Lung transplantation(LT)is now an accepted therapy for end stage lung disease in appropriate patients.Atrial arrhythmias(AA)can occur after LT.Early AA after LT are most often atrial fibrillation,whereas late arrhythm...Lung transplantation(LT)is now an accepted therapy for end stage lung disease in appropriate patients.Atrial arrhythmias(AA)can occur after LT.Early AA after LT are most often atrial fibrillation,whereas late arrhythmias which occur many months or years after LT are often atrial tachycardia.The causes of AA are multifactorial.The review begins with a brief history of LT and AA.This review further describes the pathophysiology of the AA.The risk factors,incidence,recipient characteristics including intra-operative factors are elaborated on.Since there are no clear and specific guidelines on the management of atrial arrhythmia following LT,the recommended guidelines on the management of AA in general are often extrapolated and used in the setting of post LT arrhythmia.The strategy of rate control vs rhythm control is discussed.The pros and cons of various drug regimen,need for direct current cardioversion and catheter ablation therapies are considered.Possible methods to prevent or reduce the incidence of AA after LT are considered.The impact of AA on the short-term and long-term outcomes following LT is discussed.展开更多
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
Atrial fibrillation(AF)is a prevalent cardiac arrhythmia with a multifactorial pathophysiology involving electrical,structural,and autonomic remodeling of the atria.AF is closely associated with elevated interleukin-6...Atrial fibrillation(AF)is a prevalent cardiac arrhythmia with a multifactorial pathophysiology involving electrical,structural,and autonomic remodeling of the atria.AF is closely associated with elevated interleukin-6(IL-6)levels,which contribute to atrial remodeling and the progression of AF.This review summarizes the mechanisms by which IL-6 promotes AF through inflammatory pathways,atrial fibrosis,electrical remodeling,and calcium mishandling.Experimental models have demonstrated that IL-6 neutralization reduces the incidence of AF,highlighting its potential as a therapeutic target.Future studies should focus on IL-6 blockade strategies to manage AF,aiming to improve patient outcomes.展开更多
Atrial fibrillation(AF)/atrial flutter(AFL)is the most common sustained cardiac arrhythmia.The known risk factors for developing AF/AFL include age,structural heart disease,hypertension,diabetes mellitus,or hyperthyro...Atrial fibrillation(AF)/atrial flutter(AFL)is the most common sustained cardiac arrhythmia.The known risk factors for developing AF/AFL include age,structural heart disease,hypertension,diabetes mellitus,or hyperthyroidism.This study aims to attribute the trends in AF/AFL-related mortalities over the past two decades 1999-2020 concerning race and sex and disparity among them.To the best of our knowledge,this is the first study that estimates the trends and mortality due to AF/AFL from 1999-2020 in older adults in the United States.In this 21-year analysis of mortality data,we found a constant increase in mortality rates due to AF/AFL in older adults.From 1999 to 2020,the overall mortality in older adults aged 65 and above,regardless of sex and race,is found to be almost doubled i.e.about a 50.2%increase in the number of deaths due to AF/AFL.Furthermore,other confounding risk factors such has obesity,prior myocardial infarction,inflammation,hypertension,birth weight,diabetes mellitus,hyperthyroidism,hormone replacement therapy in menopausal women increases the risk in the occurrence or recurrent occurrence of AF.展开更多
Atrial fibrillation(AF)is the most common arrhythmia in clinical setting and has been increasingly prevalent due to the aging population.AF is associated with a three to fivefold increased risk of stroke.Treatment opt...Atrial fibrillation(AF)is the most common arrhythmia in clinical setting and has been increasingly prevalent due to the aging population.AF is associated with a three to fivefold increased risk of stroke.Treatment options include pharmacological and electrical cardioversion,each carrying specific risks.AF may resolve spontaneously,but often recurs,making a“watch-andwait”strategy a reasonable approach to avoid unnecessary antiarrhythmic therapy.展开更多
Background Using Systematic Assessment of Geriatric Elements in Atrial Fibrillation(SAGE-AF) data, determine how well the rich mix of demographic, clinical history, geriatric assessments, and clinically adjudicated ev...Background Using Systematic Assessment of Geriatric Elements in Atrial Fibrillation(SAGE-AF) data, determine how well the rich mix of demographic, clinical history, geriatric assessments, and clinically adjudicated events can predict two-year survival.Methods Subjects were recruited from participating outpatient practices if they had non-valvular AF, were 65 or over with CHA_(2)DS_(2)-VASc scores of at least 2, and were candidates for anticoagulation. Demographics, clinical history, and geriatric qualities of life were assessed by interview and medical records review using standardized protocols and repeated at one and two years. Events identified were abstracted and submitted for adjudication using standard definitions of events and categories. Nonmortality event categories included hospitalizations(cardiovascular, bleeding, other), bleeding(major, clinically relevant non-major, minor), and seven major adverse cardiovascular events.Results The 1245 subjects experienced 1960 events, primarily hospitalizations(935) and/or bleeding(817);114 subjects(9.2%)died during two years of follow-up. Events initially abstracted to more than one category(172) were combined, resulting in 1788unique incidents. Most subjects had zero or one event(69%) and fewer than 7% had more than 3 types. Most variables were significant in bivariate analysis. Using multiple logistic regression with two-year survival as the outcome variable, the best-fit model included event number and type, number of unique incidents, and number of bleeding events(R^(2) = 0.511, C = 93.1) with sensitivity = 97.9% and specificity = 44.7%.Conclusions Two-year survival was high. This model, if validated, could have major implications for treatment of patients with AF. Patients in the large group with no or one event are at very low risk of death(under 2%). The small group with high risk for further complications, including death, deserve reassessment to determine if this trajectory can be altered.展开更多
Background:Elucidating mechanisms underlying atrial myopathy,which predisposes individuals to atrial fibrillation(AF),will be critical for preventing/treating AF.In a serendipitous discovery,we identified atrial enlar...Background:Elucidating mechanisms underlying atrial myopathy,which predisposes individuals to atrial fibrillation(AF),will be critical for preventing/treating AF.In a serendipitous discovery,we identified atrial enlargement,fibrosis,and thrombi in mice with reduced phosphoinositide 3-kinase(PI3K)in cardiomyocytes.PI3K(p110a)is elevated in the heart with exercise and is critical for exercise-induced ventricular enlargement and protection,but the role in the atria was unknown.Physical inactivity and extreme endurance exercise can increase AF risk.Therefore,our objective was to investigate whether too little and/or too much PI3K alone induces cardiac pathology.Methods:New cardiomyocyte-specific transgenic mice with increased or decreased PI3K(p110a)activity were generated.Multi-omics was conducted in mouse atrial tissue,and lipidomics in human plasma.Results:Elevated PI3K led to an increase in heart size with preserved/enhanced function.Reduced PI3K led to atrial dysfunction,fibrosis,arrhythmia,increased susceptibility to atrial enlargement and thrombi,and dysregulation of monosialodihexosylganglioside(GM3),a lipid that regulates insulin-like growth factor-1(IGF1)-PI3K signaling.Proteomic profiling identified distinct signatures and signaling networks acrossatria with varying degrees of dysfunction,enlargement,and thrombi,including commonalities with the human AF proteome.PI3K-related lipids were dysregulated in plasma from athletes with AF.Conclusion:PI3K(p110a)is a critical regulator of atrial biology and function in mice.This work provides a proteomic resource of candidates for further validation as potential new drug targets and biomarkers for atrial myopathy.Further investigation of PI3K-related lipids as markers for identifying individuals at risk of AF is warranted.Dysregulation of PI3K may contribute to the association between increased cardiac risk with physical inactivity and extreme endurance exercise.展开更多
Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and mo...Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and modalities of the interventions and deciding,where possible,to realize them in a single session.Here we describe the case of a patient affected by severe aortic stenosis and associated cardiac comorbidities(coronary artery disease,atrial fibrillation and left appendage thrombosis)that needed a multimodal clinical and interventional strategy to lead him to the best clinical condition for performing transcatheter aortic valve implantation(TAVI).展开更多
Objective:The occurrence and development of atrial fibrillation(AF)are influenced by the autonomic nervous system and inflammation.Acupuncture is an effective treatment for AF.This study explored the protective effect...Objective:The occurrence and development of atrial fibrillation(AF)are influenced by the autonomic nervous system and inflammation.Acupuncture is an effective treatment for AF.This study explored the protective effects of acupuncture in a rat model of paroxysmal AF and investigated its mechanisms.Methods:Male Sprague-Dawley rats(n=130)were randomly divided into blank control(Con),sham operation(Sham),AF,and acupuncture treatment(Acu)groups.A paroxysmal AF model was established by rapid atrial pacing through the jugular vein.Rats in the Acu group were immobilized to receive acupuncture treatment at Neiguan acupoint(PC6)for 20 min daily for seven days.The other groups were immobilized for the same duration over the treatment period but did not receive acupuncture.The AF induction rate,AF duration,cardiac electrophysiological parameters,and heart rate variability were evaluated by monitoring surface electrocardiogram and vagus nerve discharge signals.After the intervention,the rats were euthanized,and atrial morphology was assessed using haematoxylin and eosin staining.The expression of macrophage F4/80 antigen(F4/80)and cluster of differentiation(CD)86 in atrial myocardial tissue was detected using immunohistochemistry,immunofluorescence and flow cytometry.The expression levels or contents of interleukin(IL)-1β,IL-6,tumor necrosis factor-a(TNF-a),a7 nicotinic acetylcholine receptor(a7nAChR),phosphorylated Janus kinase 2(p-JAK2),and phosphorylated signal transducer and activator of transcription 3(p-STAT3)in atrial myocardial tissue were detected using Western blotting,reverse transcription-quantitative polymerase chain reaction,or enzyme-linked immunosorbent assay.The role of a7nAChR in acupuncture treatment was verified by intraperitoneal injection of the a7nAChR antagonist methyllycaconitine(MLA).Results:Compared with the AF group,acupuncture significantly reduced AF duration and induction rate,improved cardiac electrophysiology by enhancing vagus nerve activity and regulating autonomic balance.It also decreased the pro-inflammatory M1 macrophage proportion,alleviating myocardial injury and infiltration.MLA weakened acupuncture's electrophysiological improvement and anti-inflammatory effect.Results suggest that acupuncture triggers the a7nAChR-JAK2/STAT3 pathway and exerts cardioprotection via neuroimmune regulation.Conclusion:Acupuncture significantly reduced the AF induction rate,shortened AF duration,improved cardiac electrophysiological parameters,enhanced vagus nerve activity,and decreased the expression of pro-inflammatory M1 macrophages and inflammatory factors in rats with paroxysmal AF.展开更多
Introduction: the left atrial appendage, a dormant embryonic vestige, would play a major role in cardiac hemodynamic changes, volume homeostasis and thrombi formation. It, therefore constitutes a therapeutic target. I...Introduction: the left atrial appendage, a dormant embryonic vestige, would play a major role in cardiac hemodynamic changes, volume homeostasis and thrombi formation. It, therefore constitutes a therapeutic target. Its morphology is extremely variable. Objective: it consisted on determining the morphological variations of the left auricle as well as their interest in the prevention of thrombi in the Senegalese. Material and Method: This study was conducted by dissecting 36 fresh hearts from Senegalese anatomical subjects with a sampling of the left atrial appendage, including specimens with normal morphological appearance. Their morphology was studied using the fresh and frozen plaster molding method. The data obtained were analyzed statistically. Results: the average age of the subjects was 33 years, with a sex ratio of 1.06, the cauliflower shape was dominant with 57% of cases and the cactus shape (4%) was less frequent. The cauliflower shape presented a clear angulation compared to the others without statistically significant differences according to age. Conclusion: This work showed a great morphological variability of the left atrial appendage. It can provide an update on the specificity of Senegalese. Taking these variations into account is important in the safe management of hemodynamic conditions and the improvement of the management of recurrent strokes.展开更多
BACKGROUND Atrial fibrillation(AF)is a prevalent cardiac arrhythmia associated with significant morbidity and mortality,particularly in patients with concomitant renal dysfunction.Anticoagulation therapy reduces the r...BACKGROUND Atrial fibrillation(AF)is a prevalent cardiac arrhythmia associated with significant morbidity and mortality,particularly in patients with concomitant renal dysfunction.Anticoagulation therapy reduces the risk of thromboembolic complications in AF but presents challenges in patients with renal impairment due to altered pharmacokinetics and increased bleeding risk.AIM To support clinicians in navigating the complexities of anticoagulation in this high-risk population,ensuring optimal outcomes.METHODS The present review followed PRISMA guidelines.Data extraction was conducted using a standardized template that captured key study characteristics:Population demographics,renal function metrics,anticoagulant dosing strategies,and primary and secondary outcomes.For quality assessment,we employed the Cochrane Risk of Bias 2.0 tool for randomized controlled trials.Observational studies were appraised using the Newcastle-Ottawa Scale.RESULTS We analyze data from 16 studies to provide recommendations on optimal anticoagulation strategies,balancing thrombotic and bleeding risks.Current evidence supports the preferential use of apixaban in moderate chronic kidney disease and cautiously in end-stage renal disease,emphasizing the importance of individualized therapy.CONCLUSION The management of anticoagulation in AF patients with renal dysfunction is challenging but critical for reducing stroke risk.展开更多
Background and Objective Hypertension(HT)and atrial fibrillation(AF)are highly prevalent cardiovascular conditions that frequently coexist.Coronary artery disease(CAD)is a major global cause of mortality.The co-occurr...Background and Objective Hypertension(HT)and atrial fibrillation(AF)are highly prevalent cardiovascular conditions that frequently coexist.Coronary artery disease(CAD)is a major global cause of mortality.The co-occurrence of HT,AF,and CAD presents significant management challenges.This study aims to explore the clinical characteristics and risk factors associated with CAD in patients with HT and persistentAF(HT-AF).Methods In this retrospective cross-sectional study,data were collected from 384 hospitalized HT-AF patients at the People's Liberation Army General Hospital between January 2010 and December 2019.CAD diagnosis was confirmed by coronary angiography or computed tomography angiography.Clinical characteristics and comorbidities were compared between patients with and without CAD.Multivariate logistic regression analyses were performed to identify independent risk factors associated with CAD development.Results The prevalence of CAD among HT-AF patients was 66.41%(255/384).Cardiovascular complications,particularly heart failure(44.7%vs 25.6%,P<0.05),were significantly more prevalent in the CAD group than in the non-CAD group.Only age was identified as an independent risk factor for CAD(adjusted OR:1.047;95%CI:1.022–1.073;P=0.000).Of all HT-AF patients,54.7%had a CHA2DS2-VASc score of≥4,indicating high stroke risk.There was a slightly higher anticoagulant usage rate in the CAD group than those without CAD(8.6%vs 4.7%,P=0.157),and the overall anticoagulant usage remained low.Conclusion There is a high prevalence of CAD among hospitalized HT-AF patients,among whom age is the sole independent risk factor for CAD.Despite a high stroke risk,the utilization of oral anticoagulants is alarmingly low.展开更多
Voltage substrate mapping is a promising tool for the treatment of atrial fibrillation(AF).It is helpful to detect atrial fibrosis,which includes areas with low bipolar voltage,heterogeneous conduction properties,and ...Voltage substrate mapping is a promising tool for the treatment of atrial fibrillation(AF).It is helpful to detect atrial fibrosis,which includes areas with low bipolar voltage,heterogeneous conduction properties,and shortened effective refractory period.The voltage amplitude is typically defined as the maximal peakto-peak level within a specified time window of interest.Contemporary electroanatomic mapping platforms now enable many thousands of data points to be mapped,so that a geometric model of the atrial endocardium is constructable over a short period of time.This mapping procedure is often done with bipolar electrodes to cancel the far-field signal.The recording site coordinates are projected onto an atrial shell,with interpolation of the voltage data across the shell surface.The amplitude of the recorded bipolar electrogram depicted on the threedimensional shell provides detailed information for substrate mapping.Wherever there are areas of low peak-to-peak voltage,it is thought to mark the presence of abnormal tissue properties and conduction.However,uncontrolled variables and environmental factors affecting voltage level include the oncoming electrical activation wavefront direction,the catheter incidence angle,the force applied to the catheter,and the region-variable shape and structure of atrial tissue.Techniques and settings to acquire atrial voltage data for AF analysis have not been standardized.Methods to characterize atrial electrograms are also presently limited.These factors affect quality and reproducibility of the mapping results.Herein,voltage substrate mapping and its variables pertaining to AF and radiofrequency ablation are described and discussed,with suggestions for future work efforts.展开更多
BACKGROUND Atrial fibrillation(AF)associated with chronic kidney disease(CKD)is a prevalent condition in the United States,significantly impacting global morbidity and mortality.Understanding temporal patterns in AF-r...BACKGROUND Atrial fibrillation(AF)associated with chronic kidney disease(CKD)is a prevalent condition in the United States,significantly impacting global morbidity and mortality.Understanding temporal patterns in AF-related mortality among CKD patients is crucial for effective clinical and public health strategies.AIM To investigate AF-CKD comorbidity and mortality on the national level.METHODS Death certificates from the Centers for Disease Control Wide-Ranging Online Data for Epidemiologic Research database spanning 2011-2020 were analyzed to investigate AF-related CKD mortality in adults aged 35 to 85 or more years.Age-adjusted mortality rates(AAMRs)per 100000 persons and annual percent change(APC)were calculated,stratified by year,sex,race/ethnicity,and geographic region.RESULTS A total of 110733 deaths occurred among adults(aged 35-85 or more years)related to AF associated with CKD in the United States.Overall AAMR declined from 8.1 in 2011 to 5.5 in 2014(APC:-14.89;95%confidence interval(CI):-30.44 to-4.06),followed by an increase to 10.3 in 2020(APC:9.91;95%CI:6.1-19.62).Men had higher AAMRs than women(men:7.6,95%CI:7.6-7.7).Non-Hispanic White adults had the highest AAMR(7.8),followed by non-Hispanic Black(5).States in the top 90th percentile had approximately four times higher AAMRs than those in the lower 10th percentile.AAMR also varied by region(Midwest:7.6,West:6.7,Northeast:6.3,South:5.6),with nonmetropolitan areas exhibiting higher AF-associated CKD mortality.CONCLUSION Temporal trends in AF-related mortality among CKD patients showed fluctuations over the study period,with notable disparities across demographic and geographic factors.Targeted interventions are warranted to mitigate the burden of AF associated with CKD and reduce mortality rates in the United States.展开更多
BACKGROUND The Perceval Sorin S(perceval valve)is a sutureless bioprosthetic designed for use in a high-risk cohort who may not be suitable for transcatheter aortic valve implantation or a conventional surgical aortic...BACKGROUND The Perceval Sorin S(perceval valve)is a sutureless bioprosthetic designed for use in a high-risk cohort who may not be suitable for transcatheter aortic valve implantation or a conventional surgical aortic valve replacement(AVR).AIM To compare five-year post-operative outcomes in a cohort undergoing isolated AVR with the perceval valve to a contemporary cohort undergoing surgical AVR with a sutured bioprosthesis.METHODS This study was a retrospective,cohort study at a single tertiary unit.Between 2017 and 2023,982 suitable patients were identified.174 Perceval valve replacements were matched to 174 sutured valve replacements.Cohort characteristics,intra-operative details,and post-operative outcomes were compared between the two groups.RESULTS Time under the aortic cross-clamp(P<0.001),time on the cardiopulmonary bypass(P<0.001)and total operative time(P<0.001)were significantly reduced in the Perceval group.Patients in the Perceval valve group were at a lower risk of postoperative pneumonia[odds ratio(OR)=0.53(0.29-0.94)]and atrial fibrillation[OR=0.58(0.36-0.93)].After propensity-matching,all-cause mortality did not significantly differ between the two groups in the five-year follow-up period.Larger valve sizes conferred an increased risk of mortality(P=0.020).CONCLUSION Sutureless surgical AVR(SAVR)is a safe and efficient alternative to SAVR with a sutured bioprosthesis,and may confer a reduced risk of post-operative atrial fibrillation.Clinician tendency towards‘oversizing’sutureless aortic valves translates into adverse clinical outcomes.Less time on the cardiopulmonary bypass circuit allows for the treatment of otherwise high-risk patients.展开更多
Anticoagulation has long been the standard of care for preventing embolic events in atrial fibrillation(AF).^([1])The elderly AF generation is more susceptible to thromboembolic incidents.They are also more likely to ...Anticoagulation has long been the standard of care for preventing embolic events in atrial fibrillation(AF).^([1])The elderly AF generation is more susceptible to thromboembolic incidents.They are also more likely to encounter hemorrhagic and other complications when using anticoagulants.Therefore,percutaneous left atrial appendage occlusion(pLAAO)is regarded as an appealing alternative therapy for preventing stroke in patients who are poor candidates for long-term anticoagulation.^([2,3])Contemporary patients undergoing pLAAO are typically older and have more comorbidities than those who were enrolled in pivotal randomized controlled trials.展开更多
Atrial fibrillation(AF)is a growing global health burden,with a prevalence of over 52.55 million cases.Rising disability-adjusted life-years,increasing age,and disparities in care have contributed to the worsening sev...Atrial fibrillation(AF)is a growing global health burden,with a prevalence of over 52.55 million cases.Rising disability-adjusted life-years,increasing age,and disparities in care have contributed to the worsening severity and mortality of AF.Modifiable risk factors,such as hypertension,obesity,and diabetes mellitus,are associated with alterations in gut microbiota,making the gut-heart axis a potential therapeutic target.Gut dysbiosis influences AF pathogenesis through inflam-mation,metabolic disruption,and autonomic dysfunction.Key mechanisms include gut barrier dysfunction,short-chain fatty acid(SCFA)depletion,lipopoly-saccharides(LPS)-induced inflammation,and ferroptosis-mediated atrial remodeling.Trimethylamine N-oxide,bile acids,and tryptophan metabolites contribute to arrhythmogenic remodeling.Emerging evidence suggests that dietary interventions,including prebiotics and probiotics,as well as gut surveillance,may help mitigate AF progression.Clinical implications of gut modulation in AF include person-alized dietary strategies,microbiome assessment through metagenomic sequencing,and targeted interventions such as SCFA-based therapies and ferroptosis inhibition.Metabolite surveillance,including LPS and indoxyl sulfate monitoring,may influence the effectiveness of anticoagulant and antiarrhythmic therapy.Despite growing mechanistic evidence linking gut dysbiosis to AF,clinical applications remain unexplored.This review summarizes the current understanding of the gut microbiome's role in AF.展开更多
Congenital atrial septal defect(ASD)with severe scoliosis is a rare compound malformation inchildren.Severe sco liosis should be corrected as soon as possible.The growth rod is suitable for patients withearly scoliosi...Congenital atrial septal defect(ASD)with severe scoliosis is a rare compound malformation inchildren.Severe sco liosis should be corrected as soon as possible.The growth rod is suitable for patients withearly scoliosis and obvious scoliosis under 10 years old.However,the fluoroscopic radiopaque of titaniumalloy plate will inevitably partly make the operative field of interventional occlusion blind.We presenta7-year-old Chinese girl with ASD and scoliosis who underwent spinal correction with a dual-growthrod.In this case,we performed transcatheter closure of ASD solely under the guidance of transthoracicechocardiography.Transthoracic echocardiography(TTE)has been reported as efficacious and safe forassessment and guidance of ASD occlusion.For patients with visual field occlusion under fluoroscopy,theapplication of TTE is efficacious and safe for assessmnent and guidance of ASD occlusion.展开更多
Background:Non-valvular atrial fibrillation(NVAF),the most prevalent cardiac arrhythmia globally,poses a dual challenge of thromboembolic and bleeding risks,with stroke being the most devastating complication.Despite ...Background:Non-valvular atrial fibrillation(NVAF),the most prevalent cardiac arrhythmia globally,poses a dual challenge of thromboembolic and bleeding risks,with stroke being the most devastating complication.Despite advancements in anticoagulation and rhythm control,patient outcomes remain suboptimal.Aim:This review synthesizes current evidence on the pathophysiological mechanisms,multidimensional management strategies,and emerging innovations in NVAF to inform clinical practice and future research directions.Methods:A systematic literature search was conducted across nine databases(CNKI,Wanfang,SinoMed,VIP,PubMed,Web of Science,Cochrane Library,Embase,and MEDLINE)using combined Medical Subject Headings(MeSH)and free-text terms,including“atrial fibrillation,”“non-valvular atrial fibrillation,”“risk factors,”and“mechanism”(and their Chinese equivalents).Studies on NVAF pathogenesis,therapeutic interventions,and risk stratification tools were analyzed.Results:(1)Risk Factors and Pathophysiology:NVAF progression is driven by hemodynamic stress(e.g.,hypertension),metabolic disorders(e.g.,obesity,diabetes),chronic inflammation,and fibrosis.Biomarkers such as CRP and Galectin-3,along with TGF-β/Smad signaling,are central to atrial remodeling.(2)Anticoagulation Controversies:While NOACs reduce stroke risk compared to warfarin(HR=0.79),challenges persist in extreme body weight populations and drug-drug interactions(e.g.,with P-glycoprotein inhibitors).(3)Left Atrial Appendage Closure(LAAC):LAAC demonstrates non-inferiority to anticoagulation in stroke prevention(HR=0.79)with reduced major bleeding(HR=0.49),though device-related thrombosis(1.8–7%)remains a concern.(4)Precision Medicine:AI-driven models enhance stroke prediction(AUC=0.71;sensitivity 92%),while genotype-guided warfarin dosing shortens INR stabilization by 40%.(5)Lifestyle Interventions:Combined Mediterranean diet and moderate exercise reduce AF burden(HR=0.69)and reverse left atrial enlargement(LAVI reduced by 12%).(6)Multidisciplinary Care:Integrated“heart-brain team”approaches combining LAAC and PFO closure lower annual stroke recurrence from 8.2%to 2.1%,while comprehensive rehabilitation improves functional capacity(6MWD+45 m)and quality of life(SF-36+12 points).Conclusion:NVAF management has evolved from isolated anticoagulation to a multidimensional paradigm integrating genomics,AI,and lifestyle modification.Future priorities include validating long-term outcomes of novel therapies,addressing evidence gaps in special populations,and implementing digitally enabled,cross-disciplinary care models to mitigate the global burden of NVAF-related complications.展开更多
Atrial fibrillation(Afib)is a common arrhythmia with significant public health implications,affecting millions of individuals worldwide.Catheter ablation(CA)is an established treatment for drug-resistant Afib,yet recu...Atrial fibrillation(Afib)is a common arrhythmia with significant public health implications,affecting millions of individuals worldwide.Catheter ablation(CA)is an established treatment for drug-resistant Afib,yet recurrence remains a major concern,impacting quality of life in a significant portion of patients.Inflammation plays a critical role in the recurrence of Afib after ablation,with systemic inflammatory markers such as C-reactive protein being linked to higher recurrence rates.In this editorial,we discuss the study by Wang et al,published in the latest issue,which investigates the predictive role of the systemic immune inflammation index(SII)in Afib recurrence following radiofrequency CA.Elevated pre-ablation SII levels are identified as an independent predictor of recurrence,significantly enhancing the predictive power of the APPLE score.Integration of SII improved the APPLE score’s predictive performance,as shown by enhanced area under the curve,net reclassification improvement,and integrated discrimination improvement.This combined model highlights the importance of both structural and inflammatory factors in Afib recurrence,offering a more personalized approach to patient management.Additionally,the affordability and accessibility of SII enhance its practicality in clinical workflows.The study by Wang et al underscores the potential of integrating SII with existing scoring systems to refine risk stratification and optimize treatment strategies.Future research should validate these findings across diverse populations,explore limitations such as the potential influence of comorbidities on SII reliability,and investigate additional biomarkers to enhance predictive accuracy.展开更多
文摘Lung transplantation(LT)is now an accepted therapy for end stage lung disease in appropriate patients.Atrial arrhythmias(AA)can occur after LT.Early AA after LT are most often atrial fibrillation,whereas late arrhythmias which occur many months or years after LT are often atrial tachycardia.The causes of AA are multifactorial.The review begins with a brief history of LT and AA.This review further describes the pathophysiology of the AA.The risk factors,incidence,recipient characteristics including intra-operative factors are elaborated on.Since there are no clear and specific guidelines on the management of atrial arrhythmia following LT,the recommended guidelines on the management of AA in general are often extrapolated and used in the setting of post LT arrhythmia.The strategy of rate control vs rhythm control is discussed.The pros and cons of various drug regimen,need for direct current cardioversion and catheter ablation therapies are considered.Possible methods to prevent or reduce the incidence of AA after LT are considered.The impact of AA on the short-term and long-term outcomes following LT is discussed.
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.
基金supported by the National Natural Science Foundation of China(No.82170326 and No.82470328 to Y.D.,No.82100339 to Q.D.).
文摘Atrial fibrillation(AF)is a prevalent cardiac arrhythmia with a multifactorial pathophysiology involving electrical,structural,and autonomic remodeling of the atria.AF is closely associated with elevated interleukin-6(IL-6)levels,which contribute to atrial remodeling and the progression of AF.This review summarizes the mechanisms by which IL-6 promotes AF through inflammatory pathways,atrial fibrosis,electrical remodeling,and calcium mishandling.Experimental models have demonstrated that IL-6 neutralization reduces the incidence of AF,highlighting its potential as a therapeutic target.Future studies should focus on IL-6 blockade strategies to manage AF,aiming to improve patient outcomes.
文摘Atrial fibrillation(AF)/atrial flutter(AFL)is the most common sustained cardiac arrhythmia.The known risk factors for developing AF/AFL include age,structural heart disease,hypertension,diabetes mellitus,or hyperthyroidism.This study aims to attribute the trends in AF/AFL-related mortalities over the past two decades 1999-2020 concerning race and sex and disparity among them.To the best of our knowledge,this is the first study that estimates the trends and mortality due to AF/AFL from 1999-2020 in older adults in the United States.In this 21-year analysis of mortality data,we found a constant increase in mortality rates due to AF/AFL in older adults.From 1999 to 2020,the overall mortality in older adults aged 65 and above,regardless of sex and race,is found to be almost doubled i.e.about a 50.2%increase in the number of deaths due to AF/AFL.Furthermore,other confounding risk factors such has obesity,prior myocardial infarction,inflammation,hypertension,birth weight,diabetes mellitus,hyperthyroidism,hormone replacement therapy in menopausal women increases the risk in the occurrence or recurrent occurrence of AF.
文摘Atrial fibrillation(AF)is the most common arrhythmia in clinical setting and has been increasingly prevalent due to the aging population.AF is associated with a three to fivefold increased risk of stroke.Treatment options include pharmacological and electrical cardioversion,each carrying specific risks.AF may resolve spontaneously,but often recurs,making a“watch-andwait”strategy a reasonable approach to avoid unnecessary antiarrhythmic therapy.
文摘Background Using Systematic Assessment of Geriatric Elements in Atrial Fibrillation(SAGE-AF) data, determine how well the rich mix of demographic, clinical history, geriatric assessments, and clinically adjudicated events can predict two-year survival.Methods Subjects were recruited from participating outpatient practices if they had non-valvular AF, were 65 or over with CHA_(2)DS_(2)-VASc scores of at least 2, and were candidates for anticoagulation. Demographics, clinical history, and geriatric qualities of life were assessed by interview and medical records review using standardized protocols and repeated at one and two years. Events identified were abstracted and submitted for adjudication using standard definitions of events and categories. Nonmortality event categories included hospitalizations(cardiovascular, bleeding, other), bleeding(major, clinically relevant non-major, minor), and seven major adverse cardiovascular events.Results The 1245 subjects experienced 1960 events, primarily hospitalizations(935) and/or bleeding(817);114 subjects(9.2%)died during two years of follow-up. Events initially abstracted to more than one category(172) were combined, resulting in 1788unique incidents. Most subjects had zero or one event(69%) and fewer than 7% had more than 3 types. Most variables were significant in bivariate analysis. Using multiple logistic regression with two-year survival as the outcome variable, the best-fit model included event number and type, number of unique incidents, and number of bleeding events(R^(2) = 0.511, C = 93.1) with sensitivity = 97.9% and specificity = 44.7%.Conclusions Two-year survival was high. This model, if validated, could have major implications for treatment of patients with AF. Patients in the large group with no or one event are at very low risk of death(under 2%). The small group with high risk for further complications, including death, deserve reassessment to determine if this trajectory can be altered.
基金supported by grants from NHMRC(Grant No.1125514 and 2029334 to JRM,and 1120129 to JRM and CEH)National Heart Foundation of Australia(Vanguard-105720)+6 种基金the Victorian Government’s Operational Infrastructure Support Programsupported by a joint Baker Heart and Diabetes Institute-La Trobe University doctoral scholarshipsupported by Future Leader Fellowships from the National Heart Foundation of Australia(Grant No.102536 to EJH,102539 to KLW,and 102206 to ALG)supported by an Alice Baker and Eleanor Shaw Fellowship(The Baker Foundation,Australia)supported by a NHMRC Senior Research(Grant No.1078985)Baker Fellowship(The Baker Foundation,Australia)Cardiovascular Research Capacity Program-Research Leadership GrantsCardiovascular Research Capacity Program-Research Leadership Grants(NSW Health)。
文摘Background:Elucidating mechanisms underlying atrial myopathy,which predisposes individuals to atrial fibrillation(AF),will be critical for preventing/treating AF.In a serendipitous discovery,we identified atrial enlargement,fibrosis,and thrombi in mice with reduced phosphoinositide 3-kinase(PI3K)in cardiomyocytes.PI3K(p110a)is elevated in the heart with exercise and is critical for exercise-induced ventricular enlargement and protection,but the role in the atria was unknown.Physical inactivity and extreme endurance exercise can increase AF risk.Therefore,our objective was to investigate whether too little and/or too much PI3K alone induces cardiac pathology.Methods:New cardiomyocyte-specific transgenic mice with increased or decreased PI3K(p110a)activity were generated.Multi-omics was conducted in mouse atrial tissue,and lipidomics in human plasma.Results:Elevated PI3K led to an increase in heart size with preserved/enhanced function.Reduced PI3K led to atrial dysfunction,fibrosis,arrhythmia,increased susceptibility to atrial enlargement and thrombi,and dysregulation of monosialodihexosylganglioside(GM3),a lipid that regulates insulin-like growth factor-1(IGF1)-PI3K signaling.Proteomic profiling identified distinct signatures and signaling networks acrossatria with varying degrees of dysfunction,enlargement,and thrombi,including commonalities with the human AF proteome.PI3K-related lipids were dysregulated in plasma from athletes with AF.Conclusion:PI3K(p110a)is a critical regulator of atrial biology and function in mice.This work provides a proteomic resource of candidates for further validation as potential new drug targets and biomarkers for atrial myopathy.Further investigation of PI3K-related lipids as markers for identifying individuals at risk of AF is warranted.Dysregulation of PI3K may contribute to the association between increased cardiac risk with physical inactivity and extreme endurance exercise.
文摘Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and modalities of the interventions and deciding,where possible,to realize them in a single session.Here we describe the case of a patient affected by severe aortic stenosis and associated cardiac comorbidities(coronary artery disease,atrial fibrillation and left appendage thrombosis)that needed a multimodal clinical and interventional strategy to lead him to the best clinical condition for performing transcatheter aortic valve implantation(TAVI).
基金supported by the National Key Research and Development Program of China(No.2019YFC1712100)the National Natural Science Foundation of China(No.82105017)。
文摘Objective:The occurrence and development of atrial fibrillation(AF)are influenced by the autonomic nervous system and inflammation.Acupuncture is an effective treatment for AF.This study explored the protective effects of acupuncture in a rat model of paroxysmal AF and investigated its mechanisms.Methods:Male Sprague-Dawley rats(n=130)were randomly divided into blank control(Con),sham operation(Sham),AF,and acupuncture treatment(Acu)groups.A paroxysmal AF model was established by rapid atrial pacing through the jugular vein.Rats in the Acu group were immobilized to receive acupuncture treatment at Neiguan acupoint(PC6)for 20 min daily for seven days.The other groups were immobilized for the same duration over the treatment period but did not receive acupuncture.The AF induction rate,AF duration,cardiac electrophysiological parameters,and heart rate variability were evaluated by monitoring surface electrocardiogram and vagus nerve discharge signals.After the intervention,the rats were euthanized,and atrial morphology was assessed using haematoxylin and eosin staining.The expression of macrophage F4/80 antigen(F4/80)and cluster of differentiation(CD)86 in atrial myocardial tissue was detected using immunohistochemistry,immunofluorescence and flow cytometry.The expression levels or contents of interleukin(IL)-1β,IL-6,tumor necrosis factor-a(TNF-a),a7 nicotinic acetylcholine receptor(a7nAChR),phosphorylated Janus kinase 2(p-JAK2),and phosphorylated signal transducer and activator of transcription 3(p-STAT3)in atrial myocardial tissue were detected using Western blotting,reverse transcription-quantitative polymerase chain reaction,or enzyme-linked immunosorbent assay.The role of a7nAChR in acupuncture treatment was verified by intraperitoneal injection of the a7nAChR antagonist methyllycaconitine(MLA).Results:Compared with the AF group,acupuncture significantly reduced AF duration and induction rate,improved cardiac electrophysiology by enhancing vagus nerve activity and regulating autonomic balance.It also decreased the pro-inflammatory M1 macrophage proportion,alleviating myocardial injury and infiltration.MLA weakened acupuncture's electrophysiological improvement and anti-inflammatory effect.Results suggest that acupuncture triggers the a7nAChR-JAK2/STAT3 pathway and exerts cardioprotection via neuroimmune regulation.Conclusion:Acupuncture significantly reduced the AF induction rate,shortened AF duration,improved cardiac electrophysiological parameters,enhanced vagus nerve activity,and decreased the expression of pro-inflammatory M1 macrophages and inflammatory factors in rats with paroxysmal AF.
文摘Introduction: the left atrial appendage, a dormant embryonic vestige, would play a major role in cardiac hemodynamic changes, volume homeostasis and thrombi formation. It, therefore constitutes a therapeutic target. Its morphology is extremely variable. Objective: it consisted on determining the morphological variations of the left auricle as well as their interest in the prevention of thrombi in the Senegalese. Material and Method: This study was conducted by dissecting 36 fresh hearts from Senegalese anatomical subjects with a sampling of the left atrial appendage, including specimens with normal morphological appearance. Their morphology was studied using the fresh and frozen plaster molding method. The data obtained were analyzed statistically. Results: the average age of the subjects was 33 years, with a sex ratio of 1.06, the cauliflower shape was dominant with 57% of cases and the cactus shape (4%) was less frequent. The cauliflower shape presented a clear angulation compared to the others without statistically significant differences according to age. Conclusion: This work showed a great morphological variability of the left atrial appendage. It can provide an update on the specificity of Senegalese. Taking these variations into account is important in the safe management of hemodynamic conditions and the improvement of the management of recurrent strokes.
文摘BACKGROUND Atrial fibrillation(AF)is a prevalent cardiac arrhythmia associated with significant morbidity and mortality,particularly in patients with concomitant renal dysfunction.Anticoagulation therapy reduces the risk of thromboembolic complications in AF but presents challenges in patients with renal impairment due to altered pharmacokinetics and increased bleeding risk.AIM To support clinicians in navigating the complexities of anticoagulation in this high-risk population,ensuring optimal outcomes.METHODS The present review followed PRISMA guidelines.Data extraction was conducted using a standardized template that captured key study characteristics:Population demographics,renal function metrics,anticoagulant dosing strategies,and primary and secondary outcomes.For quality assessment,we employed the Cochrane Risk of Bias 2.0 tool for randomized controlled trials.Observational studies were appraised using the Newcastle-Ottawa Scale.RESULTS We analyze data from 16 studies to provide recommendations on optimal anticoagulation strategies,balancing thrombotic and bleeding risks.Current evidence supports the preferential use of apixaban in moderate chronic kidney disease and cautiously in end-stage renal disease,emphasizing the importance of individualized therapy.CONCLUSION The management of anticoagulation in AF patients with renal dysfunction is challenging but critical for reducing stroke risk.
文摘Background and Objective Hypertension(HT)and atrial fibrillation(AF)are highly prevalent cardiovascular conditions that frequently coexist.Coronary artery disease(CAD)is a major global cause of mortality.The co-occurrence of HT,AF,and CAD presents significant management challenges.This study aims to explore the clinical characteristics and risk factors associated with CAD in patients with HT and persistentAF(HT-AF).Methods In this retrospective cross-sectional study,data were collected from 384 hospitalized HT-AF patients at the People's Liberation Army General Hospital between January 2010 and December 2019.CAD diagnosis was confirmed by coronary angiography or computed tomography angiography.Clinical characteristics and comorbidities were compared between patients with and without CAD.Multivariate logistic regression analyses were performed to identify independent risk factors associated with CAD development.Results The prevalence of CAD among HT-AF patients was 66.41%(255/384).Cardiovascular complications,particularly heart failure(44.7%vs 25.6%,P<0.05),were significantly more prevalent in the CAD group than in the non-CAD group.Only age was identified as an independent risk factor for CAD(adjusted OR:1.047;95%CI:1.022–1.073;P=0.000).Of all HT-AF patients,54.7%had a CHA2DS2-VASc score of≥4,indicating high stroke risk.There was a slightly higher anticoagulant usage rate in the CAD group than those without CAD(8.6%vs 4.7%,P=0.157),and the overall anticoagulant usage remained low.Conclusion There is a high prevalence of CAD among hospitalized HT-AF patients,among whom age is the sole independent risk factor for CAD.Despite a high stroke risk,the utilization of oral anticoagulants is alarmingly low.
文摘Voltage substrate mapping is a promising tool for the treatment of atrial fibrillation(AF).It is helpful to detect atrial fibrosis,which includes areas with low bipolar voltage,heterogeneous conduction properties,and shortened effective refractory period.The voltage amplitude is typically defined as the maximal peakto-peak level within a specified time window of interest.Contemporary electroanatomic mapping platforms now enable many thousands of data points to be mapped,so that a geometric model of the atrial endocardium is constructable over a short period of time.This mapping procedure is often done with bipolar electrodes to cancel the far-field signal.The recording site coordinates are projected onto an atrial shell,with interpolation of the voltage data across the shell surface.The amplitude of the recorded bipolar electrogram depicted on the threedimensional shell provides detailed information for substrate mapping.Wherever there are areas of low peak-to-peak voltage,it is thought to mark the presence of abnormal tissue properties and conduction.However,uncontrolled variables and environmental factors affecting voltage level include the oncoming electrical activation wavefront direction,the catheter incidence angle,the force applied to the catheter,and the region-variable shape and structure of atrial tissue.Techniques and settings to acquire atrial voltage data for AF analysis have not been standardized.Methods to characterize atrial electrograms are also presently limited.These factors affect quality and reproducibility of the mapping results.Herein,voltage substrate mapping and its variables pertaining to AF and radiofrequency ablation are described and discussed,with suggestions for future work efforts.
文摘BACKGROUND Atrial fibrillation(AF)associated with chronic kidney disease(CKD)is a prevalent condition in the United States,significantly impacting global morbidity and mortality.Understanding temporal patterns in AF-related mortality among CKD patients is crucial for effective clinical and public health strategies.AIM To investigate AF-CKD comorbidity and mortality on the national level.METHODS Death certificates from the Centers for Disease Control Wide-Ranging Online Data for Epidemiologic Research database spanning 2011-2020 were analyzed to investigate AF-related CKD mortality in adults aged 35 to 85 or more years.Age-adjusted mortality rates(AAMRs)per 100000 persons and annual percent change(APC)were calculated,stratified by year,sex,race/ethnicity,and geographic region.RESULTS A total of 110733 deaths occurred among adults(aged 35-85 or more years)related to AF associated with CKD in the United States.Overall AAMR declined from 8.1 in 2011 to 5.5 in 2014(APC:-14.89;95%confidence interval(CI):-30.44 to-4.06),followed by an increase to 10.3 in 2020(APC:9.91;95%CI:6.1-19.62).Men had higher AAMRs than women(men:7.6,95%CI:7.6-7.7).Non-Hispanic White adults had the highest AAMR(7.8),followed by non-Hispanic Black(5).States in the top 90th percentile had approximately four times higher AAMRs than those in the lower 10th percentile.AAMR also varied by region(Midwest:7.6,West:6.7,Northeast:6.3,South:5.6),with nonmetropolitan areas exhibiting higher AF-associated CKD mortality.CONCLUSION Temporal trends in AF-related mortality among CKD patients showed fluctuations over the study period,with notable disparities across demographic and geographic factors.Targeted interventions are warranted to mitigate the burden of AF associated with CKD and reduce mortality rates in the United States.
文摘BACKGROUND The Perceval Sorin S(perceval valve)is a sutureless bioprosthetic designed for use in a high-risk cohort who may not be suitable for transcatheter aortic valve implantation or a conventional surgical aortic valve replacement(AVR).AIM To compare five-year post-operative outcomes in a cohort undergoing isolated AVR with the perceval valve to a contemporary cohort undergoing surgical AVR with a sutured bioprosthesis.METHODS This study was a retrospective,cohort study at a single tertiary unit.Between 2017 and 2023,982 suitable patients were identified.174 Perceval valve replacements were matched to 174 sutured valve replacements.Cohort characteristics,intra-operative details,and post-operative outcomes were compared between the two groups.RESULTS Time under the aortic cross-clamp(P<0.001),time on the cardiopulmonary bypass(P<0.001)and total operative time(P<0.001)were significantly reduced in the Perceval group.Patients in the Perceval valve group were at a lower risk of postoperative pneumonia[odds ratio(OR)=0.53(0.29-0.94)]and atrial fibrillation[OR=0.58(0.36-0.93)].After propensity-matching,all-cause mortality did not significantly differ between the two groups in the five-year follow-up period.Larger valve sizes conferred an increased risk of mortality(P=0.020).CONCLUSION Sutureless surgical AVR(SAVR)is a safe and efficient alternative to SAVR with a sutured bioprosthesis,and may confer a reduced risk of post-operative atrial fibrillation.Clinician tendency towards‘oversizing’sutureless aortic valves translates into adverse clinical outcomes.Less time on the cardiopulmonary bypass circuit allows for the treatment of otherwise high-risk patients.
文摘Anticoagulation has long been the standard of care for preventing embolic events in atrial fibrillation(AF).^([1])The elderly AF generation is more susceptible to thromboembolic incidents.They are also more likely to encounter hemorrhagic and other complications when using anticoagulants.Therefore,percutaneous left atrial appendage occlusion(pLAAO)is regarded as an appealing alternative therapy for preventing stroke in patients who are poor candidates for long-term anticoagulation.^([2,3])Contemporary patients undergoing pLAAO are typically older and have more comorbidities than those who were enrolled in pivotal randomized controlled trials.
文摘Atrial fibrillation(AF)is a growing global health burden,with a prevalence of over 52.55 million cases.Rising disability-adjusted life-years,increasing age,and disparities in care have contributed to the worsening severity and mortality of AF.Modifiable risk factors,such as hypertension,obesity,and diabetes mellitus,are associated with alterations in gut microbiota,making the gut-heart axis a potential therapeutic target.Gut dysbiosis influences AF pathogenesis through inflam-mation,metabolic disruption,and autonomic dysfunction.Key mechanisms include gut barrier dysfunction,short-chain fatty acid(SCFA)depletion,lipopoly-saccharides(LPS)-induced inflammation,and ferroptosis-mediated atrial remodeling.Trimethylamine N-oxide,bile acids,and tryptophan metabolites contribute to arrhythmogenic remodeling.Emerging evidence suggests that dietary interventions,including prebiotics and probiotics,as well as gut surveillance,may help mitigate AF progression.Clinical implications of gut modulation in AF include person-alized dietary strategies,microbiome assessment through metagenomic sequencing,and targeted interventions such as SCFA-based therapies and ferroptosis inhibition.Metabolite surveillance,including LPS and indoxyl sulfate monitoring,may influence the effectiveness of anticoagulant and antiarrhythmic therapy.Despite growing mechanistic evidence linking gut dysbiosis to AF,clinical applications remain unexplored.This review summarizes the current understanding of the gut microbiome's role in AF.
基金supported by the National Natural Science Foundation of China(82271725).
文摘Congenital atrial septal defect(ASD)with severe scoliosis is a rare compound malformation inchildren.Severe sco liosis should be corrected as soon as possible.The growth rod is suitable for patients withearly scoliosis and obvious scoliosis under 10 years old.However,the fluoroscopic radiopaque of titaniumalloy plate will inevitably partly make the operative field of interventional occlusion blind.We presenta7-year-old Chinese girl with ASD and scoliosis who underwent spinal correction with a dual-growthrod.In this case,we performed transcatheter closure of ASD solely under the guidance of transthoracicechocardiography.Transthoracic echocardiography(TTE)has been reported as efficacious and safe forassessment and guidance of ASD occlusion.For patients with visual field occlusion under fluoroscopy,theapplication of TTE is efficacious and safe for assessmnent and guidance of ASD occlusion.
文摘Background:Non-valvular atrial fibrillation(NVAF),the most prevalent cardiac arrhythmia globally,poses a dual challenge of thromboembolic and bleeding risks,with stroke being the most devastating complication.Despite advancements in anticoagulation and rhythm control,patient outcomes remain suboptimal.Aim:This review synthesizes current evidence on the pathophysiological mechanisms,multidimensional management strategies,and emerging innovations in NVAF to inform clinical practice and future research directions.Methods:A systematic literature search was conducted across nine databases(CNKI,Wanfang,SinoMed,VIP,PubMed,Web of Science,Cochrane Library,Embase,and MEDLINE)using combined Medical Subject Headings(MeSH)and free-text terms,including“atrial fibrillation,”“non-valvular atrial fibrillation,”“risk factors,”and“mechanism”(and their Chinese equivalents).Studies on NVAF pathogenesis,therapeutic interventions,and risk stratification tools were analyzed.Results:(1)Risk Factors and Pathophysiology:NVAF progression is driven by hemodynamic stress(e.g.,hypertension),metabolic disorders(e.g.,obesity,diabetes),chronic inflammation,and fibrosis.Biomarkers such as CRP and Galectin-3,along with TGF-β/Smad signaling,are central to atrial remodeling.(2)Anticoagulation Controversies:While NOACs reduce stroke risk compared to warfarin(HR=0.79),challenges persist in extreme body weight populations and drug-drug interactions(e.g.,with P-glycoprotein inhibitors).(3)Left Atrial Appendage Closure(LAAC):LAAC demonstrates non-inferiority to anticoagulation in stroke prevention(HR=0.79)with reduced major bleeding(HR=0.49),though device-related thrombosis(1.8–7%)remains a concern.(4)Precision Medicine:AI-driven models enhance stroke prediction(AUC=0.71;sensitivity 92%),while genotype-guided warfarin dosing shortens INR stabilization by 40%.(5)Lifestyle Interventions:Combined Mediterranean diet and moderate exercise reduce AF burden(HR=0.69)and reverse left atrial enlargement(LAVI reduced by 12%).(6)Multidisciplinary Care:Integrated“heart-brain team”approaches combining LAAC and PFO closure lower annual stroke recurrence from 8.2%to 2.1%,while comprehensive rehabilitation improves functional capacity(6MWD+45 m)and quality of life(SF-36+12 points).Conclusion:NVAF management has evolved from isolated anticoagulation to a multidimensional paradigm integrating genomics,AI,and lifestyle modification.Future priorities include validating long-term outcomes of novel therapies,addressing evidence gaps in special populations,and implementing digitally enabled,cross-disciplinary care models to mitigate the global burden of NVAF-related complications.
文摘Atrial fibrillation(Afib)is a common arrhythmia with significant public health implications,affecting millions of individuals worldwide.Catheter ablation(CA)is an established treatment for drug-resistant Afib,yet recurrence remains a major concern,impacting quality of life in a significant portion of patients.Inflammation plays a critical role in the recurrence of Afib after ablation,with systemic inflammatory markers such as C-reactive protein being linked to higher recurrence rates.In this editorial,we discuss the study by Wang et al,published in the latest issue,which investigates the predictive role of the systemic immune inflammation index(SII)in Afib recurrence following radiofrequency CA.Elevated pre-ablation SII levels are identified as an independent predictor of recurrence,significantly enhancing the predictive power of the APPLE score.Integration of SII improved the APPLE score’s predictive performance,as shown by enhanced area under the curve,net reclassification improvement,and integrated discrimination improvement.This combined model highlights the importance of both structural and inflammatory factors in Afib recurrence,offering a more personalized approach to patient management.Additionally,the affordability and accessibility of SII enhance its practicality in clinical workflows.The study by Wang et al underscores the potential of integrating SII with existing scoring systems to refine risk stratification and optimize treatment strategies.Future research should validate these findings across diverse populations,explore limitations such as the potential influence of comorbidities on SII reliability,and investigate additional biomarkers to enhance predictive accuracy.
