The role of prophylactic cavotricuspid isthmus (CTI) ablation remains controversial in atrial fibrillation (AF) patients without atrial flutter (AFL). Given the strong association between AF, AFL, and age, this study aimed to evaluate the impact of additional CTI ablation on recurrence-free survival, with a focus on age-stratified outcomes. Between June 2020 and June 2022, 1226 paroxysmal AF patients without AFL who underwent first AF catheter ablation at Beijing Anzhen Hospital were enrolled. 899 patients underwent pulmonary vein isolation (PVI) alone (PVI group) and remaining 327 patients underwent additional CTI ablation (PVI + CTI group). Both groups were stratified into four age quartiles to assess age-related recurrence risk. Over a median 36.6-month follow-up, prophylactic CTI ablation did not have a better outcome in overall population. In the PVI + CTI group, the oldest age quartile (> 70 years) was independently associated with a lower risk of recurrence compared with the youngest quartile (≤ 56 years; adjusted HR 0.41, 95

BACKGROUND:nGENTM generator is a new-generation radiofrequency (RF) energy device widely used in the catheter ablation of atrial fibrillation. Compared with SMARTABLATETM (SMA), a lower displayed impedance of nGEN can be observed during electrophysiology procedures. However, whether this impedance disparity affects ablation lesion size remains unelucidated. METHODS:Fresh ex vivo porcine hearts were used for the experiment. Impedance of the same marked points on porcine left ventricle was measured using both generators. Ablations were performed at varying RF power (35 W, 45 W) and ablation index (AI; 400, 450, 550). Five lesions for each combination of settings were created with both generators and their lesion sizes were compared. RESULTS:The impedance of nGEN was notably lower than SMA (78.1±3.2Ω vs. 87.5±4.2Ω, p < 0.05). Under identical application settings, lesion depth, maximum length, and volume did not differ significantly between the two generators in any of the groups. Surface measurements of maximum diameter and area also showed no significant differences except at 45 W/AI  =  450, where nGEN generated significantly larger values than SMA (6.5 [6.4-6.9]mm vs. 5.8 [5.5-6.0]mm; 22.8 [22.5-24.4]mm2 vs. 20.3 [18.8-20.5]mm2; all p < 0.05). Lesion depth, maximum length, and volume of both generators were strongly correlated with AI (nGEN: r = 0.796, r = 0.657, r = 0.769; SMA: r = 0.794, r = 0.678, r = 0.733; all p < 0.05). CONCLUSIONS:nGEN displays lower impedance than SMA. Lesion sizes are overall comparable between the two generators in AI-guided ablation, with the exception of surface measurements at 45 W/AI  =  450.

Background Central venous access device-associated skin injury (CASI) is a common complication in cancer patients undergoing chemotherapy, yet its current status in China remains unclear. This cross-sectional study aimed to investigate the prevalence and associated factors of CASI to provide foundational evidence for future nursing strategies. Methods This cross-sectional study was carried out at a tertiary cancer hospital between March and September 2020. Ambulatory cancer patients were enrolled through convenience sampling. Data on demographics, clinical features, catheter details, and CASI occurrence were collected. CASI was identified and classified according to established criteria. Statistical analysis was conducted using SPSS 23.0. Univariate analysis and multivariate logistic regression were employed to identify factors associated with CASI, with significance set at P < 0.05. Results Among 553 patients, 72 developed CASI, resulting in an incidence rate of 13.02%. Contact dermatitis was the most common type, and multiple types often coexisted. Univariate analysis showed significant differences between groups in hypertension history, tumor type, radiotherapy, platinum-based drugs, catheter type, catheter material, catheterized arm, and catheterized vein (all P < 0.05). Multivariate logistic regression identified four independent factors associated with CASI, with a good model fit (Hosmer-Lemeshow test: P = 0.493). Conclusions History of hypertension, left-sided catheterization, and overdue maintenance were identified as independent risk factors for CASI, with overdue maintenance being particularly prominent. These findings highlight the importance of standardizing maintenance intervals and optimizing catheterization site to reduce the risk of CASI.

Coronary vascular disease (CVD) is the leading cause of mortality worldwide, while type 2 diabetes mellitus (T2DM) coexists in up to 40

Background:Digital technologies have the potential to overcome many of the limitations associated with traditional center-based cardiac rehabilitation (CBCR), such as limited accessibility, transportation barriers, and low adherence. In this context, home-based cardiac rehabilitation (HBCR) has emerged as a promising alternative. However, maintaining adherence and providing continuous supervision in remote settings remain a major challenge. Smartwatch-based interventions may offer a novel solution to support and monitor patients in HBCR programs, yet robust clinical evidence is still limited. Objective:This study was designed to investigate the effectiveness of a smartwatch-facilitated HCBR model in improving exercise adherence and health-related outcomes in patients with coronary heart disease (CHD), aiming to improve adherence and other outcomes related to the secondary prevention of cardiovascular disease. Methods:We conducted a prospective, single-center, randomized, parallel-controlled, non-blinded trial. Eligible participants were adults (≥18 years) with a confirmed diagnosis of CHD, recruited from a tertiary hospital in Jilin Province, China. Participants were randomly assigned in a 1:1 ratio to either the intervention group (smartwatch-facilitated HBCR) or the control group (standard HBCR) for a duration of 3 months. The intervention group received a comprehensive program delivered via a smartwatch, including real-time feedback, remote supervision, physical activity monitoring, and educational content. The control group received conventional HBCR without technological assistance. The primary outcome was adherence to the HBCR program, assessed using the Home-Based Cardiac Rehabilitation Exercise Adherence Scale. Secondary outcomes included cardiopulmonary function (peak VO₂ measured via cardiopulmonary exercise testing), anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), and health-related quality of life (36-Item Short Form Survey, SF-36), evaluated at baseline and at 3 months. Results:Between January 1 and December 30, 2023, a total of 62 patients (mean [SD] age 59.93 [10.06] years; 40.4% women [25/62]) were enrolled and randomized to the intervention group (n=32) or control group (n=30). Baseline characteristics were well balanced between the groups. At 3 months, participants in the smartwatch group demonstrated significantly higher adherence scores compared to the control group (P<.01). Additionally, the smartwatch group showed significant improvements in peak VO₂ (P<.01), anxiety (GAD-7, P<.01), depression (PHQ-9, P<.01), and selected domains of SF-36 (P<.05). No serious adverse events related to the intervention were reported, and user engagement with the smartwatch platform was high throughout the study period. Conclusions:This study demonstrates that a smartwatch-facilitated HBCR model is both feasible and effective in enhancing adherence and improving clinical outcomes among patients with CHD. These findings support the integration of wearable technology into routine HBCR and lay the groundwork for future large-scale, multicenter trials.

Previous studies have found a significant association between type 2 diabetes (T2DM) and impaired cardiopulmonary fitness (CRF); however, little evidence was shown in patients after percutaneous coronary intervention (PCI). This study aimed to evaluate the independent effects of T2DM on CRF in patients who have undergone successful percutaneous coronary intervention (PCI) and received guideline-directed medical therapy. Additionally, we explored whether this association is influenced by factors such as demographic features, physical activity level, duration of diabetes, time from index PCI, and history of occlusion myocardial infarction. We retrospectively analyzed data from post-PCI patients who consecutively visited the Cardiac Rehabilitation Center at Beijing Anzhen Hospital between September 2023 and July 2024. To isolate the impact of T2DM on cardiovascular fitness, we implemented strict exclusion criteria for confounding comorbidities, particularly heart failure. Cardiorespiratory fitness was quantified through gold-standard measures: peak oxygen uptake (VO2max) and metabolic equivalents (METs). Baseline characteristics were compared between patients with T2DM and non-diabetic patients (DM group vs. non-DM group). A multivariable regression model was used to evaluate the independent effect of T2DM on CRF, adjusting for confounding factors such as demographic features, physical activity level, duration of diabetes, time since index PCI, and residual comorbidities. Subgroup analyses and interaction tests were performed to assess the impact of T2DM across different subgroups. 201 patients (150 non-DM and 51 DM patients) were included in the final analysis. Hypertension was significantly more prevalent in DM patients (68.6 vs. 42.7%, p = 0.001), while other comorbidities, anthropometric measurements, lifestyle factors, and time from index PCI showed no significant differences between groups (all p > 0.05). Multivariate logistic regression analyses demonstrated significant negative associations between T2DM and both VO2max and METs. After adjusting for basic demographic and lifestyle factors (Model 1), T2DM was inversely associated with VO2max (β=-98.3, 95% CI -193.4 to -3.3, p = 0.044) and METs (β=-0.4, 95% CI -0.8 to -0.0, p = 0.05). These negative associations remained robust and became stronger in Model 2, which further adjusted for physical activity status, hypertension, hyperlipidemia, history of occlusion myocardial infarction, time from index PCI, DM duration, and using beta-blockers, showing more pronounced inverse relationships with both VO2max (β=-212.3, 95% CI -389.4 to -35.3, p = 0.02) and METs (β=-0.9, 95% CI -1.6 to -0.2, p = 0.014). Subgroup analyses indicated consistent inverse associations, with no significant effect modification based on sex, age, body mass index (BMI), time since the index PCI, physical activity status, or a history of occlusion myocardial infarction. Our study demonstrates that T2DM is an independent negative predictor of CRF in post-PCI patients, with consistent findings across various subgroups and robust results after adjusting for confounding factors. These findings underscore the importance of CRF assessment in post-PCI patients and highlight the need for targeted interventions to improve CRF in individuals with T2DM.

Atrial fibrillation (AF) is associated with increased risks of arterial thromboembolic events, stroke, and mortality. Current treatments are limited by high bleeding risk, poor adherence, and strict renal function requirements. Thus, there is an unmet need for novel anticoagulants with improved safety profiles. SHR-2004, a humanized monoclonal antibody targeting factor XI (FXI), has potential efficacy in preventing arteriovenous thromboembolism. To evaluate the safety, tolerability, pharmacokinetics (PK) and pharmacodynamics (PD) of SHR-2004 in patients with AF. This open-label phase 1b study enrolled patients aged ≥40 and <80 years, who were either diagnosed with or had a history of atrial fibrillation or atrial flutter and had a CHA2DS2-VASc risk score ≥1 (male) or ≥2 (female). Patients received 6 doses of SHR-2004 subcutaneously (180 mg, once every 2 weeks), for nearly 3 months. The primary endpoints were safety and tolerability. PK and PD parameters, including activated partial thromboplastin time (aPTT) and FXI activity were assessed. Between April 10, 2024 and May 6, 2024, 10 patients were enrolled, with a median age of 68.0 years (IQR, 55.0-70.0), and 9 (90.0%) being male. The median CHA2DS2-VASc risk score was 2.5 (IQR, 2.0-3.0). SHR-2004 was well tolerated at the tested dose. Treatment-emergent adverse events (AEs) occurred in 8 (80.0%) patients, and treatment-related AEs were reported in 6 (60.0%). All AEs were mild or moderate. Only 1 patient experienced a serious AE (atrial fibrillation leading to hospitalization), which was considered by the investigator to be moderate and likely not to be treatment-related. Notably, no major or clinically relevant non-major bleeding events were reported. Two patients (20.0%) experienced minor bleeding events, both of which were positive urinary occult blood. The PK and PD profiles of SHR-2004 are shown in Figures 1 and 2. The SHR-2004 exposure had a rapid increase and achieved the steady state by Day 57, with drug accumulation reaching nearly a 2.0-fold trough ratio. Administration of SHR-2004 led to a rapid and nearly complete inhibition of FXI activity by Day 3. Reductions in FXI activity were associated with a rapid and sustained prolongation of aPTT with approximately a 2.3-fold prolongation reached on Day 3, which was stably maintained up to Day 85. On Day 106, FXI activity inhibition was 91%, and aPTT prolongation was 1.8-fold. By Day 136, FXI activity and aPTT had returned to baseline levels. Multiple subcutaneous doses of SHR-2004 were safe and well tolerated in patients with AF, particularly regarding the low risk of bleeding. The safety, PK, and PD data from this trial support further exploration of SHR-2004 in patients with AF.1. Pharmacokinetic profile of SHR-2004 2. Pharmacodynamics profile of SHR-2004

Digital technologies have the potential to address many of the challenges associated with the traditional center-based CR (CBCR), but the remote home-based cardiac rehabilitation(HBCR) model remains a challenge. This study is designed to investigate the feasibility, and efficacy of a smartwatch-facilitated HBCR model in patients with coronary heart disease (CHD). It was a single-center, randomized, non-blind, and parallel-controlled study. We recruited patients aged 18 years or older with coronary heart disease from a tertiary hospital in Jilin Province, China. The intervention group received a 3-month smartwatch-based HBCR program involving remotely delivered real-time feedback, supervision, and education. The control group received conventional HBCR. Adherence is the primary outcome of the trial, assessed by the Home-Based Cardiac Rehabilitation Exercise Adherence Scale. The secondary outcomes include cardiopulmonary function, measured by cardiopulmonary exercise testing, anxiety (General Anxiety Disorder-7), depression(Patient Health Questionnaire-9), and quality of life (36-Item Short Form Health Survey) at 3 months. Between January 1, 2023, and December 30, 2023, 62 patients (mean age 59.93±10.06 years), of whom 33.3% were female and 66.% were male, were recruited and subsequently randomly assigned to the smartwatch group (n=32) or control group (n=30). No difference was detected in the baseline characteristics between the two groups. After the intervention, the subjects in the smartwatch group performed significantly better in peak VO2, home-based cardiac rehabilitation adherence, GAD-7, PHQ-9, and some other parameters than those in the control group. This feasibility study showed that the smartwatch device was well-accepted and effective in supporting a home-based cardiac rehabilitation model for patients with coronary heart disease (CHD). ChiCTR2400088039; https://www.chictr.org.cn/bin/project/edit?pid=215602

BackgroundThe 6 min walk test (6MWT) is widely used to evaluate functional exercise capacity, therapeutic effects, and prognosis in patients with cardiopulmonary diseases. However, its application in phase I cardiac rehabilitation (CR) after coronary artery bypass grafting (CABG) remains under explored. This study investigates the physical performance of CABG patients during the early 6MWT and analyzes factors influencing their walking performance during inpatient CR.MethodsThis retrospective study included 360 patients who underwent isolated off-pump coronary artery bypass (OPCAB, n = 240) or minimally invasive direct coronary artery bypass (MIDCAB, n = 120) surgery. Participants, with a median age of 63 years (range: 36–80), comprised 285 males and 75 females. The study was conducted from November 22, 2023, to December 25, 2024. It specifically included patients who completed the 6MWT within 5 ± 2 days during phase I CR post-surgery.ResultsThe median 6 min walk distance (6MWD) was 183 ± 125 meters (33 ± 20% of predicted). Notably, the walking distances were significantly shorter in OPCAB patients than MIDCAB patients (175 ± 125 vs. 200 ± 134 meters, Z = −3.426, P = 0.001), in older patients than younger patients (H = 20.489, P < 0.001) and in females than males (150 ± 84 vs. 200 ± 100 meters, Z = −5.919, P < 0.001). Univariate analysis showed 6MWD significantly correlated with height, weight, body mass index (BMI), diastolic blood pressure (DBP) and peripheral oxygen saturation (SpO2) before the test, as well as heart rate (HR), systolic blood pressure (SBP), DBP, SpO2, and respiratory rate (RR) after the test, and the mean values of HR and RR during the test. The stepwise multivariate regression analysis identified that gender, type of surgery, HR and RR at the end of the test, and DBP before the test were independent predictors of the 6MWD.ConclusionThis study is the first to describe early 6MWD in CABG patients during phase I CR. The 6MWT is feasible and well-tolerated in adults and older patients shortly after CABG. The findings provide valuable insights into factors affecting walking distance, aiding clinical assessment and informing phase II CR program development post-discharge.

Background: Minimally invasive direct coronary artery bypass (MIDCAB) surgery offers advantages over off-pump coronary artery bypass (OPCAB), including reduced trauma and faster recovery. However, differences in perioperative cardiac rehabilitation (CR) outcomes between MIDCAB and OPCAB remain unclear. This study compared perioperative clinical characteristics, surgical features, and CR outcomes in patients undergoing MIDCAB versus OPCAB. Methods: This retrospective cohort analysis included 304 patients (31.2% MIDCAB, 68.8% OPCAB) who participated in a CR program, including the 6-min walk test (6MWT), from November 2023 to December 2024. Results: MIDCAB patients had shorter surgery times, fewer grafted vessels, shorter ventilator-assisted time, less total intraoperative fluid, less bleeding, and shorter postoperative hospital stays (all p < 0.05). After cardiac rehabilitation, MIDCAB patients showed shorter time to 6MWT, longer six-minute walk distance (6MWD) (200 ± 125 vs. 178 ± 125 m), higher 6MWD relative to predicted values, and greater metabolic equivalents (all p < 0.05). The median LVEF of MIDCAB patients was the same as that of OPCAB patients (p < 0.05). Conclusions: Our study demonstrates that MIDCAB patients exhibit superior exercise capacity following cardiac rehabilitation.

ObjectiveTo investigate the effects of different rehabilitation modalities on cardiopulmonary function in patients with acute coronary syndrome after revascularization.MethodsTwo randomized controlled trials were conducted. All patients were stable for more than 48 h and less than 1 week after revascularization for acute coronary syndrome and were randomly assigned to Group A (home-based rehabilitation group) or Group B (center guided home-based rehabilitation group). The cardiopulmonary exercise test was mainly performed before and 3 months after cardiac rehabilitation (at the end of intervention). The primary endpoints of the study were peak oxygen uptake (VO2peak), and the secondary endpoints were maximum metabolic equivalents (METs), anaerobic threshold exercise load (Load AT), maximal workload (Load max), and anaerobic threshold oxygen uptake (VO2 AT).ResultsA total of 106 patients were included in the study, with 47 patients in Group A (with 6 losses) and 50 patients in Group B (with 3 losses). There were no significant difference between the two groups in terms of age, gender, body mass index (BMI), left ventricular ejection fraction(LVEF), low-density lipoprotein cholesterol(LDL-C),cardiovascular risk factors. In Group A, no significant differences in CPET indices were observed before and after the intervention. In Group B, values of maximum metabolic equivalents (METs), peak heart rate (PHR), anaerobic threshold exercise load (Load AT), maximal workload (Load max), maximum ventilation per minute (VE max), peak oxygen uptake (VO2peak), anaerobic threshold oxygen uptake (VO2 AT) and maximum oxygen pulse (VO2/HRmax) were higher than those before the intervention (P < 0.05). In addition, METs (max), Load AT, Load max, VO2 AT, and VO2peak in Group B were higher than those in group A (P < 0.05). The change rates of VO2peak, METs(max), PHR, Load max, VO2 AT, VE max, VO2/HR(max) in the two groups were significantly different before and after intervention (P < 0.05).ConclusionCardiac exercise rehabilitation is helpful for improving patients’ cardiopulmonary endurance and quality of life. Moreover, rehabilitation modalities with regular hospital guidance can improve cardiopulmonary function in a shorter period,which seems to be more effective than a complete home-based rehabilitation model. Clinical Trial Registrationhttp://www.chictr.org.cn, identifier (ChiCTR2400081034).

BACKGROUND:Co-morbid hypertension is strong predictor of adverse cardiovascular (CV) outcomes in patients with atrial fibrillation (AF) but the optimal target for blood pressure (BP) control in this patient population has not been clearly defined. METHODS:The Cardiovascular Risk reduction in patients with Atrial Fibrillation Trial (CRAFT) is an investigator-initiated and conducted, international, multicenter, open-label, parallel-group, blinded outcome assessed, randomized controlled trial of intensive BP control in patients with AF. The aim is to determine whether intensive BP control (target home systolic blood pressure [SBP] <120 mmHg) is superior to standard BP control (home SBP <135 mmHg) on the hierarchical composite outcome of time to CV death, number of stroke events, time to the first stroke, number of myocardial infarction (MI) events, time to the first MI, number of heart failure hospitalization (HFH) events, and time to the first HFH. A sample size of 1,675 patients is estimated to provide 80% power to detect a win-ratio of 1.50 for intensive versus standard BP control on the primary composite outcome. Study visits are conducted at 1, 2, 3, and 6 months postrandomization, and every 6 months thereafter during the study. CONCLUSIONS:This clinical trial aims to provide reliable evidence of the effects of intensive BP control in patients with AF. TRIAL REGISTRATION:The trial is registered at ClinicalTrials.gov (NCT04347330).

Objective:To investigate current use of oral anticoagulant (OAC) therapy and influencing factors among coronary artery disease (CAD) patients with nonvalvular atrial fibrillation (NVAF) in China.Methods:Results of this study derived from “China Atrial Fibrillation Registry Study”, the study prospectively enrolled atrial fibrillation (AF) patients from 31 hospitals, and patients with valvular AF or treated with catheter ablation were excluded. Baseline data such as age, sex and type of atrial fibrillation were collected, and drug history, history of concomitant diseases, laboratory results and echocardiography results were recorded. CHA 2DS 2-VASc score and HAS-BLED score were calculated. The patients were followed up at the 3rd and 6th months after enrollment and every 6 months thereafter. Patients were divided according to whether they had coronary artery disease and whether they took OAC. Results:11 067 NVAF patients fulfilling guideline criteria for OAC treatment were included in this study, including 1 837 patients with CAD. 95.4% of NVAF patients with CAD had CHA 2DS 2-VASc score≥2, and 59.7% of patients had HAS-BLED≥3, which was significantly higher than NVAF patients without CAD ( P<0.001). Only 34.6% of NVAF patients with CAD were treated with OAC at enrollment. The proportion of HAS-BLED≥3 in the OAC group was significantly lower than in the no-OAC group (36.7% vs. 71.8%, P<0.001). After adjustment with multivariable logistic regression analysis, thromboembolism( OR=2.48,95% CI 1.50-4.10, P<0.001), left atrial diameter≥40 mm( OR=1.89,95% CI 1.23-2.91, P=0.004), stain use ( OR=1.83,95% CI 1.01-3.03, P=0.020) and β blocker use ( OR=1.74,95% CI 1.13-2.68, P=0.012)were influence factors of OAC treatment. However, the influence factors of no-OAC use were female( OR=0.54,95% CI 0.34-0.86, P=0.001), HAS-BLED≥3 ( OR=0.33,95% CI 0.19-0.57, P<0.001), and antiplatelet drug( OR=0.04,95% CI 0.03-0.07, P<0.001). Conclusion:The rate of OAC treatment in NVAF patients with CAD is still low and needs to be further improved. The training and assessment of medical personnel should be strengthened to improve the utilization rate of OAC in these patients.

Objective:To analyze the status of statins use and low-density lipoprotein cholesterol (LDL-C) management in patients with atrial fibrillation (AF) and very high/high risk of atherosclerotic cardiovascular disease (ASCVD) from Chinese Atrial Fibrillation Registry (CAFR).Methods:A total of 9 119 patients with AF were recruited in CAFR between January 1, 2015 to December 31, 2018, patients at very high and high risk of ASCVD were included in this study. Demographics, medical history, cardiovascular risk factors, and laboratory test results were collected. In patients with very high-risk, a threshold of 1.8 mmol/L was used as LDL-C management target and in patients with high risk, a threshold of 2.6 mmol/L was used as LDL-C management target. Statins use and LDL-C compliance rate were analyzed, multiple regression analysis was performed to explore the influencing factors of statins use.Results:3 833 patients were selected (1 912 (21.0%) in very high risk of ASCVD group and 1 921 (21.1%) in high risk of ASCVD group). The proportion of patients with very high and high risk of ASCVD taking statins was 60.2% (1 151/1 912) and 38.6% (741/1 921), respectively. Attainment rate of LDL-C management target in patients with very high and high risk were 26.7% (511/1 912) and 36.4% (700/1 921), respectively.Conclusion:The proportion of statins use and attainment rate of LDL-C management target are low in AF patients with very high and high risk of ASCVD in this cohort. The comprehensive management in AF patients should be further strengthened, especially the primary prevention of cardiovascular disease in AF patients with very high and high risk of ASCVD.

Objective: To investigate the timing of pericardial drainage catheter removal and restart of the anticoagulation in patients with atrial fibrillation (AF) suffered from perioperative pericardial tamponade during atrial fibrillation catheter ablation and uninterrupted dabigatran. Methods: A total of 20 patients with pericardial tamponade, who underwent AF catheter ablation with uninterrupted dabigatran in Beijing Anzhen Hospital from January 2019 to August 2021, were included in this retrospective analysis. The clinical characteristics of enrolled patients, information of catheter ablation procedures, pericardial tamponade management, perioperative complications, the timing of pericardial drainage catheter removal and restart of anticoagulation were analyzed. Results: All patients underwent pericardiocentesis and pericardial effusion drainage was successful in all patients. The average drainage volume was (427.8±527.4) ml. Seven cases were treated with idarucizumab, of which 1 patient received surgical repair. The average timing of pericardial drainage catheter removal and restart of anticoagulation in 19 patients without surgical repair was (1.4±0.7) and (0.8±0.4) days, respectively. No new bleeding, embolism and death were reported during hospitalization and within 30 days following hospital discharge. Time of removal of pericardial drainage catheter, restart of anticoagulation and hospital stay were similar between patients treated with idarucizumab or not. Conclusion: It is safe and reasonable to remove pericardial drainage catheter and restart anticoagulation as soon as possible during catheter ablation of atrial fibrillation with uninterrupted dabigatran independent of the idarucizumab use or not in case of confirmed hemostasis.

Lambl's excrescences (LEs) are excrescences with an extremely low incidence, mainly ultrasound diagnosed. Increasingly, LEs are detected by transesophageal echocardiography before catheter ablation, which raises safety concerns on whether LEs were associated with an embolism event during or after ablation, but clinical data are still lacking.

目的:探讨他汀药物对冠心病(CAD)合并非瓣膜性心房颤动(NVAF)患者远期临床结果的影响.方法:中国心房颤动注册研究于北京市31家医院前瞻性纳入心房颤动患者25 512例,排除瓣膜病性心房颤动,最终纳入冠心病合并NVAF患者2 783例.主要终点事件是心血管死亡;次要终点是全因死亡、血栓栓塞事件和心血管原因住院.结果:约有71.7％的CAD合并NVAF患者使用他汀药物.与未用他汀药物患者相比,他汀药物组患者更多合并有高血压病和Has-BLED≥3比例也更高.他汀药物组口服抗凝药物和抗血小板药物使用率更高.随访中位数时间2.99(1.48,4.90)年,Kaplan-Meier分析及单因素Cox回归分析结果显示,两组的主要终点事件和次要终点事件未见明显差异;但多因素Cox回归分析结果显示,他汀药物明显降低冠心病合并NVAF患者的全因死亡的风险(HR=0.79,95％CI 0.64～0.96,P=0.020),两组的心血管死亡、血栓栓塞事件和心血管原因住院的发生风险未见明显差异.结论:他汀药物虽然没有明显降低CAD合并NVAF患者的心血管死亡、血栓栓塞事件和心血管原因住院的风险,但明显降低了全因死亡的风险.

目的:探讨高血压及血压水平与心房颤动患者轻度认知障碍(MCI)的相关性.方法:连续入选自2019年2月至2020年8月,行认知功能测验的住院心房颤动患者218例,根据高血压病史和入院后血压平均值将患者分为无高血压(57例)、血压控制良好(77例)、血压控制欠佳(84例)三组,比较三组患者MCI患病率.用多因素Logistic回归分析探讨血压水平与患者MCI患病率的相关性,并进一步比较三组患者各认知域得分情况.结果:本研究共103例患者诊断MCI,总体患病率为47.2％,无高血压组35.1％,血压控制良好组45.5％,血压控制欠佳组57.1％,差异有统计学意义(x2=6.781,P=0.034).多因素Logistic回归分析校正年龄、性别、教育程度、心房颤动类型、心力衰竭、糖尿病、冠心病、卒中史及抗凝药后,与无高血压组相比,血压控制欠佳组MCI患病风险更高(OR=2.98,95％CI:1.37～6.46),血压控制良好组MCI患病风险有升高趋势,但未达到统计学差异(OR=2.16,95％CI:0.95～4.92).血压控制欠佳组执行和注意功能显著差于无高血压人群,而血压控制良好的患者注意功能也较无高血压人群差.结论:在心房颤动人群中,MCI患病率高.血压控制欠佳患者MCI患病率高于无高血压患者,主要表现在执行和注意功能受损.

急性缺血性卒中是我国心房颤动患者致死及致残的首要病因，及时开通血管可以改善预后。对于心房颤动射频消融术中突发急性脑梗死的患者，溶栓治疗会极大增加出血风险。该文报道1例心房颤动射频消融术中突发脑梗死，及时进行血管内血栓切除术开通血管的病例，为临床提供参考。.