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
Objectives There are two kind of atrial flutter during circumferential ablation for atrial fibrillation （AF）： new onset left atrial flutter （LAFL）, with a history of atrial flutter （AFL）. What is the relationsh...Objectives There are two kind of atrial flutter during circumferential ablation for atrial fibrillation （AF）： new onset left atrial flutter （LAFL）, with a history of atrial flutter （AFL）. What is the relationship of AFL and AF？ Whether there are some differences in clinical course and mechanism between the new onset LAFL and the with a history of AFL remained unclear. The aim of this study was to assess the impacts of circumferential ablation on the occurrence of arrhythmias in follow-up in 2 groups： （1） patients with a history of AFL and AF, and （2） patients with new onset LAFL. Methods Data from 465 patients who had circumferential pulmonary vein ablation （CPVA） or segmental pulmonary vein ablation （SPVA） were analyzed. Patients with a history of AFL ablation and patients who had concomitant AFL ablation were included from analysis. Forty-one patients constituted the history of AFL group （group 1, aged 57±13 years, 7 females） and twenty-eight patients constituted the new onset LAFL group （group 2, aged 55±12 years, 6 females）, bipolar recordings were obtained from the tricuspid annulus, coronary sinus, interatrial septum and left atrium. Target sites were identified by early, fragmented or double potentials and by concealed entrainment. Linear lesions were created between target sites and nearby anatomical barriers （1） typical atrial flutter （cycle length, 242± 39 ms）. cavotricuspid isthmus ablation was performed. （2） new onset LAFL （cycle length, 282±153 ms）. 20 episodes of AAFs were documented in 20/28 （71.4%） patients. Target sites were identified around pulmonary veins （n=10）, gap in linear lesion （n=7）, left atrial roof lines （1 case）. For those cases the ablation line between PV and mitral annulus was performed. Patients in Group 2 had larger left atria, incidence of AFL pre-CPVA, and lower ejection fraction. Results There was no significant difference in post-CPVA AF recurrence between Groups 1 and 2, but AFL incidence after CPVA was higher in Group 2 （33% vs 4%, P 〈 0.0001）. Ablation of AFL in group 1 patients resulted in an 88% acute success rate （group2, 86%） and 12% （group2,17%） recurrence over a mean follow-up of 287 ±101 days.Condusions In patients with a history of atrial flutter, post-CPVA AF recurrence is similar to patients with new onset LAFL. However, LAFL is associated with a higher recurrence of AFL after PVAI. In a significant number of patients with LAFL, mitral Isthmus ablation is needed and can be performed effectively. Its eleetrophysiologieal eonse-quenees could be considered analogus to the results achieved by eavotrieuspid isthmus ablation.展开更多
Purpose. To evaluate and compare the effects of heart rate on conduction velocity in the cavotricus-pid isthmus (CTI) and septum in patients with and without typical atrial flutter (AF) using electro-anatomic mapping ...Purpose. To evaluate and compare the effects of heart rate on conduction velocity in the cavotricus-pid isthmus (CTI) and septum in patients with and without typical atrial flutter (AF) using electro-anatomic mapping (EAM) of the right atrium (RA).Methods. Ten patients(age 53+10 yrs,7M/3F)with AF and 13 patients (age 51+11 yrs, 5M/8F) with atrio-ventricular nodal reentrant tachycardia (AVNRT) underwent conventional electrophysionogical study, electro -anatomic mapping and radiofrequency ablation. Using EAMs obtained during coronary sinus pacing at pacing cycle length (PCL) 600 ms, 400 ms, and 300 ms, we evaluated conduction velocities in the CTI and septum of RA in 10 patients with AF and compared EAMs to 13 patients with AVNRT to determine whether the conduction slowing required to maintain AFL was related to changes in volume alone or altered RA electrophysiology.Results. Conduction velocities in CTI and septum were significantly slower at all PCL when AF was compared to AVNRT(P<0.05). Additionally, in the AF group, septal conduction velocities were slower at PCL 600 ms and 400 ms, but not at 300 ms compared to CTI (P<0.05). In AF, during PCL 300. conduction in CTI slowed significantly compared to PCL 600 and 400 ms such that there was no difference between CTI and septum at PCL 300.Conclusions. There is slower conduction in the septum compared to the CTI in all patients. However, in patients with AF, there is significant slowing of conduction in the CTI and septum as well as decremen-tal rate-dependent slowing of conduction in the CTI. These findings indicate that in addition to RA enlargement, changes in atrial electrophysiology distinguish AF patients from patients with AVNRT.展开更多
A 63-year-old female patient with a history of pulmonary heart disease underwent radiofrequency ablation because of a persistent atrial fl utter.Endocardial mapping with the carto3 system confi rmed atrial fl utter co...A 63-year-old female patient with a history of pulmonary heart disease underwent radiofrequency ablation because of a persistent atrial fl utter.Endocardial mapping with the carto3 system confi rmed atrial fl utter counterclockwise reentry around the tricuspid annulus.Routine ablation of the cavo-tricuspid isthmus line to bi-directional block was performed.However,tachycardia with the same cycle length was induced again.After remapping,the tachycardia was confi rmed to be focal atrial tachycardia located in the crista terminalis.After ablation,the tachycardia was terminated and could not be induced again.展开更多
BACKGROUND Adrenocortical carcinoma(ACC),the second most aggressive malignant tumor,lacks epidemiological data worldwide;therefore,every new case can improve the understanding of the pathology and treatment of this ma...BACKGROUND Adrenocortical carcinoma(ACC),the second most aggressive malignant tumor,lacks epidemiological data worldwide;therefore,every new case can improve the understanding of the pathology and treatment of this malignancy.CASE SUMMARY We present the case of a 66-year-old Caucasian woman with a giant androgenproducing ACC(21 cm×17 cm×12 cm;2100 g),without metastases,which unusually presented with an acute onset of atrial flutter and congestive heart failure.The cardiac complications observed in our case support the hypothesis that androgen excess in women is a cardiovascular risk factor.Androgen excess in women can be a rare cause of reversible dilated cardiomyopathy,therefore a comprehensive approach to the patient is essential to improve the recognition of androgen-secreting ACC.The atrial flutter was remitted after initiation of drug treatment during admission.The severe heart failure was totally remitted at 6 mo after radical open surgery to remove the giant ACC.CONCLUSION Radical open surgery to remove a giant androgen-producing ACC was the firstline treatment to cure the excess of androgen,which determined the total remission of cardiac complications at 6 mo after surgery in the women of this case report.展开更多
BACKGROUND Left atrial flutter without prior cardiac interventions is uncommon,especially dual-loop macro-reentry atrial flutter.The critical step to ablate dual-loop macroreentry atrial flutter is to identify the dom...BACKGROUND Left atrial flutter without prior cardiac interventions is uncommon,especially dual-loop macro-reentry atrial flutter.The critical step to ablate dual-loop macroreentry atrial flutter is to identify the dominant loop and key isthmus.Although entrainment mapping could help identify the dominant loop and key isthmus,it may alter or terminate tachycardia.High-density mapping allows the generation of electroanatomic maps without altering or terminating tachycardia.CASE SUMMARY Here,we report a case of symptomatic left atrial flutter without prior intervention.In this case,high-density mapping revealed a dual-loop macro-reentry around the mitral annulus and central scar of the anterior wall.The propagation result showed that the dominant loop was around the mitral annulus,and the key isthmus was between the central scar and mitral annulus.The atrial flutter terminated successfully after ablation was performed.CONCLUSION In this case,we demonstrate that high-density mapping technology may help identify the dominant loop of dual-loop atrial flutter without entrainment,which makes ablation easier.展开更多
目的:为了提高医疗设备验收的信息化管理水平,设计多端协同医疗设备验收管理系统。方法:多端协同医疗设备验收管理系统采用前后端分离的设计架构,前端采用跨平台框架Flutter和Dart语言开发,后端采用Tornado 6.1框架和Python语言开发,前...目的:为了提高医疗设备验收的信息化管理水平,设计多端协同医疗设备验收管理系统。方法:多端协同医疗设备验收管理系统采用前后端分离的设计架构,前端采用跨平台框架Flutter和Dart语言开发,后端采用Tornado 6.1框架和Python语言开发,前端与后端服务之间的通信遵循RESTful设计原则,通过超文本传输协议(hypertext transfer protocol,HTTP)请求进行交互。整个系统包括用户管理、基础信息管理、验收管理3个功能模块。结果:该系统实现了医疗设备验收过程的信息化管理,支持跨平台管理验收报告及相关附件、医疗器械注册证等内容,提高了验收的工作质量与效率。结论:该系统实现了医疗设备验收的多端协同管理,为医院医疗设备管理的数字化和智能化转型奠定了基础。展开更多
Clinical congestive heart failure (CHF) is a major risk factor for strokes. Patients with CHF commonly have atrial fibrillation or flutter (AF), which is frequently associated with, may be a marker for, and may be the...Clinical congestive heart failure (CHF) is a major risk factor for strokes. Patients with CHF commonly have atrial fibrillation or flutter (AF), which is frequently associated with, may be a marker for, and may be the mechanism of, ischemic strokes. To determine whether stroke patients with CHF have a high incidence of AF (that may be intermittent and not diagnosed), we reviewed all the 12 lead ECGs in a fourteen year institutional ECG data base and the clinical records and the available echocardiograms of 985 patients who had an ischemic stroke over a 3-year period. We found that 31.3% of the stroke patients had evidence of AF. Clinical congestive heart failure was present in 168 stroke patients;61.9% of these stroke patients with CHF had evidence of AF. In the total stroke population, patients with other risk factors for stroke (hypertension, advanced age, diabetes, coronary artery disease) had an increased incidence of AF;but among stroke patients with CHF, only advanced age (≥75 years) in addition to CHF increased the incidence of AF. To determine whether only the CHF stroke pts with systolic dysfunction had a high incidence of AF, we compared the incidence of AF in the 41.5% of the CHF patients with a depressed ejection fraction with the AF incidence in the 58.5% of CHF stroke patients with a normal ejection fraction (≥50%). The incidence of AF was the same (63.4% vs. 60.2%, p = 0.741) whether the ejection fraction was depressed or normal. These findings suggest that AF is common in patients with CHF who have strokes whether the ejection fraction is normal or depressed. CHF patients who have strokes and who are in sinus rhythm should be meticulously investigated for intermittent AF, so anticoagulation can be administered to prevent a further stroke.展开更多
Background:Epicardial roof-dependent atrial tachycardia is rare among macroreentrant tachycardias.The importance of epicardial structure or fiber involving septopulmonary bundle(SPB)has not been realized generally.Cas...Background:Epicardial roof-dependent atrial tachycardia is rare among macroreentrant tachycardias.The importance of epicardial structure or fiber involving septopulmonary bundle(SPB)has not been realized generally.Case presentation:A 74-year-old woman who underwent catheter ablation of atrial fibrillation previously accepted a second-time radiofrequency ablation due to atrial flutter.The mapping and entrainment results of the tachycardia tended to be an epicardial SPB-dependent macroreentrant atrial tachycardia and it was ablated to sinus rate at the first single targeting site,just located in the breakout site of SPB into the posterior wall(PW)of left atrial(LA).The twice-activation mapping of PW of LA also proved the presence of SPB.No recurrent arrhythmia was seen at follow-up at 3 months.Conclusion:In this case,an uncommon phenomenon was observed post-ablation for persistent atrial fibrillation,where the epicardial muscular structure of the LA-SPB was involved in atypical atrial flutter.This should be considered as a potential factor in such cases.Further similar cases may be required to improve diagnostic accuracy and to formulate effective ablation strategies for this type of tachycardia.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
Coronary embolism secondary to atrial fibrillation can lead to myocardial infarction independently of atherosclerotic coronary arteries. We encountered a patient repeatedly tortured by atrial fibrillation who presente...Coronary embolism secondary to atrial fibrillation can lead to myocardial infarction independently of atherosclerotic coronary arteries. We encountered a patient repeatedly tortured by atrial fibrillation who presented with recurrent myocardial infarctions with normal coronary anatomy and ischemic stroke. We were frustrated by repeated failures because of some probably inappropriate decisions.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
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
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
Diabetes mellitus and atrial fibrillation(AF)are two global epidemics that frequently coexist,with diabetes mellitus contributing to both an increased risk of new-onset AF and a worse prognosis.Pathophysiological mech...Diabetes mellitus and atrial fibrillation(AF)are two global epidemics that frequently coexist,with diabetes mellitus contributing to both an increased risk of new-onset AF and a worse prognosis.Pathophysiological mechanisms underlying this relationship include chronic inflammation,oxidative stress,atrial remodeling,autonomic dysfunction,advanced glycation end-products and epicardial adiposity.Management remains challenging;however,recent advances offer promise,including guideline-directed anticoagulation,tailored rate and rhythm control,and particularly,novel antidiabetic therapies,such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists,may improve AF outcomes.A comprehensive,individualized approach is essential to mitigate morbidity and mortality in this high-risk population.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 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: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
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Objectives There are two kind of atrial flutter during circumferential ablation for atrial fibrillation （AF）： new onset left atrial flutter （LAFL）, with a history of atrial flutter （AFL）. What is the relationship of AFL and AF？ Whether there are some differences in clinical course and mechanism between the new onset LAFL and the with a history of AFL remained unclear. The aim of this study was to assess the impacts of circumferential ablation on the occurrence of arrhythmias in follow-up in 2 groups： （1） patients with a history of AFL and AF, and （2） patients with new onset LAFL. Methods Data from 465 patients who had circumferential pulmonary vein ablation （CPVA） or segmental pulmonary vein ablation （SPVA） were analyzed. Patients with a history of AFL ablation and patients who had concomitant AFL ablation were included from analysis. Forty-one patients constituted the history of AFL group （group 1, aged 57±13 years, 7 females） and twenty-eight patients constituted the new onset LAFL group （group 2, aged 55±12 years, 6 females）, bipolar recordings were obtained from the tricuspid annulus, coronary sinus, interatrial septum and left atrium. Target sites were identified by early, fragmented or double potentials and by concealed entrainment. Linear lesions were created between target sites and nearby anatomical barriers （1） typical atrial flutter （cycle length, 242± 39 ms）. cavotricuspid isthmus ablation was performed. （2） new onset LAFL （cycle length, 282±153 ms）. 20 episodes of AAFs were documented in 20/28 （71.4%） patients. Target sites were identified around pulmonary veins （n=10）, gap in linear lesion （n=7）, left atrial roof lines （1 case）. For those cases the ablation line between PV and mitral annulus was performed. Patients in Group 2 had larger left atria, incidence of AFL pre-CPVA, and lower ejection fraction. Results There was no significant difference in post-CPVA AF recurrence between Groups 1 and 2, but AFL incidence after CPVA was higher in Group 2 （33% vs 4%, P 〈 0.0001）. Ablation of AFL in group 1 patients resulted in an 88% acute success rate （group2, 86%） and 12% （group2,17%） recurrence over a mean follow-up of 287 ±101 days.Condusions In patients with a history of atrial flutter, post-CPVA AF recurrence is similar to patients with new onset LAFL. However, LAFL is associated with a higher recurrence of AFL after PVAI. In a significant number of patients with LAFL, mitral Isthmus ablation is needed and can be performed effectively. Its eleetrophysiologieal eonse-quenees could be considered analogus to the results achieved by eavotrieuspid isthmus ablation.
文摘Purpose. To evaluate and compare the effects of heart rate on conduction velocity in the cavotricus-pid isthmus (CTI) and septum in patients with and without typical atrial flutter (AF) using electro-anatomic mapping (EAM) of the right atrium (RA).Methods. Ten patients(age 53+10 yrs,7M/3F)with AF and 13 patients (age 51+11 yrs, 5M/8F) with atrio-ventricular nodal reentrant tachycardia (AVNRT) underwent conventional electrophysionogical study, electro -anatomic mapping and radiofrequency ablation. Using EAMs obtained during coronary sinus pacing at pacing cycle length (PCL) 600 ms, 400 ms, and 300 ms, we evaluated conduction velocities in the CTI and septum of RA in 10 patients with AF and compared EAMs to 13 patients with AVNRT to determine whether the conduction slowing required to maintain AFL was related to changes in volume alone or altered RA electrophysiology.Results. Conduction velocities in CTI and septum were significantly slower at all PCL when AF was compared to AVNRT(P<0.05). Additionally, in the AF group, septal conduction velocities were slower at PCL 600 ms and 400 ms, but not at 300 ms compared to CTI (P<0.05). In AF, during PCL 300. conduction in CTI slowed significantly compared to PCL 600 and 400 ms such that there was no difference between CTI and septum at PCL 300.Conclusions. There is slower conduction in the septum compared to the CTI in all patients. However, in patients with AF, there is significant slowing of conduction in the CTI and septum as well as decremen-tal rate-dependent slowing of conduction in the CTI. These findings indicate that in addition to RA enlargement, changes in atrial electrophysiology distinguish AF patients from patients with AVNRT.
文摘A 63-year-old female patient with a history of pulmonary heart disease underwent radiofrequency ablation because of a persistent atrial fl utter.Endocardial mapping with the carto3 system confi rmed atrial fl utter counterclockwise reentry around the tricuspid annulus.Routine ablation of the cavo-tricuspid isthmus line to bi-directional block was performed.However,tachycardia with the same cycle length was induced again.After remapping,the tachycardia was confi rmed to be focal atrial tachycardia located in the crista terminalis.After ablation,the tachycardia was terminated and could not be induced again.
文摘BACKGROUND Adrenocortical carcinoma(ACC),the second most aggressive malignant tumor,lacks epidemiological data worldwide;therefore,every new case can improve the understanding of the pathology and treatment of this malignancy.CASE SUMMARY We present the case of a 66-year-old Caucasian woman with a giant androgenproducing ACC(21 cm×17 cm×12 cm;2100 g),without metastases,which unusually presented with an acute onset of atrial flutter and congestive heart failure.The cardiac complications observed in our case support the hypothesis that androgen excess in women is a cardiovascular risk factor.Androgen excess in women can be a rare cause of reversible dilated cardiomyopathy,therefore a comprehensive approach to the patient is essential to improve the recognition of androgen-secreting ACC.The atrial flutter was remitted after initiation of drug treatment during admission.The severe heart failure was totally remitted at 6 mo after radical open surgery to remove the giant ACC.CONCLUSION Radical open surgery to remove a giant androgen-producing ACC was the firstline treatment to cure the excess of androgen,which determined the total remission of cardiac complications at 6 mo after surgery in the women of this case report.
基金the National Science Foundation of China,No.81800292.
文摘BACKGROUND Left atrial flutter without prior cardiac interventions is uncommon,especially dual-loop macro-reentry atrial flutter.The critical step to ablate dual-loop macroreentry atrial flutter is to identify the dominant loop and key isthmus.Although entrainment mapping could help identify the dominant loop and key isthmus,it may alter or terminate tachycardia.High-density mapping allows the generation of electroanatomic maps without altering or terminating tachycardia.CASE SUMMARY Here,we report a case of symptomatic left atrial flutter without prior intervention.In this case,high-density mapping revealed a dual-loop macro-reentry around the mitral annulus and central scar of the anterior wall.The propagation result showed that the dominant loop was around the mitral annulus,and the key isthmus was between the central scar and mitral annulus.The atrial flutter terminated successfully after ablation was performed.CONCLUSION In this case,we demonstrate that high-density mapping technology may help identify the dominant loop of dual-loop atrial flutter without entrainment,which makes ablation easier.
文摘目的:为了提高医疗设备验收的信息化管理水平,设计多端协同医疗设备验收管理系统。方法:多端协同医疗设备验收管理系统采用前后端分离的设计架构,前端采用跨平台框架Flutter和Dart语言开发,后端采用Tornado 6.1框架和Python语言开发,前端与后端服务之间的通信遵循RESTful设计原则,通过超文本传输协议(hypertext transfer protocol,HTTP)请求进行交互。整个系统包括用户管理、基础信息管理、验收管理3个功能模块。结果:该系统实现了医疗设备验收过程的信息化管理,支持跨平台管理验收报告及相关附件、医疗器械注册证等内容,提高了验收的工作质量与效率。结论:该系统实现了医疗设备验收的多端协同管理,为医院医疗设备管理的数字化和智能化转型奠定了基础。
文摘Clinical congestive heart failure (CHF) is a major risk factor for strokes. Patients with CHF commonly have atrial fibrillation or flutter (AF), which is frequently associated with, may be a marker for, and may be the mechanism of, ischemic strokes. To determine whether stroke patients with CHF have a high incidence of AF (that may be intermittent and not diagnosed), we reviewed all the 12 lead ECGs in a fourteen year institutional ECG data base and the clinical records and the available echocardiograms of 985 patients who had an ischemic stroke over a 3-year period. We found that 31.3% of the stroke patients had evidence of AF. Clinical congestive heart failure was present in 168 stroke patients;61.9% of these stroke patients with CHF had evidence of AF. In the total stroke population, patients with other risk factors for stroke (hypertension, advanced age, diabetes, coronary artery disease) had an increased incidence of AF;but among stroke patients with CHF, only advanced age (≥75 years) in addition to CHF increased the incidence of AF. To determine whether only the CHF stroke pts with systolic dysfunction had a high incidence of AF, we compared the incidence of AF in the 41.5% of the CHF patients with a depressed ejection fraction with the AF incidence in the 58.5% of CHF stroke patients with a normal ejection fraction (≥50%). The incidence of AF was the same (63.4% vs. 60.2%, p = 0.741) whether the ejection fraction was depressed or normal. These findings suggest that AF is common in patients with CHF who have strokes whether the ejection fraction is normal or depressed. CHF patients who have strokes and who are in sinus rhythm should be meticulously investigated for intermittent AF, so anticoagulation can be administered to prevent a further stroke.
基金supported in part by the Key Medical and Health Specialty Construction Project of Anhui Province.
文摘Background:Epicardial roof-dependent atrial tachycardia is rare among macroreentrant tachycardias.The importance of epicardial structure or fiber involving septopulmonary bundle(SPB)has not been realized generally.Case presentation:A 74-year-old woman who underwent catheter ablation of atrial fibrillation previously accepted a second-time radiofrequency ablation due to atrial flutter.The mapping and entrainment results of the tachycardia tended to be an epicardial SPB-dependent macroreentrant atrial tachycardia and it was ablated to sinus rate at the first single targeting site,just located in the breakout site of SPB into the posterior wall(PW)of left atrial(LA).The twice-activation mapping of PW of LA also proved the presence of SPB.No recurrent arrhythmia was seen at follow-up at 3 months.Conclusion:In this case,an uncommon phenomenon was observed post-ablation for persistent atrial fibrillation,where the epicardial muscular structure of the LA-SPB was involved in atypical atrial flutter.This should be considered as a potential factor in such cases.Further similar cases may be required to improve diagnostic accuracy and to formulate effective ablation strategies for this type of tachycardia.
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Coronary embolism secondary to atrial fibrillation can lead to myocardial infarction independently of atherosclerotic coronary arteries. We encountered a patient repeatedly tortured by atrial fibrillation who presented with recurrent myocardial infarctions with normal coronary anatomy and ischemic stroke. We were frustrated by repeated failures because of some probably inappropriate decisions.
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Diabetes mellitus and atrial fibrillation(AF)are two global epidemics that frequently coexist,with diabetes mellitus contributing to both an increased risk of new-onset AF and a worse prognosis.Pathophysiological mechanisms underlying this relationship include chronic inflammation,oxidative stress,atrial remodeling,autonomic dysfunction,advanced glycation end-products and epicardial adiposity.Management remains challenging;however,recent advances offer promise,including guideline-directed anticoagulation,tailored rate and rhythm control,and particularly,novel antidiabetic therapies,such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists,may improve AF outcomes.A comprehensive,individualized approach is essential to mitigate morbidity and mortality in this high-risk population.
文摘Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LAAO are lacking.Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data including clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite outcome was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days.Results Mean age was 75±8 years and 434(60%)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and median HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age>75 years in both unadjusted(17.1%vs.11.5%,P=0.03)and adjusted(Odds Ratio=1.59,95%CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3%vs.0,P=0.04)among patients age>75 years.The secondary outcome of procedural success was also lower among patients age>75 years(92.2%vs.96.2%,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age>75 years and less than 75years.Conclusion Patients age>75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.
文摘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.
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.
