Wenkui Lv

Impact of contact force technology on reducing the recurrence and major complications of atrial fibrillation ablation: A systematic review and meta-analysis

Contact force (CF) monitoring can be useful in accomplishing circumferential pulmonary vein (PV) isolation for atrial fibrillation (AF). This meta-analysis aimed to assess the efficacy and safety of a CF-sensing catheter in treating AF. Randomized controlled trials or non-randomized observational studies comparing AF ablation using CF-sensing or standard non-CF (NCF)-sensing catheters were identified from PubMed, EMBASE, Cochrane Library, Wanfang Data, and China National Knowledge Infrastructure (January 1, 1998–2016). A total of 19 studies were included. The primary efficacy endpoint was AF recurrence within 12 months, which significantly improved using CF-sensing catheters compared with using NCF-sensing catheters [31.1% vs. 40.5%; risk ratio (RR)=0.82; 95% confidence interval (CI), 0.73–0.93; p<0.05]. Further, the acute PV reconnection (10.1% vs. 24.2%; RR=0.45; 95% CI, 0.32–0.63; p<0.05) and incidence of major complications (1.8% vs. 3.1%; OR=0.59; 95% CI, 0.37–0.95; p<0.05) significantly improved using CF-sensing catheters compared with using NCF-sensing catheters. Procedure parameters such as procedure duration [mean difference (MD)=-28.35; 95% CI, -39.54 to -17.16; p<0.05], ablation time (MD=-3.8; 95% CI, -6.6 to -1.0; p<0.05), fluoroscopy duration (MD=-8.18; 95% CI, -14.11 to -2.24; p<0.05), and radiation dose (standard MD=-0.75; 95% CI, -1.32 to -0.18; p<0.05] significantly reduced using CF-sensing catheters. CF-sensing catheter ablation of AF can reduce the incidence of major complications and generate better outcomes compared with NCF-sensing catheters during the 12-month follow-up period.

Left atrial appendage occlusion in atrial fibrillation for stroke prevention: A systemic review

BACKGROUND Atrial fibrillation (AF) is an arrthymia characterized by increased risk of ventricle arrthymias and thromboembolism especially ischemic stroke. Most thrombus originated in the left atrial appendage, thus left atrial occlusion (LAAO) may be an effective alternative for stroke prevention in atrial fibrillation. OBJECTIVE To assess the effect and safety of left atrial occlusion for stroke prevention in atrial fibrillation. METHODS AND RESULTS We searched Pub Med, CENTRAL in The Cochrane Library, Embase, CBM-Disk, CNKI for published trials, ClinicalTrials.gov, ISI Proceedings for conference abstracts, and WHO International Clinical Trial registration Platform for ongoing studies. The search results were extracted, and then the quality of included studies was assessed. By RevMan 5.3, meta analysis was used if there was low heterogeneity. Three randomized controlled clinical trials involving 1165 participants were included (percutaneous 1114 in 2 trials, surgical 51 in 1 trial). The current data suggest that left atrial occlusion may be as efficacious as warfarin in stroke prevention (RR 0.78 [0.33, 1.84]) and mortality reduction (RR 0.68 [0.40, 1.16]) for AF. CONCLUSION In contrast to warfarin left atrial occlusion with Watchman device may have the same effectivity in stroke reduction. Surgical LAAO may also get positive outcomes compared with warfarin, but owing to the small sample size the evidence is less powerful. Total outcomes of percutaneous and surgical LAAO support this approach.

Reference values of brachial-ankle pulse wave velocity according to age and blood pressure in a central Asia population

Background Brachial-ankle pulse wave velocity (baPWV), a direct measure of aortic stiffness, has increasingly become an important assessment for cardiovascular risk. The present study established the reference and normal values of baPWV in a Central Asia population in Xinjiang, China. Methods We recruited participants from a central Asia population in Xinjiang, China. We performed multiple regression analysis to investigate the determinants of baPWV. The median and 10th-90th percentiles were calculated to establish the reference and normal values based on these categories. Results In total, 5,757 Han participants aged 15–88 years were included in the present study. Spearman correlation analysis showed that age (r = 0.587, p < 0.001) and mean blood pressure (MBP, r = 0.599, p <0.001) were the major factors influencing the values of baPWV in the reference population. Furthermore, in the multiple linear regression analysis, the standardized regression coefficients of age (0.445) and MBP (0.460) were much higher than those of body mass index, triglyceride, and glycemia (-0.054, 0.035, and 0.033, respectively). In the covariance analysis, after adjustment for age and MBP, only diabetes was the significant independent determinant of baPWV (p = 0.009). Thus, participants with diabetes were excluded from the reference value population. The reference values ranged from 14.3 to 25.2 m/s, and the normal values ranged from 13.9 to 21.2 m/s. Conclusions This is the first study that has established the reference and normal values for baPWV according to age and blood pressure in a Central Asia population.

Idiopathic premature ventricular complexes originating from the distal great cardiac vein: Clinical, cardiac and electrophysiological characteristics and catheter ablation outcome

Aims: Although catheter ablation for idiopathic ventricular arrhythmia (VA) has been generally well‐established, VA originating from the great cardiac vein (GCV) may be clinically challenging due to its epicardial origin, proximity to coronary arteries and limited accessibility. The purpose of this study was to explore its electrophysiological characteristics and identify effective mapping/ablation strategies for idiopathic premature ventricular complexes (PVCs) originating from the GCV. Materials and methods: Between January 2013 to January 2018, 12 patients (who were diagnosed with PVCs originating from the GCV) among the 305 patients with idiopathic left ventricular outflow tract tachycardia were included. The origin of the ectopy was localized by mapping, the characteristics of the electrocardiogram (ECG) were analyzed, and all the patients with PVCs originating from GCV were treated by radiofrequency catheter ablation (RFCA). The safety and efficacy of RFCA were evaluated. Key findings: The origin of the ectopy was successfully localized in GCV for all 12 patients by mapping, and access to GCV via the coronary sinus was feasible. Successful RFCA was achieved in 11 of 12 patients (91.67% acute procedural success) without perioperative complications. During a median follow‐up of 12.6 ± 6.5 months, only one patient had recurrent VA (recurrence rate: 9.1%). Significance: ECG characteristics may be helpful for identifying patients with PVCs originating from the GCV. RFCA within the coronary venous system appears to be safe and effective for these patients, and should be considered when routine RFCA from the endocardium or aortic sinus of the Valsalva is not effective.

Ethnicity and anticoagulation management of hospitalized patients with atrial fibrillation in northwest China

The therapeutic management and health challenges caused by atrial fibrillation (AF) differ between different groups. The purpose of this study was to investigate the clinical features of patients hospitalized with AF and to explore the use of anticoagulation treatments in Han and Uygur patients in Xinjiang, northwest China. Data were collected from a retrospective descriptive study involving patients hospitalized at 13 hospitals in Xinjiang, China from Jul 1, 2014 to Jun 31, 2015. Anticoagulation management was measured according to guideline-recommended risk scores. A total of 4,181 patients with AF were included (mean age 69.5 ± 11.7 years, 41.4% females; 71.5% Han, 28.5% Uygur). The prevalence of AF in Uygur individuals may occur earlier than in Han individuals (mean age 64.9 vs 71.3, P < 0.001). Most of the hospitalized patients with AF had a high risk of stroke (CHA2DS2-VASc score ≥2; 80.6% Han vs 73.7% Uygur, P < 0.05); this risk was especially high in elderly patients. In AF patients, the application of anticoagulants according to the guidelines is far from expected, and the underutilization of anticoagulants exists in both ethnic groups.