Yuehui Yin

Cryoablation Versus Radiofrequency Energy for the Ablation of Atrioventricular Nodal Reentrant Tachycardia (the CYRANO Study) Results From a Large Multicenter Prospective Randomized Trial

Background— Cryoablation has emerged as an alternative to radiofrequency catheter ablation (RFCA) for the treatment of atrioventricular (AV) nodal reentrant tachycardia (AVNRT). The purpose of this prospective randomized study was to test whether cryoablation is as effective as RFCA during both short-term and long-term follow-up with a lower risk of permanent AV block. Methods and Results— A total of 509 patients underwent slow pathway cryoablation (n=251) or RFCA (n=258). The primary end point was immediate ablation failure, permanent AV block, and AVNRT recurrence during a 6-month follow-up. Secondary end points included procedural parameters, device functionality, and pain perception. Significantly more patients in the cryoablation group than the RFCA group reached the primary end point (12.6% versus 6.3%; P=0.018). Whereas immediate ablation success (96.8% versus 98.4%) and occurrence of permanent AV block (0% versus 0.4%) did not differ, AVNRT recurrence was significantly more frequent in the cryoablation group (9.4% versus 4.4%; P=0.029). In the cryoablation group, procedure duration was longer (138±54 versus 123±48 minutes; P=0.0012) and more device problems occurred (13 versus 2 patients; P=0.033). Pain perception was lower in the cryoablation group (P<0.001). Conclusions— Cryoablation for AVNRT is as effective as RFCA over the short term but is associated with a higher recurrence rate at the 6-month follow-up. The risk of permanent AV block does not differ significantly between cryoablation and RFCA. The potential benefits of cryoenergy relative to ablation safety and pain perception are counterbalanced by longer procedure times, more device problems, and a high recurrence rate. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00196222.

Intravenous immunoglobulin plus corticosteroid to prevent coronary artery abnormalities in Kawasaki disease: a meta-analysis

Objective To summarise clinical trials that compared the incidence of coronary abnormality between intravenous immune globulin (IVIG) plus corticosteroid therapy and IVIG therapy alone, and to determine the overall efficacy and safety of IVIG plus corticosteroid therapy for the initial treatment of Kawasaki disease. Background Although use of IVIG as initial therapy has been established in Kawasaki disease, the role of corticosteroids therapy is controversial. Methods Medline, The Cochrane Library, The Clinical Trials, and Embase Database were searched for published clinical studies up to 31 March 2012. Studies that compare the efficacy of IVIG plus corticosteroid with that of IVIG in treating Kawasaki disease were included. The coronary outcome and adverse events were analysed by meta-analysis. Results 9 clinical studies with a total of 1011 patients were identified. Meta-analysis of the 9 studies showed that IVIG plus corticosteroid therapy significantly reduced the risk of coronary abnormality (OR: 0.3; 95% CI 0.20 to 0.46). Similar results were observed in subgroup analyses of randomised controlled studies (OR: 0.3; 95% CI 0.18 to 0.5), studies focused on patients with a high risk of IVIG resistance (OR: 0.2; 95% CI 0.1 to 0.36) and studies with blinded-endpoint manner (OR: 0.32; 95% CI 0.19 to 0.55). There was no significant difference in the incidence of severe adverse events between the IVIG plus corticosteroid group, and the IVIG group (OR: 1.24; 95% CI 0.33 to 4.67). Conclusions Combination of corticosteroid with the conventional regimen of IVIG as an initial treatment strategy could reduce the risk of coronary abnormality.

Radiofrequency Ablation Versus Antiarrhythmic Medication for Treatment of Ventricular Premature Beats From the Right Ventricular Outflow Tract Prospective Randomized Study

Background—The purpose of this study was to compare the efficacy of radiofrequency catheter ablation (RFCA) versus antiarrhythmic drugs (AADs) for treatment of patients with frequent ventricular premature beats (VPBs) originating from the right ventricular outflow tract (RVOT). Methods and Results—A total of 330 eligible patients were included in the study and were randomly assigned to RFCA or AADs group. The absolute number and the burden of VPBs on 12-lead Holter monitors were measured at baseline and at 1st, 3rd, 6th, and 12th months after randomization. Left ventricular eject fraction was evaluated by transthoracic echocardiogram at baseline and at 3 and 6 months after randomization. During the 1-year follow-up period, VPB recurrence was significantly lower in patients randomized to RFCA group (32 patients, 19.4%) versus AADs group (146 patients, 88.6%; P<0.001, log-rank test). In a Poisson generalized estimating equations (GEE) regression model, RFCA was associated with a greater decrease in the burden of VPBs (incidence rate ratio 0.105; 95% confidence intervals [0.104–0.105]; P<0.001) compared with AADs. In a liner GEE model, the left ventricular eject fraction had a tendency to increase after the treatment in both groups (coefficient, 0.584; 95% confidence intervals [0.467–0.702]; P<0.001). In a Cox proportional model, the QS morphology in lead I was the only predictor of VPB recurrence free for catheter ablation (hazards ratio, 0.154; 95% confidence intervals [0.044–0.543]; P=0.004). Conclusions—Catheter ablation is more efficacious than AADs for preventing VPB recurrence in patients with frequent VPBs originating from the RVOT. QS morphology in lead I was associated with better outcome after ablation.

Predictors of late recurrence of atrial fibrillation after catheter ablation

BACKGROUND To predict the recurrence of atrial fibrillation is important for selecting patients who will be undergoing catheter ablation, several studies respectively evaluated the risk factor of the recurrence of atrial fibrillation post-ablation. OBJECTIVE To investigate the factors predicting the recurrence of atrial fibrillation (AF) after catheter ablation. METHODS 186 patients (55.12 ± 12.06 years, 123 male) including 161 paroxysmal AF and 25 non-paroxysmal AF who underwent catheter ablation were studied. Clinical datum before and during ablation were recorded, and systematic follow-up was conducted after ablation. Univariate and multivariate analyses were carried out to determine the factors predicting late recurrence of AF (LRAF) which means AF recurrence after 3 months. RESULTS There were 47(25.27%) patients who experienced LRAF. Multivariate Logistic regression analysis was carried out to the parameters that P<0.10 in the univariate analysis, which includes overweight/obesity, metabolic syndrome (MetS), AF categories, duration of AF history, left atrial diameter (LAD), diabetes mellitus, ablation strategies, procedural failure and early recurrence of AF after ablation (ERAF). Ultimately, the results demonstrated that overweight/obesity (OR=4.71, 95% CI 1.71-12.98, P=0.003), MetS (OR=4.41, 95% CI 1.56-12.46, P=0.005), procedural failure (OR=58.34, 95% CI 6.83-498.34, P<0.001), and ERAF (OR=3.18, 95% CI 1.07-9.44, P=0.037) were independent predictors of AF recurrence after ablation. CONCLUSION Overweight/obesity, metabolic syndrome, procedural failure and ERAF are independent predictors of late recurrence of atrial fibrillation in this group of patients.

Paced QRS duration as a predictor for clinical heart failure events during right ventricular apical pacing in patients with idiopathic complete atrioventricular block: results from an observational cohort study (PREDICT-HF)

The aim of this study was to investigate the predictive ability of paced QRS duration (pQRSd) for heart failure events among patients receiving right ventricular apical pacing (RVAP).

The Role of Continuous Positive Airway Pressure in Blood Pressure Control for Patients With Obstructive Sleep Apnea and Hypertension: A Meta‐Analysis of Randomized Controlled Trials

The aim of this study was to review the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with obstructive sleep apnea (OSA) and hypertension. Biomedical databases were searched for randomized controlled trials (RCTs) comparing CPAP with control among these patients. Seven RCTs reporting 24‐hour ambulatory BP were identified for meta‐analysis. CPAP was associated with significant reductions in 24‐hour ambulatory systolic blood pressure (SBP) (−2.32 mm Hg; 95% confidence interval [CI], −3.65 to −1.00) and diastolic blood pressure (DBP) (−1.98 mm Hg; 95% CI, −2.82 to −1.14). CPAP led to more significant improvement in nocturnal SBP than that in diurnal SBP. Subgroup analysis showed that patients with resistant hypertension or receiving antihypertensive drugs benefited most from CPAP. Meta‐regression indicated that CPAP compliance, age, and baseline SBP were positively correlated with decrease in 24‐hour DBP, but not reduction in 24‐hour SBP.

Significance of white blood cell count and its subtypes in patients with acute coronary syndrome

Background  Inflammation plays a role in the pathogenesis of coronary atherosclerosis.

Effect of cardiac resynchronization therapy and implantable cardioverter defibrillator on quality of life in patients with heart failure: a meta-analysis.

AIMS To compare the improvement of quality of life (QoL) in cardiac resynchronization therapy plus implantable cardioverter defibrillator (CRT-D) therapy with that in implantable cardioverter defibrillator (ICD) therapy alone for patients with heart failure. METHODS AND RESULTS Medline, Embase, The Cochrane Library, and US Food and Drug Administration website were searched for published studies up to 31 December 2011. Studies were considered for inclusion if they were randomized controlled trials (RCTs) that compared the efficacy of CRT-D therapy with ICD therapy in patients with heart failure. The primary outcome of this study was improvement in QoL. Four RCTs with 1655 patients were included in this meta-analysis. Overall, the QoL score of patients in CRT-D group significantly improved [weighted mean difference (WMD): -6.02; 95% confidence interval (CI): -10.56 to -1.48] compared with that in the ICD only group. However, the benefit with respect to QoL in CRT-D group was not maintained when subset meta-analysis was performed in patients with New York Heart Association (NYHA) class I-II (WMD: 0.19; 95% CI: -3.89 to 4.72), whereas the patients with NYHA class III-IV in CRT-D group still experienced a significant improvement of QoL score compared with ICD group (WMD: -8.49; 95% CI: -13.39 to -3.59). CONCLUSIONS CRT-D therapy improves the QoL compared with ICD therapy alone, especially in patients with moderate to severe heart failure.

Two-year clinical outcomes of different drug-eluting stents with different polymer coating strategies in coronary artery heart disease: A multi-centre, randomised, controlled clinical trial

BACKGROUND The persistence of polymer may be related to late and very late stent thrombosis. Recently, biodegradable polymer (BD) and polymer-free (PF) stents have become a focus for prevention of detrimental clinical events. However, the long-term efficacy of these types of stent compared to that of permanent polymer (PP) stents is unclear. METHODS AND RESULTS A total of 989 consecutive coronary heart disease (CHD) patients from five centres who required the implantation of drug-eluting stents (DES) were randomly divided into the PP (n = 321), PF (n = 327) and BD groups (n = 341). The primary endpoint was major adverse cardiac events (MACE). The secondary endpoints were stent thrombosis events, all-cause death and rehospitalisation. The study was designed to test the noninferiority of the PF and BD stents compared with that of the PP stent with respect to two-year MACE, using a noninferiority margin of 0.05. After clinical follow-up for 26.96 ± 12.99 months, the 2-year MACE rates were 6.17% in the PF group, 6.58% in the BD group and 7.24% in the PP group. The noninferiority testing produced lower limits of the one-sided 95% confidence interval of -0.0435 (P = 0.024) for the PF group and -0.0401 (P = 0.017) for the BD group. There were no significant differences in stent thrombosis events, all-cause death and rehospitalisation among the three groups (all P>0.05). CONCLUSION In this multicentre, randomised, controlled clinical trial, PF paclitaxel-eluting stents and BD rapamycin-eluting stents were shown to be noninferior to PP rapamycin-eluting stents in two-year clinical outcomes for the treatment for CHD.

The efficacy and safety of cardiac resynchronization therapy combined with implantable cardioverter defibrillator for heart failure: a meta-analysis of 5674 patients

AIMS The purpose of this study was to evaluate the efficacy and safety of cardiac resynchronization plus implantable cardioverter defibrillator (CRT-D) therapy and implantable cardioverter defibrillator (ICD) therapy in treating heart failure by systematically reviewing randomized controlled trials. METHODS AND RESULTS Databases of Medline, Embase, and Cochrane Library were searched for published studies up to 31 May 2012. Clinicaltrials.gov and US Food and Drug Administration websites were searched as well. Only randomized controlled trials comparing the efficacy of CRT-D therapy with ICD therapy were enrolled in meta-analysis. Eight randomized controlled trials characterizing 5674 patients were finally included. Meta-analysis found that CRT-D therapy was associated with significant improvement in clinical conditions [odds ratio (OR): 1.66; 95% confidence interval (CI):1.33-2.07] and a reduction in hospitalization (OR: 0.7; 95% CI: 0.6-0.81) and all-cause mortality (OR: 0.8; 95% CI: 0.67-0.95). Although advantages of CRT-D therapy over ICD therapy were obvious, the peri-implantation adverse events of CRT-D therapy remained to be concerns. CONCLUSION Compared with ICD therapy, patients receiving CRT-D therapy have favourable outcomes regarding improvement in clinical conditions, hospitalization rate, and overall survival, but at a significantly higher risk of peri-implantation adverse events. Future studies are warranted to optimize the clinical application of CRT-D.