简介：Atrialfibrillation(AF),themostcommonlyencoun-teredarrhythmiainclinicalpractice,isassociatedwitha2-foldincreaseintotalcardiovascularmortality[1],aswellasthepotentialforsubstantialmorbidity,includingstroke,congestiveheartfailure,andcardiomyopathy.Itsincidenceandprevalenceareincreasing,anditrepresentsagrowingclinicalandeconomicburden.Owingtorela-tiveinefficacyandside

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简介：Atrialfibrillation(AF)isthecommonestcardiacarrhythmia,withsignificantmorbidityandmortality.MorethanhalfofpatientswithAFarestillsymptomaticdespiteadequateanticoagulationandratecontrol.Ifantiarrhythmicdrugsareineffectiveorpoorlytolerated,AFpatientsarethentypicallytreatedwithcatheterablationtorestoresinusrhythm.Inthepast20years,AFablationhasdevelopedfromaspecialized,experimentalprocedureintoacommontreatmentinthecardiovascularfield.Variousablationtechniquesandmappingtechnologieshavebeendescribedandarecontinuingtoevolveforincreasedsafetyandefficacy.Anincompletelistofsuchtechniquesandtechnologieswouldincludefocalandsegmental,circumferentialandlinear,complexfractionatedatrialelectrogram,ganglionatedplexus,focalimpulseandrotormodulation,bodysurfacepotentialmapping–guided,real-timeMRI–guided,cryoballoon,visuallyguidedlaserballoon,radiofrequencyhotballoon,contactforcesensingcatheter,multielectrodecatheter,andhybridablations.ThisreviewexaminesthehistoryofinvasiveAFtreatmentanditsevolutionintocatheterablationbutmainlyfocusesonthediscussionofvariousablationtechniquesandtechnologiesleadingtoourcurrentunderstandingoftheablationtherapyofthismostcommonarrhythmia.

简介：Despitethehugedevelopmentofradiofrequencycatheterablation,surgicaloperation,pacemakerimplantation,anddrugtherapyremainsthefirstlinetreatmentofatrialfibrillation.Severalnewanti-arrhythmicdrugsandanticoagulationdrugshavecomeoutrecently,andhavemadethedrugtherapyofatrialfibrillationamorepromisingchoice.Thisarticleprovidesacontemporaryhighlightonthenewanti-arrhythmicagentsofatrialfibrillation.

简介：BackgroundTheCHA2DS2-VAScschemahasrecentlybeenintroducedtocomplementtheCHADS2scoreandimprovetheidentificationofatrialfibrillation(AF)patientsat'trulylowrisk'forthromboembolism.WetestedthepredictiveabilityoftheCHA2DS2-VASc,CHADS2andvanWalravenriskstratificationschemesinacohortof'lone'AFpatientswitha12-yearfollow-up.MethodsandResultsWeconductedaregistry-based,observationalcohortstudyof345patientsinitiallydiagnosedwith'lone'AFbetween1992and2007.Atbaseline,allpatientshadtheCHADS2andvanWalravenscoresof0,and262(75.9%)hadaCHA2DS2VAScscore=0.Duringfollow-up(orwithinayearpriortostroke),228(66.1%),234(67.8%)and150patients(43.5%)retainedtheCHADS2,vanWalravenandCHA2DS2VAScscoresof0,respectively.Theoverallrateofischemicstrokewas0.19(95%CI:0.18-0.20)per100patient-years.Inthemultivariableanalysis,onlytheCHA2DS2-VAScscoreof0wassignificantlyrelatedtotheabsenceofstroke(OR5.1,95%CI:1.5-16.8,P=0.008).OnlytheCHA2DS2-VAScscorehadasignificantpredictionability(c-statistic0.72[0.61-0.84],P=0.031).ConclusionsTheCHA2DS2-VAScscorereliablyidentifiedthe'lone'AFpatientswhowereat'trulylowrisk'forthromboembolism,andwastheonlytestedriskstratificationschemewithasignificantpredictiveabilityforthromboembolismamongstloneAFpatients.

简介：AbstractBackground:Post hoc analysis of the landmark atrial fibrillation follow-up investigation of rhythm management trial revealed that amiodarone was associated with higher risks of mortality, intensive care unit admission, and non-cardiovascular death. We aim to evaluate the association between amiodarone use and patient survival under updated medical mode and level using data from the China Atrial Fibrillation (China-AF) Registry study.Methods:Clinical data of 8161 non-valvular atrial fibrillation (NVAF) patients who were antiarrhythmic drug (AAD)-naive before enrollment into the China-AF Registry, recruited between August 2011 and February 2017, were collected. The primary outcome was all-cause mortality. A Cox proportional hazard regression model was used to evaluate the association between amiodarone use and the outcome. We also calculated the rate of sinus rhythm maintenance at the penultimate follow-up.Results:Compared with 6167 patients of non-AAD group, 689 patients of the amiodarone group were younger (mean age 65.6 vs. 68.6 years), more frequently completed high school education, had fewer comorbidities such as chronic heart failure, prior bleeding, and stroke, and were more likely to be treated in tertiary hospitals while less hospitalization. The proportion of persistent AF was much lower among users of amiodarone, who were also less likely to be taking oral anticoagulants. The patients in the amiodarone group had a statistically insignificant lower incidence of all-cause mortality (2.44 vs. 3.91 per 100 person-years) over a mean follow-up duration of 300.6 ± 77.5 days. After adjusting for potential confounders, amiodarone use was not significantly associated with a lower risk of all-cause mortality (adjusted hazard ratio, 0.79; 95% confidence interval, 0.42-1.49). Sub-group analysis revealed the consistent results. The rate of sinus rhythm maintenance at the penultimate follow-up in the amiodarone group was significantly higher than in the non-AAD group.Conclusions:Our study indicated that amiodarone use was not significantly associated with a lower risk of 1-year all-cause mortality compared with a non-AAD strategy in "real-world" patients with NVAF.

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简介：Atrialfibrillation(AF)isthemostcommoncardiacarrhythmiaaffectingmillionsofpeopleworldwidewithincreasingincidenceandprevalence.RadiofrequencycatheterablationhasevolvedasthetreatmentofchoiceforbothparoxysmalandpersistentAF.Severalstudieshavebeenreportedoncatheterablationasthefirst-linetreatmentforparoxysmalAFanddifferentstrategiesforpersistentAF.Newtechnologiessuchascontact-forcesensingcathetersandcryoballoonhavebeenrecentlyusedandtheprocedurecarriestheriskofcomplicationslikehematoma,arteriovenousfistula,cardiactamponade,pulmonaryveinstenosis,atrio-esophagealfistulaanddeath.

简介：Atrialfibrillation(AF)isthemostcommonsustainedcardiacrhythmdisturbanceinclinicalpractice,increasinginprevalencewithage.CurativetreatmentofAFwithcatheterablationisnowalegitimateoptionforanumberofpatients.ThedominantablationforAFmainlyconcentratesonpulmonaryveins(PVs)orcomplexfragmentatrialelectrograms(CFAEs).However,theoptimalapproachforablationofAFarousedsomecontroversy.ThebulkoftheevidencesuggeststhattheintrinsiccardiacautonomicnervoussystemmaycontributetotheformationofrapidfiringfromthePVsitesornon-PVsitesandCFAEs,andplayacriticalroleintheinitiationandmaintenanceofAF.WehypothesizedthatganglionatedpleximaybeanidealstrategyforAFablation.

简介：Strokeisthemostcommoncomplicationofatrialfibrillation(AF).GuidelinesrecommendanticoagulanttreatmentinpatientswithCHA2DS2VAScscoresof>2.RegistrydatasuggeststhatalmosthalfofpatientswhoshouldbeontherapeuticanticoagulationforstrokepreventioninAF(SPAF)arenot.Warfarinandmorerecentlydevelopedagents,the"novelanticoagulants"(NOACs)reducetheriskofembolicstrokes.Inaddition,theNOACsalsoreduceintracranialhemorrhage(ICH)byover50%comparedtowarfarin.Anticoagulationandbridgingstrategiesinvolvingcardioversion,catheterablation,andinvasive/surgicalproceduresarereviewed.ThedevelopmentofreversalagentsforNOACsandtheintroductionofleftatrialappendageoccludingdeviceswillevolvetheuseofnewerstrategiesforpreventingstrokeinhighriskAFpatients.

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简介：BackgroundCircularRNAs(circRNAs)areendogenousnon-codingRNAsthatparticipateinregulatinggeneexpressionindiversebiologicalandpathologicalprocesses.TherolesofcircRNAsinatrialfibrillation(AF)havenotbeenwellelucidated.Inthepresentstudy,circRNAsprofileintheatrialappendagesofpatientswithAFwasexamined.MethodsHematoxylin-eosin(HE)andMassontrichromestainingwasperformedontheatrialappendagesofpatientswithsinusrhythm(SR)orAF.Expressionsoffibrosis,rennin-angiotensin-aldosteronesystem(RAAS)andinflammation-associatedgenesweredeterminedbyquantitativereversetranscriptionPCR(qRT-PCR).CircRNAsexpressionprofileinatrialappendageswasdetectedbycircRNAsmicroarray.qRT-PCRwasalsousedtodeterminetheexpressionof6representativedys-regulatedcircRNAs.PCRproductsofconcernedcircRNAswerefurtheridentifiedbygelelectrophoresisandDNAsequencingassay.ResultsMassontrichromestainingresultshowedthatfibrosiswasincreasedintheatrialappendagesofAFpatients.Thelevelsofcol1a1,Col3a1,fibrinectin-1(FN1),IL1-βandCRPmRNAexpressionweresignificantlyup-regulatedintheatrialappendagesofAFpatients.AcircRNAsarrayrevealedthatcircRNAsweredysregulatedintheatrialappendagesofAFpatients.qRT-PCRresultsdemonstratedthatcircRNA_100395wasup-regulated,circRNA_101270,circRNA_103820,circRNA_104168andcircRNA_100782weredown-regulatedsignificantlyintheatrialappendagesofAFpatientscomparedtoSRpatients.ConclusionsFibrosisandinflammationoccurintheatrialappendagesofAFpatients,whichcouldrelatetocircRNAsdysregulation.

简介：AIM:Toanalyzethepotentialrelationshipbetweengastroesophagealrefluxdisease(GERD)andthedevelopmentofatrialfibrillation(AF).METHODS:Usingthekeywords'atrialfibrillationandgastroesophagealreflux','atrialfibrillationandesophagitis,peptic','atrialfibrillationandhernia,hiatal'thePubMed,EMBASE,CochraneLibrary,OVIDSP,WILEYdatabaseswerescreenedforrelevantpublicationsonGERDandAFinadultsbetweenJanuary1972-December2013.StudieswritteninlanguagesotherthanEnglishorFrench,studiesnotperformedinhumans,reviews,casereports,abstracts,conferencepresentations,letterstotheeditor,editorials,commentsandopinionswerenottakenintoconsideration.ArticlestreatingthesubjectofradiofrequencyablationofAFandtheconsecutivedevelopmentofGERDwerealsoexcluded.RESULTS:Twothousandonehundredsixty-onetitleswerefoundofwhich8articlesmettheinclusioncriteria.ThepresenceofAFinpatientswithGERDwasreportedtobebetween0.62%-14%,highercomparedtothosewithoutGERD.EpidemiologicaldataprovidedbytheseobservationalstudiesshowedthatpatientswithGERD,especiallythosewithmoresevereGERD-relatedsymptoms,hadanincreasedriskofdevelopingAFcomparedwiththosewithoutGERD,butacausalrelationshipbetweenGERDandAFcouldnotbeestablishedbasedonthesestudies.ThemechanismsofAFasaconsequenceofGERDremainlargelyunknown,withinflammationandvagalstimulationplayingapossibleroleinthedevelopmentofthesedisorders.TreatmentwithprotonpompinhibitorsmayimprovesymptomsrelatedtoAFandfacilitateconversiontosinusrhythm.CONCLUSION:AlthoughlinksbetweenAFandGERDexist,largerandomizedclinicalstudiesarerequiredforabetterunderstandingoftherelationshipbetweenthesetwoentities.

简介：BackgroundAmongpatientsundergoingmitral-valvesurgery,30to50%presentwithatrialfibrillation,whichisassociatedwithreducedsurvivalandincreasedriskofstroke.Surgicalablationofatrialfibrillationhasbeenwidelyadopted,butevidenceregardingitssafetyandeffectivenessislimited.MethodsWerandomlyassigned260patientswithpersistentorlong-standingpersistentatrialfibrillationwhorequiredmitral-valvesurgerytoundergoeithersurgicalablation(ablationgroup)ornoablation(controlgroup)duringthemitral-valveoperation.Patientsintheablationgroupunderwentfurtherrandomizationtopulmonary-veinisolationorabiatrialmazeprocedure.Allpatientsunderwentclosureoftheleftatrialappendage.Theprimaryendpointwasfreedomfromatrialfibrillationatboth6monthsand12months(asassessedbymeansof3-dayHoltermonitoring).ResultsMorepatientsintheablationgroupthaninthecontrolgroupwerefreefromatrialfibrillationatboth6and12months(63.2%vs.29.4%,P<0.001).Therewasnosignificantdifferenceintherateoffreedomfromatrialfibrillationbetweenpatientswhounderwentpulmonary-veinisolationandthosewhounderwentthebiatrialmazeprocedure(61.0%and66.0%,respectively;P=0.60).One-yearmortalitywas6.8%intheablationgroupand8.7%inthecontrolgroup(hazardratiowithablation,0.76;95%confidenceinterval,0.32to1.84;P=0.55).Ablationwasassociatedwithmoreimplantationsofapermanentpacemakerthanwasnoablation(21.5vs.8.1per100patient-years,P=0.01).Therewerenosignificantbetween-groupdifferencesinmajorcardiacorcerebrovascularadverseevents,overallseriousadverseevents,orhospitalreadmissions.ConclusionsTheadditionofatrialfibrillationablationtomitral-valvesurgerysignificantlyincreasedtherateoffreedomfromatrialfibrillationat1yearamongpatientswithpersistentorlong-standingpersistentatrialfibrillation,buttheriskofimplantationofapermanentpacemakerwasalsoincreased

简介：Objective:Toobservetheeffectofstatinsonpreventingparoxysmalatrialfibrillation(PAF)afterpacemakerimlantationinpatientswithsicksinussyndrome.MaterialsandMethods:68patientswereselectedinwhichthepacemakershadbeenimplantedduetosicksinussyndrome,andwererandomlydividedintoastatintreatmentgroupandacontrolgroup.Afterthepacemakerimplantation,onlythepatientsintreatmentgroupweregiven20mgatorvastatinoncepernight,withotherconditionsbasicallysimilartothoseinthecontrolgroup.Atthe3rd,9th,15th,and21stmonthsaftertheimplantation,thepacemakerswereprogrammed,andthePAF-relatedinformationstoredinthepacemakerwererecalledandanalyzedstatistically.Results:Aftertheadministrationofstatinsfor9monthssincetheimlantation,theoccurrenceratesofPAFinthetreatmentgroupwasrelativelylowerthanthoseinthecontrolgroup.Afterfurtheradministrationofstatinsfor15months,boththeoccurrencerateofPAFandtheburdenofatrialfibrillationinthetreatmentgrouphadsignificantlydeclined.Aftercontinuousadministrationofstatinsfor21months,boththeoccurrencerateofPAFandtheburdenofatrialfibrillationinthetreatmentgroupweresignificantlylowerthanthoseinthecontrolgroup.Conclusion:Long-termadministrationofstatinscanreducetheriskofPAFaftertheimplantationofapacemakerinpatientswithsicksinussyndrome.

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简介：BackgroundAtrialfibrillation(AF)wasusedtobeconsideredasnongeneticsdisorder,butrecentstudieshaverevealedthatgeneticsvariantsconferredsusceptibilitytoAFdevelopment,butmostwithlimitedevidence.Inordertosystematicallyevaluatetheoverallcontributionsofgene-diseaseassociationstudiestocurrentunderstandingsofthegeneticsusceptibilitytoatrialfibrillation,weperformasystematicreviewandmeta-analysisbasedoncomprehensivesearches.MethodAllstudiesontheassociationsofgeneticsvariantswithAFriskwereidentifiedbysearchingthefollowingdatabases:Medline,Embase,BIOSIS,GlobalHealth,LILACSandCBMDisc.Oddsratios(CI)and95%confidenceintervals(CI)werecalculatedunderhomozygotecomparison(HC),dominantmodel(DM)andrecessivemodel(RM),respectively.ResultsAtotalof41studieson32genesand72polymorphismslocationswereidentified.ThesummaryORwasstatisticallysignificantassociationsin23(31.94%)singlenucleotidepolymorphisms(SNPs).Thegenesinrenin-angiotensin-aldosteronesystem(RAAS)andionchannelswerethemostlystudied.FourSNPs(50.00%)inRAASgenesweresignificantlyassociatedwithAFsusceptibility:ACEI/D(HC:OR=1.53,95%CI:1.14-2.0DM:OR=1.47,95%CI:0.86-1.53;RM:OR=0.49,95%CI:0.41-0.59);AGTA-20C(HC:OR=1.56,95%CI:1.41-2.12);AGTM235T(HC:OR=2.37,95%CI:1.21-4.65).StatisticallysignificantassociationswerealsofoundinthefollowinggenesandSNPs:ABCA1G1051A,BCHEG1615A,CETPA1061G,I405V,TaqIB,CRPC1444T,EDN2A985G,eNOST-786C,IL-10T-819C,A-592C,MinKG38S,KCNH2rs1805120,Kir3.4C171T,G810T,MMP2C-1306T,FactorⅡG20210A,SCN5AH58R,SLC26A8I639V,G-proteinβ-subunitC825T,chromatosome4q25rs2200733andrs10033464.ConclusionsNearlyone-thirdofSNPswerestatisticallysignificantassociatedwithAFrisk,withvariantsinRAASgenesmosthighlysignificantassociation.Morestudiesonawiderangeofgenesaremerited.

简介：AbstractBackground:Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic obstructive cardiomyopathy (HOCM). Data regarding the correlations of thyroid dysfunction and the incidence of AF in HOCM are quite limited. This study aimed to reveal the correlations between different thyroid status and the corresponding incidence of AF in a large HOCM cohort.Methods:A total of 806 HOCM patients with complete information on thyroid function tests and comprehensive cardiac evaluations were recruited. The participants were divided into the AF group (n = 159) and non-AF group (n = 647) according to established medical history and results of Holter monitoring. The thyroid status of the study population and the corresponding incidence of AF were assessed and analyzed.Results:Hypothyroidism accounted for the greatest proportion of thyroid dysfunction in HOCM patients. The incidence of AF significantly increased in individuals with both overt (P = 0.022) and subclinical (P = 0.007) hypothyroidism. Compared with participants in the non-AF group, those with positive AF episodes presented with lower free triiodothyronine (FT3) (2.86 ± 0.52 pg/mL vs. 3.01 ± 0.42 pg/mL, P = 0.001), higher free thyroxine (FT4) (1.24 ± 0.25 ng/dL vs. 1.15 ± 0.16 ng/dL, P < 0.001), and remarkably increased levels of thyrotropin (TSH) (12.6% vs. 5.3%, P = 0.001). Multivariable analyses demonstrated that the concentrations of FT3 (odds ratio [OR] = 0.470, 95% confidence interval [CI]: 0.272-0.813, P = 0.007) and FT4 (OR = 17.992, 95% CI: 5.750-56.296, P < 0.001), as well as TSH levels above normal ranges (OR = 2.276, 95% CI: 1.113-4.652, P = 0.024) were independently associated with the occurrence of AF in the large HOCM cohort.Conclusions:This study indicated a strong link between low thyroid function and the presence of AF in HOCM. Hypothyroidism (both overt and subclinical states) seems to be valuable for assessing the incidence of AF in patients with HOCM.

简介：AbstractBackground:The association between heart rate and 1-year clinical outcomes in heart failure (HF) patients with atrial fibrillation (AF), and whether this association depends on left ventricular ejection fraction (LVEF), are unclear. We investigated the relationship between discharge heart rate and 1-year clinical outcomes after discharge among hospitalized HF patients with AF, and further explored this association that differ by LVEF level.Methods:In this analysis, we enrolled 1760 hospitalized HF patients with AF from the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure study from August 2016 to May 2018. Patients were categorized into three groups with low (<65 beats per minute [bpm]), moderate (65-85 bpm), and high (≥86 bpm) heart rate measured at discharge. Cox proportional hazard models were employed to explore the association between heart rate and 1-year primary outcome, which was defined as a composite outcome of all-cause death and HF rehospitalization.Results:Among 1760 patients, 723 (41.1%) were women, the median age was 69 (interquartile range [IQR]: 60-77) years, median discharge heart rate was 75 (IQR: 69-84) bpm, and 934 (53.1%) had an LVEF <50%. During 1-year follow-up, a total of 792 (45.0%) individuals died or had at least one HF hospitalization. After adjusting for demographic characteristics, smoking status, medical history, anthropometric characteristics, and medications used at discharge, the groups with low (hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.05-1.68, P = 0.020) and high (HR: 1.34, 95% CI: 1.07-1.67, P = 0.009) heart rate were associated with a higher risk of 1-year primary outcome compared with the moderate group. A significant interaction between discharge heart rate and LVEF for the primary outcome was observed (P for interaction was 0.045). Among the patients with LVEF ≥50%, only those with high heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.38, 95% CI: 1.01-1.89, P = 0.046), whereas there was no difference between the groups with low and moderate heart rate. Among the patients with LVEF <50%, only those with low heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.46, 95% CI: 1.09-1.96, P = 0.012), whereas there was no difference between the groups with high and moderate heart rate.Conclusions:Among the overall HF patients with AF, both low (<65 bpm) and high (≥86 bpm) heart rates were associated with poorer outcomes as compared with moderate (65-85 bpm) heart rate. Among patients with LVEF ≥50%, only a high heart rate was associated with higher risk; while among those with LVEF <50%, only a low heart rate was associated with higher risk as compared with the group with moderate heart rate.Trail Registration:Clinicaltrials.gov; NCT02878811.

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