rate of recurrence of AF.
基金This work was supported by grants from the National Natural Science Foundation of China （No. 30971239 and No. 81070147）, Beijing Natural Science Foundation （No. 7101004）.
文摘Background The optimal endpoint for catheter ablation of persistent atrial fibrillation （AF） remains ambiguous. This study investigated the impact of AF termination as a procedural endpoint and the termination mode on long-term clinical outcome. Methods Two hundred and ninety-three patients who underwent stepwise ablation for persistent AF were categorized into the AF termination by ablation group and into the electrical cardioversion （CV） group. Subgroups were also analyzed based on different termination modes. Follow-up assessment included early recurrence and sinus rhythm （SR） maintenance. Results During initial ablation, 33 patients （11.3%） were directly converted to SR, 166 patients （56.7%） were converted to atrial tachycardia （AT） that subsequently restored SR with further ablation in 98 patients （33.4%）, and a total of 162 patients （55.3%） underwent cardioversion due to persistent atrial arrhythmias. Comparison between termination by ablation and termination by cardioversion in patients exhibiting AF or AT revealed that no significant difference was observed in early recurrence （38.2% vs. 43.8%, P=0.328） and SR maintenance （67.2% vs. 59.8%, P=0.198） during the （23±7） months follow-up. Even after repeat ablation, the SR maintenance continued to exhibit no statistical difference in above two groups （72.5% vs. 70.4%, P=0.686）. Further analysis of subgroups, however, demonstrated that patients with AF terminated directly to SR experienced better clinical outcomes than other subgroups （P 〈0.05）. Furthermore, atrial arrhythmias present during ablation have been implicated in prediction of recurrence mode： AF or AT （P 〈0.05）. Conclusions Termination as a procedural endpoint is not associated with favorable long-term SR maintenance in persistent AF. AF methods that convert arrhythmia directly to SR have, however, been linked with improved clinical outcomes, although conversions to AT may not be correlated. Atrial arrhythmias observed during the ablation may be used to predict the recurrence mode.
基金This work was supported by the National Science Foundation Council of China （No. 30900628, 81070147）, Beijing Natural Science Foundation （No. 7102048） and Beijing Nova Program （No. 2009B32） and Training Program for Excellent Talent of Beijing （No. 2010D003034000025）.
文摘Background HATCH score is an established predictor of progression from paroxysmal to persistent atrial fibrillation （AF）. The purpose of this study was to determine if HATCH score could predict recurrence after catheter ablation of AF. Methods The data of 488 consecutive paroxysmal AF patients who underwent an index circumferential pulmonary veins （PV） ablation were retrospectively analyzed. Of these patients, 250 （51.2%） patients had HATCH score=0, 185 （37.9%） patients had HATCH score=l, and 53 （10.9%） patients had HATCH score 〉2 （28 patients had HATCH score=2, 23 patients had HATCH score=3, and 2 patients had HATCH score=4）. Results The patients with HATCH score 〉2 had significantly larger left atrium size, the largest left ventricular end systolic diameter, and the lowest ejection fraction. After a mean follow-up of （823＋532） days, the recurrence rates were 36.4%, 37.8% and 28.3% from the HATCH score=0, HATCH score=l to HATCH score 〉2 categories （P=0.498）. Univariate analysis revealed that left atrium size, body mass index, and failure of PV isolation were predictors of AF recurrence. After adjustment for body mass index, left atrial size and PV isolation, the HATCH score was not an independent predictor of recurrence （HR=0.92, 95% confidence interval=0.76-1.12, P=0.406） in multivariate analysis. Conclusion HATCH score has no value in prediction of AF recurrence after catheter ablation.
文摘Background It is unclear whether a history of paroxysmal atrial fibrillation （PAF） would impact the effect of catheter ablation on persistent atrial fibrillation （AF）. This study aimed to compare the effect of catheter ablation on persistent AF with and without a history of PAF. Methods One hundred and eighty-three patients underwent catheter ablation of persistent AF lasting for 〉1 month and were reviewed. Patients were divided into two groups according to whether they had a history of PAF or not. Group I consisted of persistent AF patients with a history of PAF, and group II consisted of persistent AF patients without such a history. All patients received catheter ablation focused on pulmonary vein isolation and were observed for arrhythmia recurrences, which were defined as documented episodes of AF or atrial tachycardia after a blanking period of 3 months. Results One hundred and three patients （60.9%） in group I and sixty-six patients （39.1%） in group II were successfully followed and included in analysis. There were no significant differences in clinical and echocardiographic characteristics between both groups except for a younger age and more male patients in group II. After （15.5±10.7） months of follow-up, 59 （57.3%） patients in group I and 49 （74.2%） patients in group II maintained sinus rhythm free of anti-arrhythmia drugs （P=0.025）. Multivariate analyses found left atrial anteroposterior diameter （P=0.006） and persistent AF with a history of PAF （OR 1.792, 95% CI 1.019-3.152; P=0.043） as the only independent statistical predictors of arrhythmia recurrences. Conclusion The arrhythmia recurrence rate of catheter ablation based on pulmonary vein isolation in persistent AF with a history of PAF was hiQher than those without a history of PAF
基金This work was funded by the National Natural Science Foundation of China(No.30500202 and No.30570724)
文摘Catheter ablation of atrial fibrillation （AF） has been ,increased dramatically recently. However, it is an unpleasant procedure with intolerable pain without sedation. Propofol and fentanyl/midazolam have been widely used in painful clinical examination and cardiovascular procedures with established safety and efficacy. Propofol, alfentanyl and midazolam were administrated for catheter ablation in some electrophysiological labs for a less painful procedure. However, there is few published work on the sedation regimen for catheter ablation of AF.
文摘Background Previous studies have investigated the technique of linear ablation at the mitral isthmus （MI） in patients with idopathic atrial fibrillation （AF）, but MI ablation in patients with prosthetic natural mitral valves （MVs） was not described in detail. Present study sought to summarize our initial experience of ablating MI in patients with prosthetic MVs Methods Patients with drug refractory AF and prosthetic MVs were eligible for this study, and the patients with natural MVs but received MI ablation served as control group. Left atrium （LA） mapping and ablation was carried out guided by CARTO system. The anatomy of MI was assessed via computer topography scan. Results During the study period, a consecutive of 19 patients （male/female=12/7, mean age of （48±6） years） with prosthetic MVs （16 with metal valves, 3 with biologic valves） entered for AF ablation, other 35 patients served as control group. In study group, mapping along MI documented lower voltages （（2.0±1.0） vs. （3.1±1.3） mV, P=-0.002）, more fragmented potentials （19/19 vs. 20/15, P 〈0.001 ）, and higher impedance （（132±34） vs. （110±20） Ω, P=0.004）. After initial ablation, more residual gaps along the MI lesions were found in study group （2.4±0.4 vs. 1.7±0.3, P 〈0.001）. The mean length of MI （（6.2±3.3） vs. （7.1±2.3） cm, P=-0.25） was comparable between 2 groups, but the MI in study group was much thicker （（3.1±1.8） vs. （2.1±1.07） cm, P=0.01） and all were found as pouch type （19/19 vs. 2/35, P 〈0.001）. The follow-up results were comparable （65.1% vs. 72.3%, P=-0.30）. Conclusion For patients with prosthetic MVs, linear ablation at MI could be successfully carried out despite anatomical and pathological changes.
文摘Background When performing superior vena cava isolation, the major concerns are inadvertent ablation on sinus node and right phrenic nerve. However, little is known about the spatial relationship of electrical connections between superior vena cava and right atrium with the sinus node and phrenic nerve locations among individual patients.Methods We studied 87 patients （male/female 60/27, mean age of （51±9） years） with atrial fibrillation. Before superior vena cava isolation, the sinus node site was defined by right atrium activation mapping during sinus rhythm and the right phrenic nerve site was localized via pacing manoeuvre. Superior vena cava was isolated by ablation at the electrical connection under the guidance of circular mapping catheter. The sites of sinus node, phrenic nerve and electrical connections were noted. Continuous variables were compared using Student＇s t test. A P value 〈0.05 was considered statistically significant.Results Right atrium activation mapping revealed that the sinus node located at the anterior lateral segment of superior vena cava-right atrium junction in all patients. In 82 patients with detectable diaphragmatic stimulations, the phrenic nerve sites were predominantly at the lateral segment （70/82） with anterior lateral and anterior segments for a few patients. A total of 165 electrical connections were located among all 87 patients, and this averaged 1.8±0.6 （1-3） per patient. The anterior septum （72 patients （43.6%））, the anterior wall （40 （24.2%））, and the posterior septum （35 （35.4%）） of superior vena cava-right atrium junction were the electrical connection regular sites. Superior vena cava was isolated in all patients. Two patients developed sinus bradycardia, with 3 mild superior vena cava stenosis and 2 phrenic nerve palsy.Conclusions The sinus node, phrenic nerve and electrical connection sites were distributed along the superior vena cava-right atrium junctions at expected locations for most patients. The electrical connections were separated from the sinus node and phrenic nerve sites. With the activation mapping of right atrium and pacing along superior vena cava-right atrium junctions, the sinus node and phrenic nerve were localized and superior vena cava isolated in most patients.
基金This work was supported by a grant from the National Natural Science Foundation of China （No. 81070147）.
文摘The present report demonstrates two cases of transient inferior ST-segment elevation accompanied by profound hypotension and bradycardia immediately after transseptal puncture for catheter ablation of atrial fibrillation. This rare complication of transseptal puncture was resolved quickly within several minutes. The most likely mechanism of this phenomenon is coronary vasospasm, although coronary embolism can not be ruled out completely. This complication is characterized as follows： （1） The right coronary artery might be the most likely involved vessel and therefore myocardial ischemia usually occurs in the inferior wall of left ventricular; （2） Reflex hypotension and bradycardia by the Bezold-Jarisch reflex secondary to inferior ischemia often occur at the same time. Though it appears to be a transient and completely reversible phenomenon, there are still potential life-threatening risks because of myocardial ischemia and profound haemodynamic instability. Clinical cardioloaists should be aware of this rare comolication and orooerlv deal with it.
