ObjectiveTo investigate the technique and efficacy of left atrial appendage (LAA) occlusion during off-pump coronary artery bypass grafting (OPCABG) in elderly patients with coronary artery disease (CAD) and atrial fibrillation (AF).MethodsFrom 2013 to 2018, 84 elderly patients with CAD and AF with reduced left ventricular ejection fraction (LVEF< 50%) underwent OPCABG in our department. There were 54 males and 30 females at age of 70-82 years. They were divided into a left atrial appendage (LAA) occlusion group (n=56) and a non-LAA occlusion group (n=28). Postoperative antithrombotic therapy: the LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic therapy” for 3 months after operation, then was changed to aspirin + clopidogrel “dual antiplatelet” for long-term antithrombotic; the non-LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic” for long-term antithrombotic after operation. The clinical effectiveness of the two groups was compared.ResultsAll patients underwent the surgery successfully. There were 56 patients in the LAA occlusion group, including 44 patients of LAA exclusion and 12 patients of LAA clip. The time of LAA occlusion was 3 to 8 minutes. There was no injury of graft vessels and anastomotic stoma. Early postoperative death occurred in 2 patients (2.4%). There was no statistical difference between the two groups in postoperative hospital stay (P=0.115). Postoperative LVEF of the two groups significantly improved compared with that before operation (P<0.05). There was no stroke or bleeding in important organs during hospitalization. During follow-up of 1 year, no cerebral infarction occurred in both groups, but the incidence of bleeding related complications in the LAA occlusion group was significantly lower than that in the non-LAA occlusion group (3.6% vs. 18.5%, P=0.036).ConclusionFor elderly patients with CAD and AF with reduced LVEF, LAA occlusion during OPCABG can effectively reduce the risk of stroke and bleeding related complications, and without increasing the risk of surgery.
Atrial fibrillation is a common and refractory atrial arrhythmia. Changes of atrial mechanical circumstances are closely related to the occurrence and maintenance of atrial fibrillation. Mechanical factors can increase the automaticity, slow conduction velocity and shorten the effective refractory period of the atrium by causing electrical and structural remodeling, and eventually increase the inducibility of atrial fibrillation. The intracellular calcium level, function and structure of cytoskeleton, local renin-angiotensin system, integrin and mitogen-activated protein kinases (MAPKs) pathway might take part in the process. Here we analyze and review the underlining mechano-electric feedback process of atrial fibrillation and its related research in order to provide a theoretical basis for further research and elucidating of the mechanical mechanism of atrial fibrillation.
Objective To evaluate long-term outcomes of surgical closure of atrial septal defect (ASD) and combined surgical radiofrequency ablation for atrial fibrillation (AF). Methods A total of consecutive 15 patients with ASD undergoing surgical closure of ASD and combined surgical radiofrequency ablation in our department between March 2003 and April 2015. There were 7 males and 8 females at an average age of 47.1±10.8 years ranging from 16 to 62 years. Retrospective analysis and follow-up were performed to evaluate long-term success rate freedom from AF after surgery. Results All patients recovered and discharged, and no patient suffered death or stroke. The duration of follow-up was from 3 to 136 months for all patients. Success rate freedom from AF at 1, 3, 5 and 10 years was 81.3%, 75.0%, 68.8% and 61.1%, respectively. During follow-up, there was no death or stroke. One patient required permanent pacemaker implantation. Conclusion Concomitant surgical closure of ASD and biatrial radiofrequency ablation is safe and effetive with better long-term outcomes. It is necessary to perform the two procedures together for ASD patients.
ObjectiveTo compare the effectiveness of different β-blockers for preventing postoperative atrial fibrillation (POAF) after cardiac surgery. Methods Databases of PubMed, Science Direct, Web of Science, The Cochrane Library, SinoMed, CKNI, VIP, WanFang were searched by the computer from inception to April 31, 2022 to collect randomized controlled studies on the comparison of the effectiveness of different β-blockers for preventing POAF. Two investigators independently screened the literature and extracted information. The quality of the literature was evaluated using Cochrane bias risk tool, and RevMan 5.3 and STATA 17.0 were used for meta-analysis. Results A total of 17 randomized controlled studies with 3 290 patients were included. Direct meta-analysis showed that landiolol and metoprolol were more effective than placebo (P≤0.001), and carvedilol was more effective than metoprolol in preventing the development of POAF (P<0.001). Network meta-analysis showed that landiolol, carvedilol and metoprolol were more effective than placebo in preventing the incidence of POAF (P<0.05). Landiolol and carvedilol were more effective than metoprolol, and carvedilol were more effective than nebivolol (P<0.05). The surface under the cumulative ranking curve from high to low were carvedilol, landilol, propranolol, atenolol, metoprolol, and nebivolol. Conclusion Carvedilol and landilol have different degrees of improvement in the occurrence of POAF, and carvedilol has the best preventive effect. More studies are required to verify the strength of evidence due to the limited sample size.
Atrial fibrillation (AF) is a common arrhythmia disease. Detection of atrial fibrillation based on electrocardiogram (ECG) is of great significance for clinical diagnosis. Due to the non-linearity and complexity of ECG signals, the procedure to manually diagnose the ECG signals takes a lot of time and is prone to errors. In order to overcome the above problems, a feature extraction method based on RR interval is proposed in this paper. The discrete degree of RR interval is described with the robust coefficient of variation (RCV), the distribution shape of RR interval is described with the skewness parameter (SKP), and the complexity of RR interval is described with the Lempel-Ziv complexity (LZC). Finally, the feature vectors of RCV, SKP, and LZC are input into the support vector machine (SVM) classifier model to achieve automatic classification and detection of atrial fibrillation. To verify the validity and practicability of the proposed method, the MIT-BIH atrial fibrillation database was used to verify the data. The final classification results show that the sensitivity is 95.81%, the specificity is 96.48%, the accuracy is 96.09%, and the specificity of 95.16% is achieved in the MIT-BIH normal sinus rhythm database. The experimental results show that the proposed method is an effective classification method for atrial fibrillation.
摘要:目的:探讨胺碘酮治疗充血性心力衰竭(CHF)心房颤动伴快速心室率的临床疗效。方法: 将106例各种原因所致的房颤伴快速心室率的CHF患者按入院顺序随机分为治疗组及对照组。两组抗CHF基础治疗相同,治疗组加用静脉负荷量胺碘酮150 mg后,再以1 000μg/min静脉点滴维持6小时,500 μg/min静滴18小时。同时口服胺碘酮0.2,3次/d,1周;再0.2,2次/d,1周以后以0.2,1次/d 至观察终点,随诊为12个月。 结果: 治疗组53例使用胺碘酮治疗可显著增加抗心律失常有效性,改善左室射血分数,减少心力衰竭再住院率,42例患者转复为室性心律。 结论: 静脉及口服胺碘酮同时应用治疗充血性心力衰竭房颤是有效和安全的。Abstract: Objective: To explore the effect and safety of amiodarone in the treatment of atrial fibrillation with congestive heart failure. Methods:One hundred and six patients of AF with CHF caused by a variety of reasons were randomly divided into treatment group and control group according to hospitalized order.The two groups were treated with the same antiCHF therapy,the treatment group was treated with loaded intravenous amiodarone 150 mg;and then dripped to 1 000 μg/min for 6 hours, dripped to 500 μg/min for 18 hours. United with oral amiodarone by amiodarone tablets with 0.2 g,3 time/day a week,further 0.2 g,2 times/day a week,later 0.2 g,1 times/day to the end.The end of followup time was 12 months. Results:In treatment group,53 cases with amiodarone therapy can significantly increase the effectives of antiarrhythmic, improve the rate and heart failure rehospitalization.42/53 patients reversed to sinus rhythm. Conclusion:The results showed it is effective and safe united with intravenous amiodarone and oral amiodarone in treatment of atrial fibrillation with organic heart disease.
ObjectiveTo investigate the changes of fibrinogen and classical markers of collagen metabolism [carboxy-terminal propeptide of type Ⅰ procollagen (PICP) and carboxy-terminal cross-linked peptide of type Ⅰ collagen (ICTP)] in peripheral blood and pericardial drainage after coronary artery bypass grafting (CABG) and/or heart valve replacement (VR), and to evaluate their relationship with postoperative atrial fibrillation (POAF) after cardiac surgery. MethodsPatients who underwent CABG and/or VR in the Heart Center of Beijing Chao-Yang Hospital from March to June 2021 were included. Peripheral blood and pericardial drainage fluid samples were collected before surgery and at 0 h, 6 h, 24 h and 48 h after surgery to detect PICP, ICTP and fibrinogen levels, and preoperative, intraoperative and postoperative confounding factors were also collected. PICP, ICTP and fibrinogen levels were measured by enzyme-linked immunosorbent assay (ELISA). ResultsA total of 26 patients with 125 blood samples and 78 drainage samples were collected. There were 18 males and 8 females with an average age of 64.04±7.27 years. The incidence rate of POAF was 34.6%. Among the factors, the fibrinogen level in pericardial drainage showed two peaks within 48 h after operation (0 hand 24 h after operation) in the POAF group, while it showed a continuous downward trend in the sinus rhythm (SR) group, and the change trend of fibrinogen in pericardial drainage was significantly different over time between the two groups (P=0.022). Fibrinogen in blood, PICP and ICTP in blood and drainage showed an overall decreasing trend, and their trends over time were not significantly different between the two groups of patients (P>0.05). Univariate analysis showed that fibrinogen at 24 h and 48 h after pericardial drainage, fibrinogen in preoperative blood, PICP immediately after surgery and right atrial long axis diameter were significantly higher or longer in the POAF group than those in the SR group. Multiple regression showed that fibrinogen≥11.47 ng/mL in pericardial drainage 24 h after surgery (OR=14.911, 95%CI 1.371-162.122, P=0.026), right atrial long axis diameter≥46 mm (OR=10.801, 95%CI 1.011-115.391, P=0.049) were independent predictors of POAF. ConclusionThis study finds the regularity of changes in fibrinogen and collagen metabolic markers after CABG and/or VR surgery, and to find that fibrinogen in pericardial drainage 24 h after surgery is a potential novel and predictive factor for POAF. The results provide a new idea for exploring the mechanism of POAF, and provide a research basis for the accurate prediction and prevention of clinical POAF.
Objective To investigate the mastery of the management knowledge of patients with atrial fibrillation after coronary artery bypass grafting by cardiac surgeons in Beijing tertiary hospitals, and the practice status and obstacles of following the guidelines for postoperative atrial fibrillation. Methods A convenient sampling method was used to select cardiac surgeons from four tertiary hospitals in Beijing, and a self-designed questionnaire on the management of postoperative atrial fibrillation patients was used. Results A total of 227 valid questionnaires were collected. Only 47.9% of doctors and 12.8% of nurses passed in knowledge, and 31.3% of doctors and 28.5% of nurses passed in behavior. Among them, risk factor assessment, preventive medication, stroke and bleeding risk assessment were the weakest. "Lack of departmental requirements" was identified as a common barrier to healthcare workers' adherence to guidelines. Job title and participation in training were common influencing factors that affected the knowledge and behavior of healthcare workers, and knowledge level was an important factor affecting healthcare worker behavior. Conclusion In order to improve the effect of CABG surgery and improve the quality of postoperative patient management, hospitals should further strengthen the knowledge and skills training of medical staff on the management guidelines of postoperative atrial fibrillation with CABG, formulate relevant systems to ensure the clinical implementation of guidelines.
The effect of relaxation time in hyperbolic heat transfer model on the temperature field of microwave ablation of atrial fibrillation was investigated. And the results were compared with those calculated by Pennes model. A three-dimensional model of microwave ablation of atrial fibrillation was constructed. The relaxation time (τ) was 0, 1, 5, 8, 10, 15 and 20 s, respectively. And the temperature field of myocardial tissue was obtained. The results showed that the highest temperature of the hyperbolic model was 21.8 ℃ lower than that of the Pennes model at the beginning of ablation. With the increase of ablation time, the highest temperature tended to be the same. The lesion dimensions appeared at 3, 4, 6, 7, 8, 9, and 10 s, respectively after ablation. Therefore, the influence of hyperbolic model on temperature will decrease with the increase of the ablation time. At the beginning of ablation, the relaxation time will hinder the speed of myocardial thermal diffusion. The larger the relaxation time is, the slower the speed of thermal diffusion is. This study provides a reference for the application of hyperbolic model in microwave ablation of atrial fibrillation.
Objective To investigate the influence of T helpers 17 (Th17) cells, regulatory T (Treg) cells and their related cytokines on postoperative atrial fibrillation (POAF) after coronary artery bypass graft (CABG). Methods A total of 132 consecutive patients undergoing CABG between May 2013 and July 2016 were recruited. There were 82 males and 50 females with the age ranging from 39-76 years. Venous blood samples were collected within 2 hours after surgery. The expression of Th17 cells, Treg cells and their related cytokines in the peripheral blood was determined. Results POAF occurred in 35 patients (a POAF group) and 97 patients did not develop POAF (a No POAF group). Compared to the No POAF group, the proportion of Th17 cells and Th17/Treg ratio in the peripheral blood significantly increased in the POAF group (P>0.05) while proportion of Treg cells remained no significant change (P>0.05). The expression of Th17-related cytokines (IL-6, IL-8 and IL-17) all obviously increased in the POAF group (P>0.05). However, no significant difference was found in the expression of Treg-related cytokines (IL-10 and TGF-β) between the two groups (P>0.05). Conclusion Th17/Treg is unbanlanced in POAF patients and regulation of this imbalance may decrease the occurrence of POAF.