李晓枫
中国医学科学院阜外医院 心血管内科
OBJECTIVE:This study aims to investigate the anatomical variations in femoral vasculature and evaluate the clinical value of ultrasound-guided femoral vein puncture in catheter ablation procedures.METHODS:In this retrospective analysis conducted from January 2023 to March 2023, we examined data from patients who underwent catheter ablation with ultrasound-guided femoral venipuncture. We evaluated the anatomy of the femoral vasculature at both high and low inguinal levels. Based on the relationship between the femoral vein and artery, we classified the anatomy into four types: Type I (vein parallel to artery without overlap), Type II (vein medial to artery with lumen overlap ≤50%), Type III (vein posterior to artery with lumen overlap > 50%), and Type IV (vein lateral to artery). Additionally, we assessed procedure-related vascular complications that required interventions or prolonged hospital stays.RESULTS:A total of 254 patients were included in this study. At the upper inguinal level, most cases (92.5%) exhibited Type II, followed by Type I (6.5%), while Type III (0.6%) and IV (0.4%) were less common. At the lower inguinal level, Type II accounted for 70.7%, there was a significantly higher proportion of Type III (23.4%) and Type IV (5.9%). The overall complication rate was 0.4%, no pseudoaneurysm or hematoma was observed in our study.CONCLUSION:Our study revealed significant anatomical variations in the relationship between the femoral vein and femoral artery. Ultrasound-guided femoral venipuncture significantly reduced vascular complication rate, making it a valuable tool for guiding puncture procedures.
Pacing and clinical electrophysiology : PACE 2024
INTRODUCTION:To investigate the optimal range of quantitative ablation index (AI) value during superior vena cava (SVC) electrical isolation by radiofrequency catheter ablation (RFCA).METHODS:First, in a development cohort of patients with atrial fibrillation (AF), the RFCA with 40 W was performed to complete SVC isolation guided by the conduction breakthrough point from the right atrium to SVC. Then, the range of AI value was calculated by offline analysis on different segments of SVC. Lastly, for the validation of AF patients, the safety and effectiveness of SVC isolation with the optimized target range of AI value were evaluated with an additional adenosine test.RESULTS:A total of 101 patients with AF were included in the study (44 patients in the development cohort/57 in the validation cohort). The segmental ablation strategy was applied in 70% of the patients. According to the offline analysis of the AI values in the development cohort, the target AI value range was set as 350-400. The success rate of SVC isolation in the validation cohort was significantly higher than that in the exploration cohort (100% vs. 90.9%, p = .02), and no complications occurred in the exploration cohort. During the adenosine test, the recovery rate of electrical conduction in SVC was significantly lower than that in the pulmonary vein (3.5% vs. 17.5%).CONCLUSION:The target AI value with a range from 350 to 400 is safe and effective for high-power RFCA to complete SVC isolation.
Journal of cardiovascular electrophysiology 2023
Background:The 5-year outcomes and predictors of atrial fibrillation (AF) recurrence following cryoballoon (CB) ablation in Chinese population remain scarce. Our aim was to report 5-year outcomes and predictors of AF recurrence following a single CB ablation procedure in a Chinese population.Methods:From December 2013 to August 2016, we included 256 consecutive patients (mean age: 58 ± 10.9 years old; female: 41.0%) with paroxysmal or persistent AF successfully underwent first-generation CB ablation at Fuwai hospital in this prospective study. All patients were followed at least 5 years or when there was recurrent AF. Independent predictors of AF recurrence were determined by Cox proportional hazards regression analysis.Results:The 5-year success rate after pulmonary vein isolation (PVI) by a single procedure was 59.4%. The recurrence rate was the highest (14.5%) within the first year after the index procedure, and then stabilized. Patients with paroxysmal AF had a higher incidence of freedom from AF recurrence than patients with persistent AF (63.2% vs. 36.4%, log-rank P < 0.01). The overall incidence of complications related to CB ablation was 7.8%. Phrenic nerve injury (PNI) was the most common complication, with an incidence of 3.5%, and patients with PNI were recovered within the 1-year follow-up. Only persistent AF (HR 1.72, 95%CI 1.028-2.854, P < 0.05) was significantly and independently associated with an increased risk of AF recurrence after adjusting for other factors.Conclusion:Pulmonary vein isolation using CB ablation was safe and effective with an acceptable complication and 5-year success rate in a Chinese population with AF, and persistent AF was the independent predictor for 5-year AF recurrence after a single CB ablation procedure.
Frontiers in cardiovascular medicine 2022
BACKGROUND:Metabolic syndrome (MetS) has been reported as a risk factor of atrial fibrillation (AF) recurrence after radiofrequency catheter ablation. This study aimed to investigate the long-term influence of MetS on paroxysmal AF recurrence after a single cryoballoon ablation procedure, which was scarcely investigated yet in Chinese population.METHODS:In total, 137 paroxysmal AF patients who had successfully completed a single cryoballoon ablation procedure at Fuwai Hospital, Beijing, China from December 2013 to October 2015 were enrolled. Excepting for patients with AF recurrence, all patients were followed up for no less than five years. Independent predictors of AF recurrence were determined by Cox proportional hazards regression analysis.RESULTS:Among 137 paroxysmal AF patients, 91 patients (66.4%) had successfully achieved overall five-year follow-up after a single cryoballoon ablation procedure, and 44 patients (32.1%) had MetS. Patients with MetS had a significant lower incidence of freedom from AF recurrence than those without MetS (50.0% vs. 74.2%, log-rank P < 0.01) during the five-year follow-up. MetS (HR = 1.95, 95% CI: 1.069-3.551, P = 0.030) was an independent predictor of AF recurrence after adjusting for multiple factors. After the second year post cryoballoon ablation procedure, the recurrence rate of AF gradually increased in patients with MetS, in contrast, decreased recurrence rate of AF in patients without MetS.CONCLUSIONS:MetS is an independent predictor for five-year AF recurrence after a single cryoballoon ablation procedure in paroxysmal AF patients. Combination therapy of AF and MetS may improve the long-term outcomes of AF patients.
Journal of geriatric cardiology : JGC 2021
Background: Low-voltage zones (LVZs) were usually targeted for ablation in atrial fibrillation (AF). However, its relationship with AF initiation, perpetuation, and termination remains to be studied. This study aimed to explore such relationships. Methods: A total of 126 consecutive AF patients were enrolled, including 71 patients for AF induction protocol and 55 patients for AF termination protocol. Inducible and sustainable AF were defined as induced AF lasting over 30 and 300 s, respectively. Terminable AF was defined as those that could be terminated into sinus rhythm within 1 h after ibutilide administration. Voltage mapping was performed in sinus rhythm for all patients. LVZ was quantified as the percentage of the LVZ area (LVZ%) to the left atrium surface area. Results: The rates of inducible, sustainable, and terminable AF were 29.6, 18.3, and 38.2%, respectively. Inducible AF patients had no significant difference in overall LVZ% compared with uninducible AF patients (10.2 ± 11.8 vs. 8.5 ± 12.6, p = 0.606), while sustainable and interminable AF patients had larger overall LVZ% than unsustainable (16.2 ± 11.5 vs. 0.5 ± 0.7, p < 0.001) and terminable AF patients (44.6 ± 26.4 vs. 26.3 ± 22.3, p < 0.05), respectively. The segmental LVZ distribution pattern was diverse in the different stages of AF. Segmental LVZ% difference was initially observed in the anterior wall for patients with inducible AF, and the septum was further affected in those with sustainable AF, and the roof, posterior wall, and floor were finally affected in those with interminable AF. Conclusions: The associations between LVZ with AF initiation, perpetuation, and termination were different depending on its size and distribution.
Frontiers in cardiovascular medicine 2021
BACKGROUND:Cryoballoon ablation (CBA) is effective for patients with drug-refractory symptomatic atrial fibrillation (AF). For patients with a high risk of stroke (CHA2DS2-VASc score ≥2), life-long oral anticoagulation therapy should be continued even after successful catheter ablation. We investigated the safety and efficacy of concomitant use of a second-generation CBA catheter for pulmonary vein isolation (PVI) and a left atrial appendage closure (LAAC) device in patients with AF.METHODS:We enrolled 27 patients (64.7 ± 6.3 years, 74% male, 63% paroxysmal AF, 37% persistent AF, 4.8 ± 1.4 CHA2DS2-VASc score, and 3.6 ± 1.3 HAS-BLED score). In total, 85% of the patients had a prior stroke or TIA, and 30% of patients had a clinical history of bleeding. Patients received a CBA for PVI and underwent occlusion of the LAA with an LAAC device. The efficacy of CBA was defined as lack of arrhythmia recurrence (AF, atrial flutter, and/or atrial tachycardia lasting ≥30 s) after a 90-day blanking period. The success of LAAC was determined by the rate of stroke, TIA, and/or bleeding events.RESULTS:The mean procedural time for CBA and LAAC was 80 ± 16 min and 44 ± 12 min, respectively. Acute PVI by CBA was achieved in 100% of the procedures, and 96% of patients obtained acute LAAC device placement during the procedure. Upon complete release of the LAAC device, only 62% patients (16/26) had no detectable leakage during intraprocedural transesophageal echocardiography. Three patients experienced an acute complication: a pericardial effusion and two phrenic nerve palsy events. Mean follow-up was 18 months (range 9-23 months), and freedom from AF recurrence was 74% (20/27).CONCLUSION:The intraprocedural combination of CBA and LAAC is feasible in patients with non-valvular AF with a high risk of stroke, TIA, and/or bleeding. Larger long-term randomized studies are needed to judge the overall safety and efficacy of the combined procedure.
Herz 2021
BACKGROUND:There are several electrocardiographic algorithms to predict the origin of idiopathic outflow tract ventricular arrhythmias (OT-VAs). This study aimed to develop a more accurate and efficient stepwise electrocardiographic algorithm to discriminate left ventricular outflow tract (LVOT) from right ventricular outflow tract (RVOT) origin.METHODS AND RESULTS:We analyzed 12-lead electrocardiographic characteristics of 173 consecutive OT-VAs patients who underwent successful radiofrequency catheter ablation in the RVOT (n = 124) or LVOT (n = 49). Based on the areas under the receiver operating characteristic curves, the combination of transitional zone (TZ) index <0 and V2S/V3R index ≤1.5 exhibited 93.5% sensitivity, 85.9% specificity, and 87.3% accuracy. A further analysis was performed in the 71 OT-VAs with a V3-lead precordial transition. The sensitivity, specificity, and accuracy of the integration of V2S/V3R index ≤1.5 and R-wave deflection interval in lead V3 >80 ms were 91.7, 83.1, and 85.9%, respectively. In the prospective evaluation, the combination of TZ index and V2S/V3R index could identify the correct origin sites with 91.2% accuracy in the overall analysis, and the integration of V2S/V3R index ≤1.5 and R-wave deflection interval in lead V3 >80 ms exhibited 94% accuracy in V3-lead precordial transition.CONCLUSIONS:The combination of TZ index <0 and V2S/V3R index ≤1.5 is a simple and efficient stepwise electrocardiographic algorithm for predicting LVOT origin. For the OT-VAs with a V3-lead precordial transition, the integration of V2S/V3R index ≤1.5 and R-wave deflection interval in lead V3 >80 ms would be a better choice.
Cardiology 2020
OBJECTIVE:To investigate the characteristics of early recurrence (ER) of atrial tachyarrhythmia (ATA) defined as atrial fibrillation (AF), atrial tachycardia (AT), or atrial flutter (AFL) during a 90-day blanking period after pulmonary vein isolation by cryoablation (PVI-C) in patients with symptomatic drug refractory AF. Specifically, to determine if ER of ATA during the blanking period can predict late recurrence (LR) during a 12-month follow-up period.METHOD:A total of 51 patients with symptomatic AF (who received PVI-C) were monitored by trans-telephonic wireless electrocardiogram (TWECG) event recording during the landmark 90-day blanking period following an index ablation. Recurrent ATA was defined as any AF, AT, or AFL lasting longer than 30 s (as recorded by 12‑lead ECG, 24-hour Holter monitor, or TWECG). For data analysis, patients were grouped into ER and non-ER cohorts during the 90-day blanking period and then cohorted into LR or non-LR groups during the 12-month follow-up.RESULTS:During the 90-day blanking period, 23 patients had an ER event of ATA while 28 patients had a non-ER experience. Also, during the 12-month follow-up period, 15 patients had a LR event while 36 patients were free from ATA (and placed in the non-LR cohort). Overall, the average success rate of cryoablation for AF was 70.6% at the 12-month follow-up period. Compared to the non-LR group, patients with LR showed a higher average percentage of diabetes mellitic (33.3% vs. 5.56%; P = 0.008) and had a larger mean left atrium diameter (41.2 ± 4.3 mm vs. 36.5 ± 4.2 mm; P = 0.0006). During evaluation of the 90-day blanking period, the LR group had more frequent attacks of ATA than compared to the non-LR group (27.7% vs. 2.4%; P < 0.001). Only two patients (7.1%) without ER in the blanking period (non-ER cohort) had relapsed into a LR of ATA during the one-year period. After multi-logistic regression analysis, ER could individually predict the risk of LR (RR = 58.8; P = 0.001).CONCLUSION:In our study, ER of ATA was a common phenomenon during the 90-day blanking period after PVI-C for AF, and it mostly occurred in the first month following the index ablation across all patients. ER is not equal to the LR of ATA; however, patients with an ER event had a higher risk of a LR during the 12-month follow-up period.
Journal of electrocardiology 2020
On the basis of radiofrequency ablation of atrial fibrillation (AF), some studies suggested that early recurrences of atrial tachyarrhythmia (ERATs) were associated with late AF recurrence (LAFR), and some also suspected and challenged the current recommended 90 day blanking period. We aim to evaluate the impact of ERAT on long-term success and to determine the optimum blanking period after AF ablation using second-generation cryoballoon (sg-CB). From August 2016 to October 2018, 369 consecutive patients who successfully underwent initial AF ablation using sg-CB at the Fuwai Hospital were finally enrolled. All patients were followed up no less than 12 months. Receiver operating characteristic curve analysis was used to determine the optimum blanking period after AF ablation. There were 62 (16.8%) who experienced ERAT. After a median follow-up of 615 days, 74.5% were free of LAFR after the 90 day blanking period. Incidence of freedom from LAFR during the long-term follow-up was markedly lower in patients with ERAT than in those without ERAT (27.4% versus 84.0%; log-rank P < 0.001). Furthermore, only ERAT (HR 8.579; 95% CI 5.604-13.133; P < 0.001) was significantly associated with an increased risk of LAFR after adjusting for other factors. The optimum cut-off time point for the blanking period was 21.5 days (sensitivity: 71.1%, specificity: 94.1%). In conclusion, ERAT was an independent predictor of LAFR after AF ablation using sg-CB. Based on our findings, blanking period was advised to be shorten to 21.5 days or about 3 weeks instead of 90 days after CB ablation.
International heart journal 2020
OBJECTIVES:This study aims to research the clinical features of atrial thrombi in patients with nonvalvular atrial fibrillation (AF).METHODS:This study included 191 patients of AF who had atrial thrombi. One hundred and twenty-eight of them were assigned into nonventricular cardiomyopathy group (non-VCM), and the remaining 63 into ventricular cardiomyopathy group (VCM). After atrial thrombi diagnosed, all patients had taken oral anticoagulant therapy. The resolution rates of thrombi within 12 months were compared between the two groups, as well as the locations of thrombi.RESULTS:Of all 191 patients, 161 had thrombi only detected in left atrial appendage (LAA), 20 in both left atrium (LA) and LAA, six in LA only, and four in right atrium only. More patients had thrombi out of LAA in the VCM group than in the non-VCM group (30.2% vs 8.6%, P < .001). After propensity score matching, the atrial thrombi were resolved faster in the non-VCM group than in the VCM group (mean time length: 22 ± 2 weeks vs 30 ± 3 weeks, P = .038), and the resolution rate within 12 months was higher in the non-VCM group than in the VCM group (88.7% vs 61.4%, Log-rank, P = .038). In Cox proportional hazards model, absence of ventricular cardiomyopathy was an independent predictor for the resolution of atrial thrombus (hazard ratio: 1.76; P = .035).CONCLUSIONS:The patients of atrial fibrillation with ventricular cardiomyopathies have higher incidence of thrombosis in the body of left atrium or right atrium. And the resolution rate was lower in these patients.
Journal of arrhythmia 2020
