Objective To retrospectively identify risk factors and the prognosis for new-onset atrial fibrillation (AF)after implantation of dual-chamber pacemakers in elderly patients.Methods Consecutive patients aged >65year...Objective To retrospectively identify risk factors and the prognosis for new-onset atrial fibrillation (AF)after implantation of dual-chamber pacemakers in elderly patients.Methods Consecutive patients aged >65years who underwent their first implantation of a dual-chamber permanent pacemaker in Beijing Anzhen Hospital from October 2013to May 2016were enrolled.Their complete program- ming and follow-up data were recorded.Follow-up end points included new-onset AF and major adverse cardiovascular and cerebrovascular events.Restdts Altogether,322patients were enrolled,with new-onset AF observed in 79(24.5%)during their follow-up.Multivariable analysis identified four independent predictors of new-onset AF in elderly patients after pacemaker implantation:hypertension (HR =3.040, 95%CI:1.09-3.05,P =0.00),age (HR =1.966,95%CI:1.57-3.68,P =0.01);left atrial enlargement (HR =1.645,95%CI:1.05-1.25,P = 0.03);high ventricular pacing rate (HR =1.137,95%CI:1.01-1.06,P =0.01).Univariable analysis indicated that the CHA2DS2-VASc score was also a risk factor for AF (HR =1.368,95%CI:1.178-1.589,P =0.002),whereas multivariable regression analysis did not. Kaplan-Meier survival analysis showed that the risk for ischemic stroke was significantly higher in the new-onset AF group than in the non-AF group (P <0.05).Conclusion Hypertension,age,left atrial enlargement,and high ventricular pacing rate were independent predictors of new-onset AF in elderly patients after implantation of a permanent pacemaker.New-onset AF increased the risk for ischemic stroke.展开更多
Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia,increasing in prevalence with age.Catheter ablation is recommended to symptomatic paroxysmal AF refractory or intolerant to at least one Class I o...Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia,increasing in prevalence with age.Catheter ablation is recommended to symptomatic paroxysmal AF refractory or intolerant to at least one Class I or III antiarrhythmic medication.[1]Main current catheter ablation of AF with radiofrequency can give priority to,other include freezing,ultrasonic and laser ablation etc.Recent studies provides substantial information regarding the efficacy and safety of novel cryoballoon technology in creating pulmonary vein(PV)isolation.[2,3]Processed in cyroballoon ablation,some AF patients implanted with double chamber pacemaker are difficult to puncture atrial septal,because of the atrial electrode.My case report was as follows.展开更多
Objective: To observe the effect of statins on preventing paroxysmal atrial fibrillation (PAF) after pacemaker imlantation in patients with sick sinus syndrome. Materials and Methods: 68 patients were selected in whic...Objective: To observe the effect of statins on preventing paroxysmal atrial fibrillation (PAF) after pacemaker imlantation in patients with sick sinus syndrome. Materials and Methods: 68 patients were selected in which the pacemakers had been implanted due to sick sinus syndrome,and were randomly divided into a statin treatment group and a control group. After the pacemaker implantation, only the patients in treatment group were given 20 mg atorvastatin once per night,with other conditions basically similar to those in the control group. At the 3rd, 9th, 15th, and 21st months after the implantation, the pacemakers were programmed, and the PAF-related information stored in the pacemaker were recalled and analyzed statistically. Results: After the administration of statins for 9 months since the imlantation, the occurrence rates of PAF in the treatment group was relatively lower than those in the control group. After further administration of statins for 15 months, both the occurrence rate of PAF and the burden of atrial fibrillation in the treatment group had significantly declined. After continuous administration of statins for 21 months, both the occurrence rate of PAF and the burden of atrial fibrillation in the treatment group were significantly lower than those in the control group. Conclusion: Long-term administration of statins can reduce the risk of PAF after the implantation of a pacemaker in patients with sick sinus syndrome.展开更多
Atrioventricular junction ablation with permanent pacemaker implantation is a highly effective treatment approach in patients with atrial fibrillation and high ventricular rates resistant to other treatment modalities...Atrioventricular junction ablation with permanent pacemaker implantation is a highly effective treatment approach in patients with atrial fibrillation and high ventricular rates resistant to other treatment modalities, especially in the elderly or those with severe comorbidities. Compared with pharmacological therapy alone, the so-called ＂ablate and pace＂ approach offers the potential for more robust control ofven- tricular rate. Atrioventricular junction ablation and pacing strategy is associated with improvement in symptoms, quality of life, and exercise capacity. Given the close relationship between atrial fibrillation and heart failure, there is a particular benefit of such a rate control in patients with atrial fibrillation and reduced systolic fimction. There is increasing evidence that cardiac resynchronization therapy devices may be beneficial in selected populations after atrioventricular junction ablation. The present review article focuses on the current recommendations for atrioventricular junction ablation and pacing for heart rate control in patients with atrial fibrillation. The technique, the optimal implanta- tion time, and the proper device selection after atrioventricular junction ablation are also discussed.展开更多
Background:Right ventricular pacing disrupts atrioventricular synchrony and increases the risk of atrial fi brillation(AF).However,whether algorithms for minimizing ventricular pacing reduce the incidence of AF remain...Background:Right ventricular pacing disrupts atrioventricular synchrony and increases the risk of atrial fi brillation(AF).However,whether algorithms for minimizing ventricular pacing reduce the incidence of AF remains controversial.Therefore,we conducted a systematic review and meta-analysis to compare the incidence of AF between minimizing ventricular pacing and conventional pacing protocols in patients with pacemakers implanted.Methods:The PubMed,Embase,and Cochrane Library databases were searched up to August 1,2017,for randomized controlled trials that reported the incidence of AF in patients with and without the use of algorithms for minimizing ventricular pacing.Results:Eleven studies comprising 5705 participants(61%males,mean age 71 years[standard deviation 11 years])were fi nally included in the analysis.The mean follow-up duration was 24 months.Use of algorithms for minimizing ventricular pacing signifi cantly reduced the incidence of AF,with an odds ratio of 0.74(95%confi dence interval 0.55–1.00;P<0.05).There was moderate heterogeneity among studies(I 2=63%).Conclusions:The incidence of AF was reduced by 26%with use of algorithms for minimizing ventricular pacing.The incorporation of such algorithms in routine clinical practice should in theory lead to a decrease in AF-related morbidity and mortality.展开更多
Background： Atrial fibrillation （AF） is the rnost frequent tachyarrhythmia in patients with a permanent pacemaker. Angiotensin II receptor antagonists have a protective effect against the occurrence of AF in patien...Background： Atrial fibrillation （AF） is the rnost frequent tachyarrhythmia in patients with a permanent pacemaker. Angiotensin II receptor antagonists have a protective effect against the occurrence of AF in patients with heart diseases. This study aimed to assess the effectiveness of olmcsartan in the prevention of new-onset AF and AF burden in atrioventricular block （AVB） patients with dual-chamber （DDD） pacemaker implantation. Methods： This was a single-center, prospective, randomized, single-blind, controlled clinical study. A total of 116 AVB patients, who received DDD pacemakers implantation with the percentage of ventricular pacing （VP%） _〉40% from April 22, 2011 to December 24, 2012, were prospectively randomized to olrnesartan group （20 mg per day; n - 57） or control group （n = 59）. Patients were lbllowed up using pacernaker prograrnming± 12-lead electrocardiography in the intrinsic sinus rhythm, laboratory examinations, and transthoracic echocardiography at 24 months. Atrial high rate events （AHREs） were defined as 180 beats/min over a minimum of 5 min. AF burden was calculated by the number of hours with AHREs divided by the number of measurement hours. Results： Ten （17.5%） patients in the olmesartan group and 24 patients （40.7%） in the control group occurred new-onset AF, and the difference between two groups was statistically significant （P = 0.04）. AF burden was lower in olmesartan group than that in control group （8.02 ± 3.10% vs. 13.66 ± 6.14%, P = 0.04）. There were no significant differences in mean days to the first occurrence of AHREs and mean cumulative numbers of AHREs between two groups （P = 0.89 and P = 0.42, respectively）. Moreover, olmesartan group had smaller values of maximal P-wave durations and P-wave dispersion （PD） after 24 months follow-up compared with the control group （ 109.5 ± 7.4 ins vs. 113.4 ± 7.1 ms, P = 0.00; and 40.6 ± 4.5 ms vs. 43.3 ± 4.4 ins, P - 0.02, respectively）. Left ventricular end-diastolic diameter and left ventricular qiection traction were not significantly diiTerent between two groups （both P 〉 0.05）. Conclusion： This study suggested that 24-month ofolmesartan therapy could reduce new-onset AF and AF burden in patients with DDD pacemakers.展开更多
文摘Objective To retrospectively identify risk factors and the prognosis for new-onset atrial fibrillation (AF)after implantation of dual-chamber pacemakers in elderly patients.Methods Consecutive patients aged >65years who underwent their first implantation of a dual-chamber permanent pacemaker in Beijing Anzhen Hospital from October 2013to May 2016were enrolled.Their complete program- ming and follow-up data were recorded.Follow-up end points included new-onset AF and major adverse cardiovascular and cerebrovascular events.Restdts Altogether,322patients were enrolled,with new-onset AF observed in 79(24.5%)during their follow-up.Multivariable analysis identified four independent predictors of new-onset AF in elderly patients after pacemaker implantation:hypertension (HR =3.040, 95%CI:1.09-3.05,P =0.00),age (HR =1.966,95%CI:1.57-3.68,P =0.01);left atrial enlargement (HR =1.645,95%CI:1.05-1.25,P = 0.03);high ventricular pacing rate (HR =1.137,95%CI:1.01-1.06,P =0.01).Univariable analysis indicated that the CHA2DS2-VASc score was also a risk factor for AF (HR =1.368,95%CI:1.178-1.589,P =0.002),whereas multivariable regression analysis did not. Kaplan-Meier survival analysis showed that the risk for ischemic stroke was significantly higher in the new-onset AF group than in the non-AF group (P <0.05).Conclusion Hypertension,age,left atrial enlargement,and high ventricular pacing rate were independent predictors of new-onset AF in elderly patients after implantation of a permanent pacemaker.New-onset AF increased the risk for ischemic stroke.
文摘Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia,increasing in prevalence with age.Catheter ablation is recommended to symptomatic paroxysmal AF refractory or intolerant to at least one Class I or III antiarrhythmic medication.[1]Main current catheter ablation of AF with radiofrequency can give priority to,other include freezing,ultrasonic and laser ablation etc.Recent studies provides substantial information regarding the efficacy and safety of novel cryoballoon technology in creating pulmonary vein(PV)isolation.[2,3]Processed in cyroballoon ablation,some AF patients implanted with double chamber pacemaker are difficult to puncture atrial septal,because of the atrial electrode.My case report was as follows.
文摘Objective: To observe the effect of statins on preventing paroxysmal atrial fibrillation (PAF) after pacemaker imlantation in patients with sick sinus syndrome. Materials and Methods: 68 patients were selected in which the pacemakers had been implanted due to sick sinus syndrome,and were randomly divided into a statin treatment group and a control group. After the pacemaker implantation, only the patients in treatment group were given 20 mg atorvastatin once per night,with other conditions basically similar to those in the control group. At the 3rd, 9th, 15th, and 21st months after the implantation, the pacemakers were programmed, and the PAF-related information stored in the pacemaker were recalled and analyzed statistically. Results: After the administration of statins for 9 months since the imlantation, the occurrence rates of PAF in the treatment group was relatively lower than those in the control group. After further administration of statins for 15 months, both the occurrence rate of PAF and the burden of atrial fibrillation in the treatment group had significantly declined. After continuous administration of statins for 21 months, both the occurrence rate of PAF and the burden of atrial fibrillation in the treatment group were significantly lower than those in the control group. Conclusion: Long-term administration of statins can reduce the risk of PAF after the implantation of a pacemaker in patients with sick sinus syndrome.
文摘Atrioventricular junction ablation with permanent pacemaker implantation is a highly effective treatment approach in patients with atrial fibrillation and high ventricular rates resistant to other treatment modalities, especially in the elderly or those with severe comorbidities. Compared with pharmacological therapy alone, the so-called ＂ablate and pace＂ approach offers the potential for more robust control ofven- tricular rate. Atrioventricular junction ablation and pacing strategy is associated with improvement in symptoms, quality of life, and exercise capacity. Given the close relationship between atrial fibrillation and heart failure, there is a particular benefit of such a rate control in patients with atrial fibrillation and reduced systolic fimction. There is increasing evidence that cardiac resynchronization therapy devices may be beneficial in selected populations after atrioventricular junction ablation. The present review article focuses on the current recommendations for atrioventricular junction ablation and pacing for heart rate control in patients with atrial fibrillation. The technique, the optimal implanta- tion time, and the proper device selection after atrioventricular junction ablation are also discussed.
文摘Background:Right ventricular pacing disrupts atrioventricular synchrony and increases the risk of atrial fi brillation(AF).However,whether algorithms for minimizing ventricular pacing reduce the incidence of AF remains controversial.Therefore,we conducted a systematic review and meta-analysis to compare the incidence of AF between minimizing ventricular pacing and conventional pacing protocols in patients with pacemakers implanted.Methods:The PubMed,Embase,and Cochrane Library databases were searched up to August 1,2017,for randomized controlled trials that reported the incidence of AF in patients with and without the use of algorithms for minimizing ventricular pacing.Results:Eleven studies comprising 5705 participants(61%males,mean age 71 years[standard deviation 11 years])were fi nally included in the analysis.The mean follow-up duration was 24 months.Use of algorithms for minimizing ventricular pacing signifi cantly reduced the incidence of AF,with an odds ratio of 0.74(95%confi dence interval 0.55–1.00;P<0.05).There was moderate heterogeneity among studies(I 2=63%).Conclusions:The incidence of AF was reduced by 26%with use of algorithms for minimizing ventricular pacing.The incorporation of such algorithms in routine clinical practice should in theory lead to a decrease in AF-related morbidity and mortality.
文摘Background： Atrial fibrillation （AF） is the rnost frequent tachyarrhythmia in patients with a permanent pacemaker. Angiotensin II receptor antagonists have a protective effect against the occurrence of AF in patients with heart diseases. This study aimed to assess the effectiveness of olmcsartan in the prevention of new-onset AF and AF burden in atrioventricular block （AVB） patients with dual-chamber （DDD） pacemaker implantation. Methods： This was a single-center, prospective, randomized, single-blind, controlled clinical study. A total of 116 AVB patients, who received DDD pacemakers implantation with the percentage of ventricular pacing （VP%） _〉40% from April 22, 2011 to December 24, 2012, were prospectively randomized to olrnesartan group （20 mg per day; n - 57） or control group （n = 59）. Patients were lbllowed up using pacernaker prograrnming± 12-lead electrocardiography in the intrinsic sinus rhythm, laboratory examinations, and transthoracic echocardiography at 24 months. Atrial high rate events （AHREs） were defined as 180 beats/min over a minimum of 5 min. AF burden was calculated by the number of hours with AHREs divided by the number of measurement hours. Results： Ten （17.5%） patients in the olmesartan group and 24 patients （40.7%） in the control group occurred new-onset AF, and the difference between two groups was statistically significant （P = 0.04）. AF burden was lower in olmesartan group than that in control group （8.02 ± 3.10% vs. 13.66 ± 6.14%, P = 0.04）. There were no significant differences in mean days to the first occurrence of AHREs and mean cumulative numbers of AHREs between two groups （P = 0.89 and P = 0.42, respectively）. Moreover, olmesartan group had smaller values of maximal P-wave durations and P-wave dispersion （PD） after 24 months follow-up compared with the control group （ 109.5 ± 7.4 ins vs. 113.4 ± 7.1 ms, P = 0.00; and 40.6 ± 4.5 ms vs. 43.3 ± 4.4 ins, P - 0.02, respectively）. Left ventricular end-diastolic diameter and left ventricular qiection traction were not significantly diiTerent between two groups （both P 〉 0.05）. Conclusion： This study suggested that 24-month ofolmesartan therapy could reduce new-onset AF and AF burden in patients with DDD pacemakers.
