BACKGROUND Left-sided accessory pathways(APs)can be accessed with either a transaortic(TA)or transseptal approach(TS).For children with Marfan syndrome(MFS)who have aortic disease,the use of TA can aggravate the disea...BACKGROUND Left-sided accessory pathways(APs)can be accessed with either a transaortic(TA)or transseptal approach(TS).For children with Marfan syndrome(MFS)who have aortic disease,the use of TA can aggravate the disease,making TS the best choice for these patients.CASE SUMMARY A 10-year-old girl was hospitalized because of intermittent heart palpitations and chest tightness.She was diagnosed with MFS,supraventricular tachycardia,Wolff-Parkinson-White syndrome,and left-sided AP was detected by cardiac electrophysiological.Catheter ablation was successfully performed via TS under the guidance of the Ensite system.During the follow-up,no recurrence or complications occurred.CONCLUSION The TS for catheter ablation of left-sided APs can be considered in children with MFS.Adequate evaluation and selection of the appropriate puncture site are particularly important.展开更多
Background It is unclear whether catheter ablation(CA)for atrial fibrillation(AF)affects the long-term prognosis in the elderly.This study aims to evaluate the relationship between CA and long-term outcomes in elderly...Background It is unclear whether catheter ablation(CA)for atrial fibrillation(AF)affects the long-term prognosis in the elderly.This study aims to evaluate the relationship between CA and long-term outcomes in elderly patients with AF.Methods Patients more than 75 years old with non-valvular AF were prospectively enrolled between August 2011 and December 2017 in the Chinese Atrial Fibrillation Registry Study.Participants who underwent CA at baseline were propensity score matched(1:1)with those who did not receive CA.The outcome events included all-cause mortality,cardiovascular mortality,stroke/transient ischemic attack(TIA),and cardiovascular hospitalization.Results Overall,this cohort included 571 ablated patients and 571 non-ablated patients with similar characteristics on 18 dimensions.During a mean follow-up of 39.75±19.98 months(minimum six months),24 patients died in the ablation group,compared with 60 deaths in the non-ablation group[hazard ratio(HR)=0.49,95%confidence interval(CI):0.30-0.79,P=0.0024].Besides,6 ablated and 29 non-ablated subjects died of cardiovascular disease(HR=0.25,95%CI:0.11-0.61,P=0.0022).A total of 27 ablated and 40 non-ablated patients suffered stroke/TIA(HR=0.79,95%CI:0.48-1.28,P=0.3431).In addition,140 ablated and 194 non-ablated participants suffered cardiovascular hospitalization(HR=0.84,95%CI:0.67-1.04,P=0.1084).Subgroup analyses according to gender,type of AF,time since onset of AF,and anticoagulants exposure in initiation did not show significant heterogeneity.Conclusions In elderly patients with AF,CA may be associated with a lower incidence of all-cause and cardiovascular mortality.展开更多
BACKGROUND False tendon is a common intraventricular anatomical variation. It refers to a fibroid or fibromuscular structure that exists in the ventricle besides the normal connection of papillary muscle and mitral or...BACKGROUND False tendon is a common intraventricular anatomical variation. It refers to a fibroid or fibromuscular structure that exists in the ventricle besides the normal connection of papillary muscle and mitral or tricuspid valve. A large number of clinical studies have suggested that there is a significant correlation between false tendons and premature ventricular complexes. However, few studies have verified this correlation during radiofrequency catheter ablation of premature ventricular complexes.CASE SUMMARY A 45-year-old male was admitted to receive radiofrequency ablation for symptomatic premature ventricular complexes. A three-dimensional model of the left ventricle was established by intracardiac echocardiography using the CartoSound^TM mapping system. In addition to the left anterior papillary muscle,the posterior papillary muscle was mapped. False tendons were found at the base of the interventricular septum, and the other end was connected to the left ventricular free wall near the apex. An irrigated touch force catheter was advanced into the left ventricle via the retrograde approach. The earliest activation site was marked at the interventricular septum attachment of the false tendons and was successfully ablated.CONCLUSION This case verified that false tendons can cause premature ventricular complexes and may be cured by radiofrequency ablation guided by intracardiac echocardiography with the Carto Sound TM system.展开更多
In order to improve the efficacy of modified inferior method or middle method of radiofrequency catheter ablation (RFCA) in the treatment of atrioventricular node reentrant tachycardia (AVNRT), the clinical data of 32...In order to improve the efficacy of modified inferior method or middle method of radiofrequency catheter ablation (RFCA) in the treatment of atrioventricular node reentrant tachycardia (AVNRT), the clinical data of 325 cases of AVNRT from March 1992 to Feb. 2000 being subjected to the treatment of RFCA were retrospectively analyzed. The results showed that the successful rate was increased and recurrence was decreased year by year. In the recent 4 years the effective rate was up to 100 %. The complication of three grade of AVB occurred in 3 % and recurrent rate in 9.1 % before March 1996, but both of them were zero in the last 3 years. The time of RFCA procedure and X ray exposure was significantly reduced. It was concluded that ablating more than 3 targets by modified inferior method or middle method with energy titrating and strict endpoint was the crux of obtaining satisfactory therapeutic effects and preventing recurrence.展开更多
BACKGROUND Atrial fibrillation(AF)is one of the most common arrhythmias,and radiofrequency catheter ablation is the most effective treatment strategy.The inferior vena cava(IVC)is a common approach for radiofrequency ...BACKGROUND Atrial fibrillation(AF)is one of the most common arrhythmias,and radiofrequency catheter ablation is the most effective treatment strategy.The inferior vena cava(IVC)is a common approach for radiofrequency ablation of AF.However,this approach may not be applied to some cases such as chronic venous occlusions,surgical ligation of the IVC,and heterotaxy syndrome(HS).CASE SUMMARY A 68-year-old man with HS suffered from severely symptomatic persistent AF for 9 years,and we successfully ablated by percutaneous transhepatic access.CONCLUSION In patients without femoral vein access,the use of the hepatic vein for pulmonary vein isolation is a viable alternative for invasive electrophysiology procedures.展开更多
Atrial fibrillation(AF) and heart failure(HF) are complex clinical entities that occur concomitantly in a significant population of patients, and their prevalence is rising in epidemic proportions. Traditionally, both...Atrial fibrillation(AF) and heart failure(HF) are complex clinical entities that occur concomitantly in a significant population of patients, and their prevalence is rising in epidemic proportions. Traditionally, both rate and rhythm control strategies have been regarded as equivalent in the management of dysrhythmia in this AF-HF cohort with escalation of treatment largely guided by symptoms. Both disorders are involved in an elaborate pathophysiological interplay with shared cardiovascular risk factors that contribute to the development and sustenance of both AF and HF. Recent studies and continued development of evidence to support catheter ablation for AF has brought into question the traditional belief in equivalence between rate and rhythm control. Indeed, recent trials, in particular the CASTLE-AF(Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation) study, suggest that catheter ablation for AF improves survival and rates of hospitalisation in patients with concomitant HF and AF, threatening a paradigm shift in the management of this patient cohort. The evident mortality benefit from clinical trials suggests that catheter ablation for AF should be considered as a therapeutic intervention in all suitable patients with the AF-HF syndrome as these patients may derive the greatest benefit from restoration of sinus rhythm. Further research is needed to refine the evidence base, especially to determine which subgroup of HF patients benefit most from catheter ablation and what is the optimal timing.展开更多
Background Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia that can cause severe heart problems.Catheter ablation is one of the most ideal procedures for the treatment of AF.Physicians qualified...Background Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia that can cause severe heart problems.Catheter ablation is one of the most ideal procedures for the treatment of AF.Physicians qualified to perform this procedure need to be highly skilled in manipulating the relevant surgical devices.This study proposes an interactive surgical simulator with high fidelity to facilitate efficient training and low-cost medical education.Methods We used a shared centerline model to simulate the interaction between multiple surgical devices.An improved adaptive deviation-feedback approach is proposed to accelerate the convergence of each iteration.The periodical beating of the human heart was also simulated in real time using the position-based dynamics(PBD)framework to achieve higher fidelity.We then present a novel method for handling the interaction between the devices and the beating heart mesh model.Experiments were conducted in a homemade simulator prototype to evaluate the robustness,performance,and flexibility of the proposed method.Preliminary evaluation of the simulator was performed by medical students,residents,and surgeons.Results The interaction between surgical devices,static vascular meshes,and beating heart mesh was stably simulated in a frame rate suitable for interaction.Conclusion Our simulator is capable of simulating the procedure of catheter ablation with high fidelity and provides immersive visual experiences and haptic feedback.展开更多
BACKGROUND With an increased number of surgical procedures involving the mitral annular region,the risk of mitral valve prolapse(MVP)has also increased.Previous studies have reported that worsening of MVP occurred ear...BACKGROUND With an increased number of surgical procedures involving the mitral annular region,the risk of mitral valve prolapse(MVP)has also increased.Previous studies have reported that worsening of MVP occurred early after radiofrequency catheter ablation(RFCA)at papillary muscles in ventricular tachycardia(VT)patients with preoperative MVP.CASE SUMMARY We report a case where MVP and papillary muscle rupture occurred 2 wk after RFCA in a papillary muscle originated VT patient without mitral valve regurgitation or prolapse before.The patient then underwent mitral valve replacement with no premature ventricular contraction or VT.During the surgery,a papillary muscle rupture was identified.Pathological examination showed necrosis of the papillary muscle.The patient recovered after mitral valve replacement.CONCLUSION Too many ablation procedures and energy should be avoided.展开更多
Rhythm control is the core part of the integrated management of atrial fibrillation(AF),especially in the early stages.Despite advances in catheter ablation(CA),the recurrence rate of AF after CA remains high.As a res...Rhythm control is the core part of the integrated management of atrial fibrillation(AF),especially in the early stages.Despite advances in catheter ablation(CA),the recurrence rate of AF after CA remains high.As a result,stratification and early management of AF recurrence after CA are critical.Currently,predictors of recurrence of AF after CA are mostly based on dysfunction caused by structural remodeling,apart from traditional risk factors.Atrial strain is a recently developed important parameter for detecting the deformability of atrial myocardium during the cardiac cycle prior to atrial remodeling.Although there is only preliminary evidence,atrial strain is still a promising parameter in predicting the recurrence of AF after CA at an early stage.This review focuses on the evaluation of atrial strain,the current applications of atrial strain in assessing atrial function,and predicting the recurrence of AF after CA.We summarize the contents related as follows:(1)CA for rhythm control in AF;(2)Evaluation methods of atrial strain;(3)Atrial strain in the remodeling and reverse remodeling of AF;and(4)Clinical applications of atrial strain in predicting the recurrence of AF after CA.Although there is accumulating evidence on the role of decreased atrial strain in the early prediction of AF recurrence,atrial strain is limited in clinical practice for lacking exact cut-off values and difficulty in distinguishing specific function phases of the atrium.More research is needed in the future to add strength to the early prediction value of atrial strain in AF recurrences.展开更多
Objective:To investigate the correlation between Microfibrillar-associated protein 4(MFAP4)and recurrence and clinical outcome of atrial fibrillation(AF)after radiofrequency catheter ablation(RFCA).Methods:A total of ...Objective:To investigate the correlation between Microfibrillar-associated protein 4(MFAP4)and recurrence and clinical outcome of atrial fibrillation(AF)after radiofrequency catheter ablation(RFCA).Methods:A total of 101 patients with AF admitted to our department from December 2018 to January 2020 were treated with RFCA.The average follow-up period was(11.91±0.38)months.They were divided into recurrence group and non-recurrence group according to whether they had recurrence of AF.The levels of MFAP4,transforming growth factor-β1(TGF-β1),cardiac ultrasound indexes,body mass index(BMI)and major cardio-cerebral vascular events were compared between the two groups.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of MFAP4 for recurrence of AF after RFCA.Results:The levels of MFAP4,TGF-β1,left atrial diameter(LAD)and BMI in the recurrent group were higher than those in the non-recurrent group(P<0.05).The left ventricular ejection fraction(LVEF)in the recurrent group was lower than that in the non-recurrent group(P<0.05).The levels of MFAP4,TGF-β1 and LAD in the patients of recurrent paroxysmal AF and persistent AF after RFCA were higher than those in the respective non-recurrent patients(P<0.05).MFAP4 was positively correlated with TGF-β1 and LAD(P<0.05).Logistic regression analysis showed that MFAP4,TGF-β1,and LAD were independent risk factors for recurrence of AF after RFCA.The ROC curve analysis showed that the area under the ROC curve of MFAP4 for predicting recurrence of AF after RFCA was 0.888(P=0.000),and the optimal cut-off value was 19.295ng/ml,with a sensitivity of 77.3%and a specificity of 77.2%.The incidence of readmission and total adverse events in recurrence group was significantly higher than that in non-recurrence group(P<0.05).Conclusions:MFAP4 was significantly increased in patients with recurrence after RFCA of AF,which was one of the independent risk factors for recurrence after RFCA of AF,and had certain clinical application value.展开更多
Objective:To evaluate the application effect of telmisartan combined with spironolactone after catheter ablation of patients with paroxysmal atrial fibrillation.Methods:80 cases of patients with paroxysmal atrial fibr...Objective:To evaluate the application effect of telmisartan combined with spironolactone after catheter ablation of patients with paroxysmal atrial fibrillation.Methods:80 cases of patients with paroxysmal atrial fibrillation who received radiofrequency catheter ablation treatment from March 2013 to March 2016 in our hospital were randomly selected,these patients were divided into two groups according to the treatment methods,namely,the telmisartan with Spironolactone treatment group(combined treatment group,n=40)and the conventional therapy group(n=40).The hs-CRP,NT-proBNP,LAD and recurrence of the two groups were analyzed.Results:The hs-CRP,NT-proBNP levels after 3 months of the combined treatment group were significantly lower(P<0.05),the recurrence rate 10.0%(4/40)was significantly lower than the conventional therapy group 27.5%(11/40)(P<0.05),the time to recurrence was significantly longer than the conventional therapy group(P<0.05).Conclusion:The application effects of telmisartan combined with spironolactone after catheter ablation in the treatment of patients with paroxysmal atrial fibrillation are better than conventional therapy.展开更多
Objective\ To study electrophysiologic mechanism and radiofrequency catheter ablation of incessent atrioventricular reentrant tachycardia. Methods\ In this report, 17 cases of incessant atrioventricular reentrant tach...Objective\ To study electrophysiologic mechanism and radiofrequency catheter ablation of incessent atrioventricular reentrant tachycardia. Methods\ In this report, 17 cases of incessant atrioventricular reentrant tachycardia (IAVRT) were presented. There were twelve men and five women. The average age was (46±17) years. Mean duration of persistent tachycardia was (36±76) days. Mean ventricular rate was (180±17) min\+\{-1\} during tachycardia. Five patients had cardiac dysfunction and four had tachycardia induced dilated cardiomyopathy. Results\ All the 17 patients underwent successful radiofrequency catheter ablation. There were eleven accessory pathways(APs) in the left side posteroseptal position, three in the left free wall, two in the right free wall and one in the right side posteroseptal position. Two Aps had decremental conduction characteristics. Four patients had longer than normal atrioventricular conduction time, mean AH interval being (161±6) ms. Six patients had posteroseptal AP with RP≥PR during tachycardia on the surface ECG. All patients were free of symptomatic tachycardia during follow up period of 1 38 months. Five patients with heart dysfunction ameliorated one week after tachycardia ablated. Four tachycardia induced dilated cardiomyopathies were followed for mean of 12 months, the size and function of the heart returned normal in three patients, and the heart size became smaller in one. Conclusion\ It was concluded that electrophysiologic mechanism of IAVRT could be related to the following factors: ①Position of the AP, posteroseptal AP had the highest incidence of IAVRT; ②Characteristics of AP, AP with RP≥PR during tachycardia on the surface ECG and the decremental conduction was liable to IAVRT; ③Longer atrioventricular conduction time. As previously described, one or more factors can lead to IAVRT. Radiofrequency catheter ablation could eradicate IAVRT and cure IAVRT induced dilated cardiomyopathy.展开更多
Background Although elderly patients have been included in published series of catheter ablation for atrial fibrillation （AF）, clinicalbenefit and safety remain still less defined in this population. A retrospective...Background Although elderly patients have been included in published series of catheter ablation for atrial fibrillation （AF）, clinicalbenefit and safety remain still less defined in this population. A retrospective analysis of the results of catheter ablation for AF in a large volumecenter focused on comparison of elderly patients with the rest of the patient cohort was conducted in this study. Methods Consecutive patientswho underwent catheter ablation for AF between January 2001 and December 2016 were analysed. A total population of 3197 patients wasdichotomized by the age of 70 years （394 elderly vs. 2803 younger subjects）. Patients were followed in terms of arrhythmia status and sur-vival for a median period of 18 vs. 21 and 35 vs. 57 months, respectively. Results Elderly patients were more frequently females （49% vs.29%, P 〈 0.0001）, had a history of hypertension （79% vs. 57%, P 〈 0.0001）, diabetes （16% vs. 11%, P 〈 0.01）, stroke （9% vs. 6%, P 〈 0.01）,coronary/peripheral artery disease （14% vs. 8%, P 〈 0.0001）, and CHAzDS2-VASc score （3.1 ± 1.3 vs. 1.5 ± 1.2 s, P 〈 0.0001）. Major com-plications were more frequent in elderly （5.3% vs. 3.2%, P = 0.03）; however, this difference was driven by vascular complications （3.6% vs.1.9%, P = 0.04）. There were comparable rates of cerebrovascular （0.3 vs. 0.3%） or nonvascular complications （1.8 vs. 1.2%）. Good arrhyth-mia control was inferior in elderly patients as compared with the rest of the cohort, both without and with antiarrhythmic drugs： 44.2% vs.58.2% （P 〈 0.0001） and 78.2 vs. 83.2% （P 〈 0.01）, respectively. Poor arrhythmia control was associated with relative risk of all-cause mor-tality of 2.7 （95% CI： 1.1-6.4） in elderly patients and 1.4 （95% CI： 0.9-2.0） in younger subjects. Conclusions Catheter ablation for AF inelderly patients is safe although somewhat less effective. Good arrhythmia control is associated with better survival, especially in elderly patients.展开更多
Background Prevalence of atrial fibrillation （AF） increases with age. Radiofrequency catheter ablation （RFCA） is an establishedtreatment option superior to antiarrhythmics （AAs）. In this study, we investigated s...Background Prevalence of atrial fibrillation （AF） increases with age. Radiofrequency catheter ablation （RFCA） is an establishedtreatment option superior to antiarrhythmics （AAs）. In this study, we investigated safety and efficacy of RFCA of AF in octogenarians.Methods From our database, we extracted procedural and follow-up data for patients 〉 80 years with symptomatic AF undergoing RFCAand compared this population to RFCA patients 〈 50 years. All patients underwent pulmonary vein isolation （PVI） supplemented by linearlesions in PVI-nonresponders. Arrhythmia-free survival was assessed using seven day Holter every three months post procedure. All patientscompleted their 12 months follow-up. Results Fifty patients aged ≥80 years （80.5 ± 1.6 years） were compared to 259 patients aged 〈 50years （43.5±5.5 years）. The RFCA complication rate did not vary between groups. No differences in procedural characteristics were seenafter being analyzed by type of AF. Among patients with paroxysmal AF, 71.4% octogenarian vs. 84.7% young patients was free of anyarrhythmia, without AAs, after single procedure. For non-paroxysmal AF, arrhythmia-free survival without AAs, was considerably lower（58.6% octogenarians vs. 81.2% younger patients, P = 0.023）. If AAs were used, arrhythmia-free survival for paroxysmal AF increased to90.5% and 92.1% in octogenarians and younger patients, respectively; and in non-paroxysmal AF it increased to 79.3% vs. 88.4%. ConclusionsRFCA is a safe and effective strategy to achieve normal sinus rhythm in a highly selected group of octogenarians. Paroxysmal AF ablation inoctogenarians has similar clinical effectiveness as that seen in much younger patients. Non-paroxysmal AF ablation has lower, but still rea-sonable clinical effectiveness.展开更多
Backgroud Recent studies have demonstrated that cystatin C is a valuable risk marker for cardiovascular disease morbidity and mortality.Therefore,we hypothesized that the pre-ablation cystatin C level was associated w...Backgroud Recent studies have demonstrated that cystatin C is a valuable risk marker for cardiovascular disease morbidity and mortality.Therefore,we hypothesized that the pre-ablation cystatin C level was associated with post-ablation atrial fibrillation(AF)recurrence.Methods 207 patients were enrolled and completed in this prospective observational study.Patients with AF scheduled for receive radiofrequency catheter ablation(RFCA)therapy were screened for the study.Before ablation therapy,electrocardiogram,24 h holter monitor,transesophageal echocardiography,serum cystatin C,high-sensitivity C-reactive protein,creatinine levels,and routine blood examinations were examined.After ablation,patients were followed up every week for the first month,and then at 2,3,6,9,and 12 months.Thereafter,patients came back to out-patient clinic every six months regularly.Electrocardiogram or 24 h holter monitor were repeated if the patient experienced palpitations or every six months.AF recurrence was defined as atrial flbrillation/atrial flutter or atrial tachycardia lasting≥30 seconds within three months after therapy.Results Compared to patients with no AF recurrence,patients with recurrence had longer AF history(P=0.007),more early recurrence(P=0.000),a larger left atrium(P=0.004),and higher pre-ablation cystatin C levels(P=0.000).Multivariate regression analysis revealed that cystatin C and left atria(LA)diameter were risk factors for AF recurrence.After adjusting for LA diameter,the risk of AF recurrence increased 30%with every milligram cystatin C elevation(95%CI:1.117-1.523).Conclusions Pre-ablation cystatin C levels were associated with AF recurrence after RFCA therapy,an optimal cut-off value of 1.190 mg/L(sensitivity=0.576;specificity=0.851).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
AIM:To investigate the impact of using computed tomography(CT) and contact force(CF) technology on recurrence of atrial tachyarrhythmia after atrial fibrillation(AF) ablation.METHODS: This non-randomized study include...AIM:To investigate the impact of using computed tomography(CT) and contact force(CF) technology on recurrence of atrial tachyarrhythmia after atrial fibrillation(AF) ablation.METHODS: This non-randomized study included 2 groups of patients. All patients had symptomatic recurrent paroxysmal or persistent AF and were treated with at least 1 anti arrhythmic medication or intolerant to medication. The first group included 33 patients who underwent circumferential pulmonary veins isolation(PVI) for AF during 2012 and 2013 guided by CT image integration(Cartomerge, Biosense Webster, Diamond Bar, CA, United States) of left atrium and pulmonary veins into an electroanatomic mapping(EAM) system(CT group) using standard irrigated radiofrequency catheter(Thermo Cool, Carto, Biosense Webster, Diamond Bar, CA, United States) or irrigated catheter with integrated CF sensor(Smart Touch, Carto, Biosense Webster, Diamond Bar, CA, United States). The second group included immediately preceding 32 patients who had circumferential PVI by standard irrigated catheter(Thermo Cool) using only EAM(Carto) system(EAM group). Linear lesions were performed according to the discretion of operator. RESULTS: Sex, age, and persistent AF were not different between groups. PVI was achieved in all patients in both groups. Linear ablations including cavo-tricuspid isthmus and or roof line ablation were not different between groups. Free of atrial tachyarrhythmia during follow-up of 24 mo was significantly higher among CT group compared to EAM group(81% vs 55%; respectively; P = 0.027). When 11 patients from CT group who had ablation using Smart Touch catheter were excluded, the difference between CT group and EAM became non significant(73% vs 55%; respectively; P = 0.16). Sub analysis of CT group showed that patients who had ablation using Smart Touch catheter tend to be more free of atrial tachyarrhythmia compared to patients who had ablation using standard irrigated catheter during follow-up(100% vs 73%; respectively; P = 0.07). Major complications(pericardial effusion, cerebrovascular accident/transient ischemic attack, vascular access injury requiring intervention) did not occurred in both groups.CONCLUSION:These preliminary results suggest that CT image integration and CF technology may reduce the recurrence of atrial tachyarrhythmia after catheter ablation for AF.展开更多
Early recurrence of atrial arrhythmias(ERAA) after ablation is common and strongly predicts late recurrences and ablation failure. However, since arrhythmia may eventually resolve in up to half of patients with ERAA, ...Early recurrence of atrial arrhythmias(ERAA) after ablation is common and strongly predicts late recurrences and ablation failure. However, since arrhythmia may eventually resolve in up to half of patients with ERAA, guidelines do not recommend immediate reintervention for ERAA episodes occurring during a 3-mo postablation blanking period. Certain clinical demographic, electrophysiologic, procedural, and ERAA-related characteristics may predict a higher likelihood of longterm ablation failure. In this review, we aim to discuss potential mechanisms of ERAA, and to summarize the clinical significance, prognostic implications, and treatment options for ERAA.展开更多
Objective To evaluate the effect of modified Maze lines plus pulmonary vein (PV) isolation created by radiofrequency catheter ablation (RFCA) on atrial wall guided by a novel geometry mapping system in the treatment o...Objective To evaluate the effect of modified Maze lines plus pulmonary vein (PV) isolation created by radiofrequency catheter ablation (RFCA) on atrial wall guided by a novel geometry mapping system in the treatment of elderly patients with paroxysmal atrial fibrillation (PAF). Methods After regular electrophysiological study, transseptal punctures were achieved twice with Swartz L1 and R1 sheaths. PV angiographies were conducted to evaluate their orifices and branches. A balloon electrode array catheter with 64 electrodes was put in the middle of the left atrium. Atrium geometry was constructed using Ensite 3000 Navx system. Two RFCA lesion loops and three lines (modified Maze) were created on left and right atrial walls. Each lesion point was ablated for 30 seconds with preset temperature 50 (ae) and energy 30W. The disappearance or 80% decrease of the amplitude of target atrial potential and 10 to 20(|), decrease of ablation impedance were used as an index of effective ablation. Results A total of 11 patients (7 male and 4 female, mean age, 68.7±5.1 years) were enrolled. PAF history was 7.9±4.5 years. PAF could not be prevented by mean 3.1±1.6 antiarrhythmic agents in 6.3±3.4 years. None of the patients had complications with structural heart disease or stroke. Left atrial diameter was 41.3±3.6 mm and LVEF was 59.2±3.7% on echocardiography. Two loops and three lines were completed with 67.8±13.1 (73-167) lesion points. Altogether 76-168 (89.4±15.3) lesion points were created in each patient. PAF could not be provoked by rapid burst pacing up to 600 beat per minute delivered from paroxysmal coronary sinus electrode pair.Complete PV electrical isolation was confirmed by three-dimensional activation mapping. Mean procedure time was 2.7±0.6 hours and fluoroscopy time was 17.8±9.4 minutes. Patients were discharged with oral aspirin and without antiarrhythmic agents. During follow up of 6.5±1.8 months, seven patients were PAF symptom free (63.6%). PAF attacks were decreased more than 70% in two patients (18.2%). PAF frequency did not change in another two patients (18.2%). Conclusions Ensite 3000 Navx guided modified Maze lines plus PV isolation on the atrial wall is safe and feasible in the elderly patients. It has the advantages of exact procedural endpoint, shorter X-ray exposure, fewer complications and satisfied long-term effect PAF control.展开更多
文摘BACKGROUND Left-sided accessory pathways(APs)can be accessed with either a transaortic(TA)or transseptal approach(TS).For children with Marfan syndrome(MFS)who have aortic disease,the use of TA can aggravate the disease,making TS the best choice for these patients.CASE SUMMARY A 10-year-old girl was hospitalized because of intermittent heart palpitations and chest tightness.She was diagnosed with MFS,supraventricular tachycardia,Wolff-Parkinson-White syndrome,and left-sided AP was detected by cardiac electrophysiological.Catheter ablation was successfully performed via TS under the guidance of the Ensite system.During the follow-up,no recurrence or complications occurred.CONCLUSION The TS for catheter ablation of left-sided APs can be considered in children with MFS.Adequate evaluation and selection of the appropriate puncture site are particularly important.
基金the National Key Research and Development Program of China(2017YFC0908803&2018YFC1312501&2016YFC0900901&2016YFC1301002&2020YFC2004803).
文摘Background It is unclear whether catheter ablation(CA)for atrial fibrillation(AF)affects the long-term prognosis in the elderly.This study aims to evaluate the relationship between CA and long-term outcomes in elderly patients with AF.Methods Patients more than 75 years old with non-valvular AF were prospectively enrolled between August 2011 and December 2017 in the Chinese Atrial Fibrillation Registry Study.Participants who underwent CA at baseline were propensity score matched(1:1)with those who did not receive CA.The outcome events included all-cause mortality,cardiovascular mortality,stroke/transient ischemic attack(TIA),and cardiovascular hospitalization.Results Overall,this cohort included 571 ablated patients and 571 non-ablated patients with similar characteristics on 18 dimensions.During a mean follow-up of 39.75±19.98 months(minimum six months),24 patients died in the ablation group,compared with 60 deaths in the non-ablation group[hazard ratio(HR)=0.49,95%confidence interval(CI):0.30-0.79,P=0.0024].Besides,6 ablated and 29 non-ablated subjects died of cardiovascular disease(HR=0.25,95%CI:0.11-0.61,P=0.0022).A total of 27 ablated and 40 non-ablated patients suffered stroke/TIA(HR=0.79,95%CI:0.48-1.28,P=0.3431).In addition,140 ablated and 194 non-ablated participants suffered cardiovascular hospitalization(HR=0.84,95%CI:0.67-1.04,P=0.1084).Subgroup analyses according to gender,type of AF,time since onset of AF,and anticoagulants exposure in initiation did not show significant heterogeneity.Conclusions In elderly patients with AF,CA may be associated with a lower incidence of all-cause and cardiovascular mortality.
文摘BACKGROUND False tendon is a common intraventricular anatomical variation. It refers to a fibroid or fibromuscular structure that exists in the ventricle besides the normal connection of papillary muscle and mitral or tricuspid valve. A large number of clinical studies have suggested that there is a significant correlation between false tendons and premature ventricular complexes. However, few studies have verified this correlation during radiofrequency catheter ablation of premature ventricular complexes.CASE SUMMARY A 45-year-old male was admitted to receive radiofrequency ablation for symptomatic premature ventricular complexes. A three-dimensional model of the left ventricle was established by intracardiac echocardiography using the CartoSound^TM mapping system. In addition to the left anterior papillary muscle,the posterior papillary muscle was mapped. False tendons were found at the base of the interventricular septum, and the other end was connected to the left ventricular free wall near the apex. An irrigated touch force catheter was advanced into the left ventricle via the retrograde approach. The earliest activation site was marked at the interventricular septum attachment of the false tendons and was successfully ablated.CONCLUSION This case verified that false tendons can cause premature ventricular complexes and may be cured by radiofrequency ablation guided by intracardiac echocardiography with the Carto Sound TM system.
文摘In order to improve the efficacy of modified inferior method or middle method of radiofrequency catheter ablation (RFCA) in the treatment of atrioventricular node reentrant tachycardia (AVNRT), the clinical data of 325 cases of AVNRT from March 1992 to Feb. 2000 being subjected to the treatment of RFCA were retrospectively analyzed. The results showed that the successful rate was increased and recurrence was decreased year by year. In the recent 4 years the effective rate was up to 100 %. The complication of three grade of AVB occurred in 3 % and recurrent rate in 9.1 % before March 1996, but both of them were zero in the last 3 years. The time of RFCA procedure and X ray exposure was significantly reduced. It was concluded that ablating more than 3 targets by modified inferior method or middle method with energy titrating and strict endpoint was the crux of obtaining satisfactory therapeutic effects and preventing recurrence.
基金Supported by Shanxi Provincial Health Commission “Four batch” Science and Technology Innovation Project of Medical Development,No. 2021XM45 (to Dr. Wang HX)Academic promotion plan of Shanxi Cardiovascular Hospital,No. XYS20180102 (to Dr. Wang HX)+1 种基金Natural Science Foundation of Shanxi Province,No. 20210302123346 (to Dr. Wang HX)and Scientific Research Incentive Fund of Shanxi Cardiovascular Hospital,No. XYS20190206 (to Dr. Li N)
文摘BACKGROUND Atrial fibrillation(AF)is one of the most common arrhythmias,and radiofrequency catheter ablation is the most effective treatment strategy.The inferior vena cava(IVC)is a common approach for radiofrequency ablation of AF.However,this approach may not be applied to some cases such as chronic venous occlusions,surgical ligation of the IVC,and heterotaxy syndrome(HS).CASE SUMMARY A 68-year-old man with HS suffered from severely symptomatic persistent AF for 9 years,and we successfully ablated by percutaneous transhepatic access.CONCLUSION In patients without femoral vein access,the use of the hepatic vein for pulmonary vein isolation is a viable alternative for invasive electrophysiology procedures.
文摘Atrial fibrillation(AF) and heart failure(HF) are complex clinical entities that occur concomitantly in a significant population of patients, and their prevalence is rising in epidemic proportions. Traditionally, both rate and rhythm control strategies have been regarded as equivalent in the management of dysrhythmia in this AF-HF cohort with escalation of treatment largely guided by symptoms. Both disorders are involved in an elaborate pathophysiological interplay with shared cardiovascular risk factors that contribute to the development and sustenance of both AF and HF. Recent studies and continued development of evidence to support catheter ablation for AF has brought into question the traditional belief in equivalence between rate and rhythm control. Indeed, recent trials, in particular the CASTLE-AF(Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation) study, suggest that catheter ablation for AF improves survival and rates of hospitalisation in patients with concomitant HF and AF, threatening a paradigm shift in the management of this patient cohort. The evident mortality benefit from clinical trials suggests that catheter ablation for AF should be considered as a therapeutic intervention in all suitable patients with the AF-HF syndrome as these patients may derive the greatest benefit from restoration of sinus rhythm. Further research is needed to refine the evidence base, especially to determine which subgroup of HF patients benefit most from catheter ablation and what is the optimal timing.
基金the National Natural Science Foundation of China(61672510)the Shenzhen Basic Research Program(JCYJ20180507182441903).
文摘Background Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia that can cause severe heart problems.Catheter ablation is one of the most ideal procedures for the treatment of AF.Physicians qualified to perform this procedure need to be highly skilled in manipulating the relevant surgical devices.This study proposes an interactive surgical simulator with high fidelity to facilitate efficient training and low-cost medical education.Methods We used a shared centerline model to simulate the interaction between multiple surgical devices.An improved adaptive deviation-feedback approach is proposed to accelerate the convergence of each iteration.The periodical beating of the human heart was also simulated in real time using the position-based dynamics(PBD)framework to achieve higher fidelity.We then present a novel method for handling the interaction between the devices and the beating heart mesh model.Experiments were conducted in a homemade simulator prototype to evaluate the robustness,performance,and flexibility of the proposed method.Preliminary evaluation of the simulator was performed by medical students,residents,and surgeons.Results The interaction between surgical devices,static vascular meshes,and beating heart mesh was stably simulated in a frame rate suitable for interaction.Conclusion Our simulator is capable of simulating the procedure of catheter ablation with high fidelity and provides immersive visual experiences and haptic feedback.
基金Supported by the National Natural Science Foundation of China,No.81873484,No.81170167,and No.81270002the Natural Science Foundation of Zhejiang Province,No.LZ16H020001.
文摘BACKGROUND With an increased number of surgical procedures involving the mitral annular region,the risk of mitral valve prolapse(MVP)has also increased.Previous studies have reported that worsening of MVP occurred early after radiofrequency catheter ablation(RFCA)at papillary muscles in ventricular tachycardia(VT)patients with preoperative MVP.CASE SUMMARY We report a case where MVP and papillary muscle rupture occurred 2 wk after RFCA in a papillary muscle originated VT patient without mitral valve regurgitation or prolapse before.The patient then underwent mitral valve replacement with no premature ventricular contraction or VT.During the surgery,a papillary muscle rupture was identified.Pathological examination showed necrosis of the papillary muscle.The patient recovered after mitral valve replacement.CONCLUSION Too many ablation procedures and energy should be avoided.
基金Supported by the Young Scientist Fund of the National Natural Science Foundation of China,No.82100337Jilin Provincial Science and Technology Department,No.20210402016GH.
文摘Rhythm control is the core part of the integrated management of atrial fibrillation(AF),especially in the early stages.Despite advances in catheter ablation(CA),the recurrence rate of AF after CA remains high.As a result,stratification and early management of AF recurrence after CA are critical.Currently,predictors of recurrence of AF after CA are mostly based on dysfunction caused by structural remodeling,apart from traditional risk factors.Atrial strain is a recently developed important parameter for detecting the deformability of atrial myocardium during the cardiac cycle prior to atrial remodeling.Although there is only preliminary evidence,atrial strain is still a promising parameter in predicting the recurrence of AF after CA at an early stage.This review focuses on the evaluation of atrial strain,the current applications of atrial strain in assessing atrial function,and predicting the recurrence of AF after CA.We summarize the contents related as follows:(1)CA for rhythm control in AF;(2)Evaluation methods of atrial strain;(3)Atrial strain in the remodeling and reverse remodeling of AF;and(4)Clinical applications of atrial strain in predicting the recurrence of AF after CA.Although there is accumulating evidence on the role of decreased atrial strain in the early prediction of AF recurrence,atrial strain is limited in clinical practice for lacking exact cut-off values and difficulty in distinguishing specific function phases of the atrium.More research is needed in the future to add strength to the early prediction value of atrial strain in AF recurrences.
基金Natural Science Research Project of Anhui Educational Committee(No.KJ2019A0401)Anhui Provincial Key Research and Development Project(No.1804h08020246)+1 种基金Excellent young talents project of Anhui Educational Committee(No.gxyq2018039)Innovation and entrepreneurship training program of Bengbu Medical College(No.bydc2020007)。
文摘Objective:To investigate the correlation between Microfibrillar-associated protein 4(MFAP4)and recurrence and clinical outcome of atrial fibrillation(AF)after radiofrequency catheter ablation(RFCA).Methods:A total of 101 patients with AF admitted to our department from December 2018 to January 2020 were treated with RFCA.The average follow-up period was(11.91±0.38)months.They were divided into recurrence group and non-recurrence group according to whether they had recurrence of AF.The levels of MFAP4,transforming growth factor-β1(TGF-β1),cardiac ultrasound indexes,body mass index(BMI)and major cardio-cerebral vascular events were compared between the two groups.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of MFAP4 for recurrence of AF after RFCA.Results:The levels of MFAP4,TGF-β1,left atrial diameter(LAD)and BMI in the recurrent group were higher than those in the non-recurrent group(P<0.05).The left ventricular ejection fraction(LVEF)in the recurrent group was lower than that in the non-recurrent group(P<0.05).The levels of MFAP4,TGF-β1 and LAD in the patients of recurrent paroxysmal AF and persistent AF after RFCA were higher than those in the respective non-recurrent patients(P<0.05).MFAP4 was positively correlated with TGF-β1 and LAD(P<0.05).Logistic regression analysis showed that MFAP4,TGF-β1,and LAD were independent risk factors for recurrence of AF after RFCA.The ROC curve analysis showed that the area under the ROC curve of MFAP4 for predicting recurrence of AF after RFCA was 0.888(P=0.000),and the optimal cut-off value was 19.295ng/ml,with a sensitivity of 77.3%and a specificity of 77.2%.The incidence of readmission and total adverse events in recurrence group was significantly higher than that in non-recurrence group(P<0.05).Conclusions:MFAP4 was significantly increased in patients with recurrence after RFCA of AF,which was one of the independent risk factors for recurrence after RFCA of AF,and had certain clinical application value.
基金Observational study on effect of transcatheter radiofrequency ablation on patients with different types of atrial fibrillation(Project No.:172302089)。
文摘Objective:To evaluate the application effect of telmisartan combined with spironolactone after catheter ablation of patients with paroxysmal atrial fibrillation.Methods:80 cases of patients with paroxysmal atrial fibrillation who received radiofrequency catheter ablation treatment from March 2013 to March 2016 in our hospital were randomly selected,these patients were divided into two groups according to the treatment methods,namely,the telmisartan with Spironolactone treatment group(combined treatment group,n=40)and the conventional therapy group(n=40).The hs-CRP,NT-proBNP,LAD and recurrence of the two groups were analyzed.Results:The hs-CRP,NT-proBNP levels after 3 months of the combined treatment group were significantly lower(P<0.05),the recurrence rate 10.0%(4/40)was significantly lower than the conventional therapy group 27.5%(11/40)(P<0.05),the time to recurrence was significantly longer than the conventional therapy group(P<0.05).Conclusion:The application effects of telmisartan combined with spironolactone after catheter ablation in the treatment of patients with paroxysmal atrial fibrillation are better than conventional therapy.
文摘Objective\ To study electrophysiologic mechanism and radiofrequency catheter ablation of incessent atrioventricular reentrant tachycardia. Methods\ In this report, 17 cases of incessant atrioventricular reentrant tachycardia (IAVRT) were presented. There were twelve men and five women. The average age was (46±17) years. Mean duration of persistent tachycardia was (36±76) days. Mean ventricular rate was (180±17) min\+\{-1\} during tachycardia. Five patients had cardiac dysfunction and four had tachycardia induced dilated cardiomyopathy. Results\ All the 17 patients underwent successful radiofrequency catheter ablation. There were eleven accessory pathways(APs) in the left side posteroseptal position, three in the left free wall, two in the right free wall and one in the right side posteroseptal position. Two Aps had decremental conduction characteristics. Four patients had longer than normal atrioventricular conduction time, mean AH interval being (161±6) ms. Six patients had posteroseptal AP with RP≥PR during tachycardia on the surface ECG. All patients were free of symptomatic tachycardia during follow up period of 1 38 months. Five patients with heart dysfunction ameliorated one week after tachycardia ablated. Four tachycardia induced dilated cardiomyopathies were followed for mean of 12 months, the size and function of the heart returned normal in three patients, and the heart size became smaller in one. Conclusion\ It was concluded that electrophysiologic mechanism of IAVRT could be related to the following factors: ①Position of the AP, posteroseptal AP had the highest incidence of IAVRT; ②Characteristics of AP, AP with RP≥PR during tachycardia on the surface ECG and the decremental conduction was liable to IAVRT; ③Longer atrioventricular conduction time. As previously described, one or more factors can lead to IAVRT. Radiofrequency catheter ablation could eradicate IAVRT and cure IAVRT induced dilated cardiomyopathy.
文摘Background Although elderly patients have been included in published series of catheter ablation for atrial fibrillation （AF）, clinicalbenefit and safety remain still less defined in this population. A retrospective analysis of the results of catheter ablation for AF in a large volumecenter focused on comparison of elderly patients with the rest of the patient cohort was conducted in this study. Methods Consecutive patientswho underwent catheter ablation for AF between January 2001 and December 2016 were analysed. A total population of 3197 patients wasdichotomized by the age of 70 years （394 elderly vs. 2803 younger subjects）. Patients were followed in terms of arrhythmia status and sur-vival for a median period of 18 vs. 21 and 35 vs. 57 months, respectively. Results Elderly patients were more frequently females （49% vs.29%, P 〈 0.0001）, had a history of hypertension （79% vs. 57%, P 〈 0.0001）, diabetes （16% vs. 11%, P 〈 0.01）, stroke （9% vs. 6%, P 〈 0.01）,coronary/peripheral artery disease （14% vs. 8%, P 〈 0.0001）, and CHAzDS2-VASc score （3.1 ± 1.3 vs. 1.5 ± 1.2 s, P 〈 0.0001）. Major com-plications were more frequent in elderly （5.3% vs. 3.2%, P = 0.03）; however, this difference was driven by vascular complications （3.6% vs.1.9%, P = 0.04）. There were comparable rates of cerebrovascular （0.3 vs. 0.3%） or nonvascular complications （1.8 vs. 1.2%）. Good arrhyth-mia control was inferior in elderly patients as compared with the rest of the cohort, both without and with antiarrhythmic drugs： 44.2% vs.58.2% （P 〈 0.0001） and 78.2 vs. 83.2% （P 〈 0.01）, respectively. Poor arrhythmia control was associated with relative risk of all-cause mor-tality of 2.7 （95% CI： 1.1-6.4） in elderly patients and 1.4 （95% CI： 0.9-2.0） in younger subjects. Conclusions Catheter ablation for AF inelderly patients is safe although somewhat less effective. Good arrhythmia control is associated with better survival, especially in elderly patients.
文摘Background Prevalence of atrial fibrillation （AF） increases with age. Radiofrequency catheter ablation （RFCA） is an establishedtreatment option superior to antiarrhythmics （AAs）. In this study, we investigated safety and efficacy of RFCA of AF in octogenarians.Methods From our database, we extracted procedural and follow-up data for patients 〉 80 years with symptomatic AF undergoing RFCAand compared this population to RFCA patients 〈 50 years. All patients underwent pulmonary vein isolation （PVI） supplemented by linearlesions in PVI-nonresponders. Arrhythmia-free survival was assessed using seven day Holter every three months post procedure. All patientscompleted their 12 months follow-up. Results Fifty patients aged ≥80 years （80.5 ± 1.6 years） were compared to 259 patients aged 〈 50years （43.5±5.5 years）. The RFCA complication rate did not vary between groups. No differences in procedural characteristics were seenafter being analyzed by type of AF. Among patients with paroxysmal AF, 71.4% octogenarian vs. 84.7% young patients was free of anyarrhythmia, without AAs, after single procedure. For non-paroxysmal AF, arrhythmia-free survival without AAs, was considerably lower（58.6% octogenarians vs. 81.2% younger patients, P = 0.023）. If AAs were used, arrhythmia-free survival for paroxysmal AF increased to90.5% and 92.1% in octogenarians and younger patients, respectively; and in non-paroxysmal AF it increased to 79.3% vs. 88.4%. ConclusionsRFCA is a safe and effective strategy to achieve normal sinus rhythm in a highly selected group of octogenarians. Paroxysmal AF ablation inoctogenarians has similar clinical effectiveness as that seen in much younger patients. Non-paroxysmal AF ablation has lower, but still rea-sonable clinical effectiveness.
文摘Backgroud Recent studies have demonstrated that cystatin C is a valuable risk marker for cardiovascular disease morbidity and mortality.Therefore,we hypothesized that the pre-ablation cystatin C level was associated with post-ablation atrial fibrillation(AF)recurrence.Methods 207 patients were enrolled and completed in this prospective observational study.Patients with AF scheduled for receive radiofrequency catheter ablation(RFCA)therapy were screened for the study.Before ablation therapy,electrocardiogram,24 h holter monitor,transesophageal echocardiography,serum cystatin C,high-sensitivity C-reactive protein,creatinine levels,and routine blood examinations were examined.After ablation,patients were followed up every week for the first month,and then at 2,3,6,9,and 12 months.Thereafter,patients came back to out-patient clinic every six months regularly.Electrocardiogram or 24 h holter monitor were repeated if the patient experienced palpitations or every six months.AF recurrence was defined as atrial flbrillation/atrial flutter or atrial tachycardia lasting≥30 seconds within three months after therapy.Results Compared to patients with no AF recurrence,patients with recurrence had longer AF history(P=0.007),more early recurrence(P=0.000),a larger left atrium(P=0.004),and higher pre-ablation cystatin C levels(P=0.000).Multivariate regression analysis revealed that cystatin C and left atria(LA)diameter were risk factors for AF recurrence.After adjusting for LA diameter,the risk of AF recurrence increased 30%with every milligram cystatin C elevation(95%CI:1.117-1.523).Conclusions Pre-ablation cystatin C levels were associated with AF recurrence after RFCA therapy,an optimal cut-off value of 1.190 mg/L(sensitivity=0.576;specificity=0.851).
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AIM:To investigate the impact of using computed tomography(CT) and contact force(CF) technology on recurrence of atrial tachyarrhythmia after atrial fibrillation(AF) ablation.METHODS: This non-randomized study included 2 groups of patients. All patients had symptomatic recurrent paroxysmal or persistent AF and were treated with at least 1 anti arrhythmic medication or intolerant to medication. The first group included 33 patients who underwent circumferential pulmonary veins isolation(PVI) for AF during 2012 and 2013 guided by CT image integration(Cartomerge, Biosense Webster, Diamond Bar, CA, United States) of left atrium and pulmonary veins into an electroanatomic mapping(EAM) system(CT group) using standard irrigated radiofrequency catheter(Thermo Cool, Carto, Biosense Webster, Diamond Bar, CA, United States) or irrigated catheter with integrated CF sensor(Smart Touch, Carto, Biosense Webster, Diamond Bar, CA, United States). The second group included immediately preceding 32 patients who had circumferential PVI by standard irrigated catheter(Thermo Cool) using only EAM(Carto) system(EAM group). Linear lesions were performed according to the discretion of operator. RESULTS: Sex, age, and persistent AF were not different between groups. PVI was achieved in all patients in both groups. Linear ablations including cavo-tricuspid isthmus and or roof line ablation were not different between groups. Free of atrial tachyarrhythmia during follow-up of 24 mo was significantly higher among CT group compared to EAM group(81% vs 55%; respectively; P = 0.027). When 11 patients from CT group who had ablation using Smart Touch catheter were excluded, the difference between CT group and EAM became non significant(73% vs 55%; respectively; P = 0.16). Sub analysis of CT group showed that patients who had ablation using Smart Touch catheter tend to be more free of atrial tachyarrhythmia compared to patients who had ablation using standard irrigated catheter during follow-up(100% vs 73%; respectively; P = 0.07). Major complications(pericardial effusion, cerebrovascular accident/transient ischemic attack, vascular access injury requiring intervention) did not occurred in both groups.CONCLUSION:These preliminary results suggest that CT image integration and CF technology may reduce the recurrence of atrial tachyarrhythmia after catheter ablation for AF.
文摘Early recurrence of atrial arrhythmias(ERAA) after ablation is common and strongly predicts late recurrences and ablation failure. However, since arrhythmia may eventually resolve in up to half of patients with ERAA, guidelines do not recommend immediate reintervention for ERAA episodes occurring during a 3-mo postablation blanking period. Certain clinical demographic, electrophysiologic, procedural, and ERAA-related characteristics may predict a higher likelihood of longterm ablation failure. In this review, we aim to discuss potential mechanisms of ERAA, and to summarize the clinical significance, prognostic implications, and treatment options for ERAA.
文摘Objective To evaluate the effect of modified Maze lines plus pulmonary vein (PV) isolation created by radiofrequency catheter ablation (RFCA) on atrial wall guided by a novel geometry mapping system in the treatment of elderly patients with paroxysmal atrial fibrillation (PAF). Methods After regular electrophysiological study, transseptal punctures were achieved twice with Swartz L1 and R1 sheaths. PV angiographies were conducted to evaluate their orifices and branches. A balloon electrode array catheter with 64 electrodes was put in the middle of the left atrium. Atrium geometry was constructed using Ensite 3000 Navx system. Two RFCA lesion loops and three lines (modified Maze) were created on left and right atrial walls. Each lesion point was ablated for 30 seconds with preset temperature 50 (ae) and energy 30W. The disappearance or 80% decrease of the amplitude of target atrial potential and 10 to 20(|), decrease of ablation impedance were used as an index of effective ablation. Results A total of 11 patients (7 male and 4 female, mean age, 68.7±5.1 years) were enrolled. PAF history was 7.9±4.5 years. PAF could not be prevented by mean 3.1±1.6 antiarrhythmic agents in 6.3±3.4 years. None of the patients had complications with structural heart disease or stroke. Left atrial diameter was 41.3±3.6 mm and LVEF was 59.2±3.7% on echocardiography. Two loops and three lines were completed with 67.8±13.1 (73-167) lesion points. Altogether 76-168 (89.4±15.3) lesion points were created in each patient. PAF could not be provoked by rapid burst pacing up to 600 beat per minute delivered from paroxysmal coronary sinus electrode pair.Complete PV electrical isolation was confirmed by three-dimensional activation mapping. Mean procedure time was 2.7±0.6 hours and fluoroscopy time was 17.8±9.4 minutes. Patients were discharged with oral aspirin and without antiarrhythmic agents. During follow up of 6.5±1.8 months, seven patients were PAF symptom free (63.6%). PAF attacks were decreased more than 70% in two patients (18.2%). PAF frequency did not change in another two patients (18.2%). Conclusions Ensite 3000 Navx guided modified Maze lines plus PV isolation on the atrial wall is safe and feasible in the elderly patients. It has the advantages of exact procedural endpoint, shorter X-ray exposure, fewer complications and satisfied long-term effect PAF control.
