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Pulmonary vein isolation for atrial fibrillation using a novel multielectrode catheter:a feasibility and efficacy study

Pulmonary vein isolation for atrial fibrillation using a nov...

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中华医学会心电生理和起搏分会第十次全国学术年会

作者： Jin-hong Gerds-li Department of Cardiology First Affiliated Hospital of Jinan University Department of Internal Medicine/Cardiology German Heart Institute BerlinBerlinGermay

Obiective To evaluate the feasibility and safety of a novel multi-electrode pulmonary vein ablation catheter(PVAC) combining circular mapping and duty-cycled multi-electrode radiofrequen cy(RF) energy delivery,and guided by three-dimensional rotational angiography(3D-RTA) for at rial fibrillation(AF). Methods A total of 47 consecutive patients(aged 62±11 years) with symptomatic AF 32c ases for paroxysmal AF and 15 cases for persistent AF were enrolled. Results Mean total procedural time was 126.4±29.5 minutes(123.7±15.7 minutes for the p aroxysmal AF patients and 132.0±36.6 minutes for the persistent AF patients,P>0.05);mean flu oroscopy time was 30.3±11.3 minutes(29.4±9.8 minutes for the paroxysmal AF patients and 32.3±14.2 minutes for the persistent AF patients,P>0.05);mean PVAC ablation time was 21.6±7.7 m inutes(20.5±6.0 minutes for the paroxysmal AF patients and 24.0±10.4 minutes for the persistent AF patients,P>0.05).A total of 172 PVs(172/183,94.0%) were completely isolated.2 cases of mild pericardial effusion were detected on the first postprocedural day and absorbed in a week. No incidence of PV stenosis was observed during the *** follow-up(mean 6±5 months, range 1-21 months),32(68.1%) patients reported significantly improved symptoms or were entirel y asymptomatic.29 of 47(61.7%) patients were free from AF. Conclusion The novel technology of the PVAC catheter using duty-cycled bipolar and unip olar RF energy and guided by 3D-RTA suggests a feasible,safe,and promising alternative to co nventional point-by-point lesions.

关键词： Pulmonary vein isolation for atrial fibrillation using a novel multielectrode catheter:a feasibility and efficacy study

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Radiofrequency ablation reverse cardiac remodeling caused by idiopathic frequency premature ventricular contraction originating from the right-ventricular outflow tract in patients with a structurally normal heart

Radiofrequency ablation reverse cardiac remodeling caused by...

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中华医学会心电生理和起搏分会第十次全国学术年会

作者： Yuqiang Fang,Chunlan Wen,Li Yang,Xiaoqun Zhang,Wei Chun,Chunyu Zeng Department of Cardiology,Daping Hospital,The Third Military Medical University 400042

Objective Frequent premature ventricular contractions(FPVCs) in a structurally normal heart generally are considered as a benign ***,whether FPVCs have an effect on the cardiac structure and function in those "seemingly-normal" patients is not *** study is was to evaluate whether radiofrequency ablation(RFA) hads any effect on cardiac structure and function in patients with idiopathic FPVCs originating from the right-ventricular outflow tract(RVOT) and with a structurally normal heart. Methods Sixty-eight patients with idiopathic RVOT FPVCs and normal heart structure and function,were enrolled in this *** patients were divided into three groups:RFA group, anti-arrhythmia medicine(AAM) group and control group(without any treatment). Results The basic conditions including age,gender and PVCs history,were comparable among the three groups,except in the control group 'which had lower FPVC *** were closely followed-up for six *** PVC rate was significantly reduced in RFA and AAM groups,but had no significant change in the control *** with the increase in the FPVC rate was significant cardiac structure *** sizes of right atrium,right ventricle,and left ventricle were reduced significantly in the RFA and the AAM groups,but no changes were found in the control *** comparisons between the RFA and the AAM groups showed a greater reduction in the cardiac cavities in the RFA *** was also a tendency of improvement in the cardiac functions in both the RFA and the AAM ***,the differences was not statistical significance. Conclusions RFA reduces the FPVC rate and cardiac cavities in patients with a structurally normal heart,which might indicate that RFA can reverse the cardiac remodeling even in me structurally normal heart.

关键词： Radiofrequency ablation reverse cardiac remodeling caused by idiopathic frequency premature ventricular contraction originating from the right-ventricular outflow tract in patients with a structurally normal heart AAM

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Left atrial pressure predicts the catheter ablation outcome of atrial fibrillation

Left atrial pressure predicts the catheter ablation outcome ...

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中华医学会心电生理和起搏分会第十次全国学术年会

作者： Jae K.Oh Masaki Mitsuru Brian D.Powell David O.Hodge Winkuang Shen Douglas L.Packer Department of Medicine Mayo Clinic College ofMedicineRochesterMinnesotaUSA the First Affiliated Hospital of Dalian Medical University

Objective Pulmonary vein isolation is an effective therapy for curing symptomatic atrial fibrillation（AF）.It is known the severity of left atrial（LA） enlargement affect the success of AF ablation, while little is known about the impact of intracardiac pressure on the ablation outcome. Methods The prospective study consisted of 63 patients（mean age 57±9,73%male） who underwent catheter-based pulmonary vein isolation for drug refractory symptomatic AF（48%paroxysmal, 52%persistent）.All patients underwent simultaneous echocardiography and hemodynamic measurements including left ventricular end systolic pressure（LVEDP）,mean LA pressure（LAP） and dP/dt using Millar catheter at the time of procedure during *** volume（LAV） was measure by biplane area length *** of AF was defined as episodes of AF more than 5 min documented in 24h ambulatory ECG or event monitor. Results After a mean follow-up of 16±7 months,AF elimination off anti-arrhythmic drugs was achieved in 70%（44/63） of *** the echographic and hemodynamic measurements,the baseline LAV（P=0.02） and mean LAP（P=0.01） were significantly lower in AF free group compared to （P=0.01） AF recurrence *** and multivariate analysis showed LAP was the only independent predictor of the recurrence with an adjusted odd ratio of 1.27（95%CI 1.04-1.54,P = 0.03, Table）. Conclusions LAP is a determinant of AF recurrence after catheter *** towards reduction of LA filling pressure,especially in patients with elevated LAP,may improve the outcome of ablation.

关键词： Left atrial pressure predicts the catheter ablation outcome of atrial fibrillation

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The use of intracardiac echocardiography and method to guide noncoronary cardiac interventions

The use of intracardiac echocardiography and method to guide...

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中华医学会心电生理和起搏分会第十次全国学术年会

作者： Tao Guo1,Guicheng Liang2 1.The First Affiliated Hospital in Kunming Medical College 2.The Second Peoples Hospital of Guilin

Objective we sought to assess the utilization and strategy of intracardiac echocardiography(ICE) during noncoronary Cardiac Interventions,to evaluate the feasibility and accuracy guided with and without the help of ICE. Methods A consecutive series of 46 patients were selected from the cardiology department of the first affiliated hospital in Kunming Medical College,who underwent transcatheter closure of interatrial communications,ablations of supraventricular tachycardia and implantations of pacemakers through jugular with ICE(groupl:23patients,12men,llwomen,45.78±21.54 years) and without ICE(group2: 23patients,12men,11 women,49.22±24.79years).We measured the fluoroscopy time and the total procedure time,compared the difficulty of the procedure,locations of the ablation catheters and the complications between the two groups,assessed the feasibility,safety of using ICE for the guidance of noncoronary cardiac interventions.A level of statistical significance was set to P<0.05. Results①All the 23 patients with the ICE guidance in group land the another 23 without ICE were completed the whole procedure,and none sever complements or damage of cardiac structure was observed,②During the procedure for closure of ASD,the diameter measured with ICE and TEE were correlated with each *** predict diameter of ASD with ICE was trended to be larger(by 2～4mm) than the measurement.③During the ablation procedure,ICE could provide imaging e of the movement and position of the sheaths and catheters,guide the transseptal puncture,monitor the damage to adjacent structure,improve the whole procedure.④During the implant procedure,ICE could provide the visualization images of the movement of the cathodes,embedment of screw-in electrodes.⑤The total fluoroscopy time in patients guided with ICE were shorter than those guided with TEE:(13.87±5.63) min versus(25.09±10.32) min. Conclusion①The closure of ASD guided with ICE was superior to those with *** suggest to chose the diameter of t

关键词： The use of intracardiac echocardiography and method to guide noncoronary cardiac interventions

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Quantitative proteomic analysis of respiratory chain related proteins in left and right atrial appendages from patients with mitral valve disease at sinus rhythm and atrial fibrillation by iTRAQ-coupled 2-D LC-MS/MS

Quantitative proteomic analysis of respiratory chain related...

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中华医学会心电生理和起搏分会第十次全国学术年会

作者： Tao Tu,QimingLiu,Shenghua Zhou,Zhenjiang Liu,XupingLi,Zhongle Bai The Second Xiangya Hospital 410011

Objective To analyze the expression profiles of the respiratory chain related proteins in atrial appendages from atrial fibrillation patients and provide a better understanding of the mechanisms in AF energetic metabolism. Methods We used iTRAQ-coupled 2-D LC-MS/MS technique to screen the expression profiles of the respiratory chain related proteins in left and right atrial appendages from patients with mitral valve disease at sinus rhythm(SR) and ***,one of the differentially expressed candidate cytochrome c oxidase subunit 5B was validated by Western blot and repeated iTRAQ detection to confirm the reliability of iTRAQ-coupled 2-D LC-MS/MS technique. Results A total of 792 unique proteins were quantified,and 49 distinct proteins of them are related to biological *** the 49 distinct proteins related to biological oxidation,22 proteins were down-regulated in SR-LAA when compare to the SR-RAA and 25 proteins were down-regulated in AF-LAA when compare to the *** RAA from AF patients a significant down-regulation of 22 distinct proteins was observed as compared with their corresponding RAA from SR patients.23 different proteins were down-regulated in LAA from AF patients when compared with their corresponding LAA from SR *** of the down-regulated biological oxidation associated proteins in each comparison were components of the respiratory chain in ***,the results of Western blot and the repeated iTRAQ detection were generally consistent with the variations from the first LC-MS/MS analysis. Conclusion Amount of down-regulated respiratory chain related proteins were observed in LAA and RAA from AF patients which suggest impaired energy production in atrium of AF patients.

关键词： iTRAQ Quantitative proteomic analysis of respiratory chain related proteins in left and right atrial appendages from patients with mitral valve disease at sinus rhythm and atrial fibrillation by iTRAQ-coupled 2-D LC-MS/MS

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Clinical significance of the fragmented QRS in the acute myocardial infarction with percutaneous coronary intervention treatment

Clinical significance of the fragmented QRS in the acute myo...

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中华医学会心电生理和起搏分会第十次全国学术年会

作者： Yanjun liu? Tao Cong,Yunlong Xia,Yanzong Yang First Affiliated Hospital of Dalian Medical University,Dalian 116011,China

Objective Myocardial infarction(MI) patients' infarction myocardial will form part of the scar tissue,and the myocardial scar will directly influence the Ventricular depolarization,and then lead to conduction abnormalities,so fragmented QRS(fQRS) developed on the electro cardio gram(ECG),which on electrocardiography was defined by the presence of single or multiple notches in the R or S wave various RSR'patterns,without a typical bundle branch *** that the fQRS appeared on the ECG of MI patients can forecast the myocardial scar and the mortality,so we explore the clinical significance of acute myocardial infarction(AMI) by percutaneous coronary intervention (PCI) treatment,the fQRS changes on the body surface electrocardiogram of prcoperative and postoperative PCI. Methods 137 cases of patients with diagnosis of AMI(mean age,60.5±12.5 years,109 males,28 females),including 125 cases of ST-segment elevation myocardial infarction(STEMI),and 12 cases of non ST-segment elevation myocardial infarction(NSTEMI),who accept PCI therapy(31 cases accept emergency PCI,61 cases accept optional PCI,and 45 cases refuse to PCI).When they are hospitalized, preoperative and postoperative PCI,after 1 week of PCI,after 2weeks of PCI and after 6 months of PCI, accept conventional ECG examination respectively,so that we can observe the evolution of the *** the same time,we evaluated the patients' level cardiac function and left ventricular ejection fraction (LVEF) by heart *** patients with post-operative PCI were followed up for 6 months. Results In 137 patients,accepted preoperative PCI ECG examination,we developed 14 cases (45.16%) whose ECG appeared the fQRS on the infarction corresponding leads in emergency PCI group, in others groups the number respectively is 35 cases(57.38%)、21 cases(46.67%).The patients who accepted emergency PCI group after two weeks the fQRS incidence on ECG more lower than refused to PCI group(P=0.002);The patients who accepte

关键词： QRS Clinical significance of the fragmented QRS in the acute myocardial infarction with percutaneous coronary intervention treatment ECG PCI

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The association between the recurrence rate and different type of endpoint of slow pathway ablation in patients with atrioventricular nodal reentrant tachycardia

The association between the recurrence rate and different ty...

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中华医学会心电生理和起搏分会第十次全国学术年会

作者： Zhen Yang,Shaobin Jia,Yong Sha,Xuezhong Wang,Weina Guo,Jingjing Wang Heart Center,the General Hospital of Ningxia Medical University 750000

Objective To investigate the recurrence rate of slow pathway ablation in patients with atrioventric ular nodal reentrant tachycardia(AVNRT) in our hospital in the last 3 years,and the association betwee n the recurrence rate and different type of endpoint. Methods We analysed and investigated the 325 patients with AVNRT during the last 3 years of from 2009 to 2011 who received the slow pathway ablation procedure in our *** gross recurre nce rate was calculated,and then,according to the different end point under which the patients were grou ped into four subgroups:complete slow pathway ablation,with a residual jump without echo,with one ec ho and with the combination of a residual jump and echo,the recurrence rate for each group were respecti vely obtained also. Results The mean age was 45+19 years,and male 94(29%),female231(71%).One hundred and se venty-six(54%) patients got complete slow pathway ablation without both residual jump and echo,48(1 5%) getting an endpoint with a residual jump only,51(16%) an endpoint with one echo,50(15%)gettin g an endpoint with a combination of one residual jump and one ***,fourteen patients(4. 5%) had recurrence of *** recurrences rate were 4.0%(7/176) in patients with complete slow pa thway ablation,4.2%(2/48) in patients with a residual jump only,4.0%(2/51) in patients with one echo an d 6.0%(3/50) in patients with the combination of a residual jump and *** was no significant diffe rence in the recurrence rate among these four subgroups. Conclusions As complete slow pathway ablation,the endpoint with a residual jump only,with on e echo and with a combination of one residual jump and one echo are all dependable endpoint for slow pa thway ablation procedure for patients with AVNRT.

关键词： AVNRT The association between the recurrence rate and different type of endpoint of slow pathway ablation in patients with atrioventricular nodal reentrant tachycardia

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Effect of renal sympathetic denervation on atrial substrate remodeling and the inducibility of atrial fibrillation

Effect of renal sympathetic denervation on atrial substrate ...

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中华医学会心电生理和起搏分会第十次全国学术年会

作者： Qingyan Zhao,Zixuan Dai,Shengbo Yu,XuleWang,Jinping Xiao,Congxin Huang Renmin Hospital of Wuhan University 430060

Objective Whether renal sympathetic denervation has effect on atrial substrate remodeling and inducilibity of AF is unknown. Methods Thirteen dogs were randomly divided into control group(7 dogs) and renal artery ablation(RAA) group(6 dogs).In control group,rapid atrial pacing was performed for 7 hours and atrial effective refractory period(AERP) was measured at every hour in the status of ***, pacing was stopped and AF was induced by atrial burst *** RAA group,each renal artery was ablated via femoral artery and dogs were allowed to recover for 6 *** that,the procedure of pacing and electrophysiological measurement was nearly same as in the control *** of autonomic nerve,Cox43 and ANP in pulmonary veins and atrial tissues were measured and levels of TGF- β,Ang II and aldosterone in blood were studied. Results There was a persistent decrease in AERP in both the two groups during atrial *** cessation of pacing,induced number of times and duration of AF was higher in control group than that in RAA *** plasma AngⅡand aldosterone concentration increased significantly after rapid pacing 7 hours in control group(AngⅡ:119.8±31.1 pg/ml vs 185.3±103.5 pg/ml,P<0.01;Aldosterone: 288.2±43.1 pg/ml vs 369.6±109.8 pg/ml,P=0.01).However,compare with before RAA,the plasma AngⅡand aldosterone concentration decreased significantly after rapid pacing in RAA group(AngⅡ: 159.8±28.2 pg/ml vs 93.1±24.6 pg/ml;Aldosterone:272.2±37.4 pg/ml vs 131.3±53.8 pg/ml,P<0.01). Densities of Cox43 and levels of ANP in RAA group were lower than that in control *** was no significant difference in the densities of autonomic nerve and TGF-P between the two groups. Conclusions Renal sympathetic denervation results in atrial substrate remodeling and markedly decrease the inducilibity of AF by inhibiting activity of RAAS.

关键词： Effect of renal sympathetic denervation on atrial substrate remodeling and the inducibility of atrial fibrillation

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Carto-Merge can improve the ablation accuracy for pulmonary vein isolation

Carto-Merge can improve the ablation accuracy for pulmonary ...

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中华医学会心电生理和起搏分会第十次全国学术年会

作者： Songwen Chen,Gang Chen,Ying Zhuge,Feng Zhang,Shaowen Liu Department of Cardiology,Shanghai First People's Hospital,School of Medicine,Shanghai Jiao Tong University 200000

Objective To quantify the superiority of performing AF ablation guided by Carto-Merge. Methods Forty-eight consecutive AF patients,with four discrete pulmonary veins(PVs),were *** the four separate PVs and the two ipsilateral PVs of each patient,three types of p lanes were defined respectively at the PV *** fluoroscopy planes(FPs) were labeled in t he Carto under the guidance of contrast PVs *** procedure,the ablation planes(A Ps) were defined with the ablation *** image planes(IPs) were labeled in the CT image. Results The angle between the APs and the IPs was significantly smaller than that between the FPs and the IPs with regard to the left inferior PV planes(15.80±7.64°vs.20.69±13.91°,p =0.040) and the left superior PV planes(15.17±7.20°vs.23.21±12.97°,p=0.001).Moreover,com pared to that between the FPs and the IPs,less difference of angle and distance between the AP s and the IPs was demonstrated in the left PV planes(1.36±1.27mmvs.2.89±2.49mm,p<0.001;1 3.91±6.20°vs.30.52±20.97°,p<0.001),the right inferior PV planes(2.58±1.69mmvs.3.51±2.46m m,p<0.05;13.58±8.01°vs.17.94±8.89°,p=0.014),the right superior PV planes(2.10±1.80mmvs. 3.47±2.97mm,p=0.009;11.20±6.75°vs.33.38±15.86°,p<0.001) and the right PV planes(2.33±1.7 lmmvs.4.13±3.47mm,p=0.002;13.27±6.14°vs.26.40±18.89°,p<0.001). Conclusions Navigation by Carto-Merge,less difference of angle and distance between the ablation lesions and the actual PV ostia can be achieved,compared with the guidance of contrast PV angiography.

关键词： Carto-Merge can improve the ablation accuracy for pulmonary vein isolation

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Reversal of cardiomyopathy in patients with congestive heart failure secondary to tachycardia

Reversal of cardiomyopathy in patients with congestive heart...

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中华医学会心电生理和起搏分会第十次全国学术年会

作者： Donghua Zhao,Zhongbo Xiao,Feifei Zhang,Xinhui Peng,Hao Yang, Surong Meng,Jian Peng 南方医科大学附属南方医院心血管内科

Objective Tachycardia-induced cardiomyopathy(TCM) is a reversible cause of heart failure. Little is known of the characteristics of tachycardia associated with the development of left vent ricular(LV) dysfunction and the reversal of cardiomyopathy after cure of *** study is aim to examine the reversal of cardiomyopathy in patients underwent ablation with congestive heart failure secondary to tachycardia. Methods A total of 625 patients underwent radiofrequency ablation for tachycardiarrhymias between January 2009 and July *** analysis was performed to identify patien ts with depressed LV function,defined as a left ventricular ejection fraction NT-proBNP assessme nt was performed before ablation in patients considered to have TCM(n=17).Repeated echocardi ography study and NT-proBNP assessment were measured after a mean follow-up of 3 months.L evels of NT-proBNP before and after ablation were *** of cardiomyopathy was al so assessed. Results The incidence of TCM was 2.7%(12 males;age,35.8±17.1 years).Successful ablation was performed in 16 of 17 patients(94.1%).There was a significant improvement in left ventricular ejection fraction(36.7%±7.5%vs.59.4%±9.7%,P<0.001).The mean LVEDD before treatment was (59.5±8.3)mm(range 43 to 70mm),compared with a mean LVEDD(51.9±7.4 )(range 40 to 67mm, P=0.009) after 3 months *** levels of NT-proBNP decreased after ablation procedure,from 4092.6±3916.6 pg/ml to 478.9±881.9 pg/ml(P<0.001).After successful ablation,ventricular function normalized in 15 of 17(88.2%) of patients at a mean of 3 months. Conclusions Restoration of LV function and reversal of LV remodeling can be achieved wi th successful elimination of tachycardia in the majority of ***-proBNP levels are elevate d in subjects with TCM and decreases sharply after ablation.

关键词： LVEDD Reversal of cardiomyopathy in patients with congestive heart failure secondary to tachycardia

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