Atrial electromechanical coupling time (AEMCT) can be used to evaluate atrial electrical remodeling and early structural remodeling. This study explores the predictive role of AEMCT in postoperative new-onset AF (POAF) after off-pump isolated coronary artery bypass grafting (OPCAB). A total of 116 patients who underwent OPCAB and left atrial diameter (LAD)<44 mm were analyzed. According to 7-day continuous telemetry and Holter monitoring after OPCAB, the patients were divided into POAF group and non- POAF group. Patients were divided into two groups according to whether new-onset POAF occurred, namely, POAF group (38, 32.7%) and non-POAF group (78, 67.3%). There was no significant difference in LAD between two group. Multivariate analysis found that P-ALA ( P wave on ECG to the starting point of A´wave on tissue Doppler imaging (TDI) spectrum at the left atrial lateral wall of the mitral annulus), TLA (AEMCT in the left atrium) and HbA1c (glycosylated hemoglobin) in POAF group were significantly higher than that in non-POAF group, that is, higher HbA1c, prolonged P-ALA and TLA were independent risk factors for POAF after OPCAB. P-ALA had the highest diagnostic predicting value. The AUC of HbA1c, P-ALA and TLA with Cut -off was 0.766, 95% CI: 0.67-0.86, P < 0.001. In OPCAB patients without significant LAD enlargement, when P-ALA ≥ 96. 50 ms, there is more than 90% probability of POAF. The combination of HbA1c, P-ALA and TLA has the highest predictive value of POAF. AEMCT measured with TDI has the advantages of low cost and high repeatability.Clinical Trial Registry Registration Number: ChiCTR2200056127.

Background Atrial fibrillation (AF) increases risk of embolic stroke, and in postoperative patients, increases cost of care. Consequently, ECG screening for AF in high‐risk patients is important but labor‐intensive. Artificial intelligence (AI) may reduce AF detection workload, but AI development presents challenges. Methods and Results We used a novel approach to AI development for AF detection using both surface ECG recordings and atrial epicardial electrograms obtained in postoperative cardiac patients. Atrial electrograms were used only to facilitate establishing true AF for AI development; this permitted the establishment of an AI‐based tool for subsequent AF detection using ECG records alone. A total of 5 million 30‐second epochs from 329 patients were annotated as AF or non‐AF by expert ECG readers for AI training and validation, while 5 million 30‐second epochs from 330 different patients were used for AI testing. AI performance was assessed at the epoch level as well as AF burden at the patient level. AI achieved an area under the receiver operating characteristic curve of 0.932 on validation and 0.953 on testing. At the epoch level, testing results showed means of AF detection sensitivity, specificity, negative predictive value, positive predictive value, and F1 (harmonic mean of positive predictive value and sensitivity) as 0.970, 0.814, 0.976, 0.776, and 0.862, respectively, while the intraclass correlation coefficient for AF burden detection was 0.952. At the patient level, AF burden sensitivity and positive predictivity were 96.2% and 94.5%, respectively. Conclusions Use of both atrial electrograms and surface ECG permitted development of a robust AI‐based approach to postoperative AF recognition and AF burden assessment. This novel tool may enhance detection and management of AF, particularly in patients following operative cardiac surgery.

目的 探讨CT血管造影(CTA)和经胸超声心动图(TTE)对主动脉夹层术后主动脉根部-右心房分流术术后效果评价.方法 选取自 2020 年 1 月至 2022 年 1 月于北部战区总医院行主动脉根部-右心房分流术的 54 例Stanford A型主动脉夹层患者为研究对象.于术后 6～14 d内同期行CTA及TTE检查并观察结果.结果 CTA结果显示,主动脉周围均未见血肿,中等量以上心包积液 2 例,所有分流管影像均可显示,分流管见造影剂填充并回流至右房 50 例,分流管未见明显造影剂填充 4 例.其中,分流Ⅰ度 26 例,Ⅱ度 22 例(其中 1 例为Bentall术后冠状动脉吻合口瘘),Ⅲ度 2 例.超声检出Ⅱ度 3 例,Ⅲ度 1 例.CTA检出率 92.6％(50/54)显著高于超声检出率 7.4％(4/54),差异有统计学意义(P＜0.05).结论 CTA可以对主动脉夹层术后主动脉根部-右心房分流术进行有效、准确的评价,而TEE在主动脉根部-右心房分流术方面提供信息有限,不能进行有效评价.

Background: Postoperative atrial fibrillation (POAF) is one of the most common complications of cardiac surgery, but the underlying factors governing POAF are not well understood. The aim of this study was to investigate the efficacy of berberine administration on POAF. Methods: We conducted a randomized, double-blind, placebo-controlled trial with patients who underwent isolated coronary artery bypass grafting in China to study the impact of oral berberine on the incidence of POAF. A total of 200 patients who underwent coronary artery bypass grafting were randomized into the berberine group (n=100) and the placebo group (n=100). All patients underwent 7-day continuous telemetry and Holter monitoring. Results: The primary outcome was the incidence of POAF at 7 days. Secondary outcomes included clinical outcomes, POAF burden, intestinal endotoxin, and serum inflammatory biomarker levels. The POAF incidence was reduced from 35% to 20% under berberine treatment (hazard ratio, 0.5 [95% CI, 0.29–0.78]; P=0.0143). Perioperative mortality and morbidity did not differ between the 2 groups. POAF burden and the dose of amiodarone were significantly reduced in the berberine group. Oral berberine significantly decreased lipopolysaccharide, CRP (C-reactive protein), and IL (interleukin)-6 levels. Elevated lipopolysaccharide after surgery has been associated with POAF. Conclusions: Our results showed that administration of berberine may be effective for reducing the occurrence of POAF after coronary artery bypass grafting. Registration: URL: https://www.chictr.org.cn; Unique identifier: ChiCTR2000028839.

目的 探讨超声心动图评估升主动脉瘤、主动脉Stanford A型夹层及高血压心脏病患者的升主动脉血管弹性.方法 选取自2016年11月至2019年3月北部战区总医院心血管外科诊断为升主动脉瘤和Stanford A型主动脉夹层(以下简称A型夹层)患者为研究对象.其中,升主动脉瘤59例纳入A组,A型夹层65例纳入B组,另选取同期就诊者中患有高血压且无其他心脏疾病者65例纳入C组,70例健康成人纳入D组.采用M型超声心动图测量升主动脉收缩末期、舒张末期内径,同时,测量左侧肱动脉的收缩压(SBP)和舒张压(DBP)并计算压差(PP),通过计算得出升主动脉的应变(AS)、僵硬指数(ASI)、扩张性(ADIS),并比较各组间的差异.比较各组受试者的性别、年龄、肱动脉收缩压、升主动脉内径,采用Pearson相关性分析升主动脉夹层与AS、ASI、ADIS的关系.结果 A、B、C组的男性比例均高于D组,SBP、DBP、PP、ASD、ASI数值均高于D组,AS、ADIS数值低于D组,差异均有统计学意义(P<0.05).A、B组ASD、ASI数值高于C组,而AS、ADIS数值低于C组,差异均有统计学意义(P<0.05).B组男性比例高于A组,ASD数值低于A组,差异有统计学意义(P<0.05).Pearson相关性分析结果显示,性别、年龄、SBP、ASD及升主动脉夹层均与AS、ADIS呈负相关,与ASI呈正相关.其中,升主动脉夹层、ASD均为极强相关,与SBP也有较强的相关性.结论 超声心动图可有效评价升主动脉疾病的血管弹性.A型夹层、升主动脉瘤、高血压均可降低升主动脉血管弹性,而A型夹层和升主动脉瘤可使血管弹性降低更明显.

Background The cut-and-sew maze (CSM) procedure has an excellent efficacy for the elimination of long-standing persistent atrial fibrillation (AF) concomitant with mitral valve surgery. Because of the complexity and prolongation of cardiopulmonary bypass, CSM has not been widely used. The aim of this study was to examine a modified maze procedure that preserves the "cut-and-sew" procedure in the left atrium and uses cryoablation in the right atrium along with cavotricuspid isthmus. Methods From December 2013 to December 2018, 229 patients underwent CSM, and 43 underwent the modified maze procedure during mitral valve surgery. Propensity score matching analysis was used to perform selective 1:2 ratio matching of the 43 patients undergoing the modified maze procedure with 86 patients undergoing CSM. Early operative outcomes were analysed for differences. The absence of AF recurrence without the use of anti-arrhythmic drugs was calculated at 2 years by a generalised linear model analysis. Results One (1.1%) early death occurred in the CSM group, and no deaths occurred in the modified maze group (p=0.722). The aortic cross-clamp durations were 76.3068.86 minutes for the modified maze and 92.38610.88 for the CSM procedure (p, 0.001). There were no late strokes or deaths during the 2-year follow-up. The modified maze group showed similar rates of absence of AF without the use of antiarrhythmic drugs as the CSM group within the 2 years (p=0.332). Conclusion This modified maze simplifies the "cut-and-sew" procedure and reduces operating time while retaining the efficacy of CSM.

Abstract Background and aims Inflammation plays a key role in the initiation and progression of atrial fibrillation (AF). The systemic inflammation indexes are easily evaluated and predict AF development. However, it’s role in prediction of recurrence of AF is unknown. We aim to explore the association between the systemic inflammation indexes and recurrence of AF in patients underwent cryoablation (CryoMaze) concomitant with mitral valve surgery. Methods We examined systemic inflammation indexes during perioperative period in 122 patients between 2015 and 2018. Systemic inflammation indexes were developed by systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocytes to monocytes ratio. Univariate and multivariate analyses were performed to examine the association of each markers with recurrence of AF. Results Of the 122 patients included in this study, 22 patients (18%) experienced AF recurrence after CryoMaze concomitant with mitral valve surgery. There is no significant difference between each systemic inflammation indexes before surgery and recurrence of AF. In univariate analysis, MLR after surgery 3 days, PLR, MPLR, NLR, SII after surgery 7 days were able to predict recurrence of AF. In multivariate analyses, SII ≥ 1696 independently predicted recurrence (OR, 3.719; 95% CI, 1.417–9.760). Interestingly, baseline SII showed no significant in prediction of recurrence. It was sharply elevated after surgery and dropped slowly. In patients of recurrence, SII after 7 days of surgery increased again. Conclusions The raised SII again was associated with an increased risk of the postoperative recurrence of AF and independently predicted the late recurrence of AF after CryoMaze concomitant with mitral valve surgery.

目的 探讨外伤性孤立三尖瓣关闭不全的诊断及治疗.方法 选取自2012年1月至2020年6月手术中筛选出外伤性孤立三尖瓣关闭不全5例患者为研究对象,分析诊治过程的临床资料和超声心动图资料.结果 本组患者因胸闷就诊4例(80.0％),症状和体征多为胸闷、气短、心前区不适、活动耐力受限、双下肢浮肿等;部分患者有胸部疼痛、夜间不能平卧、恶心、面部浮肿等;仅1例存在运动耐力受限而无其他症状.心律多为窦性,心率大多正常.本组5例患者损伤类型均为较大的外力损伤,外伤时间大多较长,外伤时间(7.7±7.9)年,感觉不适时间相对外伤史短得多,而三尖瓣关闭不全的确诊时间均较短,诊断时即已为重度关闭不全.所有患者行超声心电图检查,均为阳性结果.术中探查证实右房、右室、三尖瓣瓣环均扩大.三尖瓣均有脱垂,包括前瓣5例(100.0％)、后瓣1例(20.0％)、隔瓣1例(20.0％).本组患者行三尖瓣成形术3例(60.0％),三尖瓣人工瓣置换术2例(40.0％),围术期未出现并发症及死亡.超声心动图诊断与术中探查情况大多完全符合,仅1例未检出后瓣的损伤.患者术后复查,胸闷、下肢浮肿等症状得到好转,活动耐力也有明显改善.三尖瓣人工瓣置换者功能始终正常,无关闭不全(经胸超声检查),三尖瓣成形者2例为轻度关闭不全,1例术后2年时为中度关闭不全,经服利尿剂等药物调整后为轻度关闭不全并维持至今.结论 在急诊的诊治过程中,应尽量关注外伤性孤立三尖瓣关闭不全.手术可有效治疗外伤性孤立三尖瓣关闭不全.超声心动图在外伤性孤立三尖瓣关该病的诊断、治疗和预后评价过程中均有重要作用.

This paper proposes a novel doppler spectral curve detection method. First, U-net model is used to obtain the coarse segmentation map from the spectral image. Then, in order to solve the problem of curve deviation and curve defect, two components, curve correction and curve filling, which adopt deep regression and Generative adversarial networks, are devised for spectrum curve refining operation. These two outputs are fused for final segmentation. The experiments are validated on a private collected Spectral Doppler Spectrum dataset. The results demonstrate the proposed method has achieved satisfactory performance.

目的 探讨窦性心律左心室射血分数保留型心力衰竭(HFpEF)的二尖瓣脱垂(MVP)患者术后1个月时左心室射血分数(LVEF)明显减低的危险因素.方法 连续选择我院2016年1月～2021年8月期间行手术治疗的窦性心律HFpEF型MVP患者304例为研究对象,收集术前及术后1个月的临床资料和超声心动图数据,根据术后1个月时LVEF是否≥50％分为LVEF正常组(283例)和LVEF减低组(21例),观察其术前至术后各指标的变化情况.结果 多因素分析发现,术后LVEF减低的危险因素是术前左心室收缩末期内径(LVESD)明显增大(P<0.001)、术前右心室舒张功能减低(Et/Et′增大)(P=0.023)及术后新发房颤(P=0.017,χ2=9.648);ROC曲线显示,LVESD≥40.5 mm(敏感度81.0％,特异度83.4％)及Et/Et′≥4.83(敏感度85.7％,特异度48.4％)与窦性心律HFpEF型MVP患者术后出现LVEF减低有显著关系.结论 术前LVESD明显增大、右心室舒张功能减低是窦性心律HFpEF型MVP患者术后LVEF发生减低的危险因素;右心室舒张功能减低预测术后LVEF减低的敏感性较高,常规测量Et/Et′可用于病情监测.

Abstract Introduction To explore how to measure LAPEq accurately and quantitatively, that is, the left atrial pressure (LAP) measured and calculated by equation method using mitral regurgitation spectrum. Methods The mitral regurgitation spectrum, pulmonary arteriolar wedge pressure (PAWP) and invasive arterial systolic pressure of radial artery of 28 patients were collected simultaneously, including 3 patients with rheumatic heart disease, 15 patients with mitral valve prolapse and 10 patients with coronary artery bypass grafting, patients with moderate or above aortic stenosis were excluded. LAPBp (Doppler sphygmomanometer method), LAPEq (Equation method) and LAPC (Catheter method) were measured synchronously, and the measurement results of the three methods were compared and analyzed. A special intelligent Doppler spectrum analysis software was self-designed to accurately measure LAPEq. This study had been approved by the ethics committee of the Northern Theater General Hospital (K-2019-17), and applied for clinical trial (No. Chictr 190023812). Results It was found that there was no significant statistical difference between the measurement results of LAPC and LAPEq (t = 0.954, P = 0.348), and significant correlation between the two methods [r = 0.908(0.844, 0.964), P < 0.001]. Although the measurement results of LAPC and LAPBP are consistent in the condition of non-severe eccentric mitral regurgitation, there are significant differences in the overall case and weak correlation between the two methods [r = 0.210, (−0.101, 0.510), P = 0.090]. In MVP patients with P1 or P3 prolapse, the peak pressure difference of MR was underestimated due to the serious eccentricity of MR, which affected the accuracy of LAPBP measurement. Conclusions It was shown that there is a good correlation between LAPEq and LAPC, which verifies that the non-invasive and direct quantitative measurement of left atrial pressure based on mitral regurgitation spectrum is feasible and has a good application prospect.

目的 通过随访研究,对比Fontan手术Y型心外管道(YECFO)与传统心外管道(TECFO)术后血流动力学结果,评价YECFO手术疗效.方法 收集2014年至2017年本院心外管道Fontan手术后患者12例,其中女性5例,男性7例;平均(6.6±2.4)岁,平均随访(2.7±1.3)年.YECFO 6例,TECFO 6例,术后早期对比体外循环时间、呼吸辅助时间及ICU滞留时间.随访全组均行超声心动图、CT三维重建、核素肺血灌注扫描等检查.结果 全组早期无死亡或Fontan手术拆除.YECFO手术体外循环、主动脉阻断时间较TECFO长(P<0.05),术后呼吸辅助、ICU滞留时间无明显差异.随访超声、CT三维重建指标未见明显差异.下腔静脉核素造影显示YECFO血流明显优于TECFO(P<0.01).结论 YECFO、TECFO术后早期血流动力学均良好,临床疗效无差异.YECFO手术后肺血分布更合理,主要体现在下腔静脉至左、右肺血分布更接近生理状态.

Objective To summarize the mid- and long-term curative efficacy of surgical valve surgery intervention for the patients with end-stage atrial fibrillation by analyzing the main points of clinical and ultrasonic diagnosis. Methods Clinical data of 693 patients with atrial fibrillation diagnosed by echocardiography admitted to our General Hospital of Northern Theater Command from January 2012 to June 2019 were collected and retrospectively analyzed. According to the regurgitation of atrioventricular valve, they were divided into Group A (slight or mild mitral and/or tricuspid insufficiency), Group B (moderate or above tricuspid insufficiency), Group C (moderate or above mitral insufficiency), and Group D (moderate or above mitral and tricuspid insufficiency). There were total 505 patients in the latter 3 groups, among which 124 underwent heart valve surgery. Results The severiry of atrioventricular valve regurgitation was constantly changing in the 693 patients. There were 65 patients with reduced reflux after medical treatment, and 23 of them underwent radiofrequency ablation of atrial fibrillation. Atrioventricular regurgitation was aggravated in 505 patients. Among the patients with moderate severe regurgitation, the non-operation patients had significantly longer history of atrial fibrillation, larger left ventricular diameter, and lower left ventricular systolic and diastolic functions than the operation patietns (P < 0.05). The 124 patients underwent surgical treatment, but 1 patient died during perioperative period, and the others were followed up from 6 months to 94 months (averagely 63.03 months, 54.61 to 71.44 months). Paired analysis showed that suegical treatment resulted in significantly decreased diameter of each atrium (P < 0.001), improved cardiac function classification (P < 0.001), and reduced score of Self-rating Anxiety Scale (SAS, P < 0.001). Although some patients (24 cases) had lower LVEF after operation, there was no significant difference (P=0.067). The sinus rhythm was restored and maintained in 14 (87.5%) of 16 patients who underwent valve surgery at the same time, and 18 (16.8%) of 107 patients underwent valve surgery alone. Conclusion Surgical valve surgery should be carried out actively for the patients with end-stage atrial fibrillation with massive atrioventricular valve regurgitation, with the advantages of low risk and good quality of life.

目的 探讨多层螺旋CT(MSCT)和经胸超声心动图(TTE)对法洛四联症(TOF)肺动脉发育评估的价值及对临床的指导意义.方法 回顾性分析2016-2018年期间90例TOF手术患者,男性48例,女性42例,平均年龄(5.7±11.9)岁.采集术前MSCT和TTE影像资料,比对左、右肺动脉和腹主动脉内径,并计算McGoon指数;根据是否行I期根治术分为两组:姑息手术为A组,根治手术为B组,结合手术术中观察情况,进行肺动脉发育评价方法的比较.结果 TTE对左、右肺动脉内径的测值及McGoon指数均小于MSCT,差异具有统计学意义(左肺动脉P=0.028,右肺动脉P=0.005,McGoon指数P=0.007);两者均有较好的重复性(ICC＞0.75),其中MSCT更高,B组差异具有统计学意义(P=0.037);两种方法测量的左、右肺动脉内径、腹主动脉内径和McGoon指数均具有明显的相关性(r＞0.8).肺动脉发育较差的患者中,即A组各数据的相似度均大于B组,McGoon指数更明显.MSCT与TTE评估的McGoon指数在评估肺动脉发育及实施手术依据方面有很高的符合率(95.5％、94.4％),差异无统计学意义(P＞0.05).但两种方法在评价肺动脉发育较差患者时符合率均明显低于B组(MSCTP=0.029,TTEP=0.030).结论 MSCT与TTE均是对TOF肺动脉发育的有效检查技术,两者估测的McGoon指数均可以有效地指导临床.TTE评价TOF患者的肺动脉发育,因其重复性好、无创性等优点可用于姑息手术患者观察肺动脉发育情况的评价中.

Objective:To evaluate the long-term results of bipolar radiofrequency(BRF) ablation in restoring sinus rhythm in patients with permanent atrial fibrillation(AF) undergoing surgery for cardiac surgery.Methods:This retrospective study sample consisted of 268 patients with LSP-AF underwent cardiac operations concomitant BRF maze Ⅳ procedure. Data were collected prospectively on perioperative outcomes, rhythm status, survival, and clinical events.Results:15 patients died in the early postoperative period, perioperative mortality rate was 5.5%. The rate of stable sinus rhythm(sSR)was 86.6%, 75.4%, 67.7%, 57.8% in 1, 2, 5, 8 years after operation. Multivariate analysis proved the size of the left atrium( HR=1.073, P<0.001) and duration of AF( HR=1.070, P=0.025) to be an independent predictor of the radiofrequency ablation outcome. Conclusion:Bipolar radiofrequency maze procedure can effectively eliminate AF, maintain long-term of sinus rhythm. Bipolar radiofrequency maze procedure is a safe, easy and effective surgical option for the treatment of AF, with satisfactory long-term results, is worthy of promotion.

目的 探讨主动脉瓣关闭不全(AI)合并左室射血分数(LVEF)<40％的患者瓣膜手术后心功能恢复的影响因素.方法 选取自2010年1月至2018年12月北部战区总医院收治的左室收缩功能减低(LVEF<0.40,Simpson法)的AI并行单纯主动脉瓣置换(AVR)的99例患者为研究对象.根据瓣膜术后6个月时左室收缩功能是否恢复(LVEF≥0.50,Simpson法)将患者分为恢复组(n=52,LVEF≥0.50,Simpson法)与未恢复组(n=47,LVEF<0.50 Simpson法).记录并比较两组患者术前的基本临床资料及超声数据.应用χ2检验分析左室收缩末期容积(LVESV)、三尖瓣口舒张早期前向血流峰速/三尖瓣瓣环侧壁舒张早期峰速(Et/Et′)与心功能减低的AVR术后LVEF不能恢复的关系.结果 单因素分析发现,两组患者的舒张压、左房前后径(LAD)、左室舒张末期容积(LVEDV)、LVESV、Et/Et′比较,差异有统计学意义(P<0.05).多因素分析发现,Et/Et′较高(P>0.001)和/或LVESV较大(P>0.016)是AVR术后LVEF不易恢复的危险因素.术前三尖瓣Et/Et′≥7.5和/或LVESV≥155.0 ml且LVEF<0.40的AI患者术后心功能更不易恢复.结论 术前左室收缩末期内径较大和/或右室舒张功能出现减低是LVEF<0.40的AI患者术后心功能不易恢复的危险因素.

Background: The cut-and-sew maze (CSM) procedure has excellent efficacy for the elimination of long-standing persistent atrial fibrillation (AF) concomitant with mitral valve surgery. Because of the complexity and prolongation of cardiopulmonary bypass, CSM has not been widely used. The aim of this study was to examine a modified maze procedure that preserves the “cut-and-sew” procedure in the left atrium and uses cryoablation in the right atrium along with cavotricuspid isthmus (CTI). Methods: From December 2013 to December 2018, 229 patients underwent CSM, and 43 underwent the modified maze procedure during mitral valve surgery. Propensity score matching analysis was used to perform selective 1:2 ratio matching of the 43 patients undergoing the modified maze procedure with 86 patients undergoing CSM. Early operative outcomes were analysed for differences Results: The absence of AF recurrence without the use of anti-arrhythmic drugs (AADs) was calculated at 2 years by a generalized linear model analysis. One (1.1%) early death occurred in the CSM group, and no deaths occurred in the modified maze group ( P =0.722). The aortic cross-clamp durations were 76.30±8.86 minutes for the modified maze and 92.38±10.88 for the CSM procedure ( P <0.001). There were no late strokes or deaths during the two-year follow-up. The modified maze group showed similar rates of absence of AF without the use of AADs as the CSM group within the 2 years ( P =0.332). Conclusion: This modified maze simplifies the “cut-and-sew” procedure and reduces operating time while retaining the efficacy of CSM.

In this trial, we sought to evaluate the efficacy and safety of the addition of the Maze performed by cryoablation (CryoMaze) to the mitral valve surgeries. The trial is a randomized, single-center trial to determine whether CryoMaze was noninferior to cut-and-sew maze procedure (CSM) in patients with persistent or long-standing persistent atrial fibrillation (AF), with a 15% margin to establish noninferiority. The primary endpoint was freedom from AF off antiarrhythmic drugs (AADs) at 12 months. Secondary endpoints included freedom from AF off AADs at 3 and 6 months, and a composite of serious adverse events. Two hundred patients were randomized to either CryoMaze (n = 100) or CSM (n = 100). Freedom from AF was achieved in 85 % (95% confidence interval, 0.76–0.91) in the CryoMaze group and 88% (95% confidence interval, 0.80–0.94) in the CSM group, showing that CryoMaze was noninferior to CSM at 12 months (P value for noninferiority = 0.0065). There was no significant difference in serious adverse effects (n = 12 in CryoMaze; n = 17 in CSM; P = 0.315). Perioperative bleeding and the length of surgery, ICU stay, postoperative hospital stay; and the need for temporary pacing decreased significantly in the CryoMaze group. CryoMaze was noninferior to CSM for efficacy and safety for patients with persistent or long-standing persistent AF undergoing mitral valve surgeries. CryoMaze significantly decreased bleeding, the length of surgery, ICU and hospital stay, as well the need for temporary pacing. (Chinese Clinical Trial Register number, ChiCTR-IOR-16008112.)

BACKGROUND Post-operative atrial fibrillation (POAF) is associated with worse long-term cardiovascular outcomes. OBJECTIVES This study hypothesized that injecting calcium chloride (CaCl2) into the major atrial ganglionated plexi (GPs) during isolated coronary artery bypass grafting (CABG) can reduce the incidence of POAF by calcium-induced autonomic neurotoxicity. METHODS This proof-of-concept study randomized 200 patients undergoing isolated, off-pump CABG to CaCl2 (n = 100) or sodium chloride (sham, n = 100) injection. Two milliliters of CaCl2 (5%) or sodium chloride (0.9%) was injected into the 4 major atrial GPs during CABG. All patients received 7-day continuous telemetry and Holter monitoring. The primary outcome was incidence of POAF (>= 30 s) in 7 days. Secondary outcomes included length of hospitalization, POAF burden, average ventricular rate during AF, plasma level of inflammatory markers, and actionable antiarrhythmic therapy to treat POAF. RESULTS The POAF incidence was reduced from 36% to 15% (hazard ratio: 0.366; 95% confidence interval: 0.211 to 0.635; p = 0.001). Length of hospitalization did not differ between the 2 groups. POAF burden (first 7 post-operative days), the use of amiodarone or esmolol, and the incidence of atrial couplets and nonsustained atrial tachyarrhythmias were significantly reduced in the CaCl2 group. Heart rate variability data showed a decrease in both high-frequency and low-frequency power in the CaCl2 group with a preserved low-frequency/high-frequency ratio, suggesting that the sympathetic/parasympathetic balance was not perturbed by CaCl2 injection. CONCLUSIONS Injection of CaCl2 into the 4 major atrial GPs reduced the POAF hazard by 63%. Inhibition of GP function by Ca-mediated neurotoxicity may underlie the therapeutic effect. (C) 2021 by the American College of Cardiology Foundation.