Zengzhang Liu

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).

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.

The long-term efficacy of cryoballoon vs irrigated radiofrequency ablation for the treatment of atrial fibrillation: A meta-analysis

OBJECTIVES The main purpose of this meta-analysis was to compare the long-term efficacy of cryoballoon ablation (CBA) with irrigated radiofrequency catheter ablation (RFCA) for the treatment of atrial fibrillation (AF). METHODS The Medline, Cochrane Library and Embase Database were searched for clinical studies published up to October 2014. Studies that fulfilled our predefined inclusion criteria were included. The primary clinical outcome was the proportion of patients free from AF (follow-up≥3months), and the secondary clinical outcomes included acute pulmonary vein (PV) isolated rate, fluoroscopy time, procedure time and complications. RESULTS After a literature search in the major databases, three randomized controlled trials (RCTs) and eight retrospective trials with a total of 1216 patients were identified. Pool-analysis demonstrated that, as compared RFCA, CBA was associated with a similar proportion of patients free from AF at a mean 16.5months follow-up (66.9% vs 65.1%; relative risk [RR]: 1.01; 95% CI: 0.94 to 1.07, P=0.87). Acute PV isolation rate (RR: 0.92; 95% CI: 0.82 to 1.03) and fluoroscopy time (weighted mean difference WMD: -8.60; 95% CI: -18.29 to 3.69) were not statistically significant difference. The procedure time was shorter in CBA group ([WMD]: -31.94; 95% CI: -60.43 to -3.45). Transient phrenic nerve palsy was uniquely observed in the CBA group (5.4%, P<0.00001) and resolved in all during the follow-up period, total complication was similar in both groups (RR: 1.30; 95% CI: 0.91 to 1.85). CONCLUSIONS CBA was as effective as RFCA for the treatment of atrial fibrillation during long-term follow-up with comparable procedural features.

Effect of Nifedipine Versus Telmisartan on Prevention of Atrial Fibrillation Recurrence in Hypertensive Patients

It is controversial whether angiotensin II receptor blockers provide better protection than calcium antagonists against atrial fibrillation (AF) recurrence in hypertensive patients. This study was designed to compare the effect of nifedipine- and telmisartan-based antihypertensive treatments for preventing AF recurrence in hypertensive patients with paroxysmal AF. A total of 149 hypertensive patients with paroxysmal AF were randomized to nifedipine- or telmisartan-based antihypertensive treatment groups. The target blood pressure (BP) was <130/80 mm Hg. Clinic BP, ECG, Holter monitoring, and echocardiography were followed up for 2 years. The primary end point was the incidence of overall and persistent AF recurrence. During follow-up, there was no statistical difference in the rate of patients lowering to target BP between both groups, whereas nifedipine group had slightly better BP control but similar heart rate control at 24 months. The incidence of AF recurrence was similar in both groups (nifedipine versus telmisartan: 58.7% versus 55.4%; P=0.742), and Kaplan–Meier analysis showed no significant difference in the freedom from AF recurrence (log-rank test; P=0.48). However, the rate of developing persistent AF in telmisartan group was lower than that in nifedipine group (5.4% versus 16.0%; P=0.035). Patients in telmisartan group had lower values of left atrial diameter, left atrial volume index, and left ventricular mass index at the end of follow-up. The effects of telmisartan in preventing AF recurrences in hypertensive patients with paroxysmal AF after intensive lowering BP is similar to that of nifedipine, but telmisartan has more potent effects on preventing progression to persistent AF.

Effects of renal sympathetic denervation using saline-irrigated radiofrequency ablation catheter on the activity of the renin-angiotensin system and endothelin-1.

Introduction: Excessive activation of the sympathetic nervous system (SNS) and the renin-angiotensin system (RAS) are crucial and interacted closely in the pathogenesis of chronic cardiovascular diseases. This study investigated the effects of renal denervation (RDN) on the RAS. Materials and methods: Eight Chinese Kunming dogs underwent bilateral RDN utilizing saline-irrigated radiofrequency ablation catheter. Blood pressure (BP) measurements, blood sampling assays and renal angiography were performed at baseline, 30 min, one month and three months after ablation. Results: During three months of follow-up, RDN caused a significant and uniform reduction in plasma level of renin, angiotensin II, and endothelin-1(ET-1), with the reduction of –5.7±6.8 (p=0.049), –19.4±19.3 (p=0.025), and –22.4±21 pg/ml (p=0.02) for plasma renin, –10.6±7.2 (p=0.004), –15.9±8.8 (p=0.001), and –15.2±9.6 pg/ml (p=0.003) for plasma angiotensin II, as well as –3.9±3 (p=0.007), –10.8±5 (p<0.001), and –14.6±6.1 pg/ml (p<0.001) for plasma ET-1. RDN utilizing a saline-irrigated catheter also caused a progressive and substantial BP reduction of –19±22/–8±13, –30±13/–13±14, and –36±20/–16±14 mm Hg (p=0.045, p<0.001, and p<0.002 for systolic BP; p=0.14, p=0.036, and p=0.014 for diastolic BP) without ablation-related complications. Conclusion: RDN substantially decreased BP and also significantly decreased the plasma levels of RAS and ET-1, which might be implicated in the mechanism of BP reduction by RDN.

Meta-analysis of the effects of preoperative renin-angiotensin system inhibitor therapy on major adverse cardiac events in patients undergoing cardiac surgery

The purpose of this meta-analysis was to assess the role of preoperative renin-angiotensin system inhibitor (RASI) therapy on major adverse cardiac events (MACE) in patients undergoing cardiac surgery. The Medline, Cochrane Library and Embase databases were searched for clinical studies published up to May 2014. Studies that evaluated the effects of preoperative RASI therapy in cardiac surgery were included. Odds ratio (OR) estimates were generated under a random-effects model. After a literature search in the major databases, 18 studies were identified [three randomized prospective clinical trials (RCTs) and 15 observational trials] that reported outcomes of 54 528 cardiac surgery patients with (n = 22 661; 42%) or without (n = 31 867; 58%) preoperative RASI therapy. Pool analysis indicated that preoperative RASI therapy was not associated with a significant reduction of early all-cause mortality [OR: 1.01; 95% confidence interval (CI) 0.88-1.15, P = 0.93; I(2) = 25%], myocardial infarction (OR: 1.04; 95% CI 0.91-1.19, P = 0.60; I(2) = 16%), or stroke (OR: 0.93; 95% CI 0.75-1.14, P = 0.46; I(2) = 38%). Meta-regression analysis confirmed that there was a strong negative correlation between the percentage of diabetics and early all-cause mortality (P = 0.03). Furthermore, preoperative RASI therapy significantly reduced mortality in studies containing a high proportion of diabetic patients (OR: 0.84; 95% CI 0.71-0.99, P = 0.04; I(2) = 0%). In conclusion, our meta-analysis indicated that although preoperative RASI therapy was not associated with a lower risk of MACE in cardiac surgery patients, it might provide benefits for diabetic patients.

Renin-angiotensin system-related gene polymorphisms are associated with risk of atrial fibrillation

BACKGROUND Renin-angiotensin system (RAS) plays an important role in atrial fibrillation (AF). Recently, many publications have studied the associations between RAS-related gene polymorphisms and AF risk, with inconsistent results. To further evaluate these associations, we carried out a meta-analysis of all the published studies. METHODS Electronic searches were used to identify published studies evaluating RAS-related gene polymorphisms and AF risk before April 2009. We extracted data sets and performed meta-analysis with standardized methods. RESULTS A meta-analysis of 12 publications on association between angiotensin-converting enzyme (ACE insertion/deletion) and AF risk was performed. The pooled relative risk (RR) of allele D versus I was 1.19 (95% CI, 1.07-1.32, P < .01), pooled RR of DD and DI versus II was 1.31(95% CI, 1.09-1.58, P < .01) and 1.06 (95% CI, 0.97-1.16, P = .22) respectively. In subgroup analysis, a stronger association was found in hypertensive population, Western ethnic, lone AF, and patients aged > or = 65 years, with pooled RR of DD versus II was 1.74 (95% CI, 1.39-2.18, P < .01), 1.27 (95% CI, 1.01-1.59, P = .04), 1.53 (95% CI, 1.31-1.78, P < .01) and 1.38 (95% CI, 1.10-1.73, P < .01), respectively. CONCLUSION The results suggested an association between ACE insertion/deletion and AF risk. More large-scale studies are warranted to document the conclusive evidence of the effects of the RAS genes on AF risk.

Preliminary effects of renal denervation with saline irrigated catheter on cardiac systolic function in patients with heart failure: A Prospective, Randomized, Controlled, Pilot Study.

To assess efficacy and safety of renal denervation (RDN) for heart failure (HF).