Rong-Hui Yu

Obstructive sleep apnoea risk profile and the risk of recurrence of atrial fibrillation after catheter ablation

AIMS The aim of this study was to identify the impact of obstructive sleep apnoea (OSA) on recurrence after catheter ablation of paroxysmal atrial fibrillation (AF). METHODS AND RESULTS One hundred and seventy-eight consecutive patients with paroxysmal AF who underwent index circumferential pulmonary vein (PV) isolation were prospectively enrolled. The patients were divided into high risk (HR group) and low risk (LR group) for OSA group with Berlin questionnaire. Of the 178 patients, 104 (58.4%) were in the HR group and 74 (41.6%) were in the LR group. After a mean follow-up of 344 +/- 137 (91-572) days, 44 patients (24.7%) experienced recurrence, and the recurrence rate did not differ between the HR (25.0%) and LR groups (24.3%, P = 0.855). Cox analysis revealed that PV isolation was the only independent predictor of recurrence (hazard ratio 5.11, 95% confidence interval 1.42-18.47, P = 0.013). There was no significant difference in the incidence of complications between the HR and LR groups (2.9 vs. 1.9%, P = 0.729). CONCLUSION The recurrence rate and incidence of complications did not differ in patients with different risk profiles for OSA. The presence of OSA should not lower the decision threshold to choose an ablative procedure in paroxysmal AF.

Atrial Tachycardia Arising Adjacent to Noncoronary Aortic Sinus : Distinctive Atrial Activation Patterns and Anatomic Insights

OBJECTIVES We sought to determine whether atrial tachycardia arising adjacent to the noncoronary aortic sinus (NCAS-AT) has distinctive atrial activation patterns in relation to targeted anatomic imaging. BACKGROUND The knowledge of atrial activation patterns of the NCAS-AT and its anatomic basis is very limited. METHODS Three-dimensional electroanatomic mapping was performed during NCAS-AT in 13 patients and during sequentially pacing from the noncoronary aortic sinus (NCAS) and the para-Hisian atrial area in 15 reference patients. The spatial relationship between the NCAS and the contiguous atria was studied in another 25 reference patients using computed tomography and in 12 human hearts using gross and microscopic anatomic examination. RESULTS During NCAS-AT, the para-Hisian area of the right atrium (RA) and the anteroseptal region of the left atrium were activated almost simultaneously. The initial activation area (within first 20 ms of atrial depolarization) was relatively wide (9.3 +/- 2.6 cm(2) on the RA map and 8.1 +/- 2.1 cm(2) on the left atrium map). In reference patients, NCAS pacing reproduced a biatrial activation pattern of NCAS-AT and resulted in a wider initial activation area than the para-Hisian atrial pacing within first 20 ms of RA activation (10.1 +/- 3.0 cm(2) vs. 3.9+/-1.7 cm(2); p < 0.001). Anatomically, the wall of NCAS did not contain myocardial tissue, but was intimately related to the paraseptal regions of the atria such that the shortest distances from the NCAS to the RA and the left atrium were 1.7 +/- 0.6 mm and 2.3 +/- 0.9 mm (p < 0.01), respectively. CONCLUSIONS NCAS-AT has distinct atrial activation patterns that can be explained in part by its spatial anatomic relationship with the atria.

Serum uric acid and risk of left atrial thrombus in patients with nonvalvular atrial fibrillation.

BACKGROUND Serum uric acid (SUA) is a simple and independent marker of morbidity and mortality in a variety of cardiovascular diseases. In this study we aimed to investigate SUA and the risk of left atrial (LA) thrombus in patients with nonvalvular atrial fibrillation (AF). METHODS In this retrospective study, 1359 consecutive patients undergoing transesophageal echocardiography before catheter ablation of AF were enrolled. Sixty-one of the 1359 patients (4.5%) had LA thrombus. RESULTS SUA levels in patients with LA thrombus were significantly greater (413.5 ± 98.8 μmol/L vs 366.7 ± 94.3 μmol/L; P < 0.001). Hyperuricemia was defined as SUA ≥ 359.8 μmol/L in women and ≥ 445.6 μmol/L in men determined according to receiver operating characteristic curve. The incidence of LA thrombus was significantly greater in patients with hyperuricemia than in those with a normal SUA level in women (12.1% vs 1.9%; P < 0.001) and in men (8.5% vs 2.8%; P < 0.001). Hyperuricemia had a negative predictive value of 98.1% in women and 97.1% in men for identifying LA thrombus. Hyperuricemia was associated with significantly greater risk of LA thrombus among Congestive Heart Failure, Hypertension, Age ≥ 75 Years, Diabetes Mellitus, Stroke, Vascular Disease, Age 65 to 74 Years, Sex Category (CHA2DS2-VASc) score = 0, 1, and ≥ 2 groups with odds ratios of 7.19, 4.05, and 3.25, respectively. In multivariable analysis, SUA was an independent risk factor of LA thrombus (odds ratio, 1.004; 95% confidence interval, 1.000-1.008; P = 0.028). CONCLUSIONS Hyperuricemia was a modest risk factor for LA thrombus, which might refine stratification of LA thrombus in patients with nonvalvular AF.

Predictors of very late recurrence of atrial fibrillation after circumferential pulmonary vein ablation.

Early recurrence of atrial fibrillation (ERAF) after catheter ablation is common and has been thoroughly studied. However, very late recurrence of atrial fibrillation (VLRAF) is rarely researched, and its characteristics have not been determined.

Is CHA2DS2-VASc score a predictor of left atrial thrombus in patients with paroxysmal atrial fibrillation?

Is CHA2DS2-VASc score a predictor of left atrial thrombus in patients with paroxysmal atrial fibrillation? -

Current Status and Time Trends of Oral Anticoagulation Use Among Chinese Patients With Nonvalvular Atrial Fibrillation: The Chinese Atrial Fibrillation Registry Study

Background and Purpose— Reported rates of oral anticoagulation (OAC) use have been low among Chinese patients with atrial fibrillation (AF). With improved awareness, changing guidelines, this situation may be changing over time. We aimed to explore the current status and time trends of OAC use in Beijing. Methods— We used the data set from the Chinese Atrial Fibrillation Registry (CAFR), a prospective, multicenter, hospital-based registry study involving 20 tertiary and 12 nontertiary hospitals in Beijing. A total of 11 496 patients with AF were enrolled from 2011 to 2014. Results— Seven thousand nine hundred seventy-seven eligible patients were included in this ancillary study. The proportions of OAC use were 36.5% (2268/6210), 28.5% (333/1168), and 21.4% (128/599) for patients with CHA2DS2-VASc scores ≥2, 1, and 0, respectively. Persistent AF, history of stroke/transient ischemic attack/peripheral embolism, diabetes mellitus, higher body mass index, and tertiary hospital management were factors positively associated with OAC use, whereas older age, previous bleeding, hypercholesterolemia, and established coronary artery disease were factors negatively associated with OAC use. Among patients with CHADS2 scores ≥2 and CHA2DS2-VASc scores ≥2, the proportion of OAC use increased from 31.3% to 64.5% and 30.2% to 57.7%, respectively, from 2011 to 2014. Variation in OAC use was substantial among different hospitals. Conclusions— An improvement of OAC use among Chinese patients with AF in Beijing is observed in recent years although only 36.5% of patients with CHA2DS2-VASc score ≥2 received OAC. However, variations between different hospitals were large, suggesting that better education and awareness are needed to improve efforts for stroke prevention among AF patients. Clinical Trial Registration— URL: http://www.chictr.org.cn/showproj.aspx?proj=5831. Unique identifier: ChiCTR-OCH-13003729.

A New Method to Evaluate Linear Block at the Left Atrial Roof: Is It Reliable Without Pacing?

A New Method to Evaluate Linear Block at the Left Atrial Roof. Objective: The present study aimed to evaluate a new method for validation of complete linear block at the left atrial (LA) roof.

Isolated Conduction Within the Left His-Purkenje System During Sinus Rhythm and Idiopathic Left Ventricle Tachycardia Findings From Mapping the Whole Conduction System

Background—Functionally, left His-Purkenje system (HPS) is insulated from the adjacent myocardium and exhibits isolated conduction during sinus rhythm (SR), but in vivo human study is rare. Meanwhile, whether the isolated conduction also exists during idiopathic left ventricle tachycardia (ILVT) is not clearly defined. The current study aimed to delineate the activation sequence and gross anatomy of left HPS during SR and ILVT. Methods and Results—The study involved 25 consecutive patients with ILVT. During SR, left HPS exhibited antegrade activation sequence, and its surrounding myocardium depolarized after HPS in an apical to base direction. During ILVT, the earliest retrograde presystolic potentials were mainly located at the middle portion of left posterior fascicle (0.5±0.1 [95% confidence interval, 0.46–0.58] of its full length) with an average of 29.5±6.0 mm (19.8–41.5) away from the His position. Left posterior fascicle was depolarized from the earliest retrograde presystolic potentials via 2 opposite wavefronts with significantly shorter activation time than that during SR (15.1±2.1 versus 30.0±3.2 ms; P<0.001). The left anterior fascicle was depolarized after left posterior fascicle with an antegrade activation sequence and comparable activation time with that during SR (21.9±2.9 versus 22.0±4.1 ms; P=0.932). The depolarization of ventricle septum also occurred after HPS in an apical to base direction. Conclusions—During SR, isolated conduction within the HPS is demonstrated by documenting the reverse activation sequence with its surrounding myocardium. During ILVT, the earliest retrograde presystolic potentials were usually recorded at the middle segment of left posterior fascicle, and the isolated conduction within the HPS remained.

Ablation of Right-Sided Accessory Pathways With Atrial Insertion Far From the Tricuspid Annulus Using an Electroanatomical Mapping System

Ablating Right‐Sided Accessory Pathways With Atrial Insertions Far From Tricuspid Annulus. Background: It is difficult to ablate a right‐sided accessory pathway (AP) with atrial insertion far from the tricuspid annulus (TA). We report our initial experience of ablating this rare AP by a 3‐dimensional electroanatomical mapping system (CARTO).

Significant Left Atrial Appendage Activation Delay Complicating Aggressive Septal Ablation during Catheter Ablation of Persistent Atrial Fibrillation

Background:  This study aims to describe significant left atrial appendage activation following ablation of persistent atrial fibrillation, and explore its relationship with aggressive septal ablation.