Background Clinical observations have shown that the complex fractionated atrial electrogram （CFAE） associates with ganglionated plexus activity in the cardiac autonomic nervous system. This study aimed to investiga...Background Clinical observations have shown that the complex fractionated atrial electrogram （CFAE） associates with ganglionated plexus activity in the cardiac autonomic nervous system. This study aimed to investigate the impact of CFAE ablation on vagal modulation to atria and vulnerability to develop atrial fibrillation （AF）. Methods Ten adult mongrel dogs were involved. Cervical sympathovagal trunks were decentralized and sympathetic effects were blocked. CFAE was color tagged on the atrial 3-dimensional image and ablated during AF induced by S1S2 programmed stimulation plus sympathovagal trunk stimulation. Atrial effective refractory period （ERP） and vulnerability window （VW） of AF were measured on baseline and at vagal stimulation at 4 atrium sites. Serial tissue sections from ablative and control specimens received hematoxylin and eosin staining for microscopic examination. Results Most CFAE areas were localized at the right superior pulmonary quadrant, distal coronary sinus （CS~） quadrant, and proximal coronary sinus （CSp） quadrant （21.74%, separately）. Sinus rhythm cycle length （SCL） shortening did not decrease significantly after ablation at the sites, including right atrial appendage, left atrial appendage, CSd, and CSp （P 〉0.05）. ERP shortening during vagal stimulation significantly decreased after ablation （P 〈0.01）; the VW to vagal stimulation significantly decreased after ablation （P 〈0.05）. The architecture of individual ganglia altered after ablation. Conclusions CFAE has an autonomic basis in dogs. The decreased SCL and ERP shortening to vagal stimulation after CFAE ablation demonstrate that CFAE ablation attenuates vagal modulation to the atria, thereby suppressing AF mediated by enhanced vagal activity. CFAE ablation could suppress AF mediated by enhanced vagal activity.展开更多
Background Ablation of complex fractionated atrial electrograms （CFAE） is an important adjunctive therapy in atrial fibrillation （AF）. The present study was to elucidate the substrate underlying CFAE. Methods Nine...Background Ablation of complex fractionated atrial electrograms （CFAE） is an important adjunctive therapy in atrial fibrillation （AF）. The present study was to elucidate the substrate underlying CFAE. Methods Nine adult mongrel dogs were involved in the present study. AF was induced through rapid atrial pacing with vagosympathetic nerve stimulation, CFAE was recorded during AF. Ablation was performed at CFAE sites. Based on the location of the ablation scar, the atrial specimens were divided into CFAE and non-CFAE sites. Serial sections of the atrium were stained respectively with hematoxylin-eosin （HE） and the general neural marker protein gene product 9.5 （PGP9.5）. We compared the characteristics of the myocardium and the ganglionated plexus （GPs） distribution between the CFAE and non-CFAE sites. Results The myocardium of non-CFAE sites was well-organized with little intercellular substance. However, the myocardium in the CFAE site was disorganized with more interstitial tissue （（61.7±24,3）% vs, （34.1±9,2）%, P 〈0,01 ）, G Ps in the CFAE site were more abundant than in non-CFAE sites （（34.45±37.46） bundles/cm2 vs, （6.73± 8.22） bundles/cm2, P〈0.01）. Conclusion The heterogeneity Of the myocardium and GPs distribution may account for the substrate of CFAE and serve as a potential target of ablation.展开更多
Areas with high frequency activity within the atrium are thought to be 'drivers' of the rhythm in patients with atrial fibrillation (AF) and ablation of these areas seems to be an effective therapy in e-limina...Areas with high frequency activity within the atrium are thought to be 'drivers' of the rhythm in patients with atrial fibrillation (AF) and ablation of these areas seems to be an effective therapy in e-liminating DF gradient and restoring sinus rhythm. Clinical groups have applied the traditional FFT-based approach to generate the three-dimensional dominant frequency (3D DF) maps during electro-physiology (EP) procedures but literature is restricted on using alternative spectral estimation tech-niques that can have a better frequency resolution that FFT-based spectral estimation.展开更多
Objective: Assess the location effect of the atrial electrogram in the PICC catheter tip. Method: Make online research in the CNKI, CBM, Wanfang, VIP, Database, Cochrane Library, JBI Library, PubMed, Ovid, Springer, W...Objective: Assess the location effect of the atrial electrogram in the PICC catheter tip. Method: Make online research in the CNKI, CBM, Wanfang, VIP, Database, Cochrane Library, JBI Library, PubMed, Ovid, Springer, Web of science, MEDLINE database to collect the randomized controlled trial data of using the atrial electrogram to locate the PICC catheter tip. When making the online research, only the data to November 20, 2016 can be searched out. Two researchers independently select the literature and information, make quality assessment, and then use the RevMan 5.2 software to make Meta analysis. Result: 16 random tests are done. The Meta analysis results show that compared with the traditional X ray chest radiograph location method, the atrial electrogram can increase the accuracy rate of the location of the catheter tip [RR = 1.13, 95%CI (1.07, 1.19), P −12.56, 95%CI (−18.56, −6.57), P Conclusion: The atrial electrogram can increase the accuracy rate of the location of the catheter tip, decrease the incidence rate of related complications and save the catheter placing time. Therefore, it is worthy of clinical application.展开更多
目的评价心房内心电图在PICC导管头端定位中的应用效果。方法计算机检索中国期刊全文数据库、中国生物医学文献服务系统、万方、维普数据库、Cochrane Library、JBI Library、PubMed、Ovid、Springer、Web of Science、Medline数据库,...目的评价心房内心电图在PICC导管头端定位中的应用效果。方法计算机检索中国期刊全文数据库、中国生物医学文献服务系统、万方、维普数据库、Cochrane Library、JBI Library、PubMed、Ovid、Springer、Web of Science、Medline数据库,收集应用心房内心电图定位PICC导管头端位置的随机对照试验,数据库检索时限均为建库至2016年11月20日。由2名研究者按照纳入和排除标准独立筛选文献、提取资料和质量评价后,使用Rev Man 5.2进行Meta分析。结果共纳入16项随机对照试验。Meta分析结果显示,心房内心电图定位法较传统X线胸片定位提高了导管头端到位准确率(RR=1.13,95%CI:1.07~1.19,P<0.01);降低了相关并发症的发生率(RR=0.41,95%CI:0.30~0.55,P<0.01)。结论心房内心电图定位可提高导管头端到位准确率且降低了相关并发症的发生率,值得临床推广应用。展开更多
基金This study was supported by the grants from National Natural Science Foundation of China （No. 30770866, 30971272）.
文摘Background Clinical observations have shown that the complex fractionated atrial electrogram （CFAE） associates with ganglionated plexus activity in the cardiac autonomic nervous system. This study aimed to investigate the impact of CFAE ablation on vagal modulation to atria and vulnerability to develop atrial fibrillation （AF）. Methods Ten adult mongrel dogs were involved. Cervical sympathovagal trunks were decentralized and sympathetic effects were blocked. CFAE was color tagged on the atrial 3-dimensional image and ablated during AF induced by S1S2 programmed stimulation plus sympathovagal trunk stimulation. Atrial effective refractory period （ERP） and vulnerability window （VW） of AF were measured on baseline and at vagal stimulation at 4 atrium sites. Serial tissue sections from ablative and control specimens received hematoxylin and eosin staining for microscopic examination. Results Most CFAE areas were localized at the right superior pulmonary quadrant, distal coronary sinus （CS~） quadrant, and proximal coronary sinus （CSp） quadrant （21.74%, separately）. Sinus rhythm cycle length （SCL） shortening did not decrease significantly after ablation at the sites, including right atrial appendage, left atrial appendage, CSd, and CSp （P 〉0.05）. ERP shortening during vagal stimulation significantly decreased after ablation （P 〈0.01）; the VW to vagal stimulation significantly decreased after ablation （P 〈0.05）. The architecture of individual ganglia altered after ablation. Conclusions CFAE has an autonomic basis in dogs. The decreased SCL and ERP shortening to vagal stimulation after CFAE ablation demonstrate that CFAE ablation attenuates vagal modulation to the atria, thereby suppressing AF mediated by enhanced vagal activity. CFAE ablation could suppress AF mediated by enhanced vagal activity.
基金The study was supported by a grant from the National Natural Science Foundation of China （NSFC） （No. 30971272）.
文摘Background Ablation of complex fractionated atrial electrograms （CFAE） is an important adjunctive therapy in atrial fibrillation （AF）. The present study was to elucidate the substrate underlying CFAE. Methods Nine adult mongrel dogs were involved in the present study. AF was induced through rapid atrial pacing with vagosympathetic nerve stimulation, CFAE was recorded during AF. Ablation was performed at CFAE sites. Based on the location of the ablation scar, the atrial specimens were divided into CFAE and non-CFAE sites. Serial sections of the atrium were stained respectively with hematoxylin-eosin （HE） and the general neural marker protein gene product 9.5 （PGP9.5）. We compared the characteristics of the myocardium and the ganglionated plexus （GPs） distribution between the CFAE and non-CFAE sites. Results The myocardium of non-CFAE sites was well-organized with little intercellular substance. However, the myocardium in the CFAE site was disorganized with more interstitial tissue （（61.7±24,3）% vs, （34.1±9,2）%, P 〈0,01 ）, G Ps in the CFAE site were more abundant than in non-CFAE sites （（34.45±37.46） bundles/cm2 vs, （6.73± 8.22） bundles/cm2, P〈0.01）. Conclusion The heterogeneity Of the myocardium and GPs distribution may account for the substrate of CFAE and serve as a potential target of ablation.
文摘Areas with high frequency activity within the atrium are thought to be 'drivers' of the rhythm in patients with atrial fibrillation (AF) and ablation of these areas seems to be an effective therapy in e-liminating DF gradient and restoring sinus rhythm. Clinical groups have applied the traditional FFT-based approach to generate the three-dimensional dominant frequency (3D DF) maps during electro-physiology (EP) procedures but literature is restricted on using alternative spectral estimation tech-niques that can have a better frequency resolution that FFT-based spectral estimation.
文摘Objective: Assess the location effect of the atrial electrogram in the PICC catheter tip. Method: Make online research in the CNKI, CBM, Wanfang, VIP, Database, Cochrane Library, JBI Library, PubMed, Ovid, Springer, Web of science, MEDLINE database to collect the randomized controlled trial data of using the atrial electrogram to locate the PICC catheter tip. When making the online research, only the data to November 20, 2016 can be searched out. Two researchers independently select the literature and information, make quality assessment, and then use the RevMan 5.2 software to make Meta analysis. Result: 16 random tests are done. The Meta analysis results show that compared with the traditional X ray chest radiograph location method, the atrial electrogram can increase the accuracy rate of the location of the catheter tip [RR = 1.13, 95%CI (1.07, 1.19), P −12.56, 95%CI (−18.56, −6.57), P Conclusion: The atrial electrogram can increase the accuracy rate of the location of the catheter tip, decrease the incidence rate of related complications and save the catheter placing time. Therefore, it is worthy of clinical application.
文摘目的评价心房内心电图在PICC导管头端定位中的应用效果。方法计算机检索中国期刊全文数据库、中国生物医学文献服务系统、万方、维普数据库、Cochrane Library、JBI Library、PubMed、Ovid、Springer、Web of Science、Medline数据库,收集应用心房内心电图定位PICC导管头端位置的随机对照试验,数据库检索时限均为建库至2016年11月20日。由2名研究者按照纳入和排除标准独立筛选文献、提取资料和质量评价后,使用Rev Man 5.2进行Meta分析。结果共纳入16项随机对照试验。Meta分析结果显示,心房内心电图定位法较传统X线胸片定位提高了导管头端到位准确率(RR=1.13,95%CI:1.07~1.19,P<0.01);降低了相关并发症的发生率(RR=0.41,95%CI:0.30~0.55,P<0.01)。结论心房内心电图定位可提高导管头端到位准确率且降低了相关并发症的发生率,值得临床推广应用。
