Heart rhythm最新文献

Background: Little is known about the risk factors and prognosis of new-onset atrial fibrillation (NOAF) in patients with primary percutaneous coronary intervention (PCI).

Objective: The purpose of this study was to assess the prevalence and prognosis of NOAF after PCI and the effects of anticoagulation on clinical outcomes.

Method: Using data from the CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) project, ST-elevation myocardial infarction (STEMI) patients undergoing PCI were stratified into 2 groups: with NOAF or without any atrial fibrillation. Multivariable logistic regression was used to identify NOAF predictors, and propensity-score matching estimated associations between NOAF and in-hospital outcomes. A meta-analysis was also performed by pooling our results with literature data.

Results: Of 19,288 STEMI patients undergoing PCI, 1.3% (n = 253) experienced NOAF. Independent risk factors were age ≥65 years, history of hypertension, stroke, heart failure, Killip class IV, and right coronary artery as the culprit artery. NOAF was associated with a higher risk of all-cause mortality (hazard ratio [HR] 2.26, 95% confidence interval [CI] 1.08-4.71), heart failure (HR 4.29, 95% CI 2.81-6.55), cardiogenic shock (HR 4.30, 95% CI 2.28-8.13), in-stent thrombosis (HR 6.04, 95% CI 1.71-21.45), and major bleeding (HR 2.86, 95% CI 1.44-5.66) during hospitalization. Meta-analysis found that NOAF had a higher risk of in-hospital stroke (odds ratio 3.33, 95% CI 1.73-6.43). In-hospital use of anticoagulants was associated with lower rates of all-cause mortality but similar rates of major bleeding in NOAF patients.

Conclusion: Our study suggests NOAF following PCI is uncommon but associated with poor in-hospital prognosis. Findings support the use of anticoagulants in these patients during hospitalization.

Background: The clinical efficacy of surgical occlusion of the left atrial appendage in sinus rhythm patients receiving cardiac surgery remains controversial.

Objective: This meta-analysis attempts to demonstrate the impact of left atrial appendage occlusion (LAAO) on early and late outcomes in patients with sinus rhythm undergoing cardiac surgery.

Methods: Screened and selected studies were sourced from PubMed, Embase, and Web of Science databases, following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Early clinical outcomes were pooled by odds ratio, and long-term outcomes were extracted from Kaplan-Meier curves to reconstruct individual time-to-event patient data and allow for proportional hazard regression. Bias-treated data was selected when available.

Results: Six studies, comprising 2742 patients, were included from an initial 1431 reports. Pooling demonstrated no significant association between LAAO and the development of postoperative atrial fibrillation (odds ratio (OR) 1.157, 95% confidence interval (CI) 0.904-1.481, I² = 46%, p = 0.246). Reconstruction of Kaplan Meier data revealed a higher freedom from cerebrovascular events in the LAAO group than in no-LAAO (hazards ratio (HR) 0.482, 95%CI 0.361-0.643, p <0.001). The LAAO study group also demonstrated improved mid-term survival (HR 0.701, 95%CI 0.554-0.886, p=0.003).

Conclusions: Analysis of patients in sinus rhythm undergoing cardiac surgery and receiving surgical LAAO has demonstrated improved freedom from cerebrovascular events and a mid-term survival benefit. This meta-analysis did not demonstrate an increased occurrence of postoperative atrial fibrillation in the LAAO study group. Larger randomised controlled trials stratified by cardiac pathology are required to validate these findings.

Background: Successful pulmonary vein isolation (PVI) promotes left atrial (LA) reverse remodeling, but its effect on right atrial (RA) remodeling remains unclear.

Objective: To study the impact of radiofrequency (RF) PVI on RA volumes and function in atrial fibrillation (AF) patients, assessed by cardiac MRI (CMR).

Methods: Forty-three AF patients (74.4% male, 61±7 years) undergoing first RF PVI, without atrial flutter ablation, underwent three CMR scans: pre-PVI, early (<72 hours), and 3 months post-PVI. Indexed atrial volumes (RAVImin/max, LAVImin/max) and function were derived from two- and four chamber cine images, with longitudinal atrial strain analyzed using feature tracking.

Results: Early post-PVI, RAVImin significantly decreased (28.7±10.3mL/m² to 26.0±9.9mL/m²,p=0.03), while RA EF significantly increased (37.3±11.5% to 41.7±10.1%,p=0.03). At 3 months, both RAVImin and RAVImax showed significant further reductions compared to baseline (28.7±10.3mL/m² to 24.8±8.8mL/m²,p=0.002; 45.2±11.8mL/m² to 40.3±11.9mL/m²,p<0.001, respectively). During this period, RA functional improvement persisted, as evidenced by RA reservoir and contractile strain (16.2±4.1% to 18.9±3.6%,p=0.003; 6.6±2.6% to 8.3±2.8%,p=0.005, respectively). LA volumes remained unchanged early post-PVI, but at 3 months, LAVImax significantly decreased compared to baseline (46.1±13.0mL/m² to 39.1±11.3mL/m²,p<0.001). LA function, demonstrated by reservoir and contractile strain, was significantly diminished early post-PVI, which persisted at 3 months compared with baseline (18.6±4.0% to 17.0±3.4%,p=0.04; 8.5±3.0% to 6.9±2.4%,p<0.01, respectively).

Conclusion: This study demonstrates that RF PVI results in reverse bi-atrial remodeling, with significant reductions observed in RA and LA volumes. RA function showed a significant improvement post-PVI, while LA function demonstrated a persistent impaired function at 3 months, possibly due to LA ablation scarring.

Background: Early detection and management of atrial fibrillation (AF) are crucial. Combined models incorporating genetic risks and clinical risks have been developed to improve predictive ability. Although sex differences have been reported in many aspects of AF, sex differences in genetic risk have not been studied.

Objective: To assess the sex difference in the effect of AF-PRS on AF prevalence using cross-sectional data from the Tohoku Medical Megabank Project Community-Based Cohort Study in Japan.

Methods: Polygenic risk score for AF (AF-PRS) and Cohorts for Heart and Aging Research in Genomic Epidemiology AF (CHARGE-AF) score were used for genetic AF risks and clinical AF risks, respectively. Sex differences in the association of AF-PRS with the prevalence of AF were evaluated.

Results: Among 16,853 participants (mean age, 63.4 years and 30.7% men), the prevalence of AF was 4.9% in men and 1.1% in women. In the group with high AF-PRS and high CHARGE-AF score, the odds ratio for AF was highest in men and women (8.2 in men and 9.4 in women), compared to that in the group with low AF-PRS and low CHARGE-AF score. Integrating AF-PRS into the CHARGE-AF score significantly enhanced the area under the curve of receiver operating characteristic for AF in men (from 0.639 to 0.749) but not in women (from 0.710 to 0.733).

Conclusion: Our study is the first to show a sex difference in the association of AF-PRS and AF prevalence. AF-PRS is more closely associated with the prevalence of AF in men than in women.

Background: Combining pulsed field ablation (PFA) and left atrial appendage occlusion (LAAO) to one procedure is appealing for atrial fibrillation treatment.

Objective: To compare the outcome of combined and standalone procedures METHODS: This is a retrospective cohort study of consecutive patients undergoing combined PFA and LAAO procedures in 3 centers in 2023. They underwent PFA pulmonary vein isolation (PVI) with Farapulse, followed by LAAO with Watchman FLX guided by transesophageal echocardiogram (TEE). Pulmonary ridge thickness was measured at 45 degrees, 5mm from tip of the ridge, before and after PFA. At 3-month, TEE or computed tomography was performed for LAAO patients to assess occlusion result. Peri-device leak (PDL) of more than 3mm was defined as significant. Consecutive PFA or LAAO standalone procedures served as control.

Results: This cohort included 36 combined, 48 standalone LAAO and 52 standalone PFA cases. Acute PVI was achieved in all combined and PFA standalone procedures. Successful LAAO implantation with Watchman FLX was achieved in 97.2% combined procedures, and all standalone LAAO procedures. In the combined cohort, pulmonary ridge thickness increased after ablation by 2.72±1.19mm (p<0.001) or 69.4%±51.4%. At 3-month, the rate of PDL did not differ between combined and standalone LAAO cohorts (26.7 vs 15.2%, p=0.22). However, significant PDL (>3mm) occurred more commonly in the combined cohort compared to standalone LAAO cohort (20% vs 2.2%, P=0.013).

Conclusion: Combined PFA and LAAO was feasible. However, we observed a mean 69.4% increase in pulmonary ridge thickness immediately following PFA. Significant PDL was more prevalent in combined procedure.

Sudden cardiac death is an important cause of mortality in patients with kidney failure undergoing renal replacement therapy, either hemodialysis or peritoneal dialysis. The risk factors associated with sudden cardiac death in these patients only partly overlap with those in the general population. Kidney failure per se and hemodialysis therapy expose these patients to an increased risk of sudden cardiac death compared with individuals with preserved renal function. Studies of the implantable cardioverter defibrillator for primary prevention of sudden cardiac death in patients with kidney failure have failed to demonstrate its usefulness. Moreover, the incidence of complications associated with cardiac electronic device implantation in this population is extremely high. This review aims to provide an update on the available studies on the pathophysiology and prevention of sudden cardiac death in patients with kidney failure undergoing dialysis, and to propose the adoption of clinical practices to reduce its incidence.