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
Objective:Thrombosis in patients with atrial arrhythmias might be associated with remodeling of the left atrium(LA).We aimed to describe this relationship and identify a novel factor,in addition to the CHA_(2)DS_(2)-V...Objective:Thrombosis in patients with atrial arrhythmias might be associated with remodeling of the left atrium(LA).We aimed to describe this relationship and identify a novel factor,in addition to the CHA_(2)DS_(2)-VASc score,to guide therapeutic strategies for preventing thromboembolism in the hope of improving the prognosis for such patients.Methods:Patients diagnosed with atrial arrhythmias and who met our inclusion criteria were enrolled in this study.Various clinical parameters were recorded;diameters reflecting remodeling of the LA were measured and thrombosis was diagnosed by enhanced CT.Results:Totally,192 patients were enrolled in the study.The overall prevalence of left atrial thrombosis was 8.3%.Patients with persistent atrial fibrillation exhibited the highest anteroposterior diameter of the LA(45.1±7.2 mm)and prevalence of thrombosis(15.6%).An anteroposterior LA diameter of≥50 mm was a strong independent impact risk factor for thrombosis(OR=10.1,95%CI:2.8-36.9,P<0.OO1).The prevalence of LA thrombosis in patients with and without anteroposterior LA diameter of≥50 mm was 25.8%and 5.0%,respectively.Conclusion:Marked remodeling of the LA characterized by an anteroposterior LA diameter of≥50 mm is a strong independent risk factor of thrombosis,and should be considered for the prevention of thromboembolism through various strategies.展开更多
Background Recurrent atrial arrhythmia is very common in patients after mitral valve surgery plus mini-maze procedure.Investigation about the mechanism for these patients may have important implication to improve the ...Background Recurrent atrial arrhythmia is very common in patients after mitral valve surgery plus mini-maze procedure.Investigation about the mechanism for these patients may have important implication to improve the surgery strategy.Methods Mini-maze procedure was defined as follow:Pulmonary vein encircling incision and roof line connecting the two circles lesion,left atrial isthmus lesion,and the right atrial isthmus lesion.There were 517 patients with rheumatic valvular disease and pre-operative atrial fibrillation(AF)undergoing valve surgery plus mini-maze procedure in our hospital in the last 3 years,and 93 patients(18%)had recurrent atrial arrhythmia.Twelve patients(6 males and 6 females,mean age 53.8±7.8 ys)underwent electrophysiological study using 3-D mapping system(10 pts)or conventional mapping method(2 pts).Results The first recurrent time from surgery was 4.4±2.2 months.The mean follow-up time after catheter ablation was(12.0±6.0)months.One patient with sinus bradycardia had recurrent incessant atrial tachycardia(AT),but the AT was terminated by catheter position and never could be induced any more.She underwent a repeat procedure but failed just as the course in the first time,and was treated with DDDR pacemaker plus amiodarone.Six patients had 10 kinds of stable AT,including 5 at right atrial isthmus,2 at roof line,1 related to right atrial incision,1 at anterior wall of left atrial,and 1 related to left superior pulmonary vene.All the stable AT were eliminated and remained sinus rhythm.Three patients had ATs with variable cycle length and the 3-D mapping suggested macro-reentry AT around mitral annulus.We tried to ablate at routine mitral isthmus and also in coronary sinus,but could not reach bi-directional conduction blocking.The other 2 patients were AF with reconnection at all previous ablation sites.Ablation strategy for AF included lesion at re-conduction sites and complex fractionated atrial electrogram.The patients with AF and mitral isthmus related AT were administrated with DC cardioversion and then took amiodarone.One AT and one AF recurred.Conclusions The recurrent atrial arrhythmia after mini-maze mostly related to reconnection at previous lesion sites and catheter ablation for AT could have a high success rate.It would be very hard to block mitral isthmus after valve replacement,so transmural lesion during surgery procedure is the most important strategy for preventing postoperative atrial arrhythmia.展开更多
Coronary-pulmonary artery fistula(CPAF)is a relatively rare type of congenital coronary artery variation,which is mostly asymptomatic and is discovered incidentally by coronary artery CT imaging or angiography.However...Coronary-pulmonary artery fistula(CPAF)is a relatively rare type of congenital coronary artery variation,which is mostly asymptomatic and is discovered incidentally by coronary artery CT imaging or angiography.However,CPAF can cause a phenomenon of inter-artery steal and hemodynamic disorders,leading to myocardial ischemia,arrhythmia,heart failure,syncope and even cardiac sudden death in severe cases.Here we reported a case of a 53-year-old female who complained of intermittent palpitations and had a history of paroxysmal atrial fibrillation.The coronary angiography revealed bilateral coronary artery fistulae to pulmonary artery.In this case,the multiple fistulas were very rare and significant.Multidisciplinary treatment should be considered,including cardiologists,surgeons,anesthesiologists and nurses,etc.Regular follow-up is essential for long-term disease management after diagnosis or surgery.展开更多
Atrial arrhythmia is common in clinic. Recently, it was revealed that ectopicimpulses originating in sleeve muscles around the orifices of pulmonary veins (PVs) were deemed tobe one of the most important reasons that ...Atrial arrhythmia is common in clinic. Recently, it was revealed that ectopicimpulses originating in sleeve muscles around the orifices of pulmonary veins (PVs) were deemed tobe one of the most important reasons that trigger or drive atrial arrhythmia, which was calledmyocardial sleeve related arrhythmia. Electrical isolation by radiofrequency ablation is becominghighlight and proved to be an effective method for the arrhythmia. We report a 55-year-old man withparoxysmal atrial tachy-arrhythmias admitted for PV electrical isolation. An abscess was discoveredin right inferior lung before the operation. The arrhythmia was disappeared after resection of theabscess. It implies that for such sufferer and recidivist after ablation, the factors outside thepulmonary veins should be excluded or treated as far as possible, especially before radiofrequencyablation therapy.展开更多
Atrial fibrillation is the most common arrhythmia affecting patients today. Disease prevalence is increasing at an alarming rate worldwide, and is associated with often catastrophic and costly consequences, including ...Atrial fibrillation is the most common arrhythmia affecting patients today. Disease prevalence is increasing at an alarming rate worldwide, and is associated with often catastrophic and costly consequences, including heart failure, syncope, dementia, and stroke. Therapies including anticoagulants, anti-arrhythmic medications, devices, and non-pharmacologic procedures in the last 30 years have improved patients＂ functionality with the disease. Nonetheless, it remains imperative that further research into AF epidemiology, genetics, detection, and treatments continues to push forward rapidly as the worldwide population ages dramatically over the next 20 years.展开更多
In Traditional Chinese Medicine,stimulation of the Neiguan spot has been utilized to treat palpitations and symptoms related to different cardiovascular diseases.We evaluated whether acupuncture might exert an antiarr...In Traditional Chinese Medicine,stimulation of the Neiguan spot has been utilized to treat palpitations and symptoms related to different cardiovascular diseases.We evaluated whether acupuncture might exert an antiarrhythmic effect on patients with paroxysmal or persistent atrial fibrillation(AF).Two sets of data are reviewed.The first included patients with persistent AF who underwent electrical cardioversion to restore sinus rhythm.The second included patients with symptomatic paroxysmal AF.All subjects had normal ventricular function.Acupuncture treatment consisted of 10 acupuncture sessions on a once a week basis with puncturing of the Neiguan,Shenmen and Xinshu spots.In patients with persistent AF,the recurrence rate after acupuncture treatment was similar to that observed in patients on amiodarone,but significantly smaller than that measured after sham acupuncture treatment or in the absence of any antiarrhythmic drugs.In a small group of patients with paroxysmal AF,acupuncture resulted in a significant reduction in the number and duration of symptomatic AF episodes.In conclusion,we observed that acupuncture of the Neiguan spot was associated with an antiarrhythmic effect,which was evident in patients with both persistent and paroxysmal AF.These preliminary data,observed in 2 small groups of AF patients,need to be validated in a larger population but strongly suggest that acupuncture may be an effective non-invasive and safe antiarrhythmic tool in the management of these patients.展开更多
The incorporation of biomarkers in the actually used risk scores seem to be helpful for early identifying atrial fibrillation(AF)patients at higher risk.The aim of this critical review of the scientific literature is ...The incorporation of biomarkers in the actually used risk scores seem to be helpful for early identifying atrial fibrillation(AF)patients at higher risk.The aim of this critical review of the scientific literature is to investigate the potential clinical significance of red blood cell distribution width(RDW)in AF.A systematic electronic search was carried out to identify all articles describing an epidemiological association between RDW and AF in adult human populations.Data abstraction was conducted on a final number of 35 articles(13 crosssectional,12 prospective and 10 retrospective studies).The results of these epidemiological investigations were all virtually concordant to emphasize that an enhanced RDW value is not only a predictive factor and a marker of AF but its measurement may also be helpful for predicting the risk of developing many adverse complications in patients with AF,such as recurrence and duration of AF,hospitalization for heart failure,bleeding,left atrial thrombosis and stasis,thromboembolic events and mortality.AF patients with RDW values exceeding the local reference range may be more aggressively investigated and managed,in order to identify and attenuate the impact of possible underlying disorders causing both anisocytosis and AF.展开更多
Objectives To assess and synthesize the prospective cohort studies published so far on the association between atrial fibrillation (AF) and dementia incidence.Methods We searched PubMed,Web of Science,and the Cochrane...Objectives To assess and synthesize the prospective cohort studies published so far on the association between atrial fibrillation (AF) and dementia incidence.Methods We searched PubMed,Web of Science,and the Cochrane Library for potential studies published in English previous to April 2018.Two independent reviewers screened the search results for prospective cohort studies reporting the association between AF and dementia incidence in patients with normal cognitive function at baseline and not suffering from an acute stroke.The Newcastle-Ottawa Scale was adopted to evaluate the quality of the included studies.The pooled hazard ratio (HR) of AF for dementia was calculated with the Comprehensive Meta-Analysis software,version 2.Heterogeneity and publication bias were assessed with the I2 test and funnel plot,respectively.Results We finally identified 11 prospective cohort studies covering 112,876 patients.All the included studies reported an adjusted HR obtained in multiple Cox regression models.The qualities of the included studies ranged from moderate to high.In pooled analysis with a fixed-effects model,AF was independently associated with dementia incidence (HR = 1.34,95% CI: 1.24–1.44).Subgroup analysis of studies considering anticoagulation as an important confounding factor achieved a similar result.Based on the I2 test and funnel plot,we did not detect obvious heterogeneity and publication bias in our study.Meta-regression on age did not find significant results.Conclusions The results of our meta-analysis further confirmed that AF was an independent risk factor for dementia in patients with normal baseline cognitive function not suffering from acute stroke.Screening for dementia in AF patients and including dementia as an independent outcome in large AF treatment trials is warranted.展开更多
Interactions between the functioning of the heart and the liver have been described, with heart diseases affecting the liver, liver diseases affecting the heart, and conditions that simultaneously affect both. The hea...Interactions between the functioning of the heart and the liver have been described, with heart diseases affecting the liver, liver diseases affecting the heart, and conditions that simultaneously affect both. The heart is one of the most adversely affected organs in patients with liver cirrhosis. For example, arrhythmias and electrocardiographic changes are observed in patients with liver cirrhosis. The risk for arrhythmia is influenced by factors such as cirrhotic cardiomyopathy, cardiac ion channel remodeling, electrolyte imbalances,impaired autonomic function, hepatorenal syndrome, metabolic abnormalities, advanced age, inflammatory syndrome, stressful events, impaired drug metabolism and comorbidities. Close monitoring of cirrhotic patients is needed for arrhythmias, particularly when QT intervalprolonging drugs are given, or if electrolyte imbalances or hepatorenal syndrome appear. Arrhythmia risk may persist after liver transplantation due to possible QT interval prolongation, persistence of the parasympathetic impairment, post-transplant reperfusion and chronic immunosuppression, as well as consideration of the fact that the transplant itself is a stressful event for the cardiovascular system. The aims of the present article were to provide a review of the most important data regarding the epidemiology, pathophysiology, and biomarkers of arrhythmia risk in patients with liver cirrhosis, to elucidate the association with long-term outcome, and to propose future research directions.展开更多
AIM: To evaluate the effectiveness of two different strategies using radiofrequency catheter ablation for redo procedures after cryoablation of atrial fibrillation.METHODS: Thirty patients(paroxysmal atrial fibrillati...AIM: To evaluate the effectiveness of two different strategies using radiofrequency catheter ablation for redo procedures after cryoablation of atrial fibrillation.METHODS: Thirty patients(paroxysmal atrial fibrillation: 22 patients,persistent atrial fibrillation: 8 patients) had to undergo a redo procedure after initially successful circumferential pulmonary vein(PV) isolation with the cryoballoon technique(Arctic Front Balloon,CryoCath Technologies/Medtronic).The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy(CARTO;Biosense Webster) depending on the intra-procedural findings.After discharge,patients were scheduled for repeated visits at the arrhythmia clinic.A 7-day Holter monitoring was performed at 3,12 and 24 mo after the ablation procedure.RESULTS: During the redo procedure,a mean number of 2.9 re-conducting pulmonary veins(SD ± 1.0 PVs) were detected(using a circular mapping catheter).In 20 patients,a segmental approach was sufficient to eliminate the residual pulmonary vein conduction because there were only a few recovered pulmonary vein fibres.In the remaining 10 patients,a circumferential ablation strategy was used because of a complete recovery of the PV-LA conduction.All recovered pulmonary veins could be isolated successfully again.At 2-year follow-up,73.3% of all patients were free from an arrhythmia recurrence(22/30).There were no major complications.CONCLUSION: In patients with an initial circumferential pulmonary vein isolation using the cryoballoon technique,a repeat ablation procedure can be performed safely and effectively using radiofrequency catheter ablation.展开更多
Atrial fibrillation is the most common cardiac arrhythmia and is a major risk factor for stroke, heart failure, and death. Current treatments focus on anti-coagulation as well as rate-control and rhythm-control strate...Atrial fibrillation is the most common cardiac arrhythmia and is a major risk factor for stroke, heart failure, and death. Current treatments focus on anti-coagulation as well as rate-control and rhythm-control strategies. Frequent INR checks associated with warfarin along with several adverse side effects of anti-arrhythmics have propelled investigations into novel treatments for atrial fibrillation. Research is focused not only on pioneering new pharmacological antico- agulation and anti-arrhythmic agents but also on improving surgical techniques in hopes of treating the arrhythmia. Here, we first briefly discuss the current treatment options, both pharmacological and non-pharmacological, for atrial fibrillation. We then present a focused review of recent animal and human investigations that examine the use of novel an-ticoagulation agents, mechanisms of new anti-arrhythmics, analyze potential triggers of atrial fibrillation, and highlight the role of genetics in atrial fibrillation.展开更多
Caffeine is one of the most commonly consumed stimulants and is found in many items like coffee and energy drinks. Heart arrhythmias are irregular heart rhythms, which can occur when the electrical signals that contro...Caffeine is one of the most commonly consumed stimulants and is found in many items like coffee and energy drinks. Heart arrhythmias are irregular heart rhythms, which can occur when the electrical signals that control the heart’s rhythm are not functioning properly. Due to the stimulant properties of caffeine, it is theorized that caffeine consumption may cause tachycardias-like ventricular arrhythmias. This review article describes the relationship between caffeine intake and heart arrhythmias using a comprehensive Pub-Med search. A comprehensive search was conducted using the search terms “caffeine arrhythmia” which was conducted and a total of 26 search results were obtained. The majority of clinical studies suggest that there are no strong associations between caffeine consumption and arrhythmias. There is little evidence suggesting a direct relationship between caffeine and ventricular arrhythmias (relative Risk 1.00, 95% CI 0.94 - 1.06;13.5%, p = 0.32). Conversely, caffeine consumption has an inverse relationship with the risk of atrial fibrillation (p for overall trend = 0.015;p for nonlinearity = 0.27). Caffeine related deaths are uncommon, but certain groups such as infants, psychiatric patients, and athletes may have an increased risk of arrhythmias following caffeine consumption. Overall, caffeine consumption is not strongly linked to heart arrhythmias and limited studies suggest it may reduce the risk of arrhythmias. Although there is not a strong relationship between caffeine intake and heart arrhythmias, it does cause other cardiovascular problems including high blood pressure and hence should be consumed responsibly (40 - 180 mg/day).展开更多
Objective A 7-year experience for the treatment strategy using mono- and bi-polar radiofrequency （RF） ablation procedures in a heterogeneous group of patients was reported. Methods Between July 2003 and May 2009, th...Objective A 7-year experience for the treatment strategy using mono- and bi-polar radiofrequency （RF） ablation procedures in a heterogeneous group of patients was reported. Methods Between July 2003 and May 2009, the data of 314 consecutive patients aged 13 -75 （48.70 ± 11.09 ）undergone the radiofrequency ablation procedure for atrial fibrillation （AF） associated with concomitant cardiac surgery were analyzed. Monopolar was used for 91 patients; Medtronic bi-polar RF ablation procedure for 92 patients and Atricure RF ablation procedure for 131 patients. All patients were combined with valve surgery. Regular follow-ups were performed at 3, 6 month after surgery. Results Hospital mortality after combined open heart and surgical RF ablation was 0 %. The success rates for sinus rhythm conversion with monopolar RF were 73.6 % immediately, 74. 7 % at 3 months, 79. 1% at 6 months ; with Medtronic bi- polar RF, the rates were 78.3 % immediately, 82. 8 % at 3 months, 84 % at 6 months ; with Atricure bi-polar RF, the rates were 82. 4 % immediately, 84. 1% at 3 months, 83.9 % at 6 months. Conclusions The use of RF ablation procedures is a safe and efficient option to cure AF during open heart surgery in a selective group of patients.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.
基金supported by Yunnan Applied Basic Research Projects(Kunming Medical University Union Special Fund)[No.2018FE001(-154)]Yunnan Provincial Fund for High Level Reserve Talents in Health Science(No.H-2018037)+2 种基金Scientific Research Fund Project of Fuwai Yunnan Cardiovascular Hospital(No.2019YFKT-04)Young Scientists Fund(No.81501406)Yunnan Provincial Fund for High Level Reserve Talents in Health Science(No.H-2017068).
文摘Objective:Thrombosis in patients with atrial arrhythmias might be associated with remodeling of the left atrium(LA).We aimed to describe this relationship and identify a novel factor,in addition to the CHA_(2)DS_(2)-VASc score,to guide therapeutic strategies for preventing thromboembolism in the hope of improving the prognosis for such patients.Methods:Patients diagnosed with atrial arrhythmias and who met our inclusion criteria were enrolled in this study.Various clinical parameters were recorded;diameters reflecting remodeling of the LA were measured and thrombosis was diagnosed by enhanced CT.Results:Totally,192 patients were enrolled in the study.The overall prevalence of left atrial thrombosis was 8.3%.Patients with persistent atrial fibrillation exhibited the highest anteroposterior diameter of the LA(45.1±7.2 mm)and prevalence of thrombosis(15.6%).An anteroposterior LA diameter of≥50 mm was a strong independent impact risk factor for thrombosis(OR=10.1,95%CI:2.8-36.9,P<0.OO1).The prevalence of LA thrombosis in patients with and without anteroposterior LA diameter of≥50 mm was 25.8%and 5.0%,respectively.Conclusion:Marked remodeling of the LA characterized by an anteroposterior LA diameter of≥50 mm is a strong independent risk factor of thrombosis,and should be considered for the prevention of thromboembolism through various strategies.
文摘Background Recurrent atrial arrhythmia is very common in patients after mitral valve surgery plus mini-maze procedure.Investigation about the mechanism for these patients may have important implication to improve the surgery strategy.Methods Mini-maze procedure was defined as follow:Pulmonary vein encircling incision and roof line connecting the two circles lesion,left atrial isthmus lesion,and the right atrial isthmus lesion.There were 517 patients with rheumatic valvular disease and pre-operative atrial fibrillation(AF)undergoing valve surgery plus mini-maze procedure in our hospital in the last 3 years,and 93 patients(18%)had recurrent atrial arrhythmia.Twelve patients(6 males and 6 females,mean age 53.8±7.8 ys)underwent electrophysiological study using 3-D mapping system(10 pts)or conventional mapping method(2 pts).Results The first recurrent time from surgery was 4.4±2.2 months.The mean follow-up time after catheter ablation was(12.0±6.0)months.One patient with sinus bradycardia had recurrent incessant atrial tachycardia(AT),but the AT was terminated by catheter position and never could be induced any more.She underwent a repeat procedure but failed just as the course in the first time,and was treated with DDDR pacemaker plus amiodarone.Six patients had 10 kinds of stable AT,including 5 at right atrial isthmus,2 at roof line,1 related to right atrial incision,1 at anterior wall of left atrial,and 1 related to left superior pulmonary vene.All the stable AT were eliminated and remained sinus rhythm.Three patients had ATs with variable cycle length and the 3-D mapping suggested macro-reentry AT around mitral annulus.We tried to ablate at routine mitral isthmus and also in coronary sinus,but could not reach bi-directional conduction blocking.The other 2 patients were AF with reconnection at all previous ablation sites.Ablation strategy for AF included lesion at re-conduction sites and complex fractionated atrial electrogram.The patients with AF and mitral isthmus related AT were administrated with DC cardioversion and then took amiodarone.One AT and one AF recurred.Conclusions The recurrent atrial arrhythmia after mini-maze mostly related to reconnection at previous lesion sites and catheter ablation for AT could have a high success rate.It would be very hard to block mitral isthmus after valve replacement,so transmural lesion during surgery procedure is the most important strategy for preventing postoperative atrial arrhythmia.
基金supported by the National Natural Science Foundation of China(No.82100359,No.81273878).
文摘Coronary-pulmonary artery fistula(CPAF)is a relatively rare type of congenital coronary artery variation,which is mostly asymptomatic and is discovered incidentally by coronary artery CT imaging or angiography.However,CPAF can cause a phenomenon of inter-artery steal and hemodynamic disorders,leading to myocardial ischemia,arrhythmia,heart failure,syncope and even cardiac sudden death in severe cases.Here we reported a case of a 53-year-old female who complained of intermittent palpitations and had a history of paroxysmal atrial fibrillation.The coronary angiography revealed bilateral coronary artery fistulae to pulmonary artery.In this case,the multiple fistulas were very rare and significant.Multidisciplinary treatment should be considered,including cardiologists,surgeons,anesthesiologists and nurses,etc.Regular follow-up is essential for long-term disease management after diagnosis or surgery.
文摘Atrial arrhythmia is common in clinic. Recently, it was revealed that ectopicimpulses originating in sleeve muscles around the orifices of pulmonary veins (PVs) were deemed tobe one of the most important reasons that trigger or drive atrial arrhythmia, which was calledmyocardial sleeve related arrhythmia. Electrical isolation by radiofrequency ablation is becominghighlight and proved to be an effective method for the arrhythmia. We report a 55-year-old man withparoxysmal atrial tachy-arrhythmias admitted for PV electrical isolation. An abscess was discoveredin right inferior lung before the operation. The arrhythmia was disappeared after resection of theabscess. It implies that for such sufferer and recidivist after ablation, the factors outside thepulmonary veins should be excluded or treated as far as possible, especially before radiofrequencyablation therapy.
文摘Atrial fibrillation is the most common arrhythmia affecting patients today. Disease prevalence is increasing at an alarming rate worldwide, and is associated with often catastrophic and costly consequences, including heart failure, syncope, dementia, and stroke. Therapies including anticoagulants, anti-arrhythmic medications, devices, and non-pharmacologic procedures in the last 30 years have improved patients＂ functionality with the disease. Nonetheless, it remains imperative that further research into AF epidemiology, genetics, detection, and treatments continues to push forward rapidly as the worldwide population ages dramatically over the next 20 years.
文摘In Traditional Chinese Medicine,stimulation of the Neiguan spot has been utilized to treat palpitations and symptoms related to different cardiovascular diseases.We evaluated whether acupuncture might exert an antiarrhythmic effect on patients with paroxysmal or persistent atrial fibrillation(AF).Two sets of data are reviewed.The first included patients with persistent AF who underwent electrical cardioversion to restore sinus rhythm.The second included patients with symptomatic paroxysmal AF.All subjects had normal ventricular function.Acupuncture treatment consisted of 10 acupuncture sessions on a once a week basis with puncturing of the Neiguan,Shenmen and Xinshu spots.In patients with persistent AF,the recurrence rate after acupuncture treatment was similar to that observed in patients on amiodarone,but significantly smaller than that measured after sham acupuncture treatment or in the absence of any antiarrhythmic drugs.In a small group of patients with paroxysmal AF,acupuncture resulted in a significant reduction in the number and duration of symptomatic AF episodes.In conclusion,we observed that acupuncture of the Neiguan spot was associated with an antiarrhythmic effect,which was evident in patients with both persistent and paroxysmal AF.These preliminary data,observed in 2 small groups of AF patients,need to be validated in a larger population but strongly suggest that acupuncture may be an effective non-invasive and safe antiarrhythmic tool in the management of these patients.
文摘The incorporation of biomarkers in the actually used risk scores seem to be helpful for early identifying atrial fibrillation(AF)patients at higher risk.The aim of this critical review of the scientific literature is to investigate the potential clinical significance of red blood cell distribution width(RDW)in AF.A systematic electronic search was carried out to identify all articles describing an epidemiological association between RDW and AF in adult human populations.Data abstraction was conducted on a final number of 35 articles(13 crosssectional,12 prospective and 10 retrospective studies).The results of these epidemiological investigations were all virtually concordant to emphasize that an enhanced RDW value is not only a predictive factor and a marker of AF but its measurement may also be helpful for predicting the risk of developing many adverse complications in patients with AF,such as recurrence and duration of AF,hospitalization for heart failure,bleeding,left atrial thrombosis and stasis,thromboembolic events and mortality.AF patients with RDW values exceeding the local reference range may be more aggressively investigated and managed,in order to identify and attenuate the impact of possible underlying disorders causing both anisocytosis and AF.
基金supported by a grant from the National Natural Science Foundation of China(Grant No.81471197)the National Key Research and Development Program of China(2017YFC0907703)
文摘Objectives To assess and synthesize the prospective cohort studies published so far on the association between atrial fibrillation (AF) and dementia incidence.Methods We searched PubMed,Web of Science,and the Cochrane Library for potential studies published in English previous to April 2018.Two independent reviewers screened the search results for prospective cohort studies reporting the association between AF and dementia incidence in patients with normal cognitive function at baseline and not suffering from an acute stroke.The Newcastle-Ottawa Scale was adopted to evaluate the quality of the included studies.The pooled hazard ratio (HR) of AF for dementia was calculated with the Comprehensive Meta-Analysis software,version 2.Heterogeneity and publication bias were assessed with the I2 test and funnel plot,respectively.Results We finally identified 11 prospective cohort studies covering 112,876 patients.All the included studies reported an adjusted HR obtained in multiple Cox regression models.The qualities of the included studies ranged from moderate to high.In pooled analysis with a fixed-effects model,AF was independently associated with dementia incidence (HR = 1.34,95% CI: 1.24–1.44).Subgroup analysis of studies considering anticoagulation as an important confounding factor achieved a similar result.Based on the I2 test and funnel plot,we did not detect obvious heterogeneity and publication bias in our study.Meta-regression on age did not find significant results.Conclusions The results of our meta-analysis further confirmed that AF was an independent risk factor for dementia in patients with normal baseline cognitive function not suffering from acute stroke.Screening for dementia in AF patients and including dementia as an independent outcome in large AF treatment trials is warranted.
文摘Interactions between the functioning of the heart and the liver have been described, with heart diseases affecting the liver, liver diseases affecting the heart, and conditions that simultaneously affect both. The heart is one of the most adversely affected organs in patients with liver cirrhosis. For example, arrhythmias and electrocardiographic changes are observed in patients with liver cirrhosis. The risk for arrhythmia is influenced by factors such as cirrhotic cardiomyopathy, cardiac ion channel remodeling, electrolyte imbalances,impaired autonomic function, hepatorenal syndrome, metabolic abnormalities, advanced age, inflammatory syndrome, stressful events, impaired drug metabolism and comorbidities. Close monitoring of cirrhotic patients is needed for arrhythmias, particularly when QT intervalprolonging drugs are given, or if electrolyte imbalances or hepatorenal syndrome appear. Arrhythmia risk may persist after liver transplantation due to possible QT interval prolongation, persistence of the parasympathetic impairment, post-transplant reperfusion and chronic immunosuppression, as well as consideration of the fact that the transplant itself is a stressful event for the cardiovascular system. The aims of the present article were to provide a review of the most important data regarding the epidemiology, pathophysiology, and biomarkers of arrhythmia risk in patients with liver cirrhosis, to elucidate the association with long-term outcome, and to propose future research directions.
文摘AIM: To evaluate the effectiveness of two different strategies using radiofrequency catheter ablation for redo procedures after cryoablation of atrial fibrillation.METHODS: Thirty patients(paroxysmal atrial fibrillation: 22 patients,persistent atrial fibrillation: 8 patients) had to undergo a redo procedure after initially successful circumferential pulmonary vein(PV) isolation with the cryoballoon technique(Arctic Front Balloon,CryoCath Technologies/Medtronic).The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy(CARTO;Biosense Webster) depending on the intra-procedural findings.After discharge,patients were scheduled for repeated visits at the arrhythmia clinic.A 7-day Holter monitoring was performed at 3,12 and 24 mo after the ablation procedure.RESULTS: During the redo procedure,a mean number of 2.9 re-conducting pulmonary veins(SD ± 1.0 PVs) were detected(using a circular mapping catheter).In 20 patients,a segmental approach was sufficient to eliminate the residual pulmonary vein conduction because there were only a few recovered pulmonary vein fibres.In the remaining 10 patients,a circumferential ablation strategy was used because of a complete recovery of the PV-LA conduction.All recovered pulmonary veins could be isolated successfully again.At 2-year follow-up,73.3% of all patients were free from an arrhythmia recurrence(22/30).There were no major complications.CONCLUSION: In patients with an initial circumferential pulmonary vein isolation using the cryoballoon technique,a repeat ablation procedure can be performed safely and effectively using radiofrequency catheter ablation.
文摘Atrial fibrillation is the most common cardiac arrhythmia and is a major risk factor for stroke, heart failure, and death. Current treatments focus on anti-coagulation as well as rate-control and rhythm-control strategies. Frequent INR checks associated with warfarin along with several adverse side effects of anti-arrhythmics have propelled investigations into novel treatments for atrial fibrillation. Research is focused not only on pioneering new pharmacological antico- agulation and anti-arrhythmic agents but also on improving surgical techniques in hopes of treating the arrhythmia. Here, we first briefly discuss the current treatment options, both pharmacological and non-pharmacological, for atrial fibrillation. We then present a focused review of recent animal and human investigations that examine the use of novel an-ticoagulation agents, mechanisms of new anti-arrhythmics, analyze potential triggers of atrial fibrillation, and highlight the role of genetics in atrial fibrillation.
文摘Caffeine is one of the most commonly consumed stimulants and is found in many items like coffee and energy drinks. Heart arrhythmias are irregular heart rhythms, which can occur when the electrical signals that control the heart’s rhythm are not functioning properly. Due to the stimulant properties of caffeine, it is theorized that caffeine consumption may cause tachycardias-like ventricular arrhythmias. This review article describes the relationship between caffeine intake and heart arrhythmias using a comprehensive Pub-Med search. A comprehensive search was conducted using the search terms “caffeine arrhythmia” which was conducted and a total of 26 search results were obtained. The majority of clinical studies suggest that there are no strong associations between caffeine consumption and arrhythmias. There is little evidence suggesting a direct relationship between caffeine and ventricular arrhythmias (relative Risk 1.00, 95% CI 0.94 - 1.06;13.5%, p = 0.32). Conversely, caffeine consumption has an inverse relationship with the risk of atrial fibrillation (p for overall trend = 0.015;p for nonlinearity = 0.27). Caffeine related deaths are uncommon, but certain groups such as infants, psychiatric patients, and athletes may have an increased risk of arrhythmias following caffeine consumption. Overall, caffeine consumption is not strongly linked to heart arrhythmias and limited studies suggest it may reduce the risk of arrhythmias. Although there is not a strong relationship between caffeine intake and heart arrhythmias, it does cause other cardiovascular problems including high blood pressure and hence should be consumed responsibly (40 - 180 mg/day).
文摘Objective A 7-year experience for the treatment strategy using mono- and bi-polar radiofrequency （RF） ablation procedures in a heterogeneous group of patients was reported. Methods Between July 2003 and May 2009, the data of 314 consecutive patients aged 13 -75 （48.70 ± 11.09 ）undergone the radiofrequency ablation procedure for atrial fibrillation （AF） associated with concomitant cardiac surgery were analyzed. Monopolar was used for 91 patients; Medtronic bi-polar RF ablation procedure for 92 patients and Atricure RF ablation procedure for 131 patients. All patients were combined with valve surgery. Regular follow-ups were performed at 3, 6 month after surgery. Results Hospital mortality after combined open heart and surgical RF ablation was 0 %. The success rates for sinus rhythm conversion with monopolar RF were 73.6 % immediately, 74. 7 % at 3 months, 79. 1% at 6 months ; with Medtronic bi- polar RF, the rates were 78.3 % immediately, 82. 8 % at 3 months, 84 % at 6 months ; with Atricure bi-polar RF, the rates were 82. 4 % immediately, 84. 1% at 3 months, 83.9 % at 6 months. Conclusions The use of RF ablation procedures is a safe and efficient option to cure AF during open heart surgery in a selective group of patients.
