Dong Jianzeng

e0570 Can hatch score predict recurrence of atrial fibrillation after catheter ablation

Background HATCH score (1*hypertention+1*[age>75]+2*[stroke or transient ischaemic attack]+1*[chronic obstructive pulmonary disease]+2* [heart failure]) is an established predictor of progression from paroxysmal to persistent atrial fibrillation (AF). Whether atrial remodelling indexed by HATCH score could be a predictor of recurrence after catheter ablation of AF needs to be explored. Methods The data of 608 consecutive AF patients who underwent an index circumferential pulmonary veins ablation were retrospectively analysed. Of these patients, 313 (51.5%) patients had HATCH=0, 225 (37.0%) patients had HATCH=1, 70 (11.5%) patients had HATCH≥2. Results The patients with HATCH≥2 had significantly the largest left atrium size, the largest left ventricular end systolic diameter, and the lowest ejection fraction among the three HATCH categories. There were significant differences of the proportion of diabetes mellitus, statins medication, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers medications among the three HATCH categories. After a mean follow-up of 474±330 days, the recurrence rate were 36.4%, 38.7%, 34.3%, from HATCH=0 to HATCH≥2 categories (p=0.707). Univariate analysis revealed that nonparoxysmal AF, left atrium size, body mass index were predictors of AF recurrence. Multivariate analysis revealed that nonparoxysmal AF (HR=1.43, 95% CI 1.03 to 1.99, p =0.031) was the only independent predictor of AF recurrence. HATCH and left atrium size were not independent predictors of AF recurrence. Conclusion HATCH has no value in prediction of AF recurrence after catheter ablation.

Angiographic evaluation of a new technique for common femoral artery access: the inguinal ligament-guided

Objective Various techniques have been used to acquire common femoral artery (CFA) access which was proved to be safe with lower risk of complications in percutaneous catheterisation. In order to increase the success rate of CFA puncture, a relatively simple, safe and reliable technique was developed. Methods We introduced a new inguinal ligament-guided technique and inguinal division. Clinical data were collected on 822 unselected patients undergoing transfemoral percutaneous coronary catheterisation between 2004 and 2009. Inguinal ligament was utilised as a reference to conduct artery puncture site. After palpating anterior superior iliac spine and pubic symphysis with caution to locate the inguinal ligament, medius pinpointed the intersection of inguinal ligament and femoral artery. Thereafter, place forefinger beside the medius, perform artery puncture at the inferior margin of forefinger with 45° modified seldinger technique. By femoral angiogram, we utilised the femoral head as a landmark, of which the midpoint, inferior and superior margin were referred to borderlines, to divide the inguinal region into zone A, B1, B2 and C so as to identify the location of femoral artery cannulation. Femoral head (zone B) was defined as the optimal area of femoral artery puncture. Results Successful CFA cannulation occurred in 82.8% (681/822) of cases. Arterial puncture over the femoral head (zone B) occurred in 96.8% (796/822) of patients, 36.0% (296/822) for zone B1 and 60.8% (500/822) for zone B2, respectively. When femoral artery puncture located on zone B, B1, B2 and C, CFA cannulation occurred in 83.9% (668/796), 91.6% (271/296), 79.4% (397/500) and 40% (8/20), respectively. Conclusions Inguinal ligament is a reliable reference for guiding the puncture of CFA in transfemoral percutaneous catheterisation.

Safety evaluation of vascular closure devices in femoral artery access

Objective The aim of the study was to evaluate the in-hospital and long term safety performance of vascular closure devices (VCDs) in femoral artery access. Methods One thousand and seventy eight patients who undergoing transfemoral percutaneous cardiac catheterisations from June 2008 to October 2009 were enrolled. We compared the incidence of in-hospital vascular complications between manual compression group and VCDs group. Femoroiliac angiographic data were collected and analysed on 92 patients undergoing repeat catheterisation via ipsilateral femoral artery for which VCDs have been used for at least 3 month during index transfemoral catheterisation. The percent diameter stenosis (ΔDS%) was utilised to evaluate the long-term safety performance of vascular closure devices on femoral angiogram. Restenosis of femoral artery was defined as ΔDS% ≥50%. Results The overall in-hospital incidence of vascular complication was 0.74% (8/1078). Patients in VCDs group had relatively lower rate of in-hospital complications (p=0.039) compared with manual compression group. The median interval of femoral angiogram recheck was 232 days. Femoral restenosis at the site of vascular access occurred in 3.3% of 92 patients, but no one had complaints of limb ischemia. Conclusions VCDs demonstrated greater in-hospital and long-term safety performance compared with manual compression. Femoral restenosis at puncture site is very rare and usually asymptomatic.

Selective retrograde coronary venous perfusion with over-the-wire balloon: a new technique for cell transplantation

Objective Effective cell homing to ischemic myocardium remains a practical challenge. This study evaluated the efficiency of cell delivery via coronary venous system using over-the-wire balloon in a canine model of acute myocardial infarction. Methods Acute myocardial infarction was induced by ligation of the left anterior descending (LAD) coronary artery in eight dogs (22.1±1.9 kg). Mesenchymal stem cell (MSCs) from canine bone marrow were isolated and purified by density gradient centrifugation, cultured by adhering to culture-flask and labelled with enhanced green fluorescence protein (EGFP). One week after infarction, the coronary sinus was cannulated percutaneously and an over-the wire balloon catheter advanced to the proximal portion of anterior interventricular vein (AIV) in parallel to LAD. The balloon catheter was inflated temporarily to occlude the AIV, and 1×107 EGFP-labelled MSCs was injected into the AIV. Animals were sacrificed at days 14 (n=4), 28 (n=4), and the hearts were excised and examined. Results Complete AIV occlusion had no impact on LAD flow parameters. No death, cardiac tamponade, ventricular arrhythmia, or other procedural complications occurred. Immunofluorescence studies showed that EGFP-positive cells localised primarily in the infarct region but none in infarct marginal or normal regions both at 14 and 28 days. Conclusion Selective regional myocardial perfusion is feasible through coronary venous system with over-the-wire balloon, targeting selected ischemic myocardium. This novel technique has potential application for effective cell transplantation.

Angiographic evaluation of femoral bifurcation in Chinese population

Objective Common femoral artery (CFA) access has been proved to be safe with lower risk of complications in percutaneous catheterisation. The femoral head can be utilised as a reliable landmark to locate the level of femoral bifurcation and the common femoral artery. In the present study, we evaluated the site of femoral bifurcation in Chinese population on femoroiliac angiograms. Methods We enrolled 529 patients undergoing cardiac catheterisations via femoral artery from June 2008 to October 2009. Femoral angiograms were performed in all patients preparing to use vascular closure devices. Based on the femoral head and the midpoint of pubic symphysis as landmarks, the midpoint, inferior and superior margin of the femoral head were used as borderlines to divide the inguinal region into four zones (A, B1, B2 and C). Location of femoral bifurcation and CFA were evaluated on femoral angiogram. Results Femoral bifurcations located in the area of A, B1, B2 and C with 0.2% (1/529), 2.3% (12/529), 42.4% (223/529), 55.4% (293/529), respectively. When arterial puncture located on zone B, B1, B2 and C, CFA cannulation was obtained in 85.0% (436/513), 95.8% (160/167), 79.8% (276/346) and 38.5% (5/13), respectively. Conclusions We originally introduced a reliable method for inguinal vascular zone division. The majority of femoral bifurcations located below the midpoint of femoral head in Chinese population. It is an effective measure to puncture common femoral artery between the superior and inferior border of the femoral head, especially between the superior border and the midpoint of the femoral head.

e0573 Impact of ageing on the left atrium thrombus in patients with non-valvular atrial fibrillation

Objective This study sought to investigate the impact of ageing on left atrium thrombus in patients with non-valvular atrial fibrillation (AF). Methods Four hundred and twenty-one consecutive patients with AF underwent transesophageal echocardiography prior to AF ablation were included in a prospectively established database. The elderly group was defined as age more than 65 years old. Results In all the 421 patients, 108 (25.6%) were in the elderly group and 313 (74.4%) were in the young group, with the mean age 70.0±3.7, 52.1±8.5, respectively. There was no significant difference of left atrium thrombus between the elderly group and the young group (4.6% vs 6.7%, p=0.439). It was shown there is less value for age predicting left atrium thrombus, the area under the receptor-operating curve was 0.494. The mean age (56.7±9.9 vs 56.7±10.9, p=0.989) and the proportion of the elderly (19.2% vs 26.1%, p=0.439) did not differ significantly between the patients with left atrium thrombus and those without. After adjustment for ejection fraction, heart failure, hypertension, diabetes mellitus, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers medication in logistics multivariate analysis, left atrium diameter, non-paroxysmal AF, prior thromboembolic history were independent risk factors of left atrium thrombus. However, age was not an independent risk factor of left atrium thrombus. Conclusions Ageing itself was not a risk factor of left atrium thrombus in patients with non-vavular AF.

e0574 High-normal thyroid function and risk of recurrence of atrial fibrillation after catheter ablation

Background It has been shown that serum free thyroxine (FT4) concentration is independently associated with atrial fibrillation (AF) even in euthyroid persons. This study aimed to testify the impact of high-normal level of FT4 on recurrence after catheter ablation of AF. Methods Two hundred and forty-four consecutive patients with paroxysmal AF underwent circumferential pulmonary vein isolation (PVI) were prospectively enrolled. Exclusion criteria included prior or current thyroid dysfunction on admission, amiodarone medication for three months before admission. Results After a mean follow-up of 416±204 (91–856) days, the recurrence rates were 14.8%, 23.0%, 33.3%, 38.7% from the lowest FT4 quartile to the highest FT4 quartile, respectively (p=0.016). Adjustment for age, gender, left atrium diameter, PVI, there was an increased risk of recurrence in the subjects with the highest FT4 quartile compared with those with the lowest quartile (HR 3.31, 95% CI 1.45 to 7.54, p=0.004). As a continuous variable, FT4 was also an independent predictor of recurrence (HR 1.10, 95% CI 1.02 to 1.18, p=0.016). Conclusions Patients with high-normal thyroid function were at an increased risk of AF recurrence after catheter ablation.