Jianmin Chu

Inflammation in Lone Atrial Fibrillation

This study was designed to evaluate the correlation between lone atrial fibrillation and inflammation.

Improvement of P wave dispersion after cardiac resynchronization therapy for heart failure

OBJECTIVE The purpose of this study is to investigate the effect of cardiac resynchronization therapy (CRT) on P wave maximum duration (PWM) and P wave dispersion (PWD) in patients with advanced heart failure. METHODS Forty-six patients (33 men; mean age, 60 +/- 11 years) with CRT were enrolled in the present study. PWM and PWD were measured using 12-lead surface electrocardiography (ECG) at a paper speed of 50 mm/s and 20 mm/mV. Serial ECG, echocardiography, clinical assessment, and device interrogations were performed at baseline and 3 months after CRT. RESULTS After 3 months of follow-up, PWM and PWD values were significantly decreased (129.6 +/- 11.3 to 120.7 +/- 10.7 milliseconds, P < .001; 42.6 +/- 8.0 to 32.3 +/- 10.1 milliseconds; P < .001, respectively). It showed a significant reduction in left atrial diameter (LAD) (46.5 +/- 5.2 to 44.9 +/- 5.6 mm, P = .021) and an improvement in left ventricular ejection fraction (LVEF) (29.0% +/- 7.5% to 36.2% +/- 8.0%, P < .001). The decrease of PWM and PWD was positively correlated with the reduction of LAD and negatively correlated with the improvement of LVEF. The reduction in atrial fibrillation burden was observed after 3 months of follow-up. CONCLUSIONS Cardiac resynchronization therapy decreases PWM and PWD along with an improvement of LVEF and a reduction of LAD. Further studies are needed to evaluate the clinical implications of decrease of PWD on prevention of atrial fibrillation.

C-reactive protein and atrial fibrillation in idiopathic dilated cardiomyopathy.

Previous studies have found elevated plasma C‐reactive protein (CRP) levels in atrial fibrillation (AF) patients. Most of these studies included AF patients with various heart diseases, but few studies were designed to investigate CRP in idiopathic dilated cardiomyopathy (IDCM) patients with AF.

The Morphology Changes in Limb Leads after Ablation of Verapamil‐Sensitive Idiopathic Left Ventricular Tachycardia and Their Correlation with Recurrence

Objectives: This study was designed to explore the morphology changes in limb leads of ECGs after successful ablation of verapamil sensitive idiopathic left ventricular tachycardia (ILVT) and their correlation with tachycardia recurrence.

Idiopathic ventricular fibrillation with fragmented QRS complex and J wave in resting electrocardiogram

Objective To describe the clinical characteristics of idiopathic ventricular fibrillation (IVF) with fragmented QRS complex (f-QRS) and J wave in resting electrocardiogram. Methods We reviewed data from 21 case subjects in our hospital who were resuscitated after cardiac arrest due to IVF and assessed the prevalence of f-QRS and J wave in resting electrocardiogram (ECG). All the case subjects were classified among three groups based on the electrocardiographic morphology: group I, both f-QRS and J wave were observed (n = 6), group II, only J wave was observed (n = 9), group III, neither f-QRS nor J wave was observed (n = 6). Population characteristics, history of syncope or sudden cardiac arrest, incidence of ventricular fibrillation (VF), and circumstance of VF were evaluated among the three groups. Results The incidence of index events (syncope, survived cardiac arrest and VF episodes recorded in implantable cardioverter defibrillator (ICD) or pacemakers) was 13.4 ± 5.6 per-year in group I, 10.8 ± 3.9 per-year in group II, and 9.8 ± 4.2 per-year in group III. There were significant differences in incidences among the three groups, the most frequent index events were observed in group I. The hazard ratio for incidence was 3.2 (95%CI, 1.1–7.9; P = 0.01). The history and circumstance of the index events were different among the groups. In group I, all the index events occurred during sleep in early morning. In group II, four subjects suffered VF during strenuous physical activities or agitation state, two during sleep in early morning, three in usual activity. In group III, one subject suffered VF during sleep in early morning, one in agitation state, four in usual activity. Conclusions This study suggests that the IVF patients with the combined appearance of f-QRS and J wave in the resting ECG suffer an increased risk of VF, this subgroup of IVF patients has a unique clinical feature.

Identification of the slow conduction zone in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia using electroanatomic mapping.

Identification of the Slow Conduction Zone in a Macroreentry. Background: Although idiopathic left ventricular tachycardia (ILVT) has been shown to possess a slow conduction zone (SCZ), the details of the electrophysiological and anatomic aspects are still not well understood.

Clinical Characteristics and Long-term Prognosis in Patients with Chronic Heart Failure and Reduced Ejection Fraction in China

AIMS Chronic heart failure with reduced ejection fraction (CHF-REF) remains a major public health problem with high morbidity and mortality, but the data on current treatment status and long-term prognosis in China were still missing. METHODS Among prospectively recruited 2368 patients with CHF-REF in 10 hospitals, 2154 patients provided complete followed data. Two aetiology subgroups (dilated cardiomyopathy, DCM and ischaemic cardiomyopathy, ICM) were classified. Clinical data and long-term prognosis were analysed. RESULTS After a median follow-up of 52 months, 850 (39.46%) patients died, of whom 302 (35.53%) were sudden cardiac death (SCD). Unadjusted rates of all-cause mortality and SCD were higher in DCM than those in ICM (p<0.001 for both modes of death), but mortalities were comparable after adjustment for co-variables (p=0.387 and p=0.483 respectively). ACEIs/ARBs, aldosterone receptor antagonists, β-blockers and diuretics were dominant prescribed drugs with the prescription rates of 65.97%, 74.61%, 68.29% and 74.37% respectively. Multivariable analysis identified co-morbidities (eg, hypertension), NHYA class, ventricular tachycardia/fibrillation (VT/VF), QRS duration, left ventricular EF and creatinine as independent predictors of mortalities, whereas ACEIs/ARB, β-blockers and statins were associated with better prognosis. Survived from sustained VT/VF episodes had the highest predictive value for SCD (HR, 4.230; 95% CI, 2.500-7.157; p<0.001). The predictors for mortalities in DCM and ICM were different. CONCLUSIONS Patients with CHF-REF had a poor prognosis in China despite being under current standard therapies, especially patients with DCM. Predictors for all-cause mortality and SCD might be identified for evaluating the prognosis of these patients.

Relation Between N-Terminal Pro-Brain Natriuretic Peptide and Cardiac Remodeling and Function Assessed by Cardiovascular Magnetic Resonance Imaging in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy

Although N-terminal pro-brain natriuretic peptide (NT-proBNP) is a useful screening test of impaired right ventricular (RV) function in conditions affecting the right-sided cardiac muscle, the role of NT-proBNP remains unclear in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). This study was designed to clarify the relation between the plasma NT-proBNP level and the RV function evaluated by cardiovascular magnetic resonance (CMR) imaging. We selected 56 patients with confirmed ARVC only when their blood specimens for NT-proBNP measurements were collected within 48 hours of a CMR scan. The NT-proBNP level was significantly higher in patients with RV dysfunction than in patients without RV dysfunction (median of 655.3 [interquartile range 556.4 to 870.0] vs 347.0 [interquartile range 308.0 to 456.2] pmol/L, p <0.001). The NT-proBNP levels were positively correlated with RV end-diastolic and end-systolic volume indices (r = 0.49 and 0.70, respectively) and negatively correlated with RV ejection fraction (r = -0.76, all p <0.001), which remained significant after adjustment for age, gender, and body mass index. The area under the receiver-operating characteristic curve for NT-proBNP was 0.91 (95% confidence interval 0.80 to 0.97, p <0.001). The cut-off value of NT-proBNP (458 pmol/L) was associated with sensitivity, specificity, and positive and negative predictive values of 91%, 89%, 67%, and 98%, respectively. In conclusion, NT-proBNP is a useful marker for the detection of RV dysfunction and associated with extent of RV dilatation and dysfunction determined by CMR in patients with ARVC.

A Common NOS1AP Genetic Polymorphism, rs12567209 G>A, Is Associated With Sudden Cardiac Death in Patients With Chronic Heart Failure in the Chinese Han Population

BACKGROUND Variants in NOS1AP associated with cardiac repolarization and sudden cardiac death (SCD) in coronary artery disease have been reported. Whether they are related to mortality and QTc interval in chronic heart failure (CHF) has not been investigated. METHODS AND RESULTS A total of 1,428 patients with CHF and 480 control subjects were genotyped for 6 SNPs of NOS1AP, and the genetic associations with mortality as well as QTc interval were analyzed. During a median follow-up period of 52 months, 467 patients (32.70%) died, of which deaths 169 (36.19%) were SCD. The A allele of rs12567209 was associated with greater risk of all-cause death and SCD (hazard ratio [HR] 1.381, 95% confidence interval [CI] 1.124-1.698 [P = .002], and HR 1.645, 95% CI 1.184-2.287 [P = .003], respectively). After adjusting for other risk factors, significant differences remained (HR 1.309, 95% CI 1.054-1.624 [P = .015], and HR 1.601, 95% CI 1.129-2.271 [P = .008]). The A allele was also associated with prolongation of QTc interval by 4.04 ms in the entire population (P = .026). CONCLUSIONS The A allele of rs12567209 in NOS1AP may serve as an independent predictor of all-cause death and SCD in patients with CHF, it is also associated with prolonged QTc interval in the Chinese Han population.

Variations of electroanatomic substrates and markers of successful ablation in idiopathic left ventricular tachycardia: role of electroanatomic substrates and potential mechanism of tachycardia

Objectives The variation of the substrates of verapamil-sensitive idiopathic left ventricular tachycardia (ILVT) was not understood. The purpose of this study was to investigate the variation of electroanatomic substrate [slow conduction zone (SCZ) and left ventricular conduction system (LVCS)] in ILVT and control individuals and markers of successful ablation. Methods Electroanatomical mapping was performed during sinus rhythm in 20 ILVT patients and 26 control individuals with paroxysmal supraventricular tachycardia. LVCS and SCZ were tagged in geometry and the anatomic aspects were investigated. Results According to the distribution of Purkinje potential, LVCS was distinguished into three types: left bundle branch (LBB) was divided into two discrete fascicles without interconnections; divided into three separate fascicles; and fanlike structure distribution over septum broadly. The length of LBB and its fascicles in patients with ILVT were slightly longer than those of controls (P > 0.05). In the ILVT group, the SCZ was located at the inferoposterior septum in 17, inferior apical septum in one and two SCZs were located at the posterior and mid-septal in the other two patients, which were greater in size and longer in length than those of six controls (P < 0.05). At the crossover junction area with diastolic potential and Purkinje potential, with the size of 1.5 ± 0.4 cm2, concealed entertainment and ablation were obtained successfully in all patients with ILVT. Conclusion The anatomy of the LVCS and SCZ is highly variable in patients with ILVT, and the crossover junction area with diastolic potential and Purkinje potential might be a marker of ablation.