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.
Atrial fibrillation (AF) and breast cancer are common diseases with high incidence, which can be promoted and maintained by a wide range of regulatory factors (changes of hormone secretion, chronic inflammation, dysfunctions in autonomic nervous system, coagulation system and endothelia). There may be a consistent pathophysiological link between the increased incidence of breast cancer and AF, which is currently seldomly reported. The development process of these two diseases are complex, and the occurrence of breast cancer may increase the incidence of AF. In this paper, we reviewed the relationship between breast cancer and AF based on the latest reports.
Atrial fibrillation is a common clinical arrhythmia with a high incidence. The main clinical treatment methods for atrial fibrillation at present include radiofrequency catheter ablation and cryoablation. In recent years, pulsed field ablation, a new energy source with tissue specificity, is gradually being used in clinical practice. This article presents the world's first case of atrial fibrillation treated with pulsed field surgical ablation, in which the patient underwent surgical intervention of the valves and coronary arteries at the same time and recovered to sinus rhythm intraoperatively. 24 hour-Holter electrocardiogram after 1 month and 3 months showed no atrial fibrillation. The patient’s symptoms, cardiac function, and quality of life improved significantly.
Objective To explore the technique of performing minimally invasive Cox Maze Ⅳ procedure by bipolar clamp through right lateral minithoracotomy for atrial septal defect (ASD) combined with atrial fibrillation (AF) in adults. Methods Thirty-five patients (21 males, 14 females with age ranging from 45 to 73 years) with ASD and persistent or long-standing persistent AF received minimally invasive Cox Maze Ⅳ procedure and ASD closure from August 2012 to April 2016 at Department of Cardiothoracic Surgery, Xinhua Hospital. Diameter of left atrium ranged from 39 to 60 mm and left ventricle ejection fraction (LVEF) ranged from 48% to 62%. Diameter of ASD ranged from 20 to 35 mm. Cox-maze Ⅳ procedure was performed through right minithoracotomy entirely by bipolar radiofrequency clamp. Then, mitral or tricuspid valvuloplasty and surgical ASD closure was performed through right minithoracotomy. Results All patients successfully underwent this minimally invasive surgery. No patient needed conversion to sternotomy. The mean cardiopulmonary bypass time was 120.1±14.1 min. The mean aortic cross-clamp time was 79.5±12.2 min. There was no early death or pacemaker implantation perioperatively. The average length of hospital stay was 10.1±2.7 d. At a mean follow-up of 22.8±12.2 months, sinus rhythm was restored in 32 patients (32/35, 91.4%). Cumulative maintenance of normal sinus rhythm without AF recurrence at 2 years postoperatively was 89.1%±6.0%. Conclusion The minimally invasive Cox Maze Ⅳprocedure performed by bipolar clamp through right minithoracotomy is safe, feasible, and effective for adult patients with ASD combined with AF.
Objective To analyze the preoperative risk factors of atrial fibrillation (AF) in patients with coronary artery disease after coronary artery bypass grafting (CABG). Methods From September 2007 to April 2008, the clinical information of 226 patients who underwent onpump coronary artery bypass grafting(CABG)or offpump coronary artery bypass grafting(OPCAB) was collected. The patients were divided into nonAF group and AF group according to whether AF lasted more than 5 mins in 3 days after operation. Ultrasonic cardiography (UCG) and clinical information of preoperation in two groups were analyzed. Results Twentyfour（10.6%） patients had AF after operation. There were more patients whose left atrial diameter gt;35 mm in AF group than that in nonAF group ［41.7%（10）vs. 22.3% (45),χ2=4.380, P=0.036）］, more patients had mitral regurgitation in AF group than that in nonAF group ［37.5%（9） vs. 17.3% (35),χ2=5.568, P=0.018）］, more patients had left main coronary artery involvement in AF group than that in nonAF group ［33.3% (8) vs.12.4% (25),χ2=7.560,P=0.006］, and patients in AF group were older than those in nonAF group ［65.7±9.5 years vs. 60.1±10.1 years,t=-2.724,P=0.010］. In univariate analysis, in terms of preoperative clinical indexs such as the aged, mitral regurgitation, left atrial diameter, left mainm coronary artery involvement, and postoperative clinical indexs such as ventilatory time （χ2=4.190，P=0.040）, electrocardiogram (ECG) monitoring time（χ2=5.948，P=0.015）, hospitalization expense（χ2=4.110，P=0.043）, there were significant differences between 2 groups. Conclusion Risk factors such as the aged, mitral regurgitation, left atrial diameter and left main coronary artery involvement are related to AF after CABG. Clinical index, ECG and echocardiography are helpful to predict AF, and can provide better prevention and treatment, and reduce the rate of AF.
ObjectiveTo evaluate the incidence of postoperative atrial fibrillation (POAF) after dexmedetomidine and diazepam in patients undergoing coronary artery bypass grafting (CABG). MethodsA retrospective cohort study was conducted in the patients who underwent CABG in the General Hospital of Northern Theater Command from October 2020 to June 2021. By propensity score-matching method, the incidence of POAF after dexmedetomidine and diazepam application in patients undergoing CABG was evaluated. ResultsFinally 207 patients were collected, including 150 males and 57 females, with an average age of 62.02±8.38 years. Among the 207 patients, 53 were treated with dexmedetomidine and 154 with diazepam before operation. There was a statistical difference in the proportion of hypertension patients and smoking patients between the two groups before matching (P<0.05). According to the 1∶1 propensity score-matching method, there were 53 patients in each of the two groups, with no statistical difference between the two groups after matching. After matching, the incidence of POAF in the dexmedetomidine group was lower than that in the diazepam group [9.43% (5/53) vs. 30.19% (16/53), P=0.007]. There was no death in the two groups during hospitalization, and there was no statistical difference in the main adverse events after operation. The ICU stay (21.28±2.69 h vs. 22.80±2.56 h, P=0.004) and mechanical ventilation time (18.53±2.25 h vs. 19.85±2.01 h, P=0.002) in the dexmedetomidine group were shorter. Regression analysis showed that age, smoking and diabetes were related to the increased incidence of POAF (P<0.05), and preoperative use of dexmedetomidine was associated with a reduced incidence of POAF (P=0.002). ConclusionFor patients undergoing CABG, the incidence of POAF with dexmedetomidine before operation is lower than that with diazepam. Preoperative application of dexmedetomidine is the protective factor for POAF, and old age, smoking and diabetes are the risk factors for POAF.
Objective To investigate the inhibition effect of salazosulfapyridine (SF) on the formation of post-operative abdominal adhesion and its possible mechanism. Methods Forty male Sprague-Dawley rats were randomly divided into five groups: sham operation group (Sham group), blank control group (BC group), sodium hyaluronate (HA) group, low dose of SF group (LSF group), and high dose of SF group (HSF group). Except the Sham group, all the rats in other 4 groups were created abdominal adhesion model by abrasion of caecum and its opposite abdominal wall. Rats of the BC group didn’t received any treatment after model establishment. Before closing the abdominal wall, the rats of the HA group were treated by 2 mL HA. After the operation, the rats of the LSF group and the HSF group were daily orally administrated with different dose of SF (50 mg/kg for the LSF group and 100 mg/kg for the HSF group), while the other 3 groups treated with same dose of normal saline. Seven days after operation, the rats of 5 groups were killed and abdominal adhesion conditions was evaluated by Nair’s score system. Then the abdominal adhesion tissues or blood were collected to underwent HE staining, immunohistochemistry staining, and enzyme linked immunosorbent assay (ELISA) test. The HE staining was used to assess the inflammation score and fibrillation score of rats in 5 groups and immunohistochemistry staining was used to evaluate expression of the α-smooth muscle actin(α-SMA) in adhesion tissues. The ELISA test was used to detect the concentration of serum interleukin-1β (IL-1β) and transforming growth factor-β1 (TGF-β1) in rats of 5 groups. Results ① The gross evaluation of adhesion condition:3 rats of the Sham groups had incision adhesion; in the BC group, 4 rats had incision adhesion, 8 rats had cecum to the abdominal wall adhesion, 2 rats had viscera to viscera adhesion; in the HA group, 2 rats had incision adhesion and5 rats had cecum to the abdominal wall adhesion; in the LSF group, 2 rats had incision adhesion, 6 rats had cecum to the abdominal wall adhesion, and 1 rat had viscera to viscera adhesion; in the HSF group, 2 rats had incision adhesion and 4 rats had cecum to the abdominal wall adhesion. Compared with the Sham group, the Nair’s scores of the other4 groups were higher (P<0.05); compared with the BC group, the Nair’s scores of the HA group, the LSF group, and the HSF group were all lower (P<0.05), but there was no significant difference on the Nair’s scores among the HA group, the LSF group, and the HSF group (P>0.05). ② Inflammation score and fibrillation score: on the inflammation score, compared with the Sham group, the inflammation scores of the others 4 groups were higher (P<0.05); compared with the BC and HA group, the inflammation scores of the LSF group and the HSF group were both lower (P<0.05); compared with the LSF group, there was no significant difference on the inflammation score of the HSF group (P>0.05). On the fibrillation score, compared with the Sham group, the fibrillation scores of the others 4 groups were higher (P<0.05); compared with the BC group, the fibrillation scores of the HA group, the LSF group, and the HSF group were all lower (P<0.05), but there was no significant difference on the fibrillation scores among the HA group, the LSF group, and the HSF group (P>0.05). ③ The expression scores of α-SMA: compared with the Sham group, the expression scores of α-SMA in the others 4 groups were higher (P<0.05); compared with the BC group, the expression scores of α-SMA in the HA group, the LSF group, and the HSF group were all lower (P<0.05), but there was no significant difference on the expression scores of α-SMA among the HA group, the LSF group, and the HSF group (P>0.05). ④ Concentration of serum IL-1β and TGF-β1: on the concentration of serum IL-1β, compared with the Sham group, the concentrations of serum IL-1β in the others 4 groups were higher (P<0.05); compared with the BC group, the concentrations of serum IL-1β in the HA group, the LSF group, and the HSF group were all lower (P<0.05); compared with the HA and the LSF group, the concentration of serum IL-1β in the HSF group was lower (P<0.05). On the concentration of serum TGF-β1, compared with the Sham group, the concentrations of serum TGF-β1 in the others 4 groups were higher (P<0.05); compared with the BC group, the concentrations of serum TGF-β1 in the HA group, the LSF group, and the HSF group were all lower (P<0.05); compared with the HA group, the concentrations of serum TGF-β1 in the LSF group and the HSF group were both lower (P<0.05), but there was no significant difference between the LSF group and the HSF group (P>0.05). Conclusion SF can reduce the formation of postoperative abdominal adhesion in rat models via inhibiting inflammation and fibrillation.
Atrial fibrillation, as the most common arrhythmia currently, can lead to secondary post-stroke cognitive dysfunction and chronic brain damage through various pathways, increasing the risk of cognitive dysfunction and affecting patient prognosis. The prevention and treatment drugs for cognitive dysfunction associated with atrial fibrillation mainly include anticoagulants, heart rhythm and heart rate control drugs, statins, and antihypertensive drugs. At present, there is still some controversy over the medication for cognitive dysfunction associated with atrial fibrillation, lacking guidelines and expert consensus. It is urgent and necessary to find safe, economical, and effective drugs to improve the cognitive function of atrial fibrillation patients. This article summarizes the recent advances in drug therapy for cognitive dysfunction associated with atrial fibrillation, in order to provide a reference for the treatment of cognitive dysfunction associated with atrial fibrillation in clinical practice.
ObjectiveTo analyze the clinical presentations and radiological characteristics of pulmonary vein stenosis after radiofrequency ablation. MethodsClinical and radiological data of 2 patients with pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation were retrospectively analyzed and literatures were reviewed. ResultsBoth patients had undergone circumferential pulmonary vein isolation. The symptoms appeared approximately 2 months after the operation. The major symptoms were cough, hemoptysis, exacerbation of dyspnea and chest pain. Both patients were misdiagnosed as other diseases such as pneumonia in other hospitals, and the anti-infection therapy was invalid. Both CT scans showed parenchymal exudative consolidation with varying degrees of interstitial septal thickening and small nodules. Both patients were confirmed as pulmonary vein stenosis by CT angiography. Literature review identified 21 cases of pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation. The main clinical features are hemoptysis, chest pain, shortness of breath and cough. The most common features of thoracic radiological imaging are consolidation, groud-glass attenuation, pleural effusion and interstitial septal thickening. ConclusionsIf a patient presents with hemoptysis, dyspnea, chest pain or other clinical manifestations after ablation therapy and image findings show parenchymal exudative consolidation with interstitial septal thickening and multiple small nodules, the possibility of pulmonary vein stenosis should be considered. Contrast-enhanced CT combined with pulmonary vein imaging technology can clearly show the opening diameter of each pulmonary vein and its branches, so it is an important non-invasive examination method for the evaluation and diagnosis of pulmonary vein stenosis.
Cardiac three-dimensional electrophysiological labeling technology is the prerequisite and foundation of atrial fibrillation (AF) ablation surgery, and invasive labeling is the current clinical method, but there are many shortcomings such as large trauma, long procedure duration, and low success rate. In recent years, because of its non-invasive and convenient characteristics, ex vivo labeling has become a new direction for the development of electrophysiological labeling technology. With the rapid development of computer hardware and software as well as the accumulation of clinical database, the application of deep learning technology in electrocardiogram (ECG) data is becoming more extensive and has made great progress, which provides new ideas for the research of ex vivo cardiac mapping and intelligent labeling of AF substrates. This paper reviewed the research progress in the fields of ECG forward problem, ECG inverse problem, and the application of deep learning in AF labeling, discussed the problems of ex vivo intelligent labeling of AF substrates and the possible approaches to solve them, prospected the challenges and future directions for ex vivo cardiac electrophysiology labeling.