Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LA...Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LAAO are lacking.Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data including clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite outcome was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days.Results Mean age was 75±8 years and 434(60%)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and median HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age>75 years in both unadjusted(17.1%vs.11.5%,P=0.03)and adjusted(Odds Ratio=1.59,95%CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3%vs.0,P=0.04)among patients age>75 years.The secondary outcome of procedural success was also lower among patients age>75 years(92.2%vs.96.2%,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age>75 years and less than 75years.Conclusion Patients age>75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.展开更多
Left atrial aneurysm is an exceptionally rare condition,particularly in the pediatric population,and even more so as a sequela of bacterial pericarditis.We present the case of a 16-month-old girl who developed a left ...Left atrial aneurysm is an exceptionally rare condition,particularly in the pediatric population,and even more so as a sequela of bacterial pericarditis.We present the case of a 16-month-old girl who developed a left atrial aneurysm following isolated Staphylococcus aureus pericarditis.She initially presented in decompensated shock and was later diagnosed with constrictive pericarditis.Despite undergoing pericardiectomy,she subsequently developed a left atrial aneurysm,necessitating surgical closure.This case highlights the aggressive nature of bacterial pericarditis and its potential to cause rare structural cardiac complications.展开更多
Objective To evaluate the predictive value of red cell distribution width （RDW） on left atrial thrombus （LAT） or left atrial spontane- ous echo contrast （LASEC） in patients with non-valvular atrial fibrillation ...Objective To evaluate the predictive value of red cell distribution width （RDW） on left atrial thrombus （LAT） or left atrial spontane- ous echo contrast （LASEC） in patients with non-valvular atrial fibrillation （AF）. Methods We reviewed 692 patients who were diagnosed as non-valvular AF and underwent transesophageal echocardiography （TEE） in Guangdong Cardiovascular Institute from April 2014 to December 2015. The baseline clinical characteristics, laboratory test of blood routine, electrocardiograph measurements were analyzed. Results Eighty-four patients were examined with LAT/LASEC under TEE. The mean RDW level was significantly higher in LAT/LASEC patients compared with the non-LAT/LASEC patients （13.59% ± 1.07% ws. 14.34% ± 1.34%; P 〈 0.001）. Receiver-operating characteristic curve analysis was performed and indicated the best RDW cut point was 13.16%. Furthermore, multivariate logistic regression analysis indicated that RDW level 〉 13.16% could be an independent risk factor for LAT/LASEC in patients with AF. Conclusion Elevated RDW level is associated with the presence of LAT/LASEC and could be with moderate predictive value for LAT/LASEC in patients with non-valvular AF.展开更多
Percutaneous left atrial appendage(LAA)occlusion evolved as an alternative treatment to the patients who are contraindicated or cannot tolerate oral anticoagulants with nonvalvular atrial fibrillation(AF)at risk of st...Percutaneous left atrial appendage(LAA)occlusion evolved as an alternative treatment to the patients who are contraindicated or cannot tolerate oral anticoagulants with nonvalvular atrial fibrillation(AF)at risk of stroke or systemic embolism.[1]Abnormal hemodynamic changes in elder atrial septal defect(ASD)patients cause remodeling of the left atrium,which eventually leads to right heart failure.[2]As the ASDs elderly are associated with a higher incidence of AF,simultaneous transcatheter ASD and LAA closure has become a new effective therapeutic strategy.However,only a limited number of articles involving cardiac tamponade complications have been published in the literature.What’s more,previous studies involving early hemodynamically irrelevant pericardial effusion after the procedure attribute to multiple repositioning attempts of LAA occluder or delivery sheath injured the atrial wall.展开更多
Atrial fibrillation prevalence is increasing with age, reaching up to 5% of patients older than 65 years, and is associated with 20%-30% of stroke episodes in that population.
Background:Left atrial appendage closure(LAAC)with simultaneous interventional occlusion therapy for congenital interatrial communication has become a new focus of patients with nonvalvular atrial fibrillation.Little ...Background:Left atrial appendage closure(LAAC)with simultaneous interventional occlusion therapy for congenital interatrial communication has become a new focus of patients with nonvalvular atrial fibrillation.Little is known about the results of mid-and long-term results.Objective:The aim of this study was to evaluate the midand long-term safety and effectiveness of simultaneous transcatheter closure of the left atrial appendage(LAA)and congenital interatrial communication closure in atrial fibrillation(AF)patients.Methods:From Jan 2016 to June 2017,27 patients with AF were treated with simultaneous transcatheter closure of the LAA and atrial septal defect(ASD,n=22),patent foramen ovale(PFO,n=5).Results:The perioperative closure success rate was 96.3%,except for cardiac tamponade occurred in one ASD patient.During the median 37.6-month follow-up period,no cases of cerebrovascular or peripheral vascular embolism,bleeding,infective endocarditis or thrombosis along the occluders were observed.Of the 21 patients with NYHA Class III,nineteen had significant improvements to NYHA Classes I or II,and 81.5%of patients were free from major or minor adverse events during midand long-term follow-up.Conclusions:Simultaneous closure of the LAA and congenital interatrial communication closure is a viable option for patients with nonvalvular atrial fibrillation who are at risk of stroke or systemic embolism,and it is effective and yields excellent mid-and long-term results.展开更多
BACKGROUND In patients who suffer from both atrial fibrillation(AF)and atrial septal defect(ASD),cryoballoon pulmonary vein isolation(PVI),sequential left atrial appendage(LAA)occlusion and ASD closure could be a stra...BACKGROUND In patients who suffer from both atrial fibrillation(AF)and atrial septal defect(ASD),cryoballoon pulmonary vein isolation(PVI),sequential left atrial appendage(LAA)occlusion and ASD closure could be a strategy for effective prevention of stroke and right heart failure.CASE SUMMARY A 65-year-old man was admitted to our institution due to recurrent episodes of palpitations and shortness of breath for 2 years,which had been worsening over the last 48 h.He had a history of AF,ASD,coronary heart disease with stent implantation and diabetes.Physical and laboratory examinations showed no abnormalities.The score of CHA2DS2VASc was 3,and HAS-BLED was 1.Echocardiography revealed a 25-mm secundum ASD.Pulmonary vein(PV)and LAA anatomy were assessed by cardiac computed tomography.PV mapping with 10-pole Lasso catheter was performed following ablation of all four PVs with complete PVI.Following the cryoballoon PVI,the patient underwent LAA occlusion under transesophageal echocardiographic monitoring.Lastly,a 34-mm JIYI ASD occlude device was implanted.A follow-up transesophageal echocardiography at 3 mo showed proper position of both devices and neither thrombi nor leakage was found.CONCLUSION Sequential cryoballoon PVI and LAA occlusion prior to ASD closure can be performed safely in AF patients with ASD.展开更多
Background:Fetal balloon atrial septoplasty(BAS)is performed through the restrictive foramen ovale in fetal cases with established hypoplastic left heart syndrome(HLHS)and an intact or highly restrictive atrial septum...Background:Fetal balloon atrial septoplasty(BAS)is performed through the restrictive foramen ovale in fetal cases with established hypoplastic left heart syndrome(HLHS)and an intact or highly restrictive atrial septum(RAS).Methods:In the current report,we present a case of high position BAS in a fetus with HLHS/RAS.Results:Echocardiography confirmed an adequate atrial opening above the foramen ovale and fetal pleural effusion resolved spontaneously 1 day after the procedure.Conclusion:To the best of our knowledge,the creation of a high position hole in the thinner part of the atrial septum,instead of the restrictive tiny hole,has not been reported in fetal cases with HLHS/RAS.展开更多
Objective To evaluate left atrial function in essential hypertension patients with different patterns of left ventricular geometric models by real-time three-dimensional echocardiography （RT-3DE） and left atrial tra...Objective To evaluate left atrial function in essential hypertension patients with different patterns of left ventricular geometric models by real-time three-dimensional echocardiography （RT-3DE） and left atrial tracking （EAT）.展开更多
AIM To evaluate the safety and efficacy of surgical left atrial appendage occlusion(s-LAAO)during concomitant cardiac surgery.METHODS We performed a comprehensive literature search through May 31 st 2018 for all eligi...AIM To evaluate the safety and efficacy of surgical left atrial appendage occlusion(s-LAAO)during concomitant cardiac surgery.METHODS We performed a comprehensive literature search through May 31 st 2018 for all eligible studies comparing s-LAAO vs no occlusion in patients undergoing cardiac surgery.Clinical outcomes during follow-up included:embolic events,stroke,all-cause mortality,atrial fibrillation(AF),reoperation for bleeding and postoperative complications.We further stratified the analysis based on propensity matched studies and AF predominance.RESULTS Twelve studies(n=40107)met the inclusion criteria.s-LAAO was associated with lower risk of embolic events(OR:0.63,95%CI:0.53-0.76;P<0.001)and stroke(OR:0.68,95%CI:0.57-0.82;P<0.0001).Stratified analysis demonstrated this association was more prominent in the AF predominant strata.There was no significant difference in the incidence risk of allcause mortality,AF,and reoperation for bleeding and postoperative complications.CONCLUSION Concomitant s-LAAO during cardiac surgery was associated with lower risk of follow-up thromboembolic events and stroke,especially in those with AF without significant increase in adverse events.Further randomized trials to evaluate long-term benefits of s-LAAO are warranted.展开更多
Some studies have shown that left ventricular structure and function play an important role in the risk stratifi cation and prognosis of cardiovascular disease.The clinical application of left atrial function in cardi...Some studies have shown that left ventricular structure and function play an important role in the risk stratifi cation and prognosis of cardiovascular disease.The clinical application of left atrial function in cardiovascular disease has gradually attracted attention in the cardiovascular fi eld.There are many traditional methods to evaluate left atrial function.Left atrial function related indexes measured by echocardiography has been identifi ed as a powerful predictor of cardiovascular disease in recent years,but they have some limitations.The left atrial function index has been found to evaluate left atrial function more effectively than traditional parameters.Furthermore,it is a valuable predictor of the risk stratifi cation and prognosis in patients with clinical cardiovascular disease such as heart failure,atrial fi brillation,hypertension,and coronary heart disease.展开更多
Background The long-term prognostic influence of left atrial diameter （LAD） remodeling on the status of post-radiofrequency catheter ablation （RI CA） atrial fibrillation （AF） is unclear. This study employed a tw...Background The long-term prognostic influence of left atrial diameter （LAD） remodeling on the status of post-radiofrequency catheter ablation （RI CA） atrial fibrillation （AF） is unclear. This study employed a two-stage model from 3-year echocardiographic data to ascertain whether the two-stage model predicts RFCA outcome more favorably than models using the baseline LAD. Methods Data were retrospectively collected from 263 consecutive patients with drug-refractory AF undergoing RFCA. Regular echocardiographic measurements of LAD were performed at baseline, 1, 3, 6, and 12 months and then every 6 months after RFCA. Sex, age, type of AF, number of RFCA, and AF status were recorded. We obtain the actual （predicted） 3-year LAD using a longitudinal linear mixed model （1st stage）. Logistic regression models based on the baseline LAD （Model 1）, actual （predicted） 3-year LAD （Model 2） （2nd stage）, and observed 3-year LAD （Model 3） were constructed to predict RFCA outcome. The area under the receiver operating characteristic curve （AUC） were used to assess the performance of models. Results The lowess smoothed curve indicated that the LAD declined over the first three months and remained stable up to 36 months after RFCA. The degree of LAD reduction was significantly influenced by the baseline LAD. Non-paroxysmal AF, large LAD and female gender were significant predictors of AF recurrence. Model 2 had the largest AUC among the three models. Conclusions This longitudinal study-based two-stage model outperforms the original logistic model using the baseline LAD. Non-paroxysmal AF, larger LAD and female gender are significant predictors of RFCA failure.展开更多
Transcatheter closure of the left atrial appendage has been developed as an alternative to chronic oral anticoagulation for stroke prevention in patients with atrial fibrillation, and as a primary therapy for patients...Transcatheter closure of the left atrial appendage has been developed as an alternative to chronic oral anticoagulation for stroke prevention in patients with atrial fibrillation, and as a primary therapy for patients with contraindications to chronic oral anticoagulation. The promise of this new intervention compared with warfarin has been supported by several, small studies and two pivotal randomized trial with the Watchman Device. The results regarding risk reduction for stroke have been favourable although acute complications were not infrequent. Procedural complications, which are mainly related to transseptal puncture and device implantation, include air embolism, pericardial effusions/tamponade and device embolization. Knowledge of nature, management and prevention of complications should minimize the risk of complications and allow transcatheter left atrial appendage closure to emerge as a therapeutic option for patients with atrial fibrillation at risk for cardioembolic stroke.展开更多
BACKGROUND Inflammatory indices derived from complete blood tests have been reported to be associated with poor outcomes in patients with atrial fibrillation(AF).The data about the relationship between inflammatory in...BACKGROUND Inflammatory indices derived from complete blood tests have been reported to be associated with poor outcomes in patients with atrial fibrillation(AF).The data about the relationship between inflammatory indices and left atrial appendage thrombus(LAAT)or dense spontaneous echo contrast(SEC)are limited.AIM To explore the value of inflammatory indices for predicting the presence of LAAT or dense SEC in nonvalvular AF patients.METHODS A total of 406 patients with nonvalvular AF who underwent transesophageal echocardiography were included and divided into two groups based on the presence(study group)or absence(control group)of LAAT or dense SEC.Inflammatory indices,including the neutrophil-to-lymphocyte ratio(NLR),platelet–tolymphocyte ratio(PLR),and lymphocyte-to-monocyte ratio(LMR),were calculated from complete blood analysis.The associations of inflammatory indices RESULTS LAAT and dense SEC were detected in 11(2.7%)and 42(10.3%)patients,respectively.The PLR only showed an association with LAAT/dense SEC in the univariate model.Elevated NLR(odds ratio[OR]=1.48,95%confidence interval[CI]:1.11-1.98,P=0.007)and reduced LMR(OR=0.59,95%CI:0.41-0.83,P=0.003)were found to be independent risk factors for the presence of LAAT/dense SEC.The areas under the NLR and LMR curves for predicting LAAT/dense SEC were 0.73(95%CI:0.66-0.80,P<0.001)and 0.73(95%CI:0.65-0.81,P<0.001),respectively,while the cutoff values were 2.8(sensitivity:69.8%;specificity:64.0%)and 2.4(sensitivity:71.7%;specificity:60.6%),respectively.CONCLUSION Increased NLR and decreased LMR may predict LAAT/dense SEC in patients with nonvalvular AF.展开更多
The aim of this study is to build two mathematical models of canine ionic currents specific to right atria and left atria.The canine left atria mathematical model was firstly modified from the Ramirez-Nattel-Courteman...The aim of this study is to build two mathematical models of canine ionic currents specific to right atria and left atria.The canine left atria mathematical model was firstly modified from the Ramirez-Nattel-Courtemanche(RNC) model using the recently available experimental data of ionic currents and was further developed based on our own experimental data.A model of right atria was then built by considering the differences between right atria and left atria.The two developed models well reproduced the experimental data on action potential morphology,the rate dependence,and action potential duration restitution.They are useful for investigating the mechanisms underlying the het-erogeneity of canine regional action potentials and would help the simulation of whole heart excitation propagation and cardiac arrhythmia in the near future.展开更多
The left atrium (LA) has been recognized as a morphophysiological barometer of left ventricular (LV) diastolic dysfunction. Because in the myocardial ischemia cascade where LV diastolic dysfunction often precedes LV s...The left atrium (LA) has been recognized as a morphophysiological barometer of left ventricular (LV) diastolic dysfunction. Because in the myocardial ischemia cascade where LV diastolic dysfunction often precedes LV systolic dysfunction, the LA which fashions as an early marker of diastolic anomaly, could equally reflect a declining LV function and/or be a good predictor of potential sequelae. We assessed this association of LA function with reduced LV systolic function among hospitalized patients. Among patients with reduced LV ejection fraction, LA passive ejection fraction was lower (0.172 ± 0.12 vs. 0.232 ± 0.14, p = 0.013) whereas LA kinetic energy was higher (6.48 ± 6.3 vs. 4.57 ± 3.5, p = 0.005). Echocardiographic assessment of LA function, therefore, appears correlated with LVEF and could be important when risk stratifying hospitalized patients.展开更多
Objectives This study was to investigate the differences between modeling and non-modeling left atrium （LA） in CartoXP system guided catheter ablation for paroxysmal atrial fibrillation （PAF）. Methods From Jan to ...Objectives This study was to investigate the differences between modeling and non-modeling left atrium （LA） in CartoXP system guided catheter ablation for paroxysmal atrial fibrillation （PAF）. Methods From Jan to Dec in 2008 total 31 cases with PAF were enrolled. All were treated by the same electrophysiologist with CartoXP guidance. Catheter ablation was accomplished without left atrium and pulmonary veins modeling in 17 patients （non-modeling group） and with left atrium modeling in 14 patients （modeling group）. The detailed ablation method was based on circumferential pulmonary veins isolation （CPVI）. And linear ablation of tricuspid valvular isthmus was performed individually. The ablation endpoint was a complete isolation of pulmonary vein potential from left atrium and no further induced continuous fast atrial arrhythmia including atrial fibrillation （AF）, atrial flutter （AFL） and atrial tachycardia （AT）. Each step for the procedures and the follow-up outcomes were compared correspondingly. Results The total procedure time was 107.23 ± 28.92 min in modeling group vs 93.47 ±26.09 min in non-modeling group （ P 〉 0.05 ）. The X-ray exposure time was significantly longer in modeling group （21.09 ±6. 49 rain） than in non-modeling group （14. 16 ± 5.35 min）. The CPVI times of right pulmonary veins and left pulmonary veins were 28. 14 ± 9. 26 min was 27.29 ± 18.53 min in modeling group respectively, vs 18.00 ±4. 51 min and 23.94 ± 7. 10 min in non-modeling group respectively, （P 〈 0. 05 ）. There is no significant difference between modeling group （85.7%） and non-modeling group （82.4%） over follow-up period of 2 to 13 months. Confusions CartoXP system guided catheter ablation of PAF without modeling of left atrium and pulmonary veins took less time in X-ray exposure and ablation steps, comparing with left atrium modeling procedure.展开更多
For patients with atrial fibrillation with an increased risk of stroke and contraindications to long-term anticoagulation,percutaneous left atrial appendage closure(LAAC)has become an important alternative to long-ter...For patients with atrial fibrillation with an increased risk of stroke and contraindications to long-term anticoagulation,percutaneous left atrial appendage closure(LAAC)has become an important alternative to long-term oral anticoagulation.Incomplete closure of the LAAC during the procedure leads to faster blood flow in the interstitial space around the device,resulting in peri-device leak(PDL),which is not uncommon.Studies are still inconclusive in determining the incidence,long-term safety,and management of PDL.Therefore,this article reviewed the progress made in the research and treatment of PDL after LAAC.展开更多
Atrial fibrillation (AF) is a kind of common arrhythmia, which, besides affecting cardiac function, has another serious outcome, that is, it is easy to form atrial thrombosis and induce thrombus/embolus, especially ce...Atrial fibrillation (AF) is a kind of common arrhythmia, which, besides affecting cardiac function, has another serious outcome, that is, it is easy to form atrial thrombosis and induce thrombus/embolus, especially cerebral embolus. The incidence of left atrial thrombosis ( LAT) could reach 25% - 30%(1) , the incidence of embol-展开更多
Objective To analyse the risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis. Methods From January 2001 to December 2008,2277 patients with rheumatic mitral stenosis underwent operations...Objective To analyse the risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis. Methods From January 2001 to December 2008,2277 patients with rheumatic mitral stenosis underwent operations in our hospital. There were 737 males and 1540 females,the age ranged from 19 to 84 years [average (50.9 ±10.2) years]. Left atrial thrombosis group展开更多
文摘Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LAAO are lacking.Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data including clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite outcome was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days.Results Mean age was 75±8 years and 434(60%)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and median HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age>75 years in both unadjusted(17.1%vs.11.5%,P=0.03)and adjusted(Odds Ratio=1.59,95%CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3%vs.0,P=0.04)among patients age>75 years.The secondary outcome of procedural success was also lower among patients age>75 years(92.2%vs.96.2%,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age>75 years and less than 75years.Conclusion Patients age>75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.
文摘Left atrial aneurysm is an exceptionally rare condition,particularly in the pediatric population,and even more so as a sequela of bacterial pericarditis.We present the case of a 16-month-old girl who developed a left atrial aneurysm following isolated Staphylococcus aureus pericarditis.She initially presented in decompensated shock and was later diagnosed with constrictive pericarditis.Despite undergoing pericardiectomy,she subsequently developed a left atrial aneurysm,necessitating surgical closure.This case highlights the aggressive nature of bacterial pericarditis and its potential to cause rare structural cardiac complications.
基金We appreciated Xuan Jiang for the statistical analysis. This work was supported by National Nature Science Foundation of China （No.81370295）, Science and Technology Program of Guangdong Province, China （No. 2017A02 0215054）, Science and Technology Planning of Guangzhou City, China （No.2014B070705005）. The authors declared no potential conflicts of interest with respect to the research, authorship or publication of this article.
文摘Objective To evaluate the predictive value of red cell distribution width （RDW） on left atrial thrombus （LAT） or left atrial spontane- ous echo contrast （LASEC） in patients with non-valvular atrial fibrillation （AF）. Methods We reviewed 692 patients who were diagnosed as non-valvular AF and underwent transesophageal echocardiography （TEE） in Guangdong Cardiovascular Institute from April 2014 to December 2015. The baseline clinical characteristics, laboratory test of blood routine, electrocardiograph measurements were analyzed. Results Eighty-four patients were examined with LAT/LASEC under TEE. The mean RDW level was significantly higher in LAT/LASEC patients compared with the non-LAT/LASEC patients （13.59% ± 1.07% ws. 14.34% ± 1.34%; P 〈 0.001）. Receiver-operating characteristic curve analysis was performed and indicated the best RDW cut point was 13.16%. Furthermore, multivariate logistic regression analysis indicated that RDW level 〉 13.16% could be an independent risk factor for LAT/LASEC in patients with AF. Conclusion Elevated RDW level is associated with the presence of LAT/LASEC and could be with moderate predictive value for LAT/LASEC in patients with non-valvular AF.
基金supported by the Ph.D. Launch Programs Foundation of Liaoning Province (2019-BS-266)
文摘Percutaneous left atrial appendage(LAA)occlusion evolved as an alternative treatment to the patients who are contraindicated or cannot tolerate oral anticoagulants with nonvalvular atrial fibrillation(AF)at risk of stroke or systemic embolism.[1]Abnormal hemodynamic changes in elder atrial septal defect(ASD)patients cause remodeling of the left atrium,which eventually leads to right heart failure.[2]As the ASDs elderly are associated with a higher incidence of AF,simultaneous transcatheter ASD and LAA closure has become a new effective therapeutic strategy.However,only a limited number of articles involving cardiac tamponade complications have been published in the literature.What’s more,previous studies involving early hemodynamically irrelevant pericardial effusion after the procedure attribute to multiple repositioning attempts of LAA occluder or delivery sheath injured the atrial wall.
文摘Atrial fibrillation prevalence is increasing with age, reaching up to 5% of patients older than 65 years, and is associated with 20%-30% of stroke episodes in that population.
基金This study was supported by grants from National Natural Science Foundation of China(81870367)Doctoral Start-up Foundation of Liaoning Province of China(2019-BS-266).
文摘Background:Left atrial appendage closure(LAAC)with simultaneous interventional occlusion therapy for congenital interatrial communication has become a new focus of patients with nonvalvular atrial fibrillation.Little is known about the results of mid-and long-term results.Objective:The aim of this study was to evaluate the midand long-term safety and effectiveness of simultaneous transcatheter closure of the left atrial appendage(LAA)and congenital interatrial communication closure in atrial fibrillation(AF)patients.Methods:From Jan 2016 to June 2017,27 patients with AF were treated with simultaneous transcatheter closure of the LAA and atrial septal defect(ASD,n=22),patent foramen ovale(PFO,n=5).Results:The perioperative closure success rate was 96.3%,except for cardiac tamponade occurred in one ASD patient.During the median 37.6-month follow-up period,no cases of cerebrovascular or peripheral vascular embolism,bleeding,infective endocarditis or thrombosis along the occluders were observed.Of the 21 patients with NYHA Class III,nineteen had significant improvements to NYHA Classes I or II,and 81.5%of patients were free from major or minor adverse events during midand long-term follow-up.Conclusions:Simultaneous closure of the LAA and congenital interatrial communication closure is a viable option for patients with nonvalvular atrial fibrillation who are at risk of stroke or systemic embolism,and it is effective and yields excellent mid-and long-term results.
基金Supported by Taizhou People’s Hospital Scientific Research Start-Up Fund Project,No. QDJJ202113
文摘BACKGROUND In patients who suffer from both atrial fibrillation(AF)and atrial septal defect(ASD),cryoballoon pulmonary vein isolation(PVI),sequential left atrial appendage(LAA)occlusion and ASD closure could be a strategy for effective prevention of stroke and right heart failure.CASE SUMMARY A 65-year-old man was admitted to our institution due to recurrent episodes of palpitations and shortness of breath for 2 years,which had been worsening over the last 48 h.He had a history of AF,ASD,coronary heart disease with stent implantation and diabetes.Physical and laboratory examinations showed no abnormalities.The score of CHA2DS2VASc was 3,and HAS-BLED was 1.Echocardiography revealed a 25-mm secundum ASD.Pulmonary vein(PV)and LAA anatomy were assessed by cardiac computed tomography.PV mapping with 10-pole Lasso catheter was performed following ablation of all four PVs with complete PVI.Following the cryoballoon PVI,the patient underwent LAA occlusion under transesophageal echocardiographic monitoring.Lastly,a 34-mm JIYI ASD occlude device was implanted.A follow-up transesophageal echocardiography at 3 mo showed proper position of both devices and neither thrombi nor leakage was found.CONCLUSION Sequential cryoballoon PVI and LAA occlusion prior to ASD closure can be performed safely in AF patients with ASD.
基金supported by grants from National Natural Science Foundation of China(NO 81770316)Mount Tai Scholarship ProjectQingdao Outstanding Health Professional Development Fund(2017)
文摘Background:Fetal balloon atrial septoplasty(BAS)is performed through the restrictive foramen ovale in fetal cases with established hypoplastic left heart syndrome(HLHS)and an intact or highly restrictive atrial septum(RAS).Methods:In the current report,we present a case of high position BAS in a fetus with HLHS/RAS.Results:Echocardiography confirmed an adequate atrial opening above the foramen ovale and fetal pleural effusion resolved spontaneously 1 day after the procedure.Conclusion:To the best of our knowledge,the creation of a high position hole in the thinner part of the atrial septum,instead of the restrictive tiny hole,has not been reported in fetal cases with HLHS/RAS.
基金Supported by the Natural Science Foundation of Liaoning ProvinceChina(2013023010)
文摘Objective To evaluate left atrial function in essential hypertension patients with different patterns of left ventricular geometric models by real-time three-dimensional echocardiography （RT-3DE） and left atrial tracking （EAT）.
基金Supported by no external funding.Dr.Benditt is supported in part by a grant from the Dr.Earl E Bakken family in support of heart-brain research
文摘AIM To evaluate the safety and efficacy of surgical left atrial appendage occlusion(s-LAAO)during concomitant cardiac surgery.METHODS We performed a comprehensive literature search through May 31 st 2018 for all eligible studies comparing s-LAAO vs no occlusion in patients undergoing cardiac surgery.Clinical outcomes during follow-up included:embolic events,stroke,all-cause mortality,atrial fibrillation(AF),reoperation for bleeding and postoperative complications.We further stratified the analysis based on propensity matched studies and AF predominance.RESULTS Twelve studies(n=40107)met the inclusion criteria.s-LAAO was associated with lower risk of embolic events(OR:0.63,95%CI:0.53-0.76;P<0.001)and stroke(OR:0.68,95%CI:0.57-0.82;P<0.0001).Stratified analysis demonstrated this association was more prominent in the AF predominant strata.There was no significant difference in the incidence risk of allcause mortality,AF,and reoperation for bleeding and postoperative complications.CONCLUSION Concomitant s-LAAO during cardiac surgery was associated with lower risk of follow-up thromboembolic events and stroke,especially in those with AF without significant increase in adverse events.Further randomized trials to evaluate long-term benefits of s-LAAO are warranted.
基金This work was supported by grants from the National Natural Science Foundation of China(81800056),the Science&Technology Development Fund of Tianjin Education Commission for Higher Education(2017KJ137),and the Key Research and Development Program of Hunan Province(2019SK2021).Scientifi c research project approved by Hunan Provincial Health Commission(202103012117).
文摘Some studies have shown that left ventricular structure and function play an important role in the risk stratifi cation and prognosis of cardiovascular disease.The clinical application of left atrial function in cardiovascular disease has gradually attracted attention in the cardiovascular fi eld.There are many traditional methods to evaluate left atrial function.Left atrial function related indexes measured by echocardiography has been identifi ed as a powerful predictor of cardiovascular disease in recent years,but they have some limitations.The left atrial function index has been found to evaluate left atrial function more effectively than traditional parameters.Furthermore,it is a valuable predictor of the risk stratifi cation and prognosis in patients with clinical cardiovascular disease such as heart failure,atrial fi brillation,hypertension,and coronary heart disease.
文摘Background The long-term prognostic influence of left atrial diameter （LAD） remodeling on the status of post-radiofrequency catheter ablation （RI CA） atrial fibrillation （AF） is unclear. This study employed a two-stage model from 3-year echocardiographic data to ascertain whether the two-stage model predicts RFCA outcome more favorably than models using the baseline LAD. Methods Data were retrospectively collected from 263 consecutive patients with drug-refractory AF undergoing RFCA. Regular echocardiographic measurements of LAD were performed at baseline, 1, 3, 6, and 12 months and then every 6 months after RFCA. Sex, age, type of AF, number of RFCA, and AF status were recorded. We obtain the actual （predicted） 3-year LAD using a longitudinal linear mixed model （1st stage）. Logistic regression models based on the baseline LAD （Model 1）, actual （predicted） 3-year LAD （Model 2） （2nd stage）, and observed 3-year LAD （Model 3） were constructed to predict RFCA outcome. The area under the receiver operating characteristic curve （AUC） were used to assess the performance of models. Results The lowess smoothed curve indicated that the LAD declined over the first three months and remained stable up to 36 months after RFCA. The degree of LAD reduction was significantly influenced by the baseline LAD. Non-paroxysmal AF, large LAD and female gender were significant predictors of AF recurrence. Model 2 had the largest AUC among the three models. Conclusions This longitudinal study-based two-stage model outperforms the original logistic model using the baseline LAD. Non-paroxysmal AF, larger LAD and female gender are significant predictors of RFCA failure.
文摘Transcatheter closure of the left atrial appendage has been developed as an alternative to chronic oral anticoagulation for stroke prevention in patients with atrial fibrillation, and as a primary therapy for patients with contraindications to chronic oral anticoagulation. The promise of this new intervention compared with warfarin has been supported by several, small studies and two pivotal randomized trial with the Watchman Device. The results regarding risk reduction for stroke have been favourable although acute complications were not infrequent. Procedural complications, which are mainly related to transseptal puncture and device implantation, include air embolism, pericardial effusions/tamponade and device embolization. Knowledge of nature, management and prevention of complications should minimize the risk of complications and allow transcatheter left atrial appendage closure to emerge as a therapeutic option for patients with atrial fibrillation at risk for cardioembolic stroke.
基金Public Welfare Technology Project of Ningbo Science and Technology Bureau,No.2023S140Medical Health Science and Technology Project of Zhejiang Province Health Commission,No.2024KY1518.
文摘BACKGROUND Inflammatory indices derived from complete blood tests have been reported to be associated with poor outcomes in patients with atrial fibrillation(AF).The data about the relationship between inflammatory indices and left atrial appendage thrombus(LAAT)or dense spontaneous echo contrast(SEC)are limited.AIM To explore the value of inflammatory indices for predicting the presence of LAAT or dense SEC in nonvalvular AF patients.METHODS A total of 406 patients with nonvalvular AF who underwent transesophageal echocardiography were included and divided into two groups based on the presence(study group)or absence(control group)of LAAT or dense SEC.Inflammatory indices,including the neutrophil-to-lymphocyte ratio(NLR),platelet–tolymphocyte ratio(PLR),and lymphocyte-to-monocyte ratio(LMR),were calculated from complete blood analysis.The associations of inflammatory indices RESULTS LAAT and dense SEC were detected in 11(2.7%)and 42(10.3%)patients,respectively.The PLR only showed an association with LAAT/dense SEC in the univariate model.Elevated NLR(odds ratio[OR]=1.48,95%confidence interval[CI]:1.11-1.98,P=0.007)and reduced LMR(OR=0.59,95%CI:0.41-0.83,P=0.003)were found to be independent risk factors for the presence of LAAT/dense SEC.The areas under the NLR and LMR curves for predicting LAAT/dense SEC were 0.73(95%CI:0.66-0.80,P<0.001)and 0.73(95%CI:0.65-0.81,P<0.001),respectively,while the cutoff values were 2.8(sensitivity:69.8%;specificity:64.0%)and 2.4(sensitivity:71.7%;specificity:60.6%),respectively.CONCLUSION Increased NLR and decreased LMR may predict LAAT/dense SEC in patients with nonvalvular AF.
基金supported by the National Basic Research Program (973) of China (No.2007CB512100)the National High-Tech R & D Program (863) of China (No.2006AA02Z307)the National Natural Science Foundation of China (No.30570484)
文摘The aim of this study is to build two mathematical models of canine ionic currents specific to right atria and left atria.The canine left atria mathematical model was firstly modified from the Ramirez-Nattel-Courtemanche(RNC) model using the recently available experimental data of ionic currents and was further developed based on our own experimental data.A model of right atria was then built by considering the differences between right atria and left atria.The two developed models well reproduced the experimental data on action potential morphology,the rate dependence,and action potential duration restitution.They are useful for investigating the mechanisms underlying the het-erogeneity of canine regional action potentials and would help the simulation of whole heart excitation propagation and cardiac arrhythmia in the near future.
文摘The left atrium (LA) has been recognized as a morphophysiological barometer of left ventricular (LV) diastolic dysfunction. Because in the myocardial ischemia cascade where LV diastolic dysfunction often precedes LV systolic dysfunction, the LA which fashions as an early marker of diastolic anomaly, could equally reflect a declining LV function and/or be a good predictor of potential sequelae. We assessed this association of LA function with reduced LV systolic function among hospitalized patients. Among patients with reduced LV ejection fraction, LA passive ejection fraction was lower (0.172 ± 0.12 vs. 0.232 ± 0.14, p = 0.013) whereas LA kinetic energy was higher (6.48 ± 6.3 vs. 4.57 ± 3.5, p = 0.005). Echocardiographic assessment of LA function, therefore, appears correlated with LVEF and could be important when risk stratifying hospitalized patients.
文摘Objectives This study was to investigate the differences between modeling and non-modeling left atrium （LA） in CartoXP system guided catheter ablation for paroxysmal atrial fibrillation （PAF）. Methods From Jan to Dec in 2008 total 31 cases with PAF were enrolled. All were treated by the same electrophysiologist with CartoXP guidance. Catheter ablation was accomplished without left atrium and pulmonary veins modeling in 17 patients （non-modeling group） and with left atrium modeling in 14 patients （modeling group）. The detailed ablation method was based on circumferential pulmonary veins isolation （CPVI）. And linear ablation of tricuspid valvular isthmus was performed individually. The ablation endpoint was a complete isolation of pulmonary vein potential from left atrium and no further induced continuous fast atrial arrhythmia including atrial fibrillation （AF）, atrial flutter （AFL） and atrial tachycardia （AT）. Each step for the procedures and the follow-up outcomes were compared correspondingly. Results The total procedure time was 107.23 ± 28.92 min in modeling group vs 93.47 ±26.09 min in non-modeling group （ P 〉 0.05 ）. The X-ray exposure time was significantly longer in modeling group （21.09 ±6. 49 rain） than in non-modeling group （14. 16 ± 5.35 min）. The CPVI times of right pulmonary veins and left pulmonary veins were 28. 14 ± 9. 26 min was 27.29 ± 18.53 min in modeling group respectively, vs 18.00 ±4. 51 min and 23.94 ± 7. 10 min in non-modeling group respectively, （P 〈 0. 05 ）. There is no significant difference between modeling group （85.7%） and non-modeling group （82.4%） over follow-up period of 2 to 13 months. Confusions CartoXP system guided catheter ablation of PAF without modeling of left atrium and pulmonary veins took less time in X-ray exposure and ablation steps, comparing with left atrium modeling procedure.
基金Supported by Zhejiang Provincial Foundation for Medical and Health Sciences,No.2021KY980.
文摘For patients with atrial fibrillation with an increased risk of stroke and contraindications to long-term anticoagulation,percutaneous left atrial appendage closure(LAAC)has become an important alternative to long-term oral anticoagulation.Incomplete closure of the LAAC during the procedure leads to faster blood flow in the interstitial space around the device,resulting in peri-device leak(PDL),which is not uncommon.Studies are still inconclusive in determining the incidence,long-term safety,and management of PDL.Therefore,this article reviewed the progress made in the research and treatment of PDL after LAAC.
基金This project is supported by Guangdong Provincial Ad-ministration of TCM(No.99592)
文摘Atrial fibrillation (AF) is a kind of common arrhythmia, which, besides affecting cardiac function, has another serious outcome, that is, it is easy to form atrial thrombosis and induce thrombus/embolus, especially cerebral embolus. The incidence of left atrial thrombosis ( LAT) could reach 25% - 30%(1) , the incidence of embol-
文摘Objective To analyse the risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis. Methods From January 2001 to December 2008,2277 patients with rheumatic mitral stenosis underwent operations in our hospital. There were 737 males and 1540 females,the age ranged from 19 to 84 years [average (50.9 ±10.2) years]. Left atrial thrombosis group
