Objective: To investigate whether new onset acute atrial fibrillation (AF) of< 48 hours’duration creates a prothrombotic state in the absence of anticoagulation and to assess the evolution in research indices afte...Objective: To investigate whether new onset acute atrial fibrillation (AF) of< 48 hours’duration creates a prothrombotic state in the absence of anticoagulation and to assess the evolution in research indices after spontaneous or pharmacological cardioversion. Methods: 24 patients were recruited with first onset acute non-rheumatic AF, in whom sinus rhythm was restored within 48 hours of arrhythmia onset, without anticoagulant treatment. Atrial mechanical function was assessed by transmitral inflow. Soluble thrombomodulin and von Willebrand factor concentrations (both as indices of endothelial damage or dysfunction) and fibrin D-dimer concentrations(as an index of thrombogenesis) were measured. Blood samples were drawn and echocardiographic studies were performed at days 1, 2, 7, and 30 after cardioversion. Research indices were compared with those of 24 healthy participants, 24 patientswith chronicAF, and 24 patientswith ischaemic heart disease in sinus rhythm. Results: Patients with AF had higher concentrations of soluble thrombomodulin(acute AF 12.1 (4.1) ng/ml; chronic AF 11.8(4.6) ng/ml), von Willebrand factor(acute AF 137.2(36.9)ng/ml; chronic AF 133.1(25.0)ng/ml), and fibrin Ddimer concentrations(acute AF 2.35(2.68)μg/ml; chronic AF 1.12(0.65)μg/ml) than did healthy controls (5.9(2.7)ng/ml, 86.7(33.2)ng/ml, and 0.39(0.28)μg/ml, respectively) and patients with ischaemic heart disease(7.4 (3.7)ng/ml,110.0(29.0)ng/ml, and 0.99(0.73)μg/ml, respectively)(all p < 0.05). Day 30 concentrations of fibrin D-dimer were higher in patients with acute AF than in patients with chronic AF(p=0.038) but sTM and vonWillebrand factor concentrations were not different (both not significant). There were no significant changes in research indices or echocardiographic parameters after cardioversion (all p >0.05). Conclusions: There was evidence among patients with acute onset AF of endothelial damage or dysfunction and increased thrombogenesis, which persisted up to 30 days after cardioversion.展开更多
导管消融术是目前症状性药物难治性房颤的一线治疗方法。然而,消融术后的高复发率给患者带来巨大负担,甚至一部分患者即使进行二次导管消融术,仍遭受房颤复发的困扰。因此,我们旨在分析二次导管消融术后房颤复发患者的临床与电生理特征...导管消融术是目前症状性药物难治性房颤的一线治疗方法。然而,消融术后的高复发率给患者带来巨大负担,甚至一部分患者即使进行二次导管消融术,仍遭受房颤复发的困扰。因此,我们旨在分析二次导管消融术后房颤复发患者的临床与电生理特征,进一步指导临床决策。方法:连续纳入2018年1月至2020年12月在我院接受导管消融术的房颤患者,将其分为两组:即首次及二次导管消融术后恢复窦律的房颤患者和二次导管消融术后复发的房颤患者,比较两组间的一般资料。应用单因素及多因素Logistic回归分析确定二次消融术后复发的独立危险因素,并绘制ROC曲线。结果:两组间的年龄、性别等无统计学差异,二次导管消融术后复发的房颤患者较多为非阵发性房颤;Logistic回归分析显示非阵发性房颤、首次消融术后复发时间短及二次消融术中右肺静脉电传导恢复是二次导管消融术后复发的独立危险因素(OR 4.353、4.748、0.910,每组 P < 0.05),ROC曲线下面积为0.786,95%CI:0.668~0.905。结论:房颤患者二次导管消融术后1年复发率约为62.1%,非阵发性房颤、首次消融术后复发时间短及二次消融术中右肺静脉电传导恢复是其有效的预测因子。展开更多
文摘Objective: To investigate whether new onset acute atrial fibrillation (AF) of< 48 hours’duration creates a prothrombotic state in the absence of anticoagulation and to assess the evolution in research indices after spontaneous or pharmacological cardioversion. Methods: 24 patients were recruited with first onset acute non-rheumatic AF, in whom sinus rhythm was restored within 48 hours of arrhythmia onset, without anticoagulant treatment. Atrial mechanical function was assessed by transmitral inflow. Soluble thrombomodulin and von Willebrand factor concentrations (both as indices of endothelial damage or dysfunction) and fibrin D-dimer concentrations(as an index of thrombogenesis) were measured. Blood samples were drawn and echocardiographic studies were performed at days 1, 2, 7, and 30 after cardioversion. Research indices were compared with those of 24 healthy participants, 24 patientswith chronicAF, and 24 patientswith ischaemic heart disease in sinus rhythm. Results: Patients with AF had higher concentrations of soluble thrombomodulin(acute AF 12.1 (4.1) ng/ml; chronic AF 11.8(4.6) ng/ml), von Willebrand factor(acute AF 137.2(36.9)ng/ml; chronic AF 133.1(25.0)ng/ml), and fibrin Ddimer concentrations(acute AF 2.35(2.68)μg/ml; chronic AF 1.12(0.65)μg/ml) than did healthy controls (5.9(2.7)ng/ml, 86.7(33.2)ng/ml, and 0.39(0.28)μg/ml, respectively) and patients with ischaemic heart disease(7.4 (3.7)ng/ml,110.0(29.0)ng/ml, and 0.99(0.73)μg/ml, respectively)(all p < 0.05). Day 30 concentrations of fibrin D-dimer were higher in patients with acute AF than in patients with chronic AF(p=0.038) but sTM and vonWillebrand factor concentrations were not different (both not significant). There were no significant changes in research indices or echocardiographic parameters after cardioversion (all p >0.05). Conclusions: There was evidence among patients with acute onset AF of endothelial damage or dysfunction and increased thrombogenesis, which persisted up to 30 days after cardioversion.
文摘导管消融术是目前症状性药物难治性房颤的一线治疗方法。然而,消融术后的高复发率给患者带来巨大负担,甚至一部分患者即使进行二次导管消融术,仍遭受房颤复发的困扰。因此,我们旨在分析二次导管消融术后房颤复发患者的临床与电生理特征,进一步指导临床决策。方法:连续纳入2018年1月至2020年12月在我院接受导管消融术的房颤患者,将其分为两组:即首次及二次导管消融术后恢复窦律的房颤患者和二次导管消融术后复发的房颤患者,比较两组间的一般资料。应用单因素及多因素Logistic回归分析确定二次消融术后复发的独立危险因素,并绘制ROC曲线。结果:两组间的年龄、性别等无统计学差异,二次导管消融术后复发的房颤患者较多为非阵发性房颤;Logistic回归分析显示非阵发性房颤、首次消融术后复发时间短及二次消融术中右肺静脉电传导恢复是二次导管消融术后复发的独立危险因素(OR 4.353、4.748、0.910,每组 P < 0.05),ROC曲线下面积为0.786,95%CI:0.668~0.905。结论:房颤患者二次导管消融术后1年复发率约为62.1%,非阵发性房颤、首次消融术后复发时间短及二次消融术中右肺静脉电传导恢复是其有效的预测因子。
