Prevention of atrial fibrillation with renin-angiotensin system inhibitors on essential hypertensive patients:a meta-analysis of randomized controlled trials

We aimed to investigate the effectiveness and safety of angiotensin-converting enzyme inhibitors （ACEIs） or angiotensin Ⅱ receptor blockers （ARBs） on preventing atrial fibrillation in essential hypertensive patients. Systematic literature retrieval was carried out to obtain randomized controlled trials on the effects of ACEI/ ARBs on essential hypertensive patients before December, 2013. Data extraction and quality evaluation were performed. Meta-analysis was performed by Review Manager 5.2.3. Ten high quality studies （11 articles） with a total of 42,892 patients （20,491 patients in the ACEI/ARBs group and 22,401 patients in the β-blocker or the calcium antagonist group） met the inclusion criteria and were included in the meta-analysis. The results showed that ACEI/ARBs reduced the incidence of atrial fibrillation （AF） recurrence compared to calcium antagonists （RR=0.48; 95%CI, 0.40-0.58; P〈0.00001） or β-blockers （RR=0.39; 95%CI, 0.20-0.74; P=0.005） in long-term follow-up, respectively. Furthermore, ACEI/ARBs reduced the incidence of conges- tive heart failure （RR=0.86; 95%CI, 0.77-0.96; P=0.007）. However, no significant effects were observed on the incidence of new AF, cardiac death, myocardial infarction, and stroke. Our results suggest that ACEI/ ARBs may reduce the incidence of AF recurrence and congestive heart failure, with fewer serious adverse effects.

Effects of trimetazidine on atrial structural remodeling and platelet activation in dogs with atrial fibrillation

Atrial fibrillation （AF） is one of the most common .arrhythmias in clinical practice. AF results in electrophysiological alterations which involve increased atrial effective refractory period and atrial effective refractory period dispersion, reduced rate adaptation of atrial effective refractory period, and slowed atrial conduction. These variances promote their own maintenance-AF begets AF.1 Previous study suggested that Ca^2＋ overload and metabolic derangement contributed to electrophysiological remodeling in AF. However, we did not demonstrate a persistent disturbance in energy metabolism during AF in our previous study,

Reduction of atrial fibrillation in remotely monitored pacemaker patients： results from a Chinese multicentre registry

Background Many recipients of implantable cardiac electronic devices have atrial fibrillation （AF） occurrences after device implantation, even if there is no previous history of AF, and some of the episodes are asymptomatic. The purpose of this study was to evaluate trends in AF burden following early AF detection in patients treated with pacemakers equipped with automatic, daily Home Monitoring function. Methods Between February 2009 and December 2010, the registry recruited 701 pacemaker patients （628 dual-chamber, 73 biventricular devices） at 97 clinical centers in China. Daily Home Monitoring data transmissions were analyzed to screen for the AF burden. In-office follow-ups were scheduled for 3 and 6 months after implantation. Upon first AF （i.e., mode-switch） detection in a patient, screening olAF burden by Home Monitoring was extended for the next 180 days. Results At least one episode of AF was observed in 22.9% of patients with dual-chamber pacemakers and in 28.8% of patients with biventricular pacemakers. The first AF detection in a patient occurred, on average, about 2 months before scheduled follow-up visits. In both pacemaker groups, mean AF burden decreased significantly （P〈0.05） over 180 days following first AF detection： from 12.0% to 2.5% in dual-chamber and from 12.2% to 0.5% in biventricular pacemaker recipients. The number of patients with an AF burden 〉10% per month was significantly reduced over 6 months of implantation in both dual chamber （38 patients in the first month vs. 21 patients in month 6, P〈0.05） and biventricular （7 patients in the first month vs. 0 patient in months 4-6, P〈0.05） pacemaker recipients. Conclusions Automatic, daily Home Monitoring of patients treated with cardiac pacemakers allows early detection of AF, and there is a gradual and significant decrease in AF burden.

Epicardial adipose tissue： the accomplice implicated in the genesis and maintenance of atrial fibrillation

Objective The purpose of this review was to delineate our current knowledge of the close relationship between the abundance of epicardial adipose tissue （EAT） and the risk of all major cardiovascular disease, especially atrial fibrillation （AF）. Data sources The data analyzed in this review were mainly from articles reported in PubMed published from 1972 to 2014. Study selection Original articles and critical reviews relevant to EAT and AF were selected. Results EAT, a particular form of metabolically active visceral fat deposited around the heart, is being regarded as an important independent predictor of cardio-metabolic diseases. EAT is composed of smaller adipocytes than other visceral fat depots and functioned like brown adipose tissue （BAT） to protect adjacent tissues. Improving the understanding of EAT in AF genesis and maintenance may contribute to prevent AF and reduce the complications associated with AF. Conclusion The findings suggest that EAT associates with AF severity and the recurrence of AF after catheter ablation even after adjustment forAF risk factors, but the precise mechanisms are not fully elucidated.

Atrial fibrillation in Europe

Atrial fibrillation （AF） is the most frequent arrhythmia .whose incidence increases with age. At presentabout 1%-2% of the European population suffer from AF. Presumably about 25% of the population between 40 and 50 years will develop AF in their life course and the prevalence olAF will increase by at least 2.5-fold in the next 50 years.

Atrium-atrioventricular node block： an unusual complication during catheter ablation of persistent atrial fibrillation

Ablation of persistent atrial fibrillation is still a challenge for the ablationist. Extensive ablation is required under some conditions and could lead to some unintended complications. Here we report a case of atrium-atrioventricular node block complicating multiple catheter ablation procedures for persistent atrial fibrillation. After extensive ablation, including circumferential pulmonary vein ablation, linear ablation at the left atrial roof, mitral isthmus, atrial septum, cavotricuspid isthmus, and complex fractionated atrial electrogram ablation, conduction obstacle was found, and sinus impulse could not travel from the right atrium, atrial septum and left atrium to atrioventricular node. The case indicated that intensive ablation at some key sites, especially the interatrial septum, should be careful during ablation of atrial fibrillation

Early-phase changes of P-wave characteristics after circumferential pulmonary vein isolation

Background Circumferential pulmonary vein isolation （CPVI）, as the basal ablation strategy for treating atrial fibrillation （AF）, not only isolates the connection between the left atrium （LA） and the pulmonary veins （PVs）, but also induces extensive atrial endocardia damage. This could have an effect on the sinus pulse conduction in the LA and subsequently result in changes of P-wave characteristics of surface electrocardiogram （ECG）. Methods Fifty consecutive patients underwent CPVI for symptomatic drug-refractory paroxysmal AF. The 12-lead ECGs were recorded one day before CPVI and seven days after CPVI at sinus rhythm by a standard resting ECG device. Measured characteristics of the P-wave consisted of P-wave duration （PWD）, P-wave amplitude （PWA）, P-wave polarity （PWP）, P-wave notch, P-wave dispersion and P-wave index. Results After CPVI, a prevalent decrease of PWD, PWA, and P-wave dispersion was observed; a transition of P-wave polarity was observed in the leads of III, aVL and aVF. The rate of P-wave notch decreased significantly in all leads, especially in the leads of II, III, aVF and V3. Patients with sinus rhythm had a shorter P-wave dispersion and P-wave index and had a lower rate of P-wave notch compared with the patients with recurrent atrial tachyarrhythmia. Conclusion Observations from using the surface ECG showed that CPVI has instant effects on the electrical conduction in the LA, and several changes of P-wave characteristics associated with development olAF are improved by CPVI.

Catheter ablation of persistent atrial fibrillation in a patient with dextrocardia

Dextrocardia is a rare anomaly where the heart is located on the right side of the chest instead of the normal left side. Ablation of atrial fibrillation （AF） with such an inverted anatomy may be challenging for the manipulation of the catheters. Here we report a case of dextrocardia who underwent ablation for persistent AF guided by image integration system.