侯煜
中国医学科学院阜外医院 心律失常诊治中心
BACKGROUND:Patients with persistent or permanent atrial fibrillation (AF) often need direct current cardioversion after radiofrequency ablation. The aim of this study was to investigate the effectiveness and safety of ibutilide for cardioversion of persistent or permanent atrial fibrillation after radiofrequency ablation and the factors related to conversion.METHODS:Patients with persistent or permanent atrial fibrillation were treated with combined ablation strategy including circumferential pulmonary vein isolation, linear ablation and CAFÉ potential ablation. If AF was not terminated after ablation, ibutilide was used for cardioversion (1 mg, intravenous injection in 10 minutes). These patients were divided into a conversion group and a non-conversion group according to whether AF was converted to sinus rhythm within 30 minutes after administration. ECG monitoring was performed during the injection of ibutilide. Atrial waves recorded by coronary sinus electrodes were measured for calculating average wavelength of AF waves in six seconds. The QT interval was measured immediately after conversion and 2 hours after injection of ibutilide.RESULTS:Forty patients whose AF was not converted to sinus rhythm after radiofrequency ablation were given an intravenous injection of ibutilide. Of the 40 patients, 29 cases were converted to sinus rhythm, with a conversion rate of 72.5%. The average conversion time was (13.2 ± 5.5) minutes. Compared with the conversion group, patients in the non-conversion group had a longer history of AF (9.4 ± 5.3) years vs. (4.3 ± 2.8) years, P < 0.05), and a markedly enlarged left atrium (47.3 ± 2.9) mm vs. (42.1 ± 4.5) mm, P < 0.05). There were no significant differences in gender, age, body mass index and left ventricular function between the two groups. Ibutilide significantly prolonged the average wavelength of the AF wave (171.8 ± 29.5) ms vs. (242.0 ± 40.0) ms, P < 0.001). Two hours after ibutilide treatment, the QT interval was significantly shortened (421.0 ± 24.7) ms vs. (441.0 ± 37.4) ms, P < 0.05). No cases of serious arrhythmias or other adverse reactions were found.CONCLUSIONS:A single dose of ibutilide for conversion of persistent or permanent AF after radiofrequency ablation is safe and effective.
Chinese medical journal 2011
BACKGROUND:Atrial fibrillation (AF) recurrence after circumferential pulmonary vein isolation (CPVI) is difficult to predict. Inflammation is associated with the development of AF. Inflammatory markers, such as high sensitivity C-reactive protein (hsCRP), are related to AF development via atrial remodeling. However, it is unknown whether plasma hsCRP concentration before CPVI can be used as a predictor for AF recurrence.METHODS:A total of 121 patients without structural heart disease who underwent primary CPVI by a single operator were included in the study (paroxysmal/persistent AF: 77/44). Left atrial diameter was measured by transesophageal echocardiography. Plasma hsCRP concentration was determined by enzyme-linked immunosorbent assay. Based on the follow-up outcomes, patients were divided into two groups, a recurrence group and a nonrecurrence group. AF recurrence was defined as AF or atrial flutter or atrial tachycardia episodes lasting for ≥30 s during regular follow-up (>12 months).RESULTS:A total of 36 (29.8%) patients (paroxysmal/persistent AF: 19 [24.7%]/17 [38.6%]) had AF recurrence in a mean 23 (range, 12-44) month follow-up period. The plasma hsCRP concentration in the recurrence group was significantly higher than that in the nonrecurrence group for all patients (median [quartile range] 2.22 [1.97] mg/L vs 0.89 [1.30] mg/L, P < 0.001), for patients with paroxysmal AF (2.12 [2.78] mg/L vs 0.84 [1.15] mg/L, P = 0.028), and for those with persistent AF (2.29 [1.08] mg/L vs 0.89 [1.53] mg/L, P = 0.005). Multiple logistic regression analyses showed that the higher level of the plasma hsCRP (P < 0.001) was a significant prognostic predictor of AF recurrence, both for patients with paroxysmal AF (P = 0.012) and those with persistent AF (P = 0.003).CONCLUSION:Plasma hsCRP concentration before CPVI was associated with AF recurrence after primary CPVI procedure for both paroxysmal and persistent AF patients. Plasma hsCRP concentration could play a role in prediction of AF recurrence after primary CPVI.
Pacing and clinical electrophysiology : PACE 2011
OBJECTIVE:The aim of our study was to investigate the value of the transtelephonic electrocardiogram (TTECG) monitoring system during a "blanking period" of 3 months after ablation by analyzing the frequency of atrial arrhythmias episodes and the relationship between the frequency of atrial fibrillation (AF) attacks and long-term follow-up outcomes.METHODS:Ninety-two patients with AF received primary ablation and were fitted with an external loop recorder for daily and symptomatic patient-triggered detection of AF recurrence during a "blanking period," which was defined as 3 months after discharge. All patients received regularly scheduled clinical follow-up programs that included 24-hour Holter for 12 months. Atrial fibrillation recurrence was defined as an episode of AF, atrial flutter, or atrial tachycardia lasting for 30 seconds or longer, which was documented on TTECG or 24-hour Holter. After the 12th month of monitoring, patients were divided into 2 groups based on the follow-up data: a recurrence group and a nonrecurrence group.RESULTS:A total of 18 969 TTECGs were received, the rate of effective TTECGs was 96.1% (18 236/18 969). At the end of the blanking period, 39 (42.4%) patients with AF recurrence were recorded by TTECG monitoring, whereas 27 (29.3%) patients were recorded by electrocardiogram and 24-hour Holter monitoring (P = .032). By analyzing the TTECG diagnosis, the percentage of total AF attacks in the recurrence group was higher than in the nonrecurrence group (median: 27.8% versus 10.6%, P < .01). The percentage of monthly AF attacks in the recurrence group occurred at a high level during the blanking period (sequent: 24.4%, 32.4%, and 28.1%; P = .65). There was also a certain amount of AF attacks in the nonrecurrence group during the blanking period, but the percentage of AF attacks in this group significantly decreased each month (sequent: 18.6%, 11.0%, and 4.9%; P < .01).CONCLUSION:The TTECG monitoring was superior to the standard electrocardiogram and 24-hour Holter recordings in evaluating AF recurrence after ablation. Atrial arrhythmias episodes were common during the blanking period whether the long-term follow-up outcome was a success or a failure. Atrial fibrillation attacks during the blanking period did not indicate failure of ablation in long-term outcomes. However, frequent and nonsignificantly decreasing AF attacks during the blanking period indicated a high probability of failure of AF ablation in long-term follow-up outcomes.
Journal of electrocardiology 2010
