Objective： To evaluate the safety and clinical efficacy of segmental radiofrequency ablation of pulmonary vein （PV） ostia for patients with refractory paroxysmal atrial fibrillation （AF） under multi-slice spiral ...Objective： To evaluate the safety and clinical efficacy of segmental radiofrequency ablation of pulmonary vein （PV） ostia for patients with refractory paroxysmal atrial fibrillation （AF） under multi-slice spiral computed tomography （MSCT） guidance before the procedure. Methods： A series of 58 consecutive patients with refractory paroxysmal AF were enrolled to undergo segmental radiofrequency ablation ofPV ostia. The 36 male and 22 female patients with mean age of （57.4±9.5） （32-79） years and no obvious organic heart disease. Before ablation, patients received MSCT to generate 3-dimentional image of the left atrium （LA） and proximal PVs. Patients then underwent segmental radiofrequency ablation ofPV ostia using PV circular mapping catheter manipulated several times to ensure complete isolation between PVs and LA. Results： No complications occurred during the procedure. One patient developed delayed cardiac tamponade, which was drained percutaneously. The mean follow-up time was （17.1±9.3） months. Forty-one patients （95%） experienced improved quality of life one month after the procedure. Thirty-six patients （83%） showed stable sinus rhythm, while 10 patients （23%） required additional anti-arrhythmic drugs. AF returned≥1 time in 6 （14%） patients who underwent anti-arrhythmic drug therapy, but the number of episodes was less than that before the procedure. However, one patient experienced recurrent episodes of atrial flutter. Conclusion： It is safe and effective to perform segmental radiofrequency ablation of PV ostia for patients with refractory paroxysmal AF using MSCT guidance mappening.展开更多
Objective To investigate the feasibility and effectiveness of radiofrequency catheter ablation (RFCA) to treat permanent atrial fibrillation (AF) under the guidance of Carto-Merge technique. Methods Fifteen male patie...Objective To investigate the feasibility and effectiveness of radiofrequency catheter ablation (RFCA) to treat permanent atrial fibrillation (AF) under the guidance of Carto-Merge technique. Methods Fifteen male patients with permanent AF underwent RFCA under the guidance of Carto-Merge technique. The mean age was 54.00±10.44 years, and duration of AF was 23.66±14.93 months. Cardiac magnetic resonance angiography (MRA) was performed to obtain pre-procedural three-dimensional (3D) images on the anatomy of left atrium (LA) and pulmonary veins (PVs) before RFCA procedure. Then the electroanatomical map was integrated with 3D images of MRA to form Carto-Merge map that guided step-by-step ablation strategy of permanent AF. Circumferential PV ablation was performed first until complete PVs electric isolation confirmed by Lasso catheter. If AF was not terminated, lesion lines on roof of LA, mitral isthmus, and tricuspid isthmus were produced. Results The episodes of AF were terminated during RFCA in 2 patients, by direct current cardioversion in the remaining 13 patients. Transient AF occurred in 2 patients after ablation on 1st day and 1st week respectively, AF terminated spontaneously not long after taking metoprolol. One patient developed persistent atrial flutter (AFL) in 2 months after procedure and AFL was eliminated by the second ablation. Persistent AF recurred on 1st day, 1st and 5th week respectively in 3 patients, and did not terminate after 3 months even though amiodarone was given. The remaining 12 patients were all free of AF during 2-11 months of follow-up. The recent success rate for RFCA of permanent AF was 80%. Conclusions Carto-Merge technique can effectively guide RFCA of permanent AF. When combined with single Lasso mapping, it can simplify the mapping, lower expenses, and enhance the success rate of RFCA of permanent AF.展开更多
This review discusses atrial fibrillation according to the guidelines of Brazilian Society of Cardiac Arrhythmias and the Brazilian Cardiogeriatrics Guidelines. We stress the thromboembolic burden of atrial fibrillati...This review discusses atrial fibrillation according to the guidelines of Brazilian Society of Cardiac Arrhythmias and the Brazilian Cardiogeriatrics Guidelines. We stress the thromboembolic burden of atrial fibrillation and discuss how to prevent it as well as the best way to conduct cases of atrial fibrillatios in the elderly, reverting the arrhythmia to sinus rhythm, or the option of heart rate control. The new methods to treat atrial fibrillation, such as radiofrequency ablation, new oral direct thrombin inhibitors and Xa factor inhibitors, as well as new antiarrhythmic drugs, are depicted.展开更多
Objective To compare the therapeutic effects and safety of monopolar and bipolar radiofrequency(RF) ablation used during cardiac surgery to treat atrial fibrillation.Methods We retrospectively studied a total of 81 pa...Objective To compare the therapeutic effects and safety of monopolar and bipolar radiofrequency(RF) ablation used during cardiac surgery to treat atrial fibrillation.Methods We retrospectively studied a total of 81 patients with chronic atrial fibrillation who underwent open cardiac surgery with concomitant RF ablation between January 2007 and March 2011.Fifty-eight patients received bipolar RF ablation and 23 received monopolar RF ablation,respectively.The sinus rhythm restoration rate,the procedural duration,the frequency of severe perioperative complications,and mortality were compared between the two groups.Results The sinus rhythm restoration rate did not differ significantly between the two groups after follow-up of 15.1 ± 12.6 months(P=0.199).The frequencies of severe perioperative complications and mortality were also similar in the two groups.The total procedural time using bipolar RF ablation was significantly shorter than that using monopolar ablation(19.7±4.6 minutes vs.28.1±8.5 minutes,P< 0.001).Conclusions Both monopolar and bipolar RF ablation are safe and effective in treating chronic atrial fibrillation patients during open cardiac surgery,but bipolar RF ablation is more convenient in practice.展开更多
Background and objective： Rivaroxaban is a new oral anticoagulant for stroke prevention in patients with non-valvular atrial fibrillation （NVAF）, which has less drug-food interaction than warfarin. We conducted thi...Background and objective： Rivaroxaban is a new oral anticoagulant for stroke prevention in patients with non-valvular atrial fibrillation （NVAF）, which has less drug-food interaction than warfarin. We conducted this pro- spective randomized study to evaluate the metabolic benefits as well as the safety and efficacy with rivaroxaban versus warfarin in patients with NVAF following radiofrequency catheter ablation （RFCA）. Methods： From April to July 2014, 60 patients with NVAF undergoing RFCA were prospectively enrolled in our study. Following RFCA, all patients were randomly assigned to receive rivaroxaban （Group R, n=30） or warfarin （Group W, n=30）. Metabolic indices including serum total protein, albumin, globulin, and high-density lipoprotein （HDL） as well as bleeding, stroke, and systemic thromboembolism events were evaluated and compared during follow-up after 15, 30, 60, and 90 d of RFCA procedure. Results： Serum total protein, albumin, globulin, and HDL levels were all significantly elevated at each follow-up stage in Group R when compared to the baseline （P〈0.05 respectively）. In Group W, the metabolic indices decreased at first and then had an increasing trend. There were no deaths or thromboembolic complications in each group. The prevalence of total bleeding complications was similar between Group R and Group W （11/30, 36.7% vs. 10/30, 33.3%, P=0.70）. Conclusions： Patients with NVAF receiving rivaroxaban after RFCA procedures appear to benefit from a metabolic perspective compared with warfarin, providing practical clinical reference for the choice of the anticoagulant. Rivaroxaban seems to be as safe and effective in preventing thromboembolic events as warfarin for these patients.展开更多
Background： Antithrombotic therapy using new oral anticoagulants （NOACs） in patients with atrial fibril- lation （AF） has been generally shown to have a favorable risk-benefit profile. Since there has been dispute...Background： Antithrombotic therapy using new oral anticoagulants （NOACs） in patients with atrial fibril- lation （AF） has been generally shown to have a favorable risk-benefit profile. Since there has been dispute about the risks of gastrointestinal bleeding （GIB） and intracranial hemorrhage （ICH）, we sought to conduct a systematic review and network meta-analysis using Bayesian inference to analyze the risks of GIB and ICH in AF patients taking NOACs. Methods： We analyzed data from 20 randomized controlled trials of 91 671 AF patients receiving anticoagulants, antiplatelet drugs, or placebo. Bayesian network meta-analysis of two different evidence networks was performed using a binomial likelihood model, based on a network in which different agents （and doses） were treated as separate nodes. Odds ratios （ORs） and 95% confidence intervals （CIs） were modeled using Markov chain Monte Carlo methods Results： Indirect comparisons with the Bayesian model confirmed that aspirin＋clopidogrel significantly increased the risk of GIB in AF patients compared to the placebo （OR 0.33, 95% CI 0.01-0.92）. Warfarin was identified as greatly increasing the risk of ICH compared to edoxaban 30 mg （OR 3.42, 95% CI 1.22-7.24） and dabigatran 110 mg （OR 3.56, 95% CI 1.10-8.45）. We further ranked the NOACs for the lowest risk of GIB （apixaban 5 mg） and ICH （apixaban 5 mg, dabigatran 110 mg, and edoxaban 30 mg）. Conclusions： Bayesian network meta-analysis of treatment of nonvalvular AF patients with anticoagulants suggested that NOACs do not increase risks of GIB and/or ICH, compared to each other.展开更多
Objective： The purpose of this meta-analysis was to explore the effect of corticosteroids on atrial fibrillation（AF） following catheter ablation. Methods： We searched Pub Med, Embase, and the Cochrane Central Regi...Objective： The purpose of this meta-analysis was to explore the effect of corticosteroids on atrial fibrillation（AF） following catheter ablation. Methods： We searched Pub Med, Embase, and the Cochrane Central Register of Controlled Trials for published articles describing the effect of corticosteroids in preventing AF recurrence after catheter ablation. Data on study and patient were extracted. Risk ratios（RRs） and 95% confidence intervals（CIs） were calculated by use of a random-effect model, and P values of 〈0.05 were considered significant. Results： Two randomized controlled trials（RCTs） and three cohort studies involving 846 patients were included in this meta-analysis. Within one month of catheter ablation, corticosteroid use was associated with a declined risk of recurrence of AF in RCT（RR 0.57, 95% CI 0.39 to 0.85, P=0.005）, but without significant effect in cohort studies（RR 1.01, 95% CI 0.79 to 1.30, P=0.94）. After three months of catheter ablation, corticosteroids did not have a significant effect in the prevention of late recurrence of AF in either RCT（RR 0.78, 95% CI 0.38 to 1.59, P=0.49） or cohort studies（RR 0.96, 95% CI 0.70 to 1.31, P=0.78）. Conclusions： Our meta-analysis suggested that periprocedural administration of corticosteroids of catheter ablation was associated with reduction of early but not late recurrence of AF.展开更多
文摘Objective： To evaluate the safety and clinical efficacy of segmental radiofrequency ablation of pulmonary vein （PV） ostia for patients with refractory paroxysmal atrial fibrillation （AF） under multi-slice spiral computed tomography （MSCT） guidance before the procedure. Methods： A series of 58 consecutive patients with refractory paroxysmal AF were enrolled to undergo segmental radiofrequency ablation ofPV ostia. The 36 male and 22 female patients with mean age of （57.4±9.5） （32-79） years and no obvious organic heart disease. Before ablation, patients received MSCT to generate 3-dimentional image of the left atrium （LA） and proximal PVs. Patients then underwent segmental radiofrequency ablation ofPV ostia using PV circular mapping catheter manipulated several times to ensure complete isolation between PVs and LA. Results： No complications occurred during the procedure. One patient developed delayed cardiac tamponade, which was drained percutaneously. The mean follow-up time was （17.1±9.3） months. Forty-one patients （95%） experienced improved quality of life one month after the procedure. Thirty-six patients （83%） showed stable sinus rhythm, while 10 patients （23%） required additional anti-arrhythmic drugs. AF returned≥1 time in 6 （14%） patients who underwent anti-arrhythmic drug therapy, but the number of episodes was less than that before the procedure. However, one patient experienced recurrent episodes of atrial flutter. Conclusion： It is safe and effective to perform segmental radiofrequency ablation of PV ostia for patients with refractory paroxysmal AF using MSCT guidance mappening.
文摘Objective To investigate the feasibility and effectiveness of radiofrequency catheter ablation (RFCA) to treat permanent atrial fibrillation (AF) under the guidance of Carto-Merge technique. Methods Fifteen male patients with permanent AF underwent RFCA under the guidance of Carto-Merge technique. The mean age was 54.00±10.44 years, and duration of AF was 23.66±14.93 months. Cardiac magnetic resonance angiography (MRA) was performed to obtain pre-procedural three-dimensional (3D) images on the anatomy of left atrium (LA) and pulmonary veins (PVs) before RFCA procedure. Then the electroanatomical map was integrated with 3D images of MRA to form Carto-Merge map that guided step-by-step ablation strategy of permanent AF. Circumferential PV ablation was performed first until complete PVs electric isolation confirmed by Lasso catheter. If AF was not terminated, lesion lines on roof of LA, mitral isthmus, and tricuspid isthmus were produced. Results The episodes of AF were terminated during RFCA in 2 patients, by direct current cardioversion in the remaining 13 patients. Transient AF occurred in 2 patients after ablation on 1st day and 1st week respectively, AF terminated spontaneously not long after taking metoprolol. One patient developed persistent atrial flutter (AFL) in 2 months after procedure and AFL was eliminated by the second ablation. Persistent AF recurred on 1st day, 1st and 5th week respectively in 3 patients, and did not terminate after 3 months even though amiodarone was given. The remaining 12 patients were all free of AF during 2-11 months of follow-up. The recent success rate for RFCA of permanent AF was 80%. Conclusions Carto-Merge technique can effectively guide RFCA of permanent AF. When combined with single Lasso mapping, it can simplify the mapping, lower expenses, and enhance the success rate of RFCA of permanent AF.
文摘This review discusses atrial fibrillation according to the guidelines of Brazilian Society of Cardiac Arrhythmias and the Brazilian Cardiogeriatrics Guidelines. We stress the thromboembolic burden of atrial fibrillation and discuss how to prevent it as well as the best way to conduct cases of atrial fibrillatios in the elderly, reverting the arrhythmia to sinus rhythm, or the option of heart rate control. The new methods to treat atrial fibrillation, such as radiofrequency ablation, new oral direct thrombin inhibitors and Xa factor inhibitors, as well as new antiarrhythmic drugs, are depicted.
文摘Objective To compare the therapeutic effects and safety of monopolar and bipolar radiofrequency(RF) ablation used during cardiac surgery to treat atrial fibrillation.Methods We retrospectively studied a total of 81 patients with chronic atrial fibrillation who underwent open cardiac surgery with concomitant RF ablation between January 2007 and March 2011.Fifty-eight patients received bipolar RF ablation and 23 received monopolar RF ablation,respectively.The sinus rhythm restoration rate,the procedural duration,the frequency of severe perioperative complications,and mortality were compared between the two groups.Results The sinus rhythm restoration rate did not differ significantly between the two groups after follow-up of 15.1 ± 12.6 months(P=0.199).The frequencies of severe perioperative complications and mortality were also similar in the two groups.The total procedural time using bipolar RF ablation was significantly shorter than that using monopolar ablation(19.7±4.6 minutes vs.28.1±8.5 minutes,P< 0.001).Conclusions Both monopolar and bipolar RF ablation are safe and effective in treating chronic atrial fibrillation patients during open cardiac surgery,but bipolar RF ablation is more convenient in practice.
文摘Background and objective： Rivaroxaban is a new oral anticoagulant for stroke prevention in patients with non-valvular atrial fibrillation （NVAF）, which has less drug-food interaction than warfarin. We conducted this pro- spective randomized study to evaluate the metabolic benefits as well as the safety and efficacy with rivaroxaban versus warfarin in patients with NVAF following radiofrequency catheter ablation （RFCA）. Methods： From April to July 2014, 60 patients with NVAF undergoing RFCA were prospectively enrolled in our study. Following RFCA, all patients were randomly assigned to receive rivaroxaban （Group R, n=30） or warfarin （Group W, n=30）. Metabolic indices including serum total protein, albumin, globulin, and high-density lipoprotein （HDL） as well as bleeding, stroke, and systemic thromboembolism events were evaluated and compared during follow-up after 15, 30, 60, and 90 d of RFCA procedure. Results： Serum total protein, albumin, globulin, and HDL levels were all significantly elevated at each follow-up stage in Group R when compared to the baseline （P〈0.05 respectively）. In Group W, the metabolic indices decreased at first and then had an increasing trend. There were no deaths or thromboembolic complications in each group. The prevalence of total bleeding complications was similar between Group R and Group W （11/30, 36.7% vs. 10/30, 33.3%, P=0.70）. Conclusions： Patients with NVAF receiving rivaroxaban after RFCA procedures appear to benefit from a metabolic perspective compared with warfarin, providing practical clinical reference for the choice of the anticoagulant. Rivaroxaban seems to be as safe and effective in preventing thromboembolic events as warfarin for these patients.
基金Project supported by the National Natural Science Foundation of China(No.30800999)
文摘Background： Antithrombotic therapy using new oral anticoagulants （NOACs） in patients with atrial fibril- lation （AF） has been generally shown to have a favorable risk-benefit profile. Since there has been dispute about the risks of gastrointestinal bleeding （GIB） and intracranial hemorrhage （ICH）, we sought to conduct a systematic review and network meta-analysis using Bayesian inference to analyze the risks of GIB and ICH in AF patients taking NOACs. Methods： We analyzed data from 20 randomized controlled trials of 91 671 AF patients receiving anticoagulants, antiplatelet drugs, or placebo. Bayesian network meta-analysis of two different evidence networks was performed using a binomial likelihood model, based on a network in which different agents （and doses） were treated as separate nodes. Odds ratios （ORs） and 95% confidence intervals （CIs） were modeled using Markov chain Monte Carlo methods Results： Indirect comparisons with the Bayesian model confirmed that aspirin＋clopidogrel significantly increased the risk of GIB in AF patients compared to the placebo （OR 0.33, 95% CI 0.01-0.92）. Warfarin was identified as greatly increasing the risk of ICH compared to edoxaban 30 mg （OR 3.42, 95% CI 1.22-7.24） and dabigatran 110 mg （OR 3.56, 95% CI 1.10-8.45）. We further ranked the NOACs for the lowest risk of GIB （apixaban 5 mg） and ICH （apixaban 5 mg, dabigatran 110 mg, and edoxaban 30 mg）. Conclusions： Bayesian network meta-analysis of treatment of nonvalvular AF patients with anticoagulants suggested that NOACs do not increase risks of GIB and/or ICH, compared to each other.
文摘Objective： The purpose of this meta-analysis was to explore the effect of corticosteroids on atrial fibrillation（AF） following catheter ablation. Methods： We searched Pub Med, Embase, and the Cochrane Central Register of Controlled Trials for published articles describing the effect of corticosteroids in preventing AF recurrence after catheter ablation. Data on study and patient were extracted. Risk ratios（RRs） and 95% confidence intervals（CIs） were calculated by use of a random-effect model, and P values of 〈0.05 were considered significant. Results： Two randomized controlled trials（RCTs） and three cohort studies involving 846 patients were included in this meta-analysis. Within one month of catheter ablation, corticosteroid use was associated with a declined risk of recurrence of AF in RCT（RR 0.57, 95% CI 0.39 to 0.85, P=0.005）, but without significant effect in cohort studies（RR 1.01, 95% CI 0.79 to 1.30, P=0.94）. After three months of catheter ablation, corticosteroids did not have a significant effect in the prevention of late recurrence of AF in either RCT（RR 0.78, 95% CI 0.38 to 1.59, P=0.49） or cohort studies（RR 0.96, 95% CI 0.70 to 1.31, P=0.78）. Conclusions： Our meta-analysis suggested that periprocedural administration of corticosteroids of catheter ablation was associated with reduction of early but not late recurrence of AF.
