Atrial fibrillation(AF)is one of the most common cardiac dysrhythmia encountered in clinical practice. Although major advances in management and prophylaxis in recent years, AF continues to be associated with increased morbidity, repeated hospitalization, reduced quality of life, and even death, causing great social and economic burden. So far, the mechanism underlying AF is not completely elucidated. There is an enormous and complicated pathogenesis involved in the occurrence and maintenance of AF. At present, a lot of studies show that inflammation is closely associated with AF. Inflammation may take part in the occurrence and maintenance of AF through the influence of cardiac electrical remodeling and structural remodeling. This review focuses on research progress of correlation evidence of inflammation and atrial fibrillation and anti-inflammatory drug therapies of AF.
ObjectiveTo explore the effectiveness and safety of Mei mini maze procedure for atrial fibrillation (AF). MethodsWe analyzed the clinical data of 207 patients with 111 males, 96 females at 58.9±14.8 years in our hospital between October 2010 and February 2014. Among them, 98 patients were with paroxysmal AF and 109 patients were with persistent AF. The procedure was performed through three ports on left chest wall. Radiofrequency ablation procedures of AF included pulmonary veins isolation and ablations of the roof and posterior wall of left atrium, which were achieved by bipolar radiofrequency ablation. Ganglionic plexus ablation was made by the ablation pen. Left atrial appendage was excluded. ResultsTime of the procedures was 112.4±32.5 minutes. No conversion to sternotomy or pacemaker implantation occurred and no patients died. The hospital stay was 7.2±3.1days. The mean follow-up time was 24.2±8.9 months. A total of 187 (90.3%) patients were in sinus rhythm. And 20 patients could not maintain sinus rhythm. Stroke, thrombus in the left atrium and stenosis of pulmonary vein were not found after their procedures. ConclusionMei mini maze procedure is safe and presents optimistic outcomes for the atrial fibrillation.
ObjectiveTo systematically review the correlation between atrial fibrillation and prognosis of patients with ischemic stroke after intravenous thrombolysis. MethodsLiterature search was carried out in PubMed, EMbase, Web of Science, The Cochrane Library (Issue 4, 2014), CBM and WanFang Data up to April 2014 for the domestic and foreign cohort studies on atrial fibrillation and prognosis of patients with ischemic stroke after intravenous thrombolysis. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsA total of 7 cohort studies were finally included involving 69 017 cases. The results of meta-analysis showed that, compared with patients without atrial fibrillation, atrial fibrillation reduced 3-month favourable nerve function of patients with atrial fibrillation (OR=0.85, 95%CI 0.73 to 0.98, P=0.03) but did not influence the risk of death after intravenous thrombolysis (OR=1.47, 95%CI 0.75 to 2.86, P=0.26); and increased the risks of intracranial haemorrhagic transformation (OR=1.36, 95%CI 1.26 to 1.47, P < 0.001) and symptomatic intracranial hemorrhage after intravenous thrombolysis (OR=1.43, 95%CI 1.02 to 1.99, P=0.04). ConclusionFor patients with ischemic stroke, atrial fibrillation does not influence the risk of death, but it increases the risks of intracranial hemorrhage, and worsens 3-month favourable nerve function of after intravenous thrombolysis. For those patients, more assessment before intravenous thrombolysis and more monitoring after intravenous thrombolysis are necessary. Due to limited quality and quantity of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality studies.
Atrial fibrillation (AF) and breast cancer are common diseases with high incidence, which can be promoted and maintained by a wide range of regulatory factors (changes of hormone secretion, chronic inflammation, dysfunctions in autonomic nervous system, coagulation system and endothelia). There may be a consistent pathophysiological link between the increased incidence of breast cancer and AF, which is currently seldomly reported. The development process of these two diseases are complex, and the occurrence of breast cancer may increase the incidence of AF. In this paper, we reviewed the relationship between breast cancer and AF based on the latest reports.
Atrial fibrillation is a common clinical arrhythmia with a high incidence. The main clinical treatment methods for atrial fibrillation at present include radiofrequency catheter ablation and cryoablation. In recent years, pulsed field ablation, a new energy source with tissue specificity, is gradually being used in clinical practice. This article presents the world's first case of atrial fibrillation treated with pulsed field surgical ablation, in which the patient underwent surgical intervention of the valves and coronary arteries at the same time and recovered to sinus rhythm intraoperatively. 24 hour-Holter electrocardiogram after 1 month and 3 months showed no atrial fibrillation. The patient’s symptoms, cardiac function, and quality of life improved significantly.
Objective To explore the technique of performing minimally invasive Cox Maze Ⅳ procedure by bipolar clamp through right lateral minithoracotomy for atrial septal defect (ASD) combined with atrial fibrillation (AF) in adults. Methods Thirty-five patients (21 males, 14 females with age ranging from 45 to 73 years) with ASD and persistent or long-standing persistent AF received minimally invasive Cox Maze Ⅳ procedure and ASD closure from August 2012 to April 2016 at Department of Cardiothoracic Surgery, Xinhua Hospital. Diameter of left atrium ranged from 39 to 60 mm and left ventricle ejection fraction (LVEF) ranged from 48% to 62%. Diameter of ASD ranged from 20 to 35 mm. Cox-maze Ⅳ procedure was performed through right minithoracotomy entirely by bipolar radiofrequency clamp. Then, mitral or tricuspid valvuloplasty and surgical ASD closure was performed through right minithoracotomy. Results All patients successfully underwent this minimally invasive surgery. No patient needed conversion to sternotomy. The mean cardiopulmonary bypass time was 120.1±14.1 min. The mean aortic cross-clamp time was 79.5±12.2 min. There was no early death or pacemaker implantation perioperatively. The average length of hospital stay was 10.1±2.7 d. At a mean follow-up of 22.8±12.2 months, sinus rhythm was restored in 32 patients (32/35, 91.4%). Cumulative maintenance of normal sinus rhythm without AF recurrence at 2 years postoperatively was 89.1%±6.0%. Conclusion The minimally invasive Cox Maze Ⅳprocedure performed by bipolar clamp through right minithoracotomy is safe, feasible, and effective for adult patients with ASD combined with AF.
Objective To analyze the preoperative risk factors of atrial fibrillation (AF) in patients with coronary artery disease after coronary artery bypass grafting (CABG). Methods From September 2007 to April 2008, the clinical information of 226 patients who underwent onpump coronary artery bypass grafting(CABG)or offpump coronary artery bypass grafting(OPCAB) was collected. The patients were divided into nonAF group and AF group according to whether AF lasted more than 5 mins in 3 days after operation. Ultrasonic cardiography (UCG) and clinical information of preoperation in two groups were analyzed. Results Twentyfour（10.6%） patients had AF after operation. There were more patients whose left atrial diameter gt;35 mm in AF group than that in nonAF group ［41.7%（10）vs. 22.3% (45),χ2=4.380, P=0.036）］, more patients had mitral regurgitation in AF group than that in nonAF group ［37.5%（9） vs. 17.3% (35),χ2=5.568, P=0.018）］, more patients had left main coronary artery involvement in AF group than that in nonAF group ［33.3% (8) vs.12.4% (25),χ2=7.560,P=0.006］, and patients in AF group were older than those in nonAF group ［65.7±9.5 years vs. 60.1±10.1 years,t=-2.724,P=0.010］. In univariate analysis, in terms of preoperative clinical indexs such as the aged, mitral regurgitation, left atrial diameter, left mainm coronary artery involvement, and postoperative clinical indexs such as ventilatory time （χ2=4.190，P=0.040）, electrocardiogram (ECG) monitoring time（χ2=5.948，P=0.015）, hospitalization expense（χ2=4.110，P=0.043）, there were significant differences between 2 groups. Conclusion Risk factors such as the aged, mitral regurgitation, left atrial diameter and left main coronary artery involvement are related to AF after CABG. Clinical index, ECG and echocardiography are helpful to predict AF, and can provide better prevention and treatment, and reduce the rate of AF.
ObjectiveTo evaluate the early and mid-term outcomes of total thoracoscopic Box Lesion radiofrequency ablation in patients with atrial fibrillation.MethodsThe clinical data of 31 patients with atrial fibrillation who underwent total thoracoscopic Box Lesion radiofrequency ablation between November 2011 and March 2018 at the Department of Cardiac Surgery in our hospital were retrospectively analyzed, including 23 males and 8 females at an average age of 66.17±8.32 years. All patients did not have concomitant severe organic heart disease which required surgical intervention.ResultsThere were 20 patients with paroxysmal atrial fibrillation, 8 with persistent atrial fibrillation, and 3 with long-standing persistent atrial fibrillation. Twenty-nine patients got the 3-year follow-up, and 2 patients were lost to the follow-up 6 months after the surgery. The procedure was successfully performed in all patients, with an average operation time of 113.00±26.00 min. There was no perioperative death or related complication. All patients were restored to sinus rhythm immediately after surgery. Five patients got atrial fibrillation during postoperative hospitalization, which reverted to sinus rhythm after electrical cardioversion. The rate of sinus rhythm maintenance was 62.9%, 55.9% and 52.4% in postoperative 1, 2 and 3 years, respectively. No patient died during the period, and no procedure-related complication was observed.ConclusionTotal thoracoscopic Box Lesion radiofrequency ablation effectively shortens operation time, and reduces surgical trauma and procedure-related complications, meanwhile, ensures the surgical outcomes.
Atrial fibrillation, as the most common arrhythmia currently, can lead to secondary post-stroke cognitive dysfunction and chronic brain damage through various pathways, increasing the risk of cognitive dysfunction and affecting patient prognosis. The prevention and treatment drugs for cognitive dysfunction associated with atrial fibrillation mainly include anticoagulants, heart rhythm and heart rate control drugs, statins, and antihypertensive drugs. At present, there is still some controversy over the medication for cognitive dysfunction associated with atrial fibrillation, lacking guidelines and expert consensus. It is urgent and necessary to find safe, economical, and effective drugs to improve the cognitive function of atrial fibrillation patients. This article summarizes the recent advances in drug therapy for cognitive dysfunction associated with atrial fibrillation, in order to provide a reference for the treatment of cognitive dysfunction associated with atrial fibrillation in clinical practice.
Atrial fibrillation (AF) is difficult to cure for its complex etiology and long disease duration. Heart failure, sudden death and stroke are the main causes for consequent high mortality and morbidity. In recent years, minimally invasive surgery has made rapid progress, not only improved treatment efficiency of traditional Cox Maze procedure but also massively reduced surgical injuries, and has become a preferred treatment strategy for lone AF. Minimally invasive surgery and catheter ablation complement each other, and are likely to open up a new prospect of AF treatment.