A Potential Novel Indication for Preventing Thromboembolism in Patients with Atrial Arrhythmias: Remodeling of the Left Atrium

Objective:Thrombosis in patients with atrial arrhythmias might be associated with remodeling of the left atrium(LA).We aimed to describe this relationship and identify a novel factor,in addition to the CHA_(2)DS_(2)-VASc score,to guide therapeutic strategies for preventing thromboembolism in the hope of improving the prognosis for such patients.Methods:Patients diagnosed with atrial arrhythmias and who met our inclusion criteria were enrolled in this study.Various clinical parameters were recorded;diameters reflecting remodeling of the LA were measured and thrombosis was diagnosed by enhanced CT.Results:Totally,192 patients were enrolled in the study.The overall prevalence of left atrial thrombosis was 8.3%.Patients with persistent atrial fibrillation exhibited the highest anteroposterior diameter of the LA(45.1±7.2 mm)and prevalence of thrombosis(15.6%).An anteroposterior LA diameter of≥50 mm was a strong independent impact risk factor for thrombosis(OR=10.1,95%CI:2.8-36.9,P<0.OO1).The prevalence of LA thrombosis in patients with and without anteroposterior LA diameter of≥50 mm was 25.8%and 5.0%,respectively.Conclusion:Marked remodeling of the LA characterized by an anteroposterior LA diameter of≥50 mm is a strong independent risk factor of thrombosis,and should be considered for the prevention of thromboembolism through various strategies.

Mapping and ablation of atrial arrhythmia after valve surgery plus mini-maze procedure

Background Recurrent atrial arrhythmia is very common in patients after mitral valve surgery plus mini-maze procedure.Investigation about the mechanism for these patients may have important implication to improve the surgery strategy.Methods Mini-maze procedure was defined as follow: Pulmonary vein encircling incision and roof line connecting the two circles lesion,left atrial isthmus lesion,and the right atrial isthmus lesion.There were 517 patients with rheumatic valvular disease and pre-operative atrial fibrillation (AF) undergoing valve surgery plus mini-maze procedure in our hospital in the last 3 years,and 93 patients(18%) had recurrent atrial arrhythmia.Twelve patients(6 males and 6 females,mean age 53.8±7.8 ys) underwent electrophysiological study using 3-D mapping system(10 pts) or conventional mapping method(2 pts).Results The first recurrent time from surgery was 4.4±2.2 months.The mean follow-up time after catheter ablation was(12.0±6.0) months.One patient with sinus bradycardia had recurrent incessant atrial tachycardia (AT),but the AT was terminated by catheter position and never could be induced any more.She underwent a repeat procedure but failed just as the course in the first time, and was treated with DDDR pacemaker plus amiodarone.Six patients had 10 kinds of stable AT,including 5 at right atrial isthmus,2 at roof line,1 related to right atrial incision, 1 at anterior wall of left atrial,and 1 related to left superior pulmonary vene.All the stable AT were eliminated and remained sinus rhythm.Three patients had ATs with variable cycle length and the 3-D mapping suggested macro-reentry AT around mitral annulus.We tried to ablate at routine mitral isthmus and also in coronary sinus,but could not reach bi-directional conduction blocking.The other 2 patients were AF with reconnection at all previous ablation sites.Ablation strategy for AF included lesion at re-conduction sites and complex fractionated atrial electrogram.The patients with AF and mitral isthmus related AT were administrated with DC cardioversion and then took amiodarone.One AT and one AF recurred. Conclusions The recurrent atrial arrhythmia after mini-maze mostly related to reconnection at previous lesion sites and catheter ablation for AT could have a high success rate.It would be very hard to block mitral isthmus after valve replacement,so transmural lesion during surgery procedure is the most important strategy for preventing postoperative atrial arrhythmia.

Bilateral coronary-pulmonary artery fistula with paroxysmal atrial arrhythmia:a case report

Coronary-pulmonary artery fistula(CPAF)is a relatively rare type of congenital coronary artery variation,which is mostly asymptomatic and is discovered incidentally by coronary artery CT imaging or angiography.However,CPAF can cause a phenomenon of inter-artery steal and hemodynamic disorders,leading to myocardial ischemia,arrhythmia,heart failure,syncope and even cardiac sudden death in severe cases.Here we reported a case of a 53-year-old female who complained of intermittent palpitations and had a history of paroxysmal atrial fibrillation.The coronary angiography revealed bilateral coronary artery fistulae to pulmonary artery.In this case,the multiple fistulas were very rare and significant.Multidisciplinary treatment should be considered,including cardiologists,surgeons,anesthesiologists and nurses,etc.Regular follow-up is essential for long-term disease management after diagnosis or surgery.

Covert lung abscess as a cause of atrial arrhythmia: case report

Atrial arrhythmia is common in clinic. Recently, it was revealed that ectopicimpulses originating in sleeve muscles around the orifices of pulmonary veins (PVs) were deemed tobe one of the most important reasons that trigger or drive atrial arrhythmia, which was calledmyocardial sleeve related arrhythmia. Electrical isolation by radiofrequency ablation is becominghighlight and proved to be an effective method for the arrhythmia. We report a 55-year-old man withparoxysmal atrial tachy-arrhythmias admitted for PV electrical isolation. An abscess was discoveredin right inferior lung before the operation. The arrhythmia was disappeared after resection of theabscess. It implies that for such sufferer and recidivist after ablation, the factors outside thepulmonary veins should be excluded or treated as far as possible, especially before radiofrequencyablation therapy.

Characterizing the Impact of Caffeine on Heart Arrhythmias

Caffeine is one of the most commonly consumed stimulants and is found in many items like coffee and energy drinks. Heart arrhythmias are irregular heart rhythms, which can occur when the electrical signals that control the heart’s rhythm are not functioning properly. Due to the stimulant properties of caffeine, it is theorized that caffeine consumption may cause tachycardias-like ventricular arrhythmias. This review article describes the relationship between caffeine intake and heart arrhythmias using a comprehensive Pub-Med search. A comprehensive search was conducted using the search terms “caffeine arrhythmia” which was conducted and a total of 26 search results were obtained. The majority of clinical studies suggest that there are no strong associations between caffeine consumption and arrhythmias. There is little evidence suggesting a direct relationship between caffeine and ventricular arrhythmias (relative Risk 1.00, 95% CI 0.94 - 1.06;13.5%, p = 0.32). Conversely, caffeine consumption has an inverse relationship with the risk of atrial fibrillation (p for overall trend = 0.015;p for nonlinearity = 0.27). Caffeine related deaths are uncommon, but certain groups such as infants, psychiatric patients, and athletes may have an increased risk of arrhythmias following caffeine consumption. Overall, caffeine consumption is not strongly linked to heart arrhythmias and limited studies suggest it may reduce the risk of arrhythmias. Although there is not a strong relationship between caffeine intake and heart arrhythmias, it does cause other cardiovascular problems including high blood pressure and hence should be consumed responsibly (40 - 180 mg/day).

心房颤动患者左心房内径与肾功能的相关性研究

目的 探讨心房颤动患者左心房内径(LAD)与肾功能的相关性。方法 选取364例心房颤动患者作为研究对象,收集患者的临床资料,包括性别、年龄、身高、体质量、吸烟史、饮酒史、心房颤动类型、高血压病史、冠心病病史、糖尿病病史、心力衰竭病史、用药史、高敏肌钙蛋白I、脑钠肽、C反应蛋白、肌酐、尿素氮、LAD、左室射血分数(LVEF)、左室舒张末期内径(LVDd)、左室后壁厚度(LVPWTd)和室间隔厚度(IVSTd);计算估算肾小球滤过率(eGFR)和体质量指数。采用Spearman相关分析法探讨LAD与肌酐、尿素氮、eGFR的相关性;将eGFR<60 mL/(min·1.73 m^(2))设定为肾功能不全,采用单因素Logistic回归分析探讨心房颤动患者肾功能不全的影响因素;采用二元Logistic回归分析探讨房颤患者LAD与肾功能不全的关系。结果 Spearman相关分析结果显示,心房颤动患者中LAD与肌酐(r=0.279,P<0.001)、尿素氮(r=0.190,P<0.001)呈正相关,与eGFR(r=-0.263,P<0.001)呈负相关。单因素Logistic回归分析结果显示,性别、糖尿病病史、高血压病史、冠心病病史、心力衰竭病史、房颤类型、钠-葡萄糖共转运蛋白2抑制剂用药史、利尿剂用药史、LAD、LVEF、LVDd、IVSTd均为房颤患者肾功能不全的影响因素(P<0.05)。二元Logistic回归分析结果显示,与LAD第1四分位(LAD≤38 mm)相比,LAD第4四分位(LAD>47 mm)心房颤动患者发生肾功能不全的风险升高5.199倍(OR=5.199, 95%CI:1.210~22.337,P=0.027)。结论 心房颤动患者的LAD与肾功能显著相关,且LAD是心房颤动患者肾功能不全的影响因素。

心律失常病房与非心律失常病房在心房颤动管理中的差异比较研究

目的对心律失常病房及非心律失常病房中心房颤动(房颤)患者的管理情况进行比较,以期进一步优化房颤患者的管理方案。方法收集2019年9月至2021年9月在天津医科大学第二医院心内科心律失常病房及非心律失常病房住院的1537例房颤患者资料。根据房颤患者住院时入住心律失常病房与否,分为房颤专病管理组和房颤非专病管理组。对两组患者基线情况、口服抗凝药使用情况、心率控制药物及抗心律失常药物使用情况、抗血小板药物使用情况进行比较。结果房颤非专病管理组CHA_(2)DS_(2)-VASc评分分数的平均值高于房颤专病管理组,且差异有统计学意义[(4.76±1.71)分比(3.46±1.87)分,P<0.001]。两组患者在性别、年龄、充血性心力衰竭、高血压病、糖尿病、脑卒中、血管疾病等方面比较,差异均有统计学意义(均P<0.05)。房颤非专病管理组内阵发性房颤类型及永久性房颤类型较房颤专病管理组更多(P<0.001)。房颤非专病管理组控制心室率药物使用率(56.0%比40.1%)、β受体阻滞剂使用率(50.7%比36.6%)、地高辛使用率(17.6%比5.2%)均明显高于房颤专病管理组,差异均有统计学意义(均P<0.001)。房颤专病管理组抗心律失常药物使用率(49.8%比22.6%)、胺碘酮使用率(26.2%比5.6%)、决奈达隆使用率(3.1%比0.4%)及普罗帕酮使用率(2.9%比0.1%)均明显高于房颤非专病管理组,差异均有统计学意义(均P<0.001);而索他洛尔使用率两组比较,差异无统计学意义(P=0.855)。房颤非专病管理组行冠状动脉检查的患者明显高于房颤专病管理组(43.6比25.7%,P<0.001),差异有统计学意义。结论房颤患者因接受不同专病病房的管理而在治疗方案上有一定偏差。

心房颤动导管消融术后房性心律失常复发的研究进展

心房颤动(atrial fibrillation,AF)是临床中最常见的心律失常之一,致死率及致残率较高。近年来,在导管消融等手术的帮助下,部分患者术后可维持窦性心律,达到根治房颤的效果。但目前首次射频消融手术后房性心律失常复发率仍在20%~30%,房颤射频消融疗效尚未达到预期。探究消融术后复发的危险因素并进行干预,不断改良导管消融术式,这对降低复发风险极为重要。本文就心房颤动导管消融术后房性心律失常复发的最新研究进展作综述。

心房颤动的现代中西医治疗研究进展

心房颤动(房颤)是心房心肌内环境稳态失衡,致心房纤维化而不能有效且有节律地收缩与舒张,是一种常见的心房快速性心律失常疾病,与心室无关。随着社会的发展,房颤在心血管疾病中的占比也随之增加,其可增加脑卒中、心力衰竭、心肌梗死等疾病的发病率,影响疾病的预后,给人们及社会造成很大负担和危害,反之这些疾病的发生也可增加房颤的发生率。临床上对于房颤的治疗已经有一套经验丰富且有效的治疗方法。该文主要总结近几年房颤的中西医临床分型、病因病机、药物治疗及西医非药物治疗。

脊髓电刺激对实验房颤犬左侧星状神经节的影响

目的探讨低强度脊髓电刺激(SCS)对实验房颤犬左侧星状神经节(LSG)功能的影响。方法20只健康成年比格犬在左心耳处行快速心房起搏(RAP)以诱导急性重构,建立房颤模型,随机分为两组:实验组10只,以引起肌肉震颤的最低电压强度为刺激阈值对T1-2节段脊髓神经予以高频电刺激,使用90%的阈值强度进行SCS并持续6h;对照组10只在T1-2附近体表皮肤同样予以低强度刺激6h。分别在基础状态、6h末测定递增电压刺激LSG引起的心率变化。横坐标和纵坐标分别以电压刺激强度与最大心率(HR)变化(HR降低的最大百分比)绘出LSG的心率-电压反应曲线。结果对照组LSG的心率-电压反应曲线没有明显变化;实验组LSG的心率-电压反应曲线逐渐迟钝,而且相同电压引起的心率降低的百分比明显逐渐降低。结论低强度脊髓电刺激可以抑制实验房颤犬LSG的功能。

宁心汤治疗心律失常频发房性早搏临床观察

目的 研究自拟宁心汤联合西药酒石酸美托洛尔片(倍他乐克)对心律失常频发房性早搏的临床疗效。方法 随机选取2019年1月—2021年12月到吉林工商学院校医院进行治疗的心律失常频发房性早搏患者60例,分为治疗组和对照组,各30例。其中对照组给予常规西药治疗,治疗组在常规西药治疗基础上加用自拟宁心汤。8周为1个疗程,观察两组患者治疗前后症状的变化和心电图、血常规等实验室指标的变化,对不良反应等进行观察。结果 经过1个疗程之后,治疗组临床症状总有效率为93.3%(28/30),优于对照组的76.7%(23/30)。治疗组心电图总有效率为83.3%(25/30),明显优于对照组的66.7%(20/30)(P<0.05);治疗组动态心电图早搏总有效率为76.7%(23/30),高于对照组的53.3%(16/30)。治疗组中医证候疗效总有效率为73.3%(22/30),高于对照组的40.0%(12/30)(P<0.05)。治疗组在改善患者出现的情绪抑郁、胸胁或少腹胀痛、善太息等肝郁气滞的症状积分方面,积分高于对照组(P<0.05)。两组患者的血常规、肝肾功能、血糖、血脂、离子指标和用药前比较,差异无统计学意义,且无不良反应发生。结论 自拟宁心汤联合西药酒石酸美托洛尔片治疗心律失常频发房性早搏效果显著,具有较高的安全性和临床应用价值。

Atrial fibrillation

Atrial fibrillation is the most common arrhythmia affecting patients today. Disease prevalence is increasing at an alarming rate worldwide, and is associated with often catastrophic and costly consequences, including heart failure, syncope, dementia, and stroke. Therapies including anticoagulants, anti-arrhythmic medications, devices, and non-pharmacologic procedures in the last 30 years have improved patients＂ functionality with the disease. Nonetheless, it remains imperative that further research into AF epidemiology, genetics, detection, and treatments continues to push forward rapidly as the worldwide population ages dramatically over the next 20 years.

Acupuncture for paroxysmal and persistent atrial fibrillation:An effective non-pharmacological tool?

In Traditional Chinese Medicine,stimulation of the Neiguan spot has been utilized to treat palpitations and symptoms related to different cardiovascular diseases.We evaluated whether acupuncture might exert an antiarrhythmic effect on patients with paroxysmal or persistent atrial fibrillation(AF).Two sets of data are reviewed.The first included patients with persistent AF who underwent electrical cardioversion to restore sinus rhythm.The second included patients with symptomatic paroxysmal AF.All subjects had normal ventricular function.Acupuncture treatment consisted of 10 acupuncture sessions on a once a week basis with puncturing of the Neiguan,Shenmen and Xinshu spots.In patients with persistent AF,the recurrence rate after acupuncture treatment was similar to that observed in patients on amiodarone,but significantly smaller than that measured after sham acupuncture treatment or in the absence of any antiarrhythmic drugs.In a small group of patients with paroxysmal AF,acupuncture resulted in a significant reduction in the number and duration of symptomatic AF episodes.In conclusion,we observed that acupuncture of the Neiguan spot was associated with an antiarrhythmic effect,which was evident in patients with both persistent and paroxysmal AF.These preliminary data,observed in 2 small groups of AF patients,need to be validated in a larger population but strongly suggest that acupuncture may be an effective non-invasive and safe antiarrhythmic tool in the management of these patients.

Red blood cell distribution width: A marker of anisocytosis potentially associated with atrial fibrillation

The incorporation of biomarkers in the actually used risk scores seem to be helpful for early identifying atrial fibrillation(AF)patients at higher risk.The aim of this critical review of the scientific literature is to investigate the potential clinical significance of red blood cell distribution width(RDW)in AF.A systematic electronic search was carried out to identify all articles describing an epidemiological association between RDW and AF in adult human populations.Data abstraction was conducted on a final number of 35 articles(13 crosssectional,12 prospective and 10 retrospective studies).The results of these epidemiological investigations were all virtually concordant to emphasize that an enhanced RDW value is not only a predictive factor and a marker of AF but its measurement may also be helpful for predicting the risk of developing many adverse complications in patients with AF,such as recurrence and duration of AF,hospitalization for heart failure,bleeding,left atrial thrombosis and stasis,thromboembolic events and mortality.AF patients with RDW values exceeding the local reference range may be more aggressively investigated and managed,in order to identify and attenuate the impact of possible underlying disorders causing both anisocytosis and AF.

The association of atrial fibrillation and dementia incidence: a meta-analysis of prospective cohort studies

Objectives To assess and synthesize the prospective cohort studies published so far on the association between atrial fibrillation (AF) and dementia incidence.Methods We searched PubMed,Web of Science,and the Cochrane Library for potential studies published in English previous to April 2018.Two independent reviewers screened the search results for prospective cohort studies reporting the association between AF and dementia incidence in patients with normal cognitive function at baseline and not suffering from an acute stroke.The Newcastle-Ottawa Scale was adopted to evaluate the quality of the included studies.The pooled hazard ratio (HR) of AF for dementia was calculated with the Comprehensive Meta-Analysis software,version 2.Heterogeneity and publication bias were assessed with the I2 test and funnel plot,respectively.Results We finally identified 11 prospective cohort studies covering 112,876 patients.All the included studies reported an adjusted HR obtained in multiple Cox regression models.The qualities of the included studies ranged from moderate to high.In pooled analysis with a fixed-effects model,AF was independently associated with dementia incidence (HR = 1.34,95% CI: 1.24–1.44).Subgroup analysis of studies considering anticoagulation as an important confounding factor achieved a similar result.Based on the I2 test and funnel plot,we did not detect obvious heterogeneity and publication bias in our study.Meta-regression on age did not find significant results.Conclusions The results of our meta-analysis further confirmed that AF was an independent risk factor for dementia in patients with normal baseline cognitive function not suffering from acute stroke.Screening for dementia in AF patients and including dementia as an independent outcome in large AF treatment trials is warranted.

Arrhythmia risk in liver cirrhosis

Interactions between the functioning of the heart and the liver have been described, with heart diseases affecting the liver, liver diseases affecting the heart, and conditions that simultaneously affect both. The heart is one of the most adversely affected organs in patients with liver cirrhosis. For example, arrhythmias and electrocardiographic changes are observed in patients with liver cirrhosis. The risk for arrhythmia is influenced by factors such as cirrhotic cardiomyopathy, cardiac ion channel remodeling, electrolyte imbalances,impaired autonomic function, hepatorenal syndrome, metabolic abnormalities, advanced age, inflammatory syndrome, stressful events, impaired drug metabolism and comorbidities. Close monitoring of cirrhotic patients is needed for arrhythmias, particularly when QT intervalprolonging drugs are given, or if electrolyte imbalances or hepatorenal syndrome appear. Arrhythmia risk may persist after liver transplantation due to possible QT interval prolongation, persistence of the parasympathetic impairment, post-transplant reperfusion and chronic immunosuppression, as well as consideration of the fact that the transplant itself is a stressful event for the cardiovascular system. The aims of the present article were to provide a review of the most important data regarding the epidemiology, pathophysiology, and biomarkers of arrhythmia risk in patients with liver cirrhosis, to elucidate the association with long-term outcome, and to propose future research directions.

Catheter ablation of atrial fibrillation: Radiofrequency catheter ablation for redo procedures after cryoablation

AIM: To evaluate the effectiveness of two different strategies using radiofrequency catheter ablation for redo procedures after cryoablation of atrial fibrillation.METHODS: Thirty patients(paroxysmal atrial fibrillation: 22 patients,persistent atrial fibrillation: 8 patients) had to undergo a redo procedure after initially successful circumferential pulmonary vein(PV) isolation with the cryoballoon technique(Arctic Front Balloon,CryoCath Technologies/Medtronic).The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy(CARTO;Biosense Webster) depending on the intra-procedural findings.After discharge,patients were scheduled for repeated visits at the arrhythmia clinic.A 7-day Holter monitoring was performed at 3,12 and 24 mo after the ablation procedure.RESULTS: During the redo procedure,a mean number of 2.9 re-conducting pulmonary veins(SD ± 1.0 PVs) were detected(using a circular mapping catheter).In 20 patients,a segmental approach was sufficient to eliminate the residual pulmonary vein conduction because there were only a few recovered pulmonary vein fibres.In the remaining 10 patients,a circumferential ablation strategy was used because of a complete recovery of the PV-LA conduction.All recovered pulmonary veins could be isolated successfully again.At 2-year follow-up,73.3% of all patients were free from an arrhythmia recurrence(22/30).There were no major complications.CONCLUSION: In patients with an initial circumferential pulmonary vein isolation using the cryoballoon technique,a repeat ablation procedure can be performed safely and effectively using radiofrequency catheter ablation.

Novel therapies for treating atrial fibrillation

Atrial fibrillation is the most common cardiac arrhythmia and is a major risk factor for stroke, heart failure, and death. Current treatments focus on anti-coagulation as well as rate-control and rhythm-control strategies. Frequent INR checks associated with warfarin along with several adverse side effects of anti-arrhythmics have propelled investigations into novel treatments for atrial fibrillation. Research is focused not only on pioneering new pharmacological antico- agulation and anti-arrhythmic agents but also on improving surgical techniques in hopes of treating the arrhythmia. Here, we first briefly discuss the current treatment options, both pharmacological and non-pharmacological, for atrial fibrillation. We then present a focused review of recent animal and human investigations that examine the use of novel an-ticoagulation agents, mechanisms of new anti-arrhythmics, analyze potential triggers of atrial fibrillation, and highlight the role of genetics in atrial fibrillation.

地中海饮食模式和心房颤动的发生风险

目的:探讨地中海饮食模式与心房颤动之间的相关性。方法:本研究为单中心,病例对照研究。收集2018年至2021年,在北京安贞医院就诊的873例患者,首次发生心房颤动患者436例,匹配对照组437例。根据饮食频率调查问卷(food frequency questionnaires,FFQ)计算出改良地中海饮食评分(alternate Mediterranean diet,AMED),改良地中海饮食评分可以评价非地中海人群对地中海饮食模式的依从性,其得分为0~9分。分析AMED与心房颤动的相关性。结果:研究参与者的平均年龄(58.2±1.3)岁,男性596例(68.3%)。经多因素回归分析后发现,AMED,高血压病史以及BMI与首发心房颤动相关(OR=0.72,95%CI:0.50~0.95,P <0.001;OR=1.75,95%CI:1.26~2.45,P <0.001;OR=1.53,95%CI:1.05~2.16,P=0.006)。分析AMED中每种食物与心房颤动的相关性,发现水果类食物,蔬菜类食物减少心房颤动发生风险,饮酒增加心房颤动发生风险(OR=0.74,95%CI:0.57~0.97,P=0.028;OR=0.53,95%CI:0.41~0.70,P <0.001;OR=2.0195%CI:1.52~2.63,P<0.001)。与AMED<4分的人群相比较,AMED≥6分的人群新发心房颤动的风险明显减少(OR=0.69,95%CI:0.47~0.96,P=0.030)。结论:AMED和首发心房颤动成负相关,地中海饮食模式依从性好的人群较依从性差的人群,心房颤动发生风险明显减少。