Backgrounds: Cardioversion for atrial fibrillation(AF) is the most effective treatment for the restoration of sinus rhythm(SR). Recently, an elevated level of hs-CRP has been shown to be associated with AF burden, sug...Backgrounds: Cardioversion for atrial fibrillation(AF) is the most effective treatment for the restoration of sinus rhythm(SR). Recently, an elevated level of hs-CRP has been shown to be associated with AF burden, suggesting that inflammation increases the propensity for persistence of AF. We examined whether the level of high-sensitivity C-reactive protein(hs-CRP) was predictive of the outcome of cardioversion for AF. Methods and results: One hundred and six patients with a history of symptomatic AF lasting ≥ 1 day(age 63± 14 years, mean± S.D.) underwent cardioversion. Echocardiography and hs-CRP assay were performed immediately prior to cardioversion. SR was restored in 84 patients(79% ). By using selected cutoff values,multiple discriminant analysis revealed significant associations between successful cardioversion and a shorter duration of AF(AF duration≤ 36 days, odds ratio(OR), 0.98; 95% confidence interval(CI), 0.97-0.99), smaller left atrial diameter(left atrial diameter ≤ 40 mm, OR 0.82, 95% CI 0.71-0.94), better-preserved left ventricular ejection fraction(left ventricular ejection fraction ≥ 60% , OR 0.92, 95% CI 0.86-0.99), and lower hs-CRP level(hs-CRP ≤ 0.12 mg/dL, OR 0.33, 95% CI 0.21-0.51). During a follow-up period of 140± 144 days, AF recurred in 64 patients(76% ). By using a cutoff value of hs-CRP ≥ 0.06 mg/dL, Cox proportional-hazards regression model found that only hs-CRP level was an independent predictor of AF recurrence(OR 5.30, 95% CI 2.46-11.5) after adjustment for coexisting cardiovascular risks. When patients were divided by the hs-CRP level of 0.06 mg/dL, percentage of maintenance of SR below and above the cutoff was 53% and 4% , respectively(log-rank test, p< 0.0001). Conclusions: hs-CRP level determined prior to cardioversion represents an independent predictor of both successful cardioversion for AF and the maintenance of SR after conversion.展开更多
《新英格兰医学杂志》（New England Journal of Medicine）在2012年5月17日发表了一项关于华法林和阿司匹林在治疗射血分数（LVEF）降低患者疗效比较研究（WARCEF）的结果。该项研究表明：对于窦性节律LVEF降低的患者，使用华法林治疗...《新英格兰医学杂志》（New England Journal of Medicine）在2012年5月17日发表了一项关于华法林和阿司匹林在治疗射血分数（LVEF）降低患者疗效比较研究（WARCEF）的结果。该项研究表明：对于窦性节律LVEF降低的患者，使用华法林治疗还是阿司匹林治疗，主要终点事件没有总体上的差异。华法林降低缺血性卒中风险的获益被其严重出血风险的增加所抵？肖。因此，选择华法林还是阿司匹林治疗要因人而异（N Engl J Med，2012，366：1859—1869）。展开更多
This prospective, randomized, single-blinded, placebo-controlled study compared the efficacy and safety of sotalol and propafenone when used for long-term prevention of atrial fibrillation. For the long-term maintenan...This prospective, randomized, single-blinded, placebo-controlled study compared the efficacy and safety of sotalol and propafenone when used for long-term prevention of atrial fibrillation. For the long-term maintenance of normal sinus rhythm, propafenone seems to be more effective than sotalol.展开更多
Objective: The purpose of this study was to describe pregnant patients with mitral stenosis who had intracardiac thrombosis in the absence of atrial fibrillation. Study design: We reviewed the clinical course of 3 pre...Objective: The purpose of this study was to describe pregnant patients with mitral stenosis who had intracardiac thrombosis in the absence of atrial fibrillation. Study design: We reviewed the clinical course of 3 pregnant women with severe mitral stenosis and normal sinus rhythm who had clinically significant intracardiac thrombosis. Results: The first patient was examined at 21 weeks of gestation with embolic stroke that was the result of left atrial thrombus. A second patient was found to have a large left atrial thrombus that prevented the performance of balloon valvuloplasty. The third patient had left atrial clot that partially occluded the mitral valve orifice and led to the development of pulmonary edema that resulted in an emergent cesarean delivery and anoxic brain injury in the newborn infant. Conclusion: Pregnant patients with mitral stenosis in normal sinus rhythm can experience thromboembolic events that can be detrimental to both the mother and the fetus. Anticoagulation therefore should be strongly considered in this group.展开更多
Cardiac resynchronization therapy(CRT) is a new therapeutic option for patients who have drug-refractory end-stage heart failure. Much information has been obtained from patients who have sinus rhythm, but the use of ...Cardiac resynchronization therapy(CRT) is a new therapeutic option for patients who have drug-refractory end-stage heart failure. Much information has been obtained from patients who have sinus rhythm, but the use of CRT in patients who have chronic atrial fibrillation(AF) has not been studied extensively. Accordingly, we evaluated the clinical response and long-term survival rate of CRT in patients who had heart failure and chronic AF, and the results were compared with those in patients who had sinus rhythm and who underwent CRT. Sixty patients who had end-stage heart failure(30 had sinus rhythm and 30 had chronic AF), New York Heart Association classes III to IV, left ventricular ejection fraction< 35%, QRS interval >120 ms, and a left bundle branch block received a biventricular pacemaker. New York Heart Association class, Minnesota Quality of Life score, and 6-minutew-alking distance were evaluated at baseline and after 6 months of CRT. Longterm follow-up was ≤2 years. New York Heart Association class, Minnesota Quality of Life score, and 6-minute walking distance improved significantly in the 2 groups after 6 months of CRT. The number of nonresponders was greater among patients who had AF.Nevertheless, the long-term survival rate was comparable between patients who had sinus rhythm and those who had AF. Patients who had AF demonstrated comparable benefit from CRT as those who had sinus rhythm.展开更多
文摘Backgrounds: Cardioversion for atrial fibrillation(AF) is the most effective treatment for the restoration of sinus rhythm(SR). Recently, an elevated level of hs-CRP has been shown to be associated with AF burden, suggesting that inflammation increases the propensity for persistence of AF. We examined whether the level of high-sensitivity C-reactive protein(hs-CRP) was predictive of the outcome of cardioversion for AF. Methods and results: One hundred and six patients with a history of symptomatic AF lasting ≥ 1 day(age 63± 14 years, mean± S.D.) underwent cardioversion. Echocardiography and hs-CRP assay were performed immediately prior to cardioversion. SR was restored in 84 patients(79% ). By using selected cutoff values,multiple discriminant analysis revealed significant associations between successful cardioversion and a shorter duration of AF(AF duration≤ 36 days, odds ratio(OR), 0.98; 95% confidence interval(CI), 0.97-0.99), smaller left atrial diameter(left atrial diameter ≤ 40 mm, OR 0.82, 95% CI 0.71-0.94), better-preserved left ventricular ejection fraction(left ventricular ejection fraction ≥ 60% , OR 0.92, 95% CI 0.86-0.99), and lower hs-CRP level(hs-CRP ≤ 0.12 mg/dL, OR 0.33, 95% CI 0.21-0.51). During a follow-up period of 140± 144 days, AF recurred in 64 patients(76% ). By using a cutoff value of hs-CRP ≥ 0.06 mg/dL, Cox proportional-hazards regression model found that only hs-CRP level was an independent predictor of AF recurrence(OR 5.30, 95% CI 2.46-11.5) after adjustment for coexisting cardiovascular risks. When patients were divided by the hs-CRP level of 0.06 mg/dL, percentage of maintenance of SR below and above the cutoff was 53% and 4% , respectively(log-rank test, p< 0.0001). Conclusions: hs-CRP level determined prior to cardioversion represents an independent predictor of both successful cardioversion for AF and the maintenance of SR after conversion.
文摘《新英格兰医学杂志》（New England Journal of Medicine）在2012年5月17日发表了一项关于华法林和阿司匹林在治疗射血分数（LVEF）降低患者疗效比较研究（WARCEF）的结果。该项研究表明：对于窦性节律LVEF降低的患者，使用华法林治疗还是阿司匹林治疗，主要终点事件没有总体上的差异。华法林降低缺血性卒中风险的获益被其严重出血风险的增加所抵？肖。因此，选择华法林还是阿司匹林治疗要因人而异（N Engl J Med，2012，366：1859—1869）。
文摘This prospective, randomized, single-blinded, placebo-controlled study compared the efficacy and safety of sotalol and propafenone when used for long-term prevention of atrial fibrillation. For the long-term maintenance of normal sinus rhythm, propafenone seems to be more effective than sotalol.
文摘Objective: The purpose of this study was to describe pregnant patients with mitral stenosis who had intracardiac thrombosis in the absence of atrial fibrillation. Study design: We reviewed the clinical course of 3 pregnant women with severe mitral stenosis and normal sinus rhythm who had clinically significant intracardiac thrombosis. Results: The first patient was examined at 21 weeks of gestation with embolic stroke that was the result of left atrial thrombus. A second patient was found to have a large left atrial thrombus that prevented the performance of balloon valvuloplasty. The third patient had left atrial clot that partially occluded the mitral valve orifice and led to the development of pulmonary edema that resulted in an emergent cesarean delivery and anoxic brain injury in the newborn infant. Conclusion: Pregnant patients with mitral stenosis in normal sinus rhythm can experience thromboembolic events that can be detrimental to both the mother and the fetus. Anticoagulation therefore should be strongly considered in this group.
文摘Cardiac resynchronization therapy(CRT) is a new therapeutic option for patients who have drug-refractory end-stage heart failure. Much information has been obtained from patients who have sinus rhythm, but the use of CRT in patients who have chronic atrial fibrillation(AF) has not been studied extensively. Accordingly, we evaluated the clinical response and long-term survival rate of CRT in patients who had heart failure and chronic AF, and the results were compared with those in patients who had sinus rhythm and who underwent CRT. Sixty patients who had end-stage heart failure(30 had sinus rhythm and 30 had chronic AF), New York Heart Association classes III to IV, left ventricular ejection fraction< 35%, QRS interval >120 ms, and a left bundle branch block received a biventricular pacemaker. New York Heart Association class, Minnesota Quality of Life score, and 6-minutew-alking distance were evaluated at baseline and after 6 months of CRT. Longterm follow-up was ≤2 years. New York Heart Association class, Minnesota Quality of Life score, and 6-minute walking distance improved significantly in the 2 groups after 6 months of CRT. The number of nonresponders was greater among patients who had AF.Nevertheless, the long-term survival rate was comparable between patients who had sinus rhythm and those who had AF. Patients who had AF demonstrated comparable benefit from CRT as those who had sinus rhythm.
