Strategies for Successful Electrical Cardioversion in Atrial Fibrillation

Atrial fibrillation (AF) is the most common arrhythmia in the world, and its management relies on restoring sinus rhythm through external electrical shock and controlling the heart rate. This procedure should be performed under sedation with strict monitoring of blood pressure and saturation after the elimination of thrombus in the left atrium. Objective: The aim of this article is to provide an overview of the impact of anticoagulation and imaging in the periprocedural period, the modalities, and the complications associated with electrical cardioversion (ECV). Research Method: A review of recent literature was conducted using medical databases such as PubMed and Scopus. Searches were performed on articles published between 2003 and 2024, focusing on the new ESC guidelines for 2024. The keywords used included “electrical cardioversion”, “atrial fibrillation”, “orthogonal cardioversion” and “anticoagulation”. Inclusion criteria encompassed clinical trials, meta-analyses, and literature reviews, while studies addressing other treatment forms for AF or lacking information on ECV were excluded. Relevant data were extracted and synthesized to provide an overview of the modalities and complications related to ECV in the context of AF. Results and Conclusion: The use of high-energy biphasic shocks significantly improves rhythm control success and also reduces the incidence of ventricular fibrillation. Furthermore, orthogonal electrical cardioversion (OECV) has proven effective for cases of AF refractory to standard protocols, allowing for a lower defibrillation threshold and promoting better current distribution. However, complications must be considered, particularly thromboembolic events in non-anticoagulated patients. Other complications, such as bradycardia and recurrence of AF, may arise post-procedure. It is therefore crucial to ensure adequate anticoagulation before and after ECV, as well as continuous monitoring, to minimize these risks and optimize clinical outcomes.

Understanding the effect of propofol and electrical cardioversion on the systolic blood pressure of emergency department patients with atrial fibrillation

Dear editor, We read with pleasure the well-designed study by Butler et al of electrical cardioversion of emergency department patients with atrial fibrillation. We appreciate their analysis of the distinctives of procedural sedation when employed for this indication. Understanding the dosing adjustments to propofol undertaken by their sedationists will help us more carefully evaluate our own approach to sedating patients undergoing electrical cardioversion of atrial fibrillation.

Effect of cyclosporine-A on electrophysiological properties of atria in tachycardia-induced atrial fibrillation

Objective To investigate the effects of ciyelosporine-A(CsA).a calcinenrin(CAN)inhibitor,on electrophysiological propertiesof atria in canine tachycardia-induced model of AF.Methods Eighteen healthy adult mongrel canines weighing 17.0 to 23.2 kg(rangedfrom 2 to 4 years old)were randomized to 3 groups,Sham group(no pacemaker was implanted),atrial tachypacing group(ATP group)each group at baseline and after 8 weeks' tachypacing.Measurements included atrial effective refractory period(AERP),conductionvelocity(CV),wave length(WE),atrial fibrillation load and rate-adaptability. Results After 8 weeks' atrial tachypacing,ATP andCsA groups showed significant longer duration of the P wave,shorter AERP,decreased adaptation of AERE slower CV,shorter Wland longer AF duration compared to the shamg roup (all P＜0.05).AERP of the CsA group was longer than that of ATP group (P＜0.05),but there were no differences in rate-adaptability,CV,incidence of induced AF and AF duration between CsA group and ATP group.Conclusions Our results suggest that calcineurin pathway intervention by CsA have a positive effect on tachycardia-inducedelectrical remodeling of atria,but can not prevent or reverse AF.

Approach to Paroxysmal Atrial Fibrillation Type Arrhythmia in a Cardiology Service:A Case Report

Atrial fibrillation is a cardiac arrhythmia of high prevalence in the population, especially in the elderly. Its main electrical characteristics are the interval between two successive irregular R waves, absence of P waves and presence of f waves between QRS complexes. The most common symptoms of atrial fibrillation are irregular palpitations associated with dyspnea, dizziness, feeling tired, fatigue and general malaise, but not all patients have any symptoms. The present report presents the history of an elderly patient who arrived at the hospital’s emergency department with irregular heart rhythm and palpitations. The patient’s symptoms, associated with the electrocardiogram results, indicated paroxysmal atrial fibrillation. Electrical cardioversion was performed, and after, cardiac ablation via the femoral vein at the hospital’s cardiology service. There were no complications during the procedure. As a routine imaging exam after ablation, control esophagogastroduodenoscopy was requested to verify that there was no formation of atrio-esophageal fistula developed by the invasive ablation procedure and electrocardiogram, which showed normal sinus rhythm. The patient remained in the cardiac intensive care unit for observation for 24 hours. After the electrical cardioversion and catheter ablation procedures, the patient improved his clinical picture of atrial fibrillation and was discharged after 24 hours of hospitalization. He received treatment to perform at home, to reduce acid reflux into the esophagus and to prevent thrombosis. He did not present pulmonary thromboembolism after hospital discharge. It is believed, therefore, that this form of treatment and management of paroxysmal atrial fibrillation is effective for the solution of the proposed problem and can also serve as a reference for other professionals within the cardiology service.

Modulation of vagal activity to atria electrical remodeling resulted from rapid atrial pacing

Background Atrial electrical remodeling(AER) plays an important role in the pathogenesis and maintenance of atrial fibrillation.However,little is known about modulation of vagal activity to AER.This study aimed to investigate the relationship between vagal moduation and AER.Methods Twenty four adult mongrel dogs under general anesthesia were randomized into 3 groups.Sympathetic activity was blocked by administration of metoprolol in 3 groups.The changes in vagal modulation to atria after AER were observed in 10 dogs without vagal interruption in group A.The effects ofvagal intervention on AER were investigated in 8 dogs with administration of atropine in group B.The impact of aggressively vagal activity on AER was studied in 6 dogs with bilateral cervical vag sympathetic trunks stimulation during AER in group C.Bilateral cervical vagosympathetic trunks were decentralized. Multipolar catheters were placed into high right atria (RA),coronary sinus (CS) and right ventricle (RV).AER was induced by 600 bpm pacing through RA catheter for 30 minutes.Atrial effective refractory period (ERP) and vulnerability window (VW) of atrial fibrillation were measured with and without vagal stimulation before and after AER.Results In group A,ERP decreased significantly at baseline and during vagal stimulation after AER compared with that before AER (all P【0.05).In group B,ERP remained unchanged at baseline and vagal stimulation after AER compared with that before AER (all P】0.05).In group C,ERP shortened significantly at baseline and vagal stimulation after AER compared with that before AER (all P【0.05).ERP shortening after AER in Groups A and C increased significantly than that in group B (all P【0.05).Atrial fibrillation could not be induced at baseline (VW close to 0) before and after AER in three groups.VW became widen significantly during vagal stimulation after AER compared with that before AER in Groups A and C (all P【0.05),while VW remained unchanged in group B (VW close to 0).Conclusions Short-term AER results in the decrease in ERP.AER is accompanied by the increases in atrial vagal modulation.The increased vagal activity and vagal stimulation promote AER, thereby increase the susceptibility to atrial fibrillation.The interrupted vagal activity attenuates AER,thereby suppresses the atrial fibrillation mediated by vagal stimulation.

Coronary sinus reentrant tachycardia after atrial fibrillation ablation: From bad to worse

Herein we present a case of atrial tachycardia as a sequel of AF ablations. A 42-year-old man was admitted to our department because of a very symptomatic tachycardia. The patient, because of paroxysmal AF and typical atrial flutter, had been already submitted (three times) to ablation procedures in both left (pulmonary vein insulation) and right atria (cavo-tricuspidal isthmus). During the electrophysiological study, a huge and very fast atrial tachycardia was induced: 230 ms cycle length, 1/1 atrio-ventricular conduction with the ventricular rate of 260 bpm, complete left bundle branch block, and clinically recognized by the patient. Four minutes later, a 2/1 AV conduction without branch block permitted mapping and ablation. A high-density mapping around isthmus and coronary sinus (CS) was performed. The analysis of the chronological activation clearly showed a circuit propagation around the CS ostium with a very slow conduction in the anterior zone enlightened by the tight color progression, and counterclockwise activation of the right atrium lateral wall. In anterior zone of CS ostium diastolic fragmented electrograms were detected. After preventing his position localization, radiofrequency delivering (35 W) was effective to interrupt the arrhythmia in 3 seconds. Energy delivering was continued to anchor the lesion to the inferior vena cava. Confirmation of successful ablation was determined by unsuccessful attempts at reinduction of the arrhythmia, in basal state and during infusion of isoproterenol.

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.

Contribution of mi RNAs to ion-channel remodelling in atrial fibrillation

Atrial fibrillation(AF) is the most commonly encountered clinical arrhythmia associated with pronounced mortality and morbidity, which are related to palpitations, fainting, congestive heart failure, and stroke. Prolonged episodes of AF promote AF persistence mainly due to electrical remodelling that alters ion-channel expression and/or function. Micro RNAs(mi RNAs), a new class of noncoding mR NAs of around 22 nucleotides in length, have recently emerged as one of the key players in the geneexpression regulatory networks. The potential roles of miR NAs in controlling AF have recently been investigated. Several recent studies have provided promising results for a better understanding of the molecular mechanisms of AF. In this review, we summarize the mechanism of miR NAs as regulators of ion-channel gene expression and their role in causing AF through electrical remodelling.

Transesophageal cardioversion of atrial flutter and atrial fibrillation using an electric balloon electrode system

Objective To determine the feasibility and efficiency of terminating atrial flutter (AFL) and atrial fibrillation (AF) using synchronous low-energy shocks delivered through a novel transesophageal electric balloon electrode system.Methods By using a novel electric balloon electrode system, we attempted 91 transesophageal cardioversions in 52 patients, to treat 53 episodes of AFL and 38 episodes of AF.Results Of the 40 patients of AFL that failed to respond to drug therapy, 37 (92. 5%) were successfully countershocked to sinus rhythm by transesophageal cardioversion, with a mean energy of (22. 70 ?4. 50) J (20 - 30 J). Of the 19 patients in AF, transesophageal cardioversion was successful in 16 (84. 2%) cases, requiring a mean delivered energy of (17. 38±8. 58) J (3 -30 J). There were no complications such as heart block or ventricular fibrillation, and no evidence of esophageal injury.Conclusions Transesophageal cardioversion using an electric balloon electrode system is an effective and feasible method for the treatment of AFL and AF. It requires low energy and no anesthesia, leads to less trauma, and shows a high cardioversion success rate that may prove valuable in the management of tachyarrhythmias.

Electrical remodeling in human atrial fibrillation

Atrial fibrillation is the most common clinically important cardiac arrhythmia accounting for 20% to 25% of strokes and is a common cause of congestive heart failure.1,2 With the aging population and changing demographics,atrial fibrillation has become an epidemic affecting 2.66 million people in the United States.The prevalence of atrial fibrillation is estimated to increase by 5 fold to 12 million by 2050.3 The diagnosis and treatment of atrial fibrillation represent a significant health care burden of $15.7 billion per year.4 Treatment of atrial fibrillation using antiarrhythmic drugs has been disappointing,while radiofrequency ablation approaches have limitations,including unclear long-term efficacy.Innovation in treatment is needed and pursuit of novel modalities of therapy requires fundamental knowledge in the molecular mechanisms that lead to atrial fibrillation,including electrical remodeling in atrial fibrillation.

Emergency department procedural sedation for primary electrical cardioversion — a comparison with procedural sedations for other reasons

BACKGROUND: Atrial fibrillation(AF) is the most common arrhythmia treated in the emergency department(ED), with primary electrical cardioversion(PEC) the preferred method of rhythm control. Anecdotally, patients undergoing ED procedural sedation(EDPS) for PEC differ from those requiring EDPS for other procedures: they are at higher risk of adverse events, and require fewer drugs and lower doses. We attempt to verify this using an EDPS registry at a Canadian, tertiary care teaching hospital.METHODS: This is a retrospective review of patients that underwent EDPS for the period of June 2006 to September 2014. We compared demographics, medication use and intra-procedural adverse events between those receiving EDPS for PEC for AF compared to that for other indications. We report the asssociation between AEs and predictors using logistic regression.RESULTS: A total of 4 867 patients were included, 714 for PEC for AF and 4 153 for other indications. PEC patients were more likely male(58.5% vs. 47.1%), older(59.5 years vs. 48.1 years), and less likely to be ASA I(46.6% vs. 69.0%). PEC patients received smaller doses of propofol and less likely to receive adjuvant analgesic therapy(11.5% vs. 78.2%). PEC patients were more likely to experience hypotension(27.6% vs. 16.5%) but respiratory AEs(apnea, hypoxia and airway intervention) were not different.CONCLUSION: EDPS for PEC differs from that conducted for other purposes: patients tend to be less healthy, receive smaller doses of medication and more likely to suffer hypotension without an increase in respiratory AEs. These factors should be considered when performing EDPS.

Electrical cardioversion for supraventricular arrhythmias in octagenarians

Atrial fibrillation(AF)is the most common arrhythmia in the elderly and its incidence increases with aging.[1]Electrical cardioversion is used as a strategy for rhythm control in patients with supraventricular arrhythmias.In octagenarians,there are challenges associated with the indication for electrical cardioversion,such as the use of appropriate sedation and anticoagulant agents.Most decisions in clinical practice for these patients derive from observational data and personal experience,since octagenarians represent a minority of patients included in randomized clinical trials.Little evidence is available regarding the clinical context of electrical cardioversion in this vulnerable population.Therefore,we aimed to describe the clinical profile of octagenarians undergoing electrical cardioversion in a cardiology reference center from 2014 to 2018.

Repeated atrial arrhythmia induced by cochineal red poisoning:A case report

BACKGROUND Cochineal red is an organic compound widely used in food,cosmetics,pharmaceuticals,textiles,and other fields due to its excellent safety profile.Poisoning caused by eating foods containing cochineal red is rare,and repeated atrial arrhythmia due to cochineal red poisoning is even rarer.CASE SUMMARY An 88-year-old Asian female patient was admitted to hospital due to a disturbance of consciousness.Twelve hours prior to presentation,the patient consumed 12 eggs containing cochineal red over a period of 2 h.At presentation,the patient was in a coma and had a score of 6 on the Glasgow Coma Scale(E2+VT+M4).The patient’s skin and mucous membranes were pink.Electrocardiography(ECG)revealed rapid atrial fibrillation without any signs of ischemia.We prescribed cedilan and fluid replacement for arrhythmia correction.Shortly after admission,the atrial fibrillation corrected to a normal sinus rhythm.On the day 2 of admission,the patient had a sudden atrial flutter accompanied by hemodynamic instability and rapidly declining arterial oxygen saturation between 85%and 90%.The sinus rhythm returned to normal after two electrical cardioversions.Six days after admission,the skin color of the patient returned to normal,and the ECG results were normal.The patient was transferred out of the intensive care unit and eventually discharged after 12 d in hospital.At the 2-mo follow-up visit,the patient was in good health with no recurrence of arrhythmia.CONCLUSION Although cochineal red is a safe,natural food additive,excessive consumption or occupational exposure can induce cardiac arrhythmias.

Effect of nifekalant on acute electrical remodelling in rapid atrial pacing canine model

Background Nifekalant may prevent atrial fibrillation （AF） and possibly be useful in treatment of atrial tachyarrhythmia in patients with severe heart failure. This study investigated the electophysiologic effect of nifekalant on the acute atrial remodeling in rapid atrial pacing （RAP） model of canine. Methods Twelve mongrel dogs subjected to rapid stimulation （400 beats/min） at left atrial appendage （LAA） for 24 hours, were randomized into the control group （rapid pacing only, n=6） and the nifekalant group （intravenous nifekalant therapy immediately after RAP, n=6）. Atrial electrophysiological parameters were measured in right atrium, coronary sinus, LAA, posterior wall of left atrium （PWLA） and left superior pulmonary vein （LSPV）, before and after the RAP. Results In the control group, the effective refractory periods （ERP） were shortened greatly at all sites, paced dogs had substantially shorter ERPs in the high right atrium, LAA, and LSPV, but fewer changes in the PWLA, the coefficient variation of ERP （COV ERP） was increased significantly. After rapid atrial stimulation, the inducibility of AF increased significantly [induction number： pre-RAP vs post-RAP, 1.00 ± 0.89 vs 8.17 ± 2.79, P〈0.01; duration of AF： pre-RAP vs post-RAP, （450.34± 362.59） ms vs （9975.77±4376.99） ms, P〈0.01]. In the nifekalant group, although the ERPs were prolonged at all sites compared with those in pre-RAP state, only the value at LSPV differed significantly from that in pre-RAP state [pre-RAP vs post-RAP, （102.50±5.24） ms vs （132.51 ±5.20） ms, P〈0.01]; the COV ERP did not change statistically in this group. The inducibility of AF slightly increased but insignificantly after pacing [induction number： pre-RAP vs post-RAP, 0.83 ±0.75 vs 1.67±0.82, P=0.19; duration of AF： pre-RAP vs post-RAP, （378.67±317.88） ms vs （1124.08± 1109.77） ms, P=0.06]. Conduction time values did not alter significantly in either of the two groups after RAP. Condusions In canine RAP model, nifekalant inhibited ERP shortening and ERP heterogeneity increasing, decreased AF induction. Nifekalant can reverse acute electrical remodeling effect in this model.

Effects of Losartan on acute atrial electrical remodeling

Background Atrial electrical remodeling (AER) contributes to the maintainance of atrial fibrillation (AF). This study was to compare the effects of Losartan with those of Diltiazem on tachycardia-induced acute AER in rabbits Methods Twenty-one rabbits paced with maximal atrial capture rate for 3 hours in the right atrium (RA) were randomly divided into saline group, Diltiazem group and Losartan group After autonomic blockage, we measured atrial effective refractory period (AERP), AERP rate adapting feature, AERP dispersion and RA conduction time at basic cycle lengths (BCLs) of 200 ms and 150 ms at baseline, 0 5 hour, 1 hour, 2 and 3 hours after rapid atrial pacing Results In the saline group, there was a prompt decrease in AERP as a result of rapid atrial pacing, and AERP 200 and AERP 150 were shortened sharply within 0 5 hour of pacing (30 2±10 5 ms and 24 1±9 1 ms, respectively) The AERP did not change dramatically in the Diltiazem and Losartan groups In the saline group, the value of (AERP 200 -AERP 150 )/50 ms in high RA was 0 17±0 08 at baseline and became significantly smaller at 0 5 hour (0 08±0 06), 1 hour (0 09±0 06), 2 hours (0 08±0 04) and 3 hours (0 09±0.05) (all P <0 05), suggesting a reduction of rate adaptation of AERP The value of (AERP 200-AERP 150)/50 ms in high RA did not change during the 3 hours of pacing in both Diltiazem and Losartan groups In the saline group, AERP dispersion increased significantly at 2 and 3 hours ( P <0 05) However, Diltiazem could not prevent the increase of AERP dispersion at 3 hours ( P <0 05) During Losartan infusion, the AERP dispersion was no longer increased after rapid atrial pacing There was no significant difference in RA conduction time among the three groups Conclusion Like calcium antagonist Diltiazem, Losartan could prevent AERP shortening and preserve rate adaptation of AERP after rapid atrial pacing Losartan is more effective than Diltiazem in inhibiting the increase of AERP dispersion

Effects of Amiodarone plus Losartan on Electrical Remodeling in Rapid Atrial Pacing in Rabbits

Objectives To investigate the electrical remodeling and the effects of amiodarone and losartan on electrical remodeling in rapid atrial pacing on rabbit model. Methods 40 normal rabbits were randomly divided into 4 groups ： the saline group （control group）, amiodarone group, losartan group, anti ＋ los group. All rabbits were raised drugs in a week. The atrial effective refractory period （AERP） was measured. Then, take a rapid atrial pacing （600 bpm） and the AERP was measured after 0.5, 1, 2, 4, 6 and 8 hours pacing and 30 minutes after the termination of rapid pacing. Results （1） In control group, after 8 hours rapid pacing, AERP200 and AERP150 were significantly shortened 16. 11% ± 3.1% （ P 〈 0. 01 ） and 9. 99 % ± 4. 2% （ P 〈 0. 01 ）. And the degree of AERP shortening induced by rapid pacing was greater at basic cycle lengths of 200 ms （BCL200） than that at BCL150. The AERP of amiodarone, losartan group and ami ＋ los group were not shortened during rapid pacing. （2） In the control group, after the termination of rapid pacing, the AERP gradually increased. The AERP at all of the BCLS examined recovered to almost the 95.78% and 96. 76% of baseline values within the first 10 minutes and recovered to almost the 99.07% and 99.39% of baseline values within the first 30 minutes. Conclusions Short-term atrial rapid pacing can induce the atrial electrical remodeling. Amiodarone and losartan can prevent the electrical remodeling.

Treatment of Supraventricular Arrhythmias by Transcatheter Radiofrequency Ablation： The Experience of the Electrophysiology Unit of the University Hospital

TC-RF （transcatheter radiofrequency） ablation has an important role in the treatment ofSVA （supraventricular arrhythmias）. The indication to TC-RF ablation is usually made to improve the patient＇s quality of life through the elimination of the arrhythmic substrate. The objective of this study is to make a brief review of the literature and to report the Electrophysiology Unit experience of the Cardiovascular Department of the University Hospital of Trieste. From the study, it can be found that about one thousand of patients are visited annually in the Cardiovascular Department of the University Hospital of Trieste （1,019 ± 71/year over the past five years）. The acute success rate of atrial fibrillation and flutter ablation procedures was respectively 93.9% and 97.9% with a relapse rate of 30% and 10% at 12 month. Accessory pathways and nodal atrio ventricular re-entry tachycardia ablation procedures had an acute success rate of respectively 91.1% and 96.6% with a relapse rate of 10% at 12 months. The overall complication rate was 5%. Catheter ablation is an effective therapy for SVA treatment. It can often be definitive, and it is generally superior to drug therapy, with a low complication rate. The improvement in patients＇ quality of life is associated with a reduced need for access to health services.

无水乙醇注射Marshall静脉消融二尖瓣峡部的效果观察

目的:评估无水乙醇注射Marshall静脉(vein of Marshall,VOM)在持续性心房扑动(简称房扑)、心房颤动(简称房颤)二尖瓣峡部线性消融中的有效性和安全性。方法:收集2019年9月—2020年5月上海市胸科医院采用射频消融+无水乙醇注射VOM治疗持续性房扑、房颤患者72例(VOM组)的临床资料,同时选择采用左房线性消融治疗持续性房扑、房颤患者72例作为对照(对照组)。入选患者均行二尖瓣峡部线性消融手术,术中验证二尖瓣峡部线阻断情况,术后随访房性心律失常和心包积液发生情况,均随访12个月以上。结果:VOM组术中验证二尖瓣峡部线阻断63例,其中需要联合心内和心外膜补点消融达到二尖瓣峡部线14例,未能阻断二尖瓣峡部线9例。对照组术中验证二尖瓣峡部线53例,未能阻断19例。随访12~20个月,VOM组房性心律失常复发20例,而对照组房性心律失常复发30例。结论:在持续性房扑、房颤消融治疗中,经VOM行无水乙醇注射能有效阻断二尖瓣峡部线性传导,有助于提高二尖瓣峡部线成功率,减少房颤消融术中二尖瓣峡部相关的房扑发生率,且不增加严重并发症的发生率。

基于孟德尔随机化研究房颤/房扑与失眠的因果关系

目的通过双样本孟德尔随机化(Mendelian randomization,MR)研究方法探究心房颤动(简称“房颤”)/心房扑动(简称“房扑”)与失眠潜在的双向因果关系。方法从IEU OpenGWAS project数据库中获取房颤/房扑和失眠的全基因组关联研究汇总数据,提取显著且独立的单核苷酸多态性(single nucleotide polymorphism,SNPs)用于MR分析。采用逆方差加权法(inverse-variance weighted,IVW)、加权中位数、MREgger回归、简单众数法和加权众数法五种方法进行因果关系评估。Cochran's Q检验评估IVW的异质性,MR-Egger检测水平多效性,MR-PRESSO方法检测离群值以检验基因多效性,留一法(leave-one-out)进行敏感性分析。结果以房颤/房扑为暴露,失眠为结局,共筛选获得47个SNPs作为工具变量,IVW显示房颤/房扑与失眠间存在正向因果关系[OR=1.103,95%CI(1.008,1.208),P<0.05],加权中位数、MR-Egger回归及简单众数法和加权众数法的β值与IVW的β值方向均一致。敏感性检测方面,Cochran's Q检验P>0.05说明不存在异质性,MR-Egger检验P>0.05说明不存在水平多效性,同时MR-PRESSO方法未检测到离群值,表明没有基因多效性,留一法未检测到对结果影响大的SNP,表明结果稳固无偏倚。反向,以失眠为暴露,房颤/房扑为结局,筛选到12个SNPs作为工具变量,IVW显示失眠与房颤/房扑间不存在因果关系[OR=0.989,95%CI(0.951,1.029),P>0.05)]。结论房颤/房扑会增加失眠的发生风险,在失眠患者的健康管理中应积极预防和治疗房颤、房扑等常见心律失常疾病。

高功率短时程脉冲式消融电隔离上腔静脉的有效性和安全性

目的 探讨高功率短时程脉冲式消融方法电隔离上腔静脉(SVC)的有效性和安全性。方法 回顾性分析2023年1月至2023年10月在郑州大学第一附属医院心血管内科一病区和许昌市中心医院心血管内科一病区接受导管射频消融术且接受SVC电隔离术的108例心房颤动患者。SVC消融策略为首选节段性消融,先进行SVC间隔侧消融,之后消融前壁和后壁,最后消融游离壁侧。消融间隔侧时为连续放电策略,消融前壁、后壁和游离壁时采用高功率短时程脉冲式放电。有效性指标为完成SVC电隔离,安全性指标为心脏压塞、窦房结损伤和膈神经损伤。结果 有107例(99.1%)心房颤动患者完成SVC电隔离,在成功完成SVC电隔离的患者中,所有患者均需要进行间隔侧消融,89例(83.2%)患者进行了前壁侧消融,63例(58.9%)患者进行了后壁侧消融,101例(94.4%)患者进行了游离壁侧消融。采用高功率短时程脉冲式消融时每点放电4(3,5)次达到消融终点。从SVC建模至完成SVC电隔离的时间是7(6,8)min。完成SVC电隔离后观察15 min电位均未恢复。所有患者均未出现心脏压塞、窦房结损伤和膈神经损伤。结论 采用高功率短时程脉冲式放电消融的方法可以高效和安全地完成SVC的电隔离。