The influence of metabolic syndrome on atrial fibrillation recurrence: five-year outcomes after a single cryoballoon ablation procedure

BACKGROUND Metabolic syndrome(MetS)has been reported as a risk factor of atrial fibrillation(AF)recurrence after radi-ofrequency catheter ablation.This study aimed to investigate the long-term influence of MetS on paroxysmal AF recurrence after a single cryoballoon ablation procedure,which was scarcely investigated yet in Chinese population.METHODS In total,137 paroxysmal AF patients who had successfully completed a single cryoballoon ablation procedure at Fuwai Hospital,Beijing,China from December 2013 to October 2015 were enrolled.Excepting for patients with AF recurrence,all patients were followed up for no less than five years.Independent predictors of AF recurrence were determined by Cox propor-tional hazards regression analysis.RESULTS Among 137 paroxysmal AF patients,91 patients(66.4%)had successfully achieved overall five-year follow-up after a single cryoballoon ablation procedure,and 44 patients(32.1%)had MetS.Patients with MetS had a significant lower incidence of freedom from AF recurrence than those without MetS(50.0%vs.74.2%,log-rank P<0.01)during the five-year follow-up.MetS(HR=1.95,95%CI:1.069−3.551,P=0.030)was an independent predictor of AF recurrence after adjusting for multiple factors.After the second year post cryoballoon ablation procedure,the recurrence rate of AF gradually increased in patients with MetS,in con-trast,decreased recurrence rate of AF in patients without MetS.CONCLUSIONS MetS is an independent predictor for five-year AF recurrence after a single cryoballoon ablation procedure in paroxysmal AF patients.Combination therapy of AF and MetS may improve the long-term outcomes of AF patients.

Catheter ablation of premature ventricular complexes associated with false tendons: A case report

BACKGROUND False tendon is a common intraventricular anatomical variation. It refers to a fibroid or fibromuscular structure that exists in the ventricle besides the normal connection of papillary muscle and mitral or tricuspid valve. A large number of clinical studies have suggested that there is a significant correlation between false tendons and premature ventricular complexes. However, few studies have verified this correlation during radiofrequency catheter ablation of premature ventricular complexes.CASE SUMMARY A 45-year-old male was admitted to receive radiofrequency ablation for symptomatic premature ventricular complexes. A three-dimensional model of the left ventricle was established by intracardiac echocardiography using the CartoSound^TM mapping system. In addition to the left anterior papillary muscle,the posterior papillary muscle was mapped. False tendons were found at the base of the interventricular septum, and the other end was connected to the left ventricular free wall near the apex. An irrigated touch force catheter was advanced into the left ventricle via the retrograde approach. The earliest activation site was marked at the interventricular septum attachment of the false tendons and was successfully ablated.CONCLUSION This case verified that false tendons can cause premature ventricular complexes and may be cured by radiofrequency ablation guided by intracardiac echocardiography with the Carto Sound TM system.