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
Objectives To address whether menopause affects outcome of catheter ablation （CA） for atrial fibrillation （AF） by comparing the safety and long-term outcome of a single-procedure in pre-and post-menopausal women. ...Objectives To address whether menopause affects outcome of catheter ablation （CA） for atrial fibrillation （AF） by comparing the safety and long-term outcome of a single-procedure in pre-and post-menopausal women. Methods A total of 743 female patients who underwent a single CA procedure of drug-refractory AF were retrospectively analyzed. The differences in clinical presentation and outcomes of CA for AF between the pre-menopausal women （PreM group, 94 patients, 12.7%） and the post-menopausal women （PostM group, 649 patients, 87.3%） were assessed. Results The patients in the PreM group were younger （P＆lt;0.001） and less likely to have hypertension （P＆lt;0.001） and diabetes （P=0.005） than those in the PostM group. The two groups were similar with regards to the proportion of concomitant mitral valve regurgitation coronary artery disease, left atrium dimensions, and left ventricular ejection fraction. The overall rate of complica-tions related to AF ablation was similar in both groups （P=0.385）. After 43 （16-108） months of follow-up, the success rate of ablation was 54.3%in the PreM group and 54.2%in the PostM group （P=0.842）. The overall freedom from atrial tachyarrhythmia recurrence was simi-lar in both groups. Menopause was not found to be an independent predictive factor of the recurrence of atrial tachyarrhythmia. Conclusions The long-term outcomes of single-procedure CA for AF are similar in pre-and post-menopausal women. Results indicated that CA of AF appears to be as safe and effective in pre-menopausal women as in post-menopausal women.展开更多
Objective To evaluate the trend of change in the efficacy and safety of catheter ablation compared with antiarrhythmic drug therapy （ADT） for rhythm control in patients with atrial fibrillation （AF） over time. Met...Objective To evaluate the trend of change in the efficacy and safety of catheter ablation compared with antiarrhythmic drug therapy （ADT） for rhythm control in patients with atrial fibrillation （AF） over time. Methods The online databases PubMed and EMBASE were searched for relevant studies. STATA software （version 12.0） was used to perform the meta-analysis and meta-regression. Results Fifteen randomized controlled trials including 2249 patients with AF were identified. The pooled results showed that catheter ablation was associated with a 52% reduction in the risk of AF recurrence compared with ADT [risk ratio （RR） = 0.48, 95% confidence interval （CI）： 0.40-0.57, I2 = 70.7%）. Subgroup analyses showed that catheter ablation exhibited less efficacy in studies after 2011 compared to studies before 2011 （RR = 0.61, 95% CI： 0.54-0.68, I2 = 9.3% and RR = 0.34, 95% CI： 0.24-0.47, I2 = 69.9%, respectively）, and the safety outcome showed a 1.08-fold higher incidence of adverse events （14.2% vs. 7.3%; RR = 1.08, 95% CI： 1.04-1.13） in studies after 2011. Conclusions Catheter ablation appears to be superior to ADT for rhythm control. However, less efficacy and a higher rate of adverse events were observed in studies after 2011 compared to studies before 2011.展开更多
Seventy patients with left atrioventricular accessory pathways and paroxysmal supraventricular tachycardia(PSVT) underwent radiofrequency catheter ablation(RFCA). The success rate was 94. 3%. Among these patients,26 h...Seventy patients with left atrioventricular accessory pathways and paroxysmal supraventricular tachycardia(PSVT) underwent radiofrequency catheter ablation(RFCA). The success rate was 94. 3%. Among these patients,26 had manifest preexcitation syndrome, and 44 had concealed preexcitation. Eighteen patients with concealed preexcitation underwent coronary sinus (CS) pacing, and delta wave appeared in 15. The keys to successful RFCA were correct positioning of the radiofrequency(RF) catheter tip, A/V amplitude ratio, AV interval (in sinus rhythm) and VA interval(during SVT or ventricular pacing). After 1～14 months of follow-up. two patients had supraventricular tachycardia(SVT) recurrence.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 an independent risk factor for ischemic stroke and is associated with increased risk of death. Randomized studies suggest improved quality of life for patients with AF after su...Background Atrial fibrillation （AF） is an independent risk factor for ischemic stroke and is associated with increased risk of death. Randomized studies suggest improved quality of life for patients with AF after successful catheter ablation compared to antiarrhythmic drug therapy. The value of ablation in long-term risk of ischemic stroke, however, has not been assessed. We conducted a meta-analysis to determine whether AF ablation reduces the long-term risk of stroke compared to antiarrhythmic drug therapy in randomized controlled trials. Methods ＆ Results PubMed and the Cochrane Central Register were searched for randomized trials from January 1990 to December 2014 comparing AF catheter ablation to drug therapy. The results are reported as risk differences （RDs） and 95% CI. Thirteen trials were analyzed with 1097 patients treated by catheter ablation and 855 patients received antiarrhythmic drug therapy. Overall, seven patients （0.64%） in the catheter ablation group had ischemic stroke or transient ischemic attacks vs. two patients （0.23%） in the drug therapy group. No difference was shown in the rate of stroke or transient ischemic attack between ablation and drug therapy （RD： 0.003, 95% CI： -0.006 to 0.012, P = 0.470）, and no evidence of heterogeneity was observed （I^2 = 0, P = 0.981）. No potential publication bias was found. There was also no difference in mortality between the two groups （RD： -0.004, 95% CI： -0.014 to 0.006, P = 0.472）. Conclusions This meta-analysis of randomized controlled trials showed similar rates of ischemic stroke or transient ischemic attack and death in AF patients undergoing catheter ablation compared to drug therapy. A larger prospective randomized trial to confirm this finding is warranted.展开更多
Objective To investigate the feasibility and effectiveness of radiofrequency catheter ablation (RFCA) to treat permanent atrial fibrillation (AF) under the guidance of Carto-Merge technique. Methods Fifteen male patie...Objective To investigate the feasibility and effectiveness of radiofrequency catheter ablation (RFCA) to treat permanent atrial fibrillation (AF) under the guidance of Carto-Merge technique. Methods Fifteen male patients with permanent AF underwent RFCA under the guidance of Carto-Merge technique. The mean age was 54.00±10.44 years, and duration of AF was 23.66±14.93 months. Cardiac magnetic resonance angiography (MRA) was performed to obtain pre-procedural three-dimensional (3D) images on the anatomy of left atrium (LA) and pulmonary veins (PVs) before RFCA procedure. Then the electroanatomical map was integrated with 3D images of MRA to form Carto-Merge map that guided step-by-step ablation strategy of permanent AF. Circumferential PV ablation was performed first until complete PVs electric isolation confirmed by Lasso catheter. If AF was not terminated, lesion lines on roof of LA, mitral isthmus, and tricuspid isthmus were produced. Results The episodes of AF were terminated during RFCA in 2 patients, by direct current cardioversion in the remaining 13 patients. Transient AF occurred in 2 patients after ablation on 1st day and 1st week respectively, AF terminated spontaneously not long after taking metoprolol. One patient developed persistent atrial flutter (AFL) in 2 months after procedure and AFL was eliminated by the second ablation. Persistent AF recurred on 1st day, 1st and 5th week respectively in 3 patients, and did not terminate after 3 months even though amiodarone was given. The remaining 12 patients were all free of AF during 2-11 months of follow-up. The recent success rate for RFCA of permanent AF was 80%. Conclusions Carto-Merge technique can effectively guide RFCA of permanent AF. When combined with single Lasso mapping, it can simplify the mapping, lower expenses, and enhance the success rate of RFCA of permanent AF.展开更多
Background The long-term prognostic influence of left atrial diameter （LAD） remodeling on the status of post-radiofrequency catheter ablation （RI CA） atrial fibrillation （AF） is unclear. This study employed a tw...Background The long-term prognostic influence of left atrial diameter （LAD） remodeling on the status of post-radiofrequency catheter ablation （RI CA） atrial fibrillation （AF） is unclear. This study employed a two-stage model from 3-year echocardiographic data to ascertain whether the two-stage model predicts RFCA outcome more favorably than models using the baseline LAD. Methods Data were retrospectively collected from 263 consecutive patients with drug-refractory AF undergoing RFCA. Regular echocardiographic measurements of LAD were performed at baseline, 1, 3, 6, and 12 months and then every 6 months after RFCA. Sex, age, type of AF, number of RFCA, and AF status were recorded. We obtain the actual （predicted） 3-year LAD using a longitudinal linear mixed model （1st stage）. Logistic regression models based on the baseline LAD （Model 1）, actual （predicted） 3-year LAD （Model 2） （2nd stage）, and observed 3-year LAD （Model 3） were constructed to predict RFCA outcome. The area under the receiver operating characteristic curve （AUC） were used to assess the performance of models. Results The lowess smoothed curve indicated that the LAD declined over the first three months and remained stable up to 36 months after RFCA. The degree of LAD reduction was significantly influenced by the baseline LAD. Non-paroxysmal AF, large LAD and female gender were significant predictors of AF recurrence. Model 2 had the largest AUC among the three models. Conclusions This longitudinal study-based two-stage model outperforms the original logistic model using the baseline LAD. Non-paroxysmal AF, larger LAD and female gender are significant predictors of RFCA failure.展开更多
Background Catheter ablation for ventricular tachycardia(VT) in patients with arrhythmogenic right ventricular cardiomyopathy(ARVC) has significantly evolved over the past decade. However, different ablation strategie...Background Catheter ablation for ventricular tachycardia(VT) in patients with arrhythmogenic right ventricular cardiomyopathy(ARVC) has significantly evolved over the past decade. However, different ablation strategies showed inconsistency in acute and long-term outcomes. Methods We searched the databases of Medline, Embase and Cochrane Library through October 17, 2019 for studies describing the clinical outcomes of VT ablation in ARVC. Data including VT recurrence, all-cause mortality, acute procedural efficacy and major procedural complications were extracted. A meta-analysis with trial sequential analysis was further performed in comparative studies of endo-epicardial versus endocardial-only ablation. Results A total of 24 studies with 717 participants were enrolled. The literatures of epicardial ablation were mainly published after 2010 with total ICD implantation of 73.7%, acute efficacy of 89.8%, major complication of 5.2%, follow-up of 28.9 months, VT freedom of 75.3%, all-cause mortality of 1.1% and heart transplantation of 0.6%. Meta-analysis of 10 comparative studies revealed that compared with endocardial-only approach, epicardial ablation significantly decreased VT recurrence(OR: 0.50;95% CI: 0.30–0.85;P = 0.010), but somehow increased major procedural complications(OR: 4.64;95% CI: 1.28–16.92;P = 0.02), with not evident improvement of acute efficacy(OR: 2.74;95% CI: 0.98–7.65;P = 0.051) or all-cause mortality(OR: 0.87;95% CI: 0.09–8.31;P = 0.90). Conclusion Catheter ablation for VT in ARVC is feasible and effective. Epicardial ablation is associated with better long-term VT freedom, but with more major complications and unremarkable survival or acute efficacy benefit.展开更多
Recurrent or incessant tachycardia is frequently found in symptomatic Wolff-Parkinson-White （WPW） syndrome, leading to ventricular dysfunction, dilated cardiomyopathy （DCM） and heart failure in infants and childre...Recurrent or incessant tachycardia is frequently found in symptomatic Wolff-Parkinson-White （WPW） syndrome, leading to ventricular dysfunction, dilated cardiomyopathy （DCM） and heart failure in infants and children.[1] Recently, Winter, et al.[2] report that WPW syndrome could provoke many kinds of cardiac dysfunction, leading to remodeling and progressive ventricular dilatation through pre-excita- tion-related dyssynchrony, even without arrhythmia.展开更多
Objective:To evaluate the electrophysiological characteristics and radiofrequency catheter ablation of atrial tachycardia (AT) in patients with repaired atrial septal defects(ASD). Methods: In 76 consecutive patients ...Objective:To evaluate the electrophysiological characteristics and radiofrequency catheter ablation of atrial tachycardia (AT) in patients with repaired atrial septal defects(ASD). Methods: In 76 consecutive patients with AT who underwent the electrophysiological study and radiofrequency catheter ablation (RFCA). 4 patients (one male and three female aged 35. 5±11. 5 years) had AT-related myocardial scar or incision. Earliest activation combined with entrainment mapping was adopted to determine a critical isthmus. Results: Re-entry related to the lateral atriotomy scar was inducible in 3 of 4 patients. With en-trainment mapping, the PPI-TCL difference was <30 ms when pacing at the inferior margins of the right lateral atriotomy scar. Among them, 2 patients had successful linear ablation between scar area to inferior vena cava, and 1 patient between scar areas to tricuspid annulus. Re-entry involving an ASD patch was demonstrated in 1 of 4 patients. PPI-TCL differences <30 ms were found when entraining tachycardia at sites near the septal patch. But linear ablation failed in terminating AT. There was no complication during procedure. No recurrence of incision-related AT was found during follow-up except for the failed patient. Conclusion: Under conventional electrophysiological mapping, adopting linear ablation from scar area to anatomic barrier, successful ablation also can be obtained in patients with IRAT related to myocardial scar or incision.展开更多
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Objectives To address whether menopause affects outcome of catheter ablation （CA） for atrial fibrillation （AF） by comparing the safety and long-term outcome of a single-procedure in pre-and post-menopausal women. Methods A total of 743 female patients who underwent a single CA procedure of drug-refractory AF were retrospectively analyzed. The differences in clinical presentation and outcomes of CA for AF between the pre-menopausal women （PreM group, 94 patients, 12.7%） and the post-menopausal women （PostM group, 649 patients, 87.3%） were assessed. Results The patients in the PreM group were younger （P＆lt;0.001） and less likely to have hypertension （P＆lt;0.001） and diabetes （P=0.005） than those in the PostM group. The two groups were similar with regards to the proportion of concomitant mitral valve regurgitation coronary artery disease, left atrium dimensions, and left ventricular ejection fraction. The overall rate of complica-tions related to AF ablation was similar in both groups （P=0.385）. After 43 （16-108） months of follow-up, the success rate of ablation was 54.3%in the PreM group and 54.2%in the PostM group （P=0.842）. The overall freedom from atrial tachyarrhythmia recurrence was simi-lar in both groups. Menopause was not found to be an independent predictive factor of the recurrence of atrial tachyarrhythmia. Conclusions The long-term outcomes of single-procedure CA for AF are similar in pre-and post-menopausal women. Results indicated that CA of AF appears to be as safe and effective in pre-menopausal women as in post-menopausal women.
文摘Objective To evaluate the trend of change in the efficacy and safety of catheter ablation compared with antiarrhythmic drug therapy （ADT） for rhythm control in patients with atrial fibrillation （AF） over time. Methods The online databases PubMed and EMBASE were searched for relevant studies. STATA software （version 12.0） was used to perform the meta-analysis and meta-regression. Results Fifteen randomized controlled trials including 2249 patients with AF were identified. The pooled results showed that catheter ablation was associated with a 52% reduction in the risk of AF recurrence compared with ADT [risk ratio （RR） = 0.48, 95% confidence interval （CI）： 0.40-0.57, I2 = 70.7%）. Subgroup analyses showed that catheter ablation exhibited less efficacy in studies after 2011 compared to studies before 2011 （RR = 0.61, 95% CI： 0.54-0.68, I2 = 9.3% and RR = 0.34, 95% CI： 0.24-0.47, I2 = 69.9%, respectively）, and the safety outcome showed a 1.08-fold higher incidence of adverse events （14.2% vs. 7.3%; RR = 1.08, 95% CI： 1.04-1.13） in studies after 2011. Conclusions Catheter ablation appears to be superior to ADT for rhythm control. However, less efficacy and a higher rate of adverse events were observed in studies after 2011 compared to studies before 2011.
文摘Seventy patients with left atrioventricular accessory pathways and paroxysmal supraventricular tachycardia(PSVT) underwent radiofrequency catheter ablation(RFCA). The success rate was 94. 3%. Among these patients,26 had manifest preexcitation syndrome, and 44 had concealed preexcitation. Eighteen patients with concealed preexcitation underwent coronary sinus (CS) pacing, and delta wave appeared in 15. The keys to successful RFCA were correct positioning of the radiofrequency(RF) catheter tip, A/V amplitude ratio, AV interval (in sinus rhythm) and VA interval(during SVT or ventricular pacing). After 1～14 months of follow-up. two patients had supraventricular tachycardia(SVT) recurrence.
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Acknowledgments This study was supported by the National Natural Science Foundation of China （No. 30801213 and No. 81170167）, International Collaboration Projects of Science and Technology Department of Zhejiang Province （No., 2011c14027） and the foundation from Zhejiang Provincial Administration of traditional Chinese Medicine （2011ZQ013）. The corresponding author is sponsored by Zhejiang Provincial Program for the Cultivation of High-level Innovative Health talents.
文摘Background Atrial fibrillation （AF） is an independent risk factor for ischemic stroke and is associated with increased risk of death. Randomized studies suggest improved quality of life for patients with AF after successful catheter ablation compared to antiarrhythmic drug therapy. The value of ablation in long-term risk of ischemic stroke, however, has not been assessed. We conducted a meta-analysis to determine whether AF ablation reduces the long-term risk of stroke compared to antiarrhythmic drug therapy in randomized controlled trials. Methods ＆ Results PubMed and the Cochrane Central Register were searched for randomized trials from January 1990 to December 2014 comparing AF catheter ablation to drug therapy. The results are reported as risk differences （RDs） and 95% CI. Thirteen trials were analyzed with 1097 patients treated by catheter ablation and 855 patients received antiarrhythmic drug therapy. Overall, seven patients （0.64%） in the catheter ablation group had ischemic stroke or transient ischemic attacks vs. two patients （0.23%） in the drug therapy group. No difference was shown in the rate of stroke or transient ischemic attack between ablation and drug therapy （RD： 0.003, 95% CI： -0.006 to 0.012, P = 0.470）, and no evidence of heterogeneity was observed （I^2 = 0, P = 0.981）. No potential publication bias was found. There was also no difference in mortality between the two groups （RD： -0.004, 95% CI： -0.014 to 0.006, P = 0.472）. Conclusions This meta-analysis of randomized controlled trials showed similar rates of ischemic stroke or transient ischemic attack and death in AF patients undergoing catheter ablation compared to drug therapy. A larger prospective randomized trial to confirm this finding is warranted.
文摘Objective To investigate the feasibility and effectiveness of radiofrequency catheter ablation (RFCA) to treat permanent atrial fibrillation (AF) under the guidance of Carto-Merge technique. Methods Fifteen male patients with permanent AF underwent RFCA under the guidance of Carto-Merge technique. The mean age was 54.00±10.44 years, and duration of AF was 23.66±14.93 months. Cardiac magnetic resonance angiography (MRA) was performed to obtain pre-procedural three-dimensional (3D) images on the anatomy of left atrium (LA) and pulmonary veins (PVs) before RFCA procedure. Then the electroanatomical map was integrated with 3D images of MRA to form Carto-Merge map that guided step-by-step ablation strategy of permanent AF. Circumferential PV ablation was performed first until complete PVs electric isolation confirmed by Lasso catheter. If AF was not terminated, lesion lines on roof of LA, mitral isthmus, and tricuspid isthmus were produced. Results The episodes of AF were terminated during RFCA in 2 patients, by direct current cardioversion in the remaining 13 patients. Transient AF occurred in 2 patients after ablation on 1st day and 1st week respectively, AF terminated spontaneously not long after taking metoprolol. One patient developed persistent atrial flutter (AFL) in 2 months after procedure and AFL was eliminated by the second ablation. Persistent AF recurred on 1st day, 1st and 5th week respectively in 3 patients, and did not terminate after 3 months even though amiodarone was given. The remaining 12 patients were all free of AF during 2-11 months of follow-up. The recent success rate for RFCA of permanent AF was 80%. Conclusions Carto-Merge technique can effectively guide RFCA of permanent AF. When combined with single Lasso mapping, it can simplify the mapping, lower expenses, and enhance the success rate of RFCA of permanent AF.
文摘Background The long-term prognostic influence of left atrial diameter （LAD） remodeling on the status of post-radiofrequency catheter ablation （RI CA） atrial fibrillation （AF） is unclear. This study employed a two-stage model from 3-year echocardiographic data to ascertain whether the two-stage model predicts RFCA outcome more favorably than models using the baseline LAD. Methods Data were retrospectively collected from 263 consecutive patients with drug-refractory AF undergoing RFCA. Regular echocardiographic measurements of LAD were performed at baseline, 1, 3, 6, and 12 months and then every 6 months after RFCA. Sex, age, type of AF, number of RFCA, and AF status were recorded. We obtain the actual （predicted） 3-year LAD using a longitudinal linear mixed model （1st stage）. Logistic regression models based on the baseline LAD （Model 1）, actual （predicted） 3-year LAD （Model 2） （2nd stage）, and observed 3-year LAD （Model 3） were constructed to predict RFCA outcome. The area under the receiver operating characteristic curve （AUC） were used to assess the performance of models. Results The lowess smoothed curve indicated that the LAD declined over the first three months and remained stable up to 36 months after RFCA. The degree of LAD reduction was significantly influenced by the baseline LAD. Non-paroxysmal AF, large LAD and female gender were significant predictors of AF recurrence. Model 2 had the largest AUC among the three models. Conclusions This longitudinal study-based two-stage model outperforms the original logistic model using the baseline LAD. Non-paroxysmal AF, larger LAD and female gender are significant predictors of RFCA failure.
基金supported by the National Natural Science Foundation (81570309)National Key R&D Program of China (2017YFC1307800)。
文摘Background Catheter ablation for ventricular tachycardia(VT) in patients with arrhythmogenic right ventricular cardiomyopathy(ARVC) has significantly evolved over the past decade. However, different ablation strategies showed inconsistency in acute and long-term outcomes. Methods We searched the databases of Medline, Embase and Cochrane Library through October 17, 2019 for studies describing the clinical outcomes of VT ablation in ARVC. Data including VT recurrence, all-cause mortality, acute procedural efficacy and major procedural complications were extracted. A meta-analysis with trial sequential analysis was further performed in comparative studies of endo-epicardial versus endocardial-only ablation. Results A total of 24 studies with 717 participants were enrolled. The literatures of epicardial ablation were mainly published after 2010 with total ICD implantation of 73.7%, acute efficacy of 89.8%, major complication of 5.2%, follow-up of 28.9 months, VT freedom of 75.3%, all-cause mortality of 1.1% and heart transplantation of 0.6%. Meta-analysis of 10 comparative studies revealed that compared with endocardial-only approach, epicardial ablation significantly decreased VT recurrence(OR: 0.50;95% CI: 0.30–0.85;P = 0.010), but somehow increased major procedural complications(OR: 4.64;95% CI: 1.28–16.92;P = 0.02), with not evident improvement of acute efficacy(OR: 2.74;95% CI: 0.98–7.65;P = 0.051) or all-cause mortality(OR: 0.87;95% CI: 0.09–8.31;P = 0.90). Conclusion Catheter ablation for VT in ARVC is feasible and effective. Epicardial ablation is associated with better long-term VT freedom, but with more major complications and unremarkable survival or acute efficacy benefit.
文摘Recurrent or incessant tachycardia is frequently found in symptomatic Wolff-Parkinson-White （WPW） syndrome, leading to ventricular dysfunction, dilated cardiomyopathy （DCM） and heart failure in infants and children.[1] Recently, Winter, et al.[2] report that WPW syndrome could provoke many kinds of cardiac dysfunction, leading to remodeling and progressive ventricular dilatation through pre-excita- tion-related dyssynchrony, even without arrhythmia.
文摘Objective:To evaluate the electrophysiological characteristics and radiofrequency catheter ablation of atrial tachycardia (AT) in patients with repaired atrial septal defects(ASD). Methods: In 76 consecutive patients with AT who underwent the electrophysiological study and radiofrequency catheter ablation (RFCA). 4 patients (one male and three female aged 35. 5±11. 5 years) had AT-related myocardial scar or incision. Earliest activation combined with entrainment mapping was adopted to determine a critical isthmus. Results: Re-entry related to the lateral atriotomy scar was inducible in 3 of 4 patients. With en-trainment mapping, the PPI-TCL difference was <30 ms when pacing at the inferior margins of the right lateral atriotomy scar. Among them, 2 patients had successful linear ablation between scar area to inferior vena cava, and 1 patient between scar areas to tricuspid annulus. Re-entry involving an ASD patch was demonstrated in 1 of 4 patients. PPI-TCL differences <30 ms were found when entraining tachycardia at sites near the septal patch. But linear ablation failed in terminating AT. There was no complication during procedure. No recurrence of incision-related AT was found during follow-up except for the failed patient. Conclusion: Under conventional electrophysiological mapping, adopting linear ablation from scar area to anatomic barrier, successful ablation also can be obtained in patients with IRAT related to myocardial scar or incision.
