Role of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in cryoballoon ablation outcomes for paroxysmal atrial fibrillation

BACKGROUND Cryoballoon ablation(CBA)is recommended for patients with paroxysmal atrial fibrillation(AF)refractory to antiarrhythmic drugs.However,only 80%of patients benefit from initial CBA.There is growing evidence that pretreatment with angiotensin-converting enzyme inhibitors(ACEIs)and angiotensin receptor blockers(ARBs)decreases the recurrence of AF postablation,particularly in nonparoxysmal AF undergoing radiofrequency ablation.The role of ACEIs and ARBs in patients with paroxysmal AF in CBA remains unknown.We decided to investigate the role of ACEIs and ARBs in preventing the recurrence of atrial arrhythmia(AA)following CBA for paroxysmal AF.AIM To investigate the role of ACEIs and ARBs in preventing recurrence of AA following CBA for paroxysmal AF.METHODS We followed 103 patients(age 60.6±9.1 years,29%women)with paroxysmal AF undergoing CBA 1-year post procedure.Recurrence was assessed by documented AA on electrocardiogram or any form of long-term cardiac rhythm monitoring.A multivariable Cox proportional hazard model was used to assess if ACEI or ARB treatment predicted the risk of AA recurrence.RESULTS After a 1-year follow-up,19(18.4%)participants developed recurrence of AA.Use of ACEI or ARB therapy was noted in the study population.Patients on ACEI/ARB had a greater prevalence of hypertension and coronary artery disease.On a multivariate model adjusted for baseline demographics and risk factors for AF,ACEI or ARB therapy did not prevent recurrence of AA following CBA(P=0.72).Similarly,on Kaplan–Meier analysis pretreatment with ACEI/ARB did not predict the time to first recurrence of AA(P=0.2173).CONCLUSION In our study population,preablation treatment with an ACEI or ARB had no influence on the recurrence of AA following CBA for paroxysmal AF.

Traditional Chinese Medicine nursing protocols for paroxysmal atrial fibrillation

Atrial fibrillation(AF), the most common cardiac arrhythmia worldwide, is associated with a higher risk of mortality and morbidity, in which paroxysmal atrial fibrillation(PAF) approximately accounts for 25%-60% of AF. Anti-arrhythmic drugs(AAD) have been used to treat different indications of AF for a long time, but its use is limited due to potential proarrhythmic cardiovascular and non-cardiovascular toxicity as well as the modest impact on the maintenance of sinus rhythm. Recently, Traditional Chinese Medicine(TCM) exhibits an excellent effect on PAF. This article primarily investigated the key points of common syndromes, TCM nursing methods and healthy guidance of PAF, aiming at maintaining and developing the strengths of TCM, improving its efficacy and standardizing its behavior.

Study on the mechanism of Renshen Gansong herb in the treatment of paroxysmal atrial fibrillation based on network pharmacology

Objective:To explore the target gene and mechanism of effective components of Renshen-Gansong in the treatment of paroxysmal atrial fibrillation based on network pharmacology.Methods:The chemical constituents of Renshen-Gansong drug pairs were searched by TCMSP traditional Chinese medicine database.The potentially effective components were screened under the conditions of bioavailability(OB)≥30%and drug-like(DL)≥0.18,and the potential targets were predicted by TCMSP database.The human gene name corresponding to the potential target was found by Uniprot database,and the disease target of paroxysmal atrial fibrillation was searched by Genecards database,the intersection target was mapped with the potential target of drug pair,the Wayne diagram was drawn,and the disease-drug-component-target network map was constructed by Cytoscape3.7.2.The PPI protein interaction network map was constructed by STRING database to select the core targets,and finally GO analysis and KEGG analysis were carried out.Results:A total of 28 active components and 45 effective targets were obtained.GO enrichment analysis showed that the main pathways were neurotransmitter receptor activity,ion gated channel activity,passive transmembrane transporter activity,G protein coupled neurotransmitter receptor activity and so on.KEGG pathway enrichment analysis showed that the main pathways were IL-17 signal pathway,calcium signal pathway,TNF signal pathway and so on.Conclusion:Renshen-Gansong has a synergistic effect on the treatment of paroxysmal atrial fibrillation through multi-targets,multi-pathways and multiple signal pathways,which provides a basis for further study of drug mechanism and clinical guidance.

Application Effect Evaluation of Telmisartan combined with Spironolactone after Catheter Ablation of Patients with Paroxysmal Atrial Fibrillation

Objective:To evaluate the application effect of telmisartan combined with spironolactone after catheter ablation of patients with paroxysmal atrial fibrillation.Methods:80 cases of patients with paroxysmal atrial fibrillation who received radiofrequency catheter ablation treatment from March 2013 to March 2016 in our hospital were randomly selected,these patients were divided into two groups according to the treatment methods,namely,the telmisartan with Spironolactone treatment group(combined treatment group,n=40)and the conventional therapy group(n=40).The hs-CRP,NT-proBNP,LAD and recurrence of the two groups were analyzed.Results:The hs-CRP,NT-proBNP levels after 3 months of the combined treatment group were significantly lower(P<0.05),the recurrence rate 10.0%(4/40)was significantly lower than the conventional therapy group 27.5%(11/40)(P<0.05),the time to recurrence was significantly longer than the conventional therapy group(P<0.05).Conclusion:The application effects of telmisartan combined with spironolactone after catheter ablation in the treatment of patients with paroxysmal atrial fibrillation are better than conventional therapy.

A randomized prospective comparison of CartoMerge and CartoXP to guide circumferential pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation

Background CartoXP and CartoMerge have been used to treat atrial fibrillation （AF） for several years. Our randomized prospective study compared clinical outcomes of these two versions of three dimensional electroanatomic mapping system in guiding catheter ablation for paroxysmal atrial fibrillation （PAF）. Methods Eighty-one patients with symptomatic, drug refractory PAF were randomly assigned to CartoMerge group （n=-42, mean age （54.5 ＋ 13.1） years, history of AF = 3.2 years） or CartoXP group （n=39, mean age （59.8 ± 15.6） years, history of AF = 2.9 years）. All patients underwent 64-slice computed tomography （MSCT） 1 to 3 days prior to ablation procedure. Using CartoMergeTM Image Integration Module, 3D anatomical images of the left atrium （LA） and pulmonary veins （PVS） derived from MSCT of CartoMerge group were established and merged with the electroanatomical map. The integrated images were used to guide the procedure of circumferential pulmonary vein isolation （CPVl）. In the other group, CPVl was guided just by CartoXP. The endpoint of CPVl in both groups was abolition or dissociation of pulmonary vein potentials （PVPs）. Results Mapping points to establish the electroanatomical model of the LA/PVs were 48.7＋13.4 in CartoMerge group and 62.5±15.7 in CartoXP group （P〈0.001）. Mean distance between mapping points and the MSCT surfaces in CartoMerge group was （1.59±0.33） mm. Accomplishment of abolition or dissociation of PVPs was achieved 95.2% in CartoMerge group and 92.3% in CartoXP group. Durations of procedure and exposure to X-ray were （156±25） minutes, （179±21） minutes （P〈0.001） and （19.6±7.5） minutes, （28.5±12.8） minutes （P 〈0.001）, respectively. After a follow-up with duration of （11.9＋3.1） months vs （12.4±3.6） months post the first ablation procedure, patients free of AF were 33 （78.6%） in CartoMerge group and 29 （74.4%） in CartoXP group （P〉0.50）. No patient suffered pulmonary vein stenosis, atenoesophageal fistula, stroke or death. Conclusion Compared to CartoXP, CartoMerge shortened the catheter ablation procedure and exposure to X-ray, without affecting the clinical outcomes of circumferential pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation in experienced centres.

nterventional Therapy for Bilateral Acute Renal Artery Embolism Caused by Paroxysmal Atrial Fibrillation

Clinically persistent atrial fibrillation （AF） occurring with systemic embolism is not uncommon. In contrast, the incidence of embolism due to paroxysmal AF is far lower than that of persistent AF. Cerebral arteries are the most common sites of emboli caused by AF, followed by the mesenteric artery, splenic artery, lower extremity arteries, and renal arteries. However, the occurrence of concurrent bilateral renal artery emboli is extremely rare in paroxysmal AF patients. Within the scope of the information, we have collected, only three similar cases have been reported.

Comparison of the efficacy and safety of pulmonary vein isolation using cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation： An updated metaanalysis

Background Radiofrequency catheter ablation （RFCA） and cryoballoon ablation （CBA） are the two common ablation technologies used for the treatment of paroxysmal atrial fibrillation （PAF）. However, there is no consensus on which ablation method is the optimal choice. Methods We searched PubMed, EMBASE, Cochrane Library, Web of Knowledge and clinical trials.gov for clinically controlled trials （published up to January 11, 2017）. All included studies included fulfilled our previously defined criteria. The primary clinical outcome was the proportion of participants free from atrial fibrillation at 12-months follow-up. ; The secondary clinical outcomes were as the procedure time, fluoroscopy time, and total complications. Results We identified 573 studies, seven randomized controlled trials （RCTs） and 11 non-RCTs were included in this analysis （n=4982 participants）. Compared with RFCA, CBA had similar proportion of participants free from PAF at 12-months follow-up （70.8% vs. 69%; relative risk [RR] ： 1.01; 95% CI： 0.97 to 1.05）. Additionally, procedure time （149.61 vs. 174.73min; weighted mean difference WMD： 25.55; 95% CI： 44.69 to 6.41） was shorter in the CBA group, but the fluoroscopy time （34.52 vs. 38.59 min; WMD： 2.08; 95% CI： 5.86 to 1.71） did not have any significant difference. Total complication was not significantly different in both groups （RR： 1.22; 95% CI： 0.74 to 2.02 ）. Conclusions CBA is similar to RFCA with respect to clinical efficacy for PAF during the follow-up period of 12 months, and with no increased overall safety risk in the cryoballoon group CBA.

CartoXP Guided Catheter Ablation for Paroxysmal Atrial Fibrillation Without Three-dimensional Modeling of Left Atrium and Pulmonary Veins

Objectives This study was to investigate the differences between modeling and non-modeling left atrium （LA） in CartoXP system guided catheter ablation for paroxysmal atrial fibrillation （PAF）. Methods From Jan to Dec in 2008 total 31 cases with PAF were enrolled. All were treated by the same electrophysiologist with CartoXP guidance. Catheter ablation was accomplished without left atrium and pulmonary veins modeling in 17 patients （non-modeling group） and with left atrium modeling in 14 patients （modeling group）. The detailed ablation method was based on circumferential pulmonary veins isolation （CPVI）. And linear ablation of tricuspid valvular isthmus was performed individually. The ablation endpoint was a complete isolation of pulmonary vein potential from left atrium and no further induced continuous fast atrial arrhythmia including atrial fibrillation （AF）, atrial flutter （AFL） and atrial tachycardia （AT）. Each step for the procedures and the follow-up outcomes were compared correspondingly. Results The total procedure time was 107.23 ± 28.92 min in modeling group vs 93.47 ±26.09 min in non-modeling group （ P 〉 0.05 ）. The X-ray exposure time was significantly longer in modeling group （21.09 ±6. 49 rain） than in non-modeling group （14. 16 ± 5.35 min）. The CPVI times of right pulmonary veins and left pulmonary veins were 28. 14 ± 9. 26 min was 27.29 ± 18.53 min in modeling group respectively, vs 18.00 ±4. 51 min and 23.94 ± 7. 10 min in non-modeling group respectively, （P 〈 0. 05 ）. There is no significant difference between modeling group （85.7%） and non-modeling group （82.4%） over follow-up period of 2 to 13 months. Confusions CartoXP system guided catheter ablation of PAF without modeling of left atrium and pulmonary veins took less time in X-ray exposure and ablation steps, comparing with left atrium modeling procedure.

Radiofrequency ablation for treating paroxysmal supraventricular tachycardia complicated by atrial fibrillation： A single-center retrospective analysis

The effect of selective radiofrequency ablation for treating paroxysmal supraventricular tachycardia （PSVT） and its associated paroxysmal atrial fibrillation （PAF） was assessed. Methods Data were collected retrospectively from patients diagnosed of PSVT and subsequently treated with radiofrequency ablation. Regular monthly follow-up by dynamic electrocardiography （ECG） was performed. Incident rates of atrial fibrillation before and after ablation were compared. Results 382 PSVT patients with 58 having atrial fibrillation were en- rolled. The order of complicated PAF from high to low in these patients was displayed as： atrial tachycardia （AT）, atrioventricular reentrant tachycardia （AVRT） and atrioventricular nodal reentrant tachycardia （AVNRT）. Among AVRT patients, PAF was more frequent in patients having accessory pathways. AVNRT patients had significant- ly lower PAF rate comparing to other patients. PAF incident rate was significantly reduced by radiofrequency ablation therapy. Conclusion We advise regular dynamic ECG for PSVT patients, especially those with atrial flutter, AT or pre-excitation syndrome. Selective radiofrequency ablation is a feasible approach for treating AF complicated PSVT patients.

Study of the Impact of the Patient Rhythm during Cryoballoon Ablation on the Acute Biophysical Parameters

Background: Pulmonary vein isolation by means of cryoballoon is a well-established way of treatment of atrial fibrillation. The aim of the study was to compare the acute cryoballoon biophysical parameters attained during energy applications to the individual pulmonary vein during sinus rhythm versus atrial fibrillation. Methods: 100 Patients who underwent their first-time PVI using second-generation cryoballoon for symptomatic and drug-refractory AF, between the beginning of March to end of August 2016, were initially screened. 61 patients with paroxysmal AF were included in the present study. 39 patients with persistent AF were excluded. No pre-procedural anatomical imaging was reported. Results: A total of 61 patients (male 80%, age 59.3 ± 13.4 years) were included in the present analysis. A total of 243 pulmonary veins were isolated with an average of 1.87 ± 1.14 cryo energy applications per individual vein. During cryo application, there were no significant differences between applications delivered during sinus rhythm or ongoing AF in the rate of temperature drop at 5 and 30 s, rate of warming at 5 s after freezing stop or achieved balloon nadir temperature. The same also was observed for both the balloon cooling rate and warming times. Conclusions: The present analysis shows no impact of the patient baseline rhythm at the time of energy application upon the acute balloon biophysical parameters in patients with normal sinus rhythm and those with ongoing atrial fibrillation using the second-generation cryoballoon.