ObjectiveThis study aims to systematically evaluate and perform a meta-analysis on the effects of LBBAP on right ventricular (RV) function by collecting data on Right Ventricular Fractional Area Change (RV-FAC), Tricuspid Annular Plane Systolic Excursion (TAPSE), Interventricular Mechanical Delay (IVMD), and the incidence of tricuspid regurgitation (TR) worsening in Left bundle branch area pacing (LBBAP) patients.MethodsA comprehensive search was conducted for studies published from the establishment of the respective databases until October 2024 in PubMed, Embase, Web of Science, and the Cochrane Library. After screening and data extraction, the Newcastle-Ottawa Scale was used for the quality assessment of the included cohort studies, and meta-analysis was performed using R software. The effect size was estimated using either a random-effect model or a fixed-effect model, with odds ratio (OR) and mean difference (MD).ResultsA total of 14 studies were included, analyzing 1,555 LBBAP patients. The meta-analysis revealed that compared with intrinsic conduction, LBBAP implantation significantly improved RV-FAC (MD = 1.93; 95% CI: 0.64–3.23, P = 0.0034) and TAPSE (MD = 1.57; 95% CI: 1.07–2.06, P < 0.0001). Compared to the RVP group, LBBAP implantation significantly shortened IVMD (MD = −21.27; 95% CI: −31.33 to −11.22, P < 0.0001). For patients with RV dysfunction or right bundle branch block (RBBB), LBBAP implantation also significantly reduced IVMD (MD = −31.31; 95% CI: −37.10 to −25.52, P < 0.0001). The incidence of TR worsening within one year after LBBAP was approximately 8%, increasing to 23% beyond one year.ConclusionThis meta-analysis demonstrates the superiority of LBBAP over intrinsic conduction in improving RV systolic function. Compared to RVP, LBBAP significantly enhances biventricular synchronization. Furthermore, LBBAP also improves ventricular synchronization in patients with RV dysfunction or RBBB.

BACKGROUND:Inflammation is associated with early recurrence after atrial fibrillation (AF) ablation and is linked to stroke in AF. AIMS:The aim of this study is to investigate the time course of inflammatory biomarkers following radiofrequency ablation (RFA) for AF and its relation to early AF recurrence. MATERIAL AND METHODS:Ninety patients who underwent successful RFA for AF were enrolled. Blood samples were collected from the median cubital vein preoperatively and on postoperative days 1, 2, 3, 7, and 14 to measure levels of high-sensitivity C-reactive protein (hs-CRP), fibrinogen, creatine kinase isoenzyme (CKMB), and cardiac troponin I (cTnI). Follow-up evaluations of AF recurrence were conducted at weeks 1, 2, 3, and 4 and months 2 and 3 postoperatively. RESULTS:The hs-CRP levels significantly increased on postoperative days 2 and 3 compared to preoperative values, followed by a decline on days 7 and 14 (P <0.05). The fibrinogen level peaked between postoperative days 2 and 7 (P <0.05), and then declined by day 14. CKMB and cTnI levels peaked between postoperative days 1 and 3 (P <0.05). The escalation of hs-CRP following RFA was identified as an independent risk factor for early AF recurrence (OR, 2.948; 95% CI, 1.892-4.602; P = 0.004). CONCLUSIONS:The degree of inflammatory response following RFA serves as a predictive marker for early AF recurrence, and the significant inflammatory response and hypercoagulable state are evident within the first week post-RFA for AF, potentially explaining the heightened risk of early thromboembolic events.

Cardiac troponin I (cTnI), as a cardiac biomarker, holds significant importance in the diagnosis of acute myocardial infarction. However, the current detection methods mostly require specialized personnel and large analytical instruments, making it difficult to achieve convenient and on-site testing. This situation leads to delayed disease diagnosis and treatment, that increases patient suffering, and reduces the cure rate. This strategy presents the development of a portable visual DNA hydrogel colorimetric sensing platform based on a smartphone. Utilizing dual-mode detection with ultraviolet signals and solution colorimetry, the platform achieves ultra-sensitive and real-time detection of cTnI. Furthermore, optimization of detection conditions, such as the amount of polyacrylamide, reaction time, aptamer concentration, encapsulation of the nanozyme, incubation time, and reaction temperature, were performed based on this platform. The proposed ultraviolet and visual detection platforms exhibited good linear relationships with the signal within the ranges of 0.003 ng mL- 1 to 10.00 ng mL- 1 and 0.01 ng mL- 1 to 7.00 ng mL- 1, with detection limits of 2.57 pg mL- 1 and 0.013 pg mL- 1, respectively. Additionally, utilizing 3D printing technology, a portable detection device was designed and employed for the detection of cTnI concentrations in human serum samples. Whatever in the initial and spiked samples, the results showed high sensitivities. The sensitivity and convenience of the sensor in detecting cTnI make it promising for home testing of patients, with broad market prospects.

Background Cryoballoon ablation (CbA) for pulmonary vein isolation (PVI) is increasingly used in the treatment of paroxysmal atrial fibrillation (PAF). We aimed to assess the relationship between pulmonary vein ostium (PVO) morphology and procedural outcomes after CbA for PAF. Methods A total of 463 patients with PAF were enrolled. PVO morphology was evaluated using preprocedural computed tomography (CT). Intraoperative cryoablation parameters and adverse events were recorded. Patients were followed up for at least 1 year. Results The superior PVs exhibited the longest long-axis diameter at PVO (left, 21.85 +/- 3.22 mm; right, 21.55 +/- 3.71 mm, all p < 0.05), while the right superior PVs had the largest short-axis diameter (18.46 +/- 3.56 mm, all p < 0.05). The left superior PVO showed the greatest ellipticity (difference between long-axis and short-axis diameters: 6.60 +/- 3.35 mm, all p < 0.05), whereas the right superior PVO had the largest mean diameter (20.00 +/- 3.42 mm, all p < 0.05). Left-sided PVOs demonstrated the highest ellipticity. The size of the left superior PVO was negatively correlated with the nadir freezing temperature and positively correlated with rewarming time (both p < 0.05). The long-axis diameter of PVO was positively associated with the additional radiofrequency ablation (p < 0.05). Multivariate analysis identified left superior PVO morphology as an independent predictor of late recurrence (beta = 2.703, p = 0.010). Conclusions Large PVO dimensions, particularly in the left superior PV, are associated with intraoperative difficulty during second-generation CbA for PAF. Additionally, left superior PVO ellipticity predicts late recurrence. Preprocedural PV CT imaging may be valuable for a quick clinical predict for PAF.

Background: The goal of this study was to compare the procedural safety and long-term outcome associated with a combined catheter ablation and left atrial appendage occlusion (LAAO) procedure utilizing intracardiac echocardiography (ICE) guidance versus transesophageal echocardiography (TEE) guidance. The study focuses on implementing LAmbre and Watchman devices in patients diagnosed with nonvalvular atrial fibrillation (AF). Methods: A total of 363 patients diagnosed with nonvalvular AF and who underwent a combined procedure were prospectively enrolled between November 2017 and May 2022. Following 1:1 propensity score matching, the TEE group (n = 132) and ICE group (n = 132) were systematically compared in terms of the combined procedure, imaging parameters, events related to the procedure, and subsequent outcomes during follow-up, including mortality, stroke, bleeding, device-related thrombus (DRT), and peri-device leaks (PDLs). Results: The ICE group exhibited a significant reduction in total procedural duration (153.71 ± 31.71 vs. 174.74 ± 18.79 min), fluoroscopy radiation dosage (207.24 ± 108.39 vs. 268.61 ± 122.88 mGy), left atrial appendage occlusion procedure time (34.69 ± 10.91 vs. 51.46 ± 15.84 min), and contrast agent exposure (108.71 ± 37.59 vs. 158.41 ± 45.00 mL) compared to the TEE group. Angiography and ICE demonstrated a substantial correlation between the left atrial appendage (LAA) orifice and landing zone/LAA ostium (Pearson’s correlation coefficient r = 0.808 and 0.536/0.697, two-tailed p < 0.001). No occurrences of device-related embolism, thromboembolism, significant bleeding, or unexpected fatalities were observed in either group. Comparable rates of all-cause death (0.76% vs. 0.76%), stroke or transient ischemic attack (2.27% vs. 1.52%), severe bleeding (1.52% vs. 0.76%), PDL (23.81% vs. 24.62%), and DRT (1.52% vs. 1.52%) were noted after an average follow-up of 18.46 ± 7.70 months in both groups, with no discernible differences. Multivariate logistic regression analysis identified a correlation between LAA velocity and the risk of PDL. Conclusions: The effectiveness and safety of ICE-guided combined treatment were demonstrated to be comparable to TEE guidance, accompanied by the additional advantages of decreased procedure time and fluoroscopy radiation exposure. Clinical Trial Registration: NCT04391504, https://register.clinicaltrials.gov.

BackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia, significantly increasing the risk of death and stroke. The left atrial appendage (LAA) plays a crucial role in the development of AF. Reduced left atrial appendage emptying velocity (LAAEV) is an important indicator of nonvalvular AF, associated with thrombosis and recurrence after catheter ablation. This study aims to identify factors influencing LAAEV and construct a predictive model for LAAEV in nonvalvular AF patients.MethodsThis retrospective cohort study included 1,048 nonvalvular AF patients hospitalized at the Second Hospital of Hebei Medical University from January 1, 2015, to December 31, 2021. Patients underwent transthoracic and transesophageal echocardiography and had complete laboratory data. Statistical analyses included binary logistic regression and multiple linear regression to identify independent predictors of reduced LAAEV and construct a predictive model.ResultsPatients were divided into two groups: reduced LAAEV (<40 cm/s) and normal LAAEV (≥40 cm/s). The reduced LAAEV group included 457 patients (43.61%), with significant differences in age, gender, alcohol consumption, heart failure (HF), ischemic stroke, AF type, resting heart rate, CHA2DS2-VASc score, serum creatinine (SCR), serum uric acid (SUA), estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1C), β2 macroglobulin (B2M), left atrial diameter (LAD), and left ventricular ejection fraction (LVEF) compared to the normal LAAEV group. Logistic regression analysis identified age (OR 0.974, 95% CI 0.951–0.997, P = 0.028), HF (OR 0.637, 95% CI 0.427–0.949, P = 0.027), AF type [Persistent AF vs. PAF (OR 0.063, 95% CI 0.041–0.095, P = 0) Long-standing Persistent AF vs. PAF (OR 0.077, 95% CI 0.043–0.139, P = 0)], LAD (OR 0.872, 95% CI 0.836–0.91, P < 0.001), and LVEF (OR 1.057, 95% CI 1.027–1.089, P = 0) as independent predictors of reduced LAAEV. Multiple linear regression analysis included age, AF type, LAD, and LVEF in the final predictive model, explaining 43.5% of the variance in LAAEV (adjusted R² = 0.435).ConclusionAge, HF, type of AF, LAD, and LVEF are independent predictors of reduced LAAEV. The predictive model (LAAEV = 96.567–15.940 × AFtype–1.309 × LAD–0.18 × Age + 37.069 × LVEF) demonstrates good predictive value, aiding in the initial assessment and management of nonvalvular AF patients.

Objective:In the present study, we investigated the impact of left atrial appendage closure (LAAC) following catheter ablation (CA) on the left atrial structure and functioning of patients with paroxysmal atrial fibrillation (AF).Methods:Patients with paroxysmal AF were enrolled in this single-center prospective cohort study between April 2015 and July 2021; 353 patients received CA alone, while 93 patients received CA in combination with Watchman LAAC. We used age, gender, CHA2DS2-VASc, and HAS-BLED scores as well as other demographic variables to perform propensity score matching. Patients with paroxysmal AF were randomly assigned to the CA combined with Watchman LAAC group (combined treatment group) and the simple CA group, with 89 patients in each group. The left atrial structure, reserve, ventricular diastole, and pump functions and their changes in patients were assessed using routine Doppler echocardiography and 2D speckle tracking echocardiography over the course of a 1-year follow-up.Results:At 1-week follow-up, the reserve, ventricular diastole, and pump functions of the left atrium (LA) increased in both groups; these functions were gradually restored at the 1- to 3-month follow-up; they were close to or returned to their pre-operative levels at the 3-month follow-up; and no significant differences were found compared with the pre-operative levels at the 12-month follow-up. In the first 3 months, the reserve (Ƹ, SRs) and pump functions (SRa) in the combined treatment group decreased significantly when compared with the simple CA group, and the differences were statistically significant.Conclusion:Patients with paroxysmal AF may experience a short term, partial effect of LAAC on LA reserve and pump functions, which are gradually restored and the effect disappears by 12 months.

Objective. We aimed to examine the benefits of catheter ablation on left heart structure and function in patients with persistent atrial fibrillation (AF) accompanied by heart failure (HF) with preserved ejection fraction (HFpEF), in comparison with the benefits in patients with AF accompanied by HF with reduced ejection fraction (HFrEF) or patients with no HF. Methods. A total of 399 patients with nonvalvular persistent AF who underwent catheter ablation from 2015 to 2021 were retrospectively included sixty‐seven patients with recurrence of AF within 1 year were excluded, as well as 53 patients who failed to be followed up at (12 ± 1) months after the procedure. Finally, 279 patients who fulfilled the criteria were included and divided into these groups: the HFpEF group (left ventricular ejection fraction (LVEF) ≥50% and N‐Terminal Pro‐Brain Natriuretic Peptide (NT‐proBNP) ≥125 pg/ml or E/e′ ≥15, n = 116), HFrEF group (LVEF <50%, n = 48), and no HF group (NT‐proBNP <125 pg/ml, n = 115). The endpoints were changes in image‐based functional status from baseline to 1 year, including echocardiogram and speckle‐tracking echocardiography. Results. The left atrial structure of patients with HFpEF decreased significantly 1 year after catheter ablation (left atrial anteroposterior dimension: 41.48 ± 4.53 mm vs. 38.64 ± 4.40; left atrial mediolateral dimension: 41.99 ± 5.52 vs. 38.24 ± 4.63 mm; left atrial superoinferior dimension: 61.36 ± 6.73 vs. 56.44 ± 6.97 mm). The left atrial and left ventricular volumes were significantly reduced and the ejection fraction was increased in all three groups, with HFrEF patients benefiting more. In the speckle‐tracking echocardiography indexes, significant improvements were observed in left atrial strain (16.83 ± 6.91 vs. 28.05 ± 9.92), left atrial storage function (0.97 ± 0.38 vs. 1.49 ± 0.58), and left atrial pump function (−1.15 ± 0.55 vs. −1.68 ± 0.75) among HFpEF patients after 1 year, with no changes in left atrial conduit function (−1.55 ± 0.62 vs. −1.50 ± 0.54). In addition to the above improvements in left atrial structure and function, there was no significant improvement in left ventricular diastolic function in patients with HFpEF (E/e′, 14.11 ± 5.52 vs. 14.30 ± 7.25, P = 0.85). Conclusion. Catheter ablation is beneficial in restoring sinus rhythm in patients with persistent AF with coexisting HFpEF, significantly decreasing the left atrial size, improving left atrial storage function and left atrial pump function, and increasing left atrial and left ventricular ejection fraction.

BACKGROUND Recent studies suggested that the left bundle branch area pacing (LBBAP) has a better efficacy to reduce QRS duration and produce a lower pacing threshold than the conventional right ventricular outflow tract septal pacing (RVOP), which resulted in a better cardiac function and ventricular synchronization. However, whether the LBBAP has a better efficacy in improving left atrial structure, function in pace-dependent patients compared with RVOP has not been well studied. OBJECTIVE The purpose of this study was to compare the atrial outcomes of pace-dependent patients who received LBBAP or RVOP procedures. METHODS AND RESULTS A total of 72 patients (including II° AVB, high AVB, and III° AVB, excluding atrial fibrillation patients with atrioventricular block) consecutively enrolled in this single-center prospective clinical study and randomly assigned to the RVOP group and the LBBP group with 36 patients. All patients were pace-dependent. The changes in echocardiogram, speckle-tracking echocardiography, brain natriuretic peptide (BNP), and 6-min walking distance were documented and compared between two groups at baseline, 7 days, 1, 3, and 6 months after the implantation. There were no significant differences in baseline characteristics between the two groups. The results of the study were as following: (1) left atrial structure index: Our study indicated that there are no significant differences in left atrial anteroposterior dimension (LAAPD), left atrial superoinferior dimension, and left atrial mediolateral dimension between two groups. While the LAAPD in the LBBAP group was significantly reduced at 6 months after implantation ([38.22 ± 2.17] mm vs. [34.13 ± 1.59] mm, p < .05). (2) Left atrial strain index: We observed that the S% was significantly improved in both groups at 3 and 6 months after implantation but more prominent in the LBBAP group at 6 months (36.94 ± 11.67 vs. 25.87 ± 8.93, p = .01). SRs, SRe were improved in the RVOP group at 6 months after implantation but was further significantly increased in the LBBAP group. Similarly, the SRa in the LBBAP group was significantly better than the RVOP group after 6 months (-2.11 ± 0.75 vs. -2.51 ± 0.70, p = .04). (3) Left atrial ejection index: LAEF% in the LBBAP group was significantly improved compared with the RVOP group (60.02 ± 1.88 vs. 53.65 ± 2.45, p = .047) and baseline (60.02 ± 1.88 vs. 49.68 ± 2.75, p < .05) at 6 months after the surgery. (4) Left ventricular ejection index: The LVEF% in the LBBAP group was significantly increased than the RVOP group after 6 months (69.14 ± 4.99 vs. 64.60 ± 4.84, p = .01) and the BNP level was significantly lower in the LBBAP group compared with the RVOP group at 7 days, 1, 3, and 6 months after implantation (p < .05). (5) 6-min walking distance: the 6-min walking distance was significantly increased at 3 and 6 months after implantation compared with that before (p < .05) in both groups, but was more prominent in LBBAP groups ([483.03 ± 11.02] m vs. [431.09 ± 10.69] m,p < .05). CONCLUSION Compared with the traditional RVOP, the LBBAP procedure increased left atrial myocardial stress as well as left atrial ejection in pace-dependent patients at follow-up to 6 months.

(1) Background: This study aimed to investigate the effect of an additional catheter ablation (CA) procedure on the risk of post-procedure adverse events during CA combined with left atrial appendage closure (LAAC). (2) Methods: From July 2017 to February 2022, data from 361 patients with atrial fibrillation who underwent LAAC at our center were analyzed retrospectively. The adverse events were compared between CA + LAAC and LAAC-only groups. (3) Results: The incidence of device-related thrombus (DRT) and embolic events was significantly lower in the CA + LAAC group than in the LAAC-only group (p = 0.01 and 0.04, respectively). A logistic regression analysis revealed that the combined procedure served as a protective factor for DRT (OR = 0.09; 95% confidence interval: 0.01–0.89; p = 0.04). Based on a Cox regression analysis, the risk of embolism marginally increased in patients aged ≥65 years (HR = 7.49, 95% CI: 0.85–66.22 p = 0.07), whereas the combined procedure was found to be a protective factor (HR = 0.25, 95% CI: 0.07–0.87 p = 0.03). Further subgroup and interaction analyses revealed similar results. (4) Conclusions: The combined procedure may be associated with a lower rate of post-procedure DRT and embolization without a higher occurrence of other adverse events after LAAC. A risk-score-based prediction model was conducted, showing a good prediction performance.

目的 探讨持续性心房颤动(房颤)患者在射频消融的基础上加行经皮左心耳封堵术的有效性和安全性及对消融复发率的影响.方法 纳入2015年4月至2018年10月在河北医科大学第二医院心内科行射频消融及Watchman左心耳封堵一站式手术的非瓣膜性持续性房颤患者66例(一站式组),以及同期在本中心接受射频消融的持续性房颤患者174例(射频消融组).经1∶1倾向性评分匹配后,两组各有65例患者纳入分析.比较两组临床特征、围术期与随访期间主要不良事件发生率以及房颤复发率.结果 两组患者临床基线资料比较,差异均无统计学意义(均P＞0.05).两组均成功进行了环肺静脉电隔离,术后均为窦性心律.一站式组患者均成功置入Watchman封堵器,在3个月的经食管超声心动图随访中1例患者出现器械相关血栓.在12个月的随访中,一站式组出现2例出血事件,射频消融组1例患者在房颤消融后3个月出现脑出血.两组术后不良事件的发生率比较,差异均无统计学意义(均P＞0.05).Kaplan-Meier生存曲线显示,在3个月的空白期内,两组的早期事件发生率比较,差异无统计学意义(P=0.224);在12个月的随访中,一站式组房颤复发率与射频消融组相比,差异无统计学意义(27.7％比24.6％,P=0.984).多因素Cox回归分析显示,在空白期(HR 1.44,95％CI 0.72～2.86,P=0.300)或长期随访期(HR 0.95,95％CI 0.47～1.90,P=0.876)均没有确定不同术式与早期事件及房颤复发之间的关联.结论 射频消融及Watchman左心耳封堵一站式手术治疗房颤是安全有效的,但在射频消融的基础上,加行左心耳封堵对持续性房颤的消融复发率并无影响.

Objective:To explore the effectiveness and safety of intracardiac echocardiography(ICE)guidance of combined catheter ablation and left atrial appendage occlusion(LAAO, one-stop procedure)for atrial fibrillation(AF)to simulate and replace traditional transesophageal echocardiography(TEE)image.Methods:In this prospective study, patients with non-valvular atrial fibrillation(NVAF)in The First Department of Cardiology, The Second Hospital of Hebei Medical University from April 2018 to April 2021 who received one-stop procedure were sequentially enrolled, and matched with a propensity score of 1∶2, respectively receiving XR-Star technique(ICE group)and traditional TEE assisted treatment(TEE group). The differences in intraoperative parameters(such as procedure time, fluoroscopy radiation dose, etc.), peridevice leakage(PDL), device-related thrombosis, device displacement and recurrence in 1-year follow-up were compared between the two groups.Results:A total of 165 patients were included, 46 in the ICE group, aged(63.70±7.16)years, 26 males; and 92 patients in TEE group, aged(63.27±7.81) years, 49 males.①There was no significant difference in successful rate of first device chosen between the two groups(84.78% vs.91.30%, P=0.284). ②Compared with TEE group, the total procedure time of ICE group [(160.62±23.20) min vs.(177.72±19.53) min, P < 0.001], fluoroscopy radiation dose [(172.84±46.49) mGy vs.(253.98±99.76) mGy, P < 0.001], LAAO procedural time [(36.03±11.37) min vs.(47.60±15.56) min, P=0.001], LAAO fluoroscopy radiation dose [(124.85±41.01) mGy vs.(198.83±84.57) mGy, P < 0.001] and contrast usage [(100.00±26.52) ml vs.(152.26±49.70) ml, P < 0.001] were significantly lower than those in TEE group.③The measurements of left atrial appendage(LAA)in ICE group were larger than that in TEE especially at 135° [(21.32±3.42) mm vs.(19.26±4.01) mm, P=0.027]. The measured value of ICE 135° was significantly correlated with LAA measurements under fluoroscopy(Person correlation coefficient r=0.83, P<0.000 1 for two-tailed test). ④There was no significant difference in the incidence of PDL between the two groups immediately after occlusion and 3 months after procedure(10.87% vs.14.13%, P=0.592; 19.56% vs. 22.83%, P=0.661). After 3 months, 1 patient in ICE group had 3 mm PDL, and 3 patients in TEE group had (3.2±0.3) mm PDL.One year after procedure, PDL in ICE group decreased to 1.8 mm, while 3 mm PDL was still present in 1 case of TEE group.⑤No serious complications such as pericardial effusion, stroke, massive hemorrhage or device dislocation occurred in both groups, and 1 patient in TEE group was found to have device-related thrombosis. Conclusion:ICE-guided one-stop procedure based XR-Star technology was effective and safe, which can significantly reduce the procedure time and radiation exposure.The measurements obtained by ICE of LAA ostium were highly correlated with fluoroscopy, but there was no significant difference in residual shunt ratio comparing with traditional TEE.

Objective. Long non-coding RNAs (lncRNAs) play many important roles in gene regulation and disease pathogenesis. Here, we sought to determine that mitochondrial dynamic related lncRNA (MDRL) modulates NLRP3 inflammasome activation and apoptosis of vascular smooth muscle cells (VSMCs) and protects arteries against atherosclerosis. Methods. In vivo experiments, we applied LDLR knockout (LDLR-/-) mice fed the high-fat diet to investigate the effects of MDRL on atherosclerosis. In vitro experiments, we applied mouse aortic smooth muscle cells to determine the mechanism of MDRL in abrogating NLRP3 inflammasome and inhibiting cell apoptosis through miR-361/sequentosome 1 (SQSTM1) by TUNEL staining, quantitative RT-PCR, western blot, microribonucleoprotein immunoprecipitation, and luciferase reporter assay. Results. Downregulated MDRL and increased NLRP3 were observed in mouse atherosclerotic plaques, accompanied with the increase of miR-361. The results showed that MDRL overexpression significantly attenuated the burden of atherosclerotic plaque and facilitated plaque stability through inhibiting NLRP3 inflammasome activation and cell apoptosis, and vice versa. Mechanically, MDRL suppressed NLRP3 inflammasome activation and VSMC apoptosis via suppressing miR-361. Furthermore, miR-361 directly bound to the 3'UTR of SQSTM1 and inhibited its translation, subsequently activating NLRP3 inflammasome. Systematic delivery of miR-361 partly counteracted the beneficial effects of MDRL overexpression on atherosclerotic development in LDLR-/- mice. Conclusions. In summary, MDRL alleviates NLRP3 inflammasome activation and apoptosis in VSMCs through miR-361/SQSTM1/NLRP3 pathway during atherogenesis. These data indicate that MDRL and inhibition of miR-361 represent potential therapeutic targets in atherosclerosis-related diseases.

目的:对于经皮左心耳封堵术后的患者,指南推荐进行短期口服抗凝治疗,但许多患者由于有抗凝禁忌而接受抗血小板治疗.本研究旨在比较经皮左心耳封堵术后短期口服抗凝治疗与抗血小板治疗的有效性和安全性.方法:检索PubMed、Embase、Cochrane Library、中国知网数据库中2002年1月至2021年11月以经皮左心耳封堵术后接受短期口服抗凝治疗或抗血小板治疗的患者为研究对象及以器械相关血栓、脑卒中、大出血为研究终点的研究.分别采用Jadad评分量表和纽卡斯尔-渥太华量表(NOS)对纳入的随机对照研究和观察性研究进行质量评价.采用RevMan 5.3软件进行Meta分析.结果:最终纳入15项研究,其中随机对照研究1项,观察性研究14项(包括10项前瞻性队列研究和4项回顾性研究);共纳入5500例患者,其中3215例接受抗血小板治疗,2285例接受口服抗凝治疗.Meta分析结果显示:经皮左心耳封堵术后短期抗血小板治疗和口服抗凝治疗在器械相关血栓(OR=1.34,95％CI:0.91～1.97,P=0.14)、脑卒中(OR=1.27,95％CI:0.75～2.16,P=0.36)、大出血(OR=1.26,95％CI:0.92～1.74,P=0.15)发生风险方面的差异均无统计学意义.排除接受单联抗血小板治疗的患者后,双联抗血小板治疗与口服抗凝治疗在上述终点事件发生风险方面的差异也均无统计学意义(P均>0.05).结论:在经皮左心耳封堵术后接受短期口服抗凝治疗和抗血小板治疗的患者中,器械相关血栓、脑卒中、大出血发生风险均相似.

Objective The present study aimed to investigate whether different preoperative left atrial appendage emptying speeds (LAAEVs) have an effect on left atrial function in patients with sinus arrhythmia after left atrial appendage closure (LAAC) combined with catheter ablation (CA). Methods A total of 163 patients with persistent non-valvular atrial fibrillation who received combined LAAC+CA surgery were included in the present study. Regular follow-up was conducted for 12 months, and patients with complete data and successful sinus rhythm recovery were selected as the study subjects ( n = 82). The patients were divided into two groups: the LAAEV < 25 cm/s group and the LAAEV ≥ 25 cm/s group ( n = 41 each). The propensity score was used for matching according to gender, age, CHA 2 DS 2 -VASc score, and HAS-BLED score. The changes in the two groups in LA structure, storage function, conduit function, and pump function were compared. Results Before surgery, the maximum LA volume (LAV max ) and minimum LA volume (LAV min ) were greater in the LAAEV < 25 cm/s group than in the LAAEV ≥ 25 cm/s group. The LA storage function (eg. Ƹ and SRs), conduit function (eg. SRe), and pump function (eg. SRa) were all worse in the LAAEV < 25 cm/s group than in the LAAEV ≥ 25 cm/s group. After the combined LAAC+CA surgery, the LA storage, conduit, and pump functions improved in both groups. At 12 months after surgery, there were no statistically significant differences between the two groups. Conclusion Before combined LAAC+CA surgery, the LA structure and function of the LAAEV < 25 cm/s group were worse than those of the LAAEV ≥ 25 cm/s group. However, after LAAC+CA surgery, the LA structure and function of the patients were improved, and there were no significant differences between the two groups. Inferred improvement in LA structure and function in the LAAEV < 25 cm/s group was superior to that in the LAAEV ≥ 25 cm/s group.

Abstract Objective: Our aim for this study was to develop a model using clinical, laboratory and echocardiographic factors, in addition to CHA2DS2-VASC score, to increase predictability of AF related stroke in patients with non-valvular atrial fibrillation (NVAF).Methods: We retrospectively analyzed the medical history, clinical characteristics, laboratory and echocardiographic data of 373 patients with NVAF.Results: In multiple logistic regression, CHA2DAS2 VASC score (OR 1.22 (95%CI 1.04-1.43), P=0.016), anion gap (OR 1.19 (95%CI 1.08-1.30), P < 0.001), e-peak deceleration time （EDT） (OR 1.01 (95%CI 1.00-1.01), P=0.001) and the left atrial appendage emptying rate （LAAEV） (OR 0.99 (95%CI 0.97-0.99), P=0.013) were risk factors for predicting stroke in NVAF patients. For patients with low CHA2DAS2 VASC score, anion gap (OR 1.35 (95%CI 1.03-1.77), P=0.028) and EDT (OR 1.01 (95%CI 1.00-1.02), P=0.043) were associated with stroke.Receiver operating characteristic (ROC) curve showed that area under curve (AUC) is 11% higher in the model including anion gap, EDT， LAAEV and CHA2DS2-VASc score, compared to only using CHA2DS2-VASc score as predictor (0.70 (95%CI 0.64-0.75) vs 0.59 (95%CI 0.54-0.65)).Conclusions: Our study showed that incorporating anion gap, EDT and LAAEV into CHA2DS2-VASC score increases the ability to predict atrial fibrillation related stroke.

Background. The combined procedure of left atrial appendage closure (LAAC) and catheter ablation (CA) is a safe and feasible therapy to treat patients with atrial fibrillation (AF). However, the effect of the combined procedure on cardiac function remains unclear. This study aimed to investigate the changes in endocrine and mechanical function of the heart following the combined procedure. Methods. This retrospective study included 62 consecutive patients who underwent the combined procedure of AF ablation and WATCHMAN LAAC and 62 sex and age-matched patients who only received AF ablation. During follow-up, patients were examined for brain natriuretic peptide (BNP) levels to represent endocrine cardiac function. Mechanical cardiac function was assessed during echocardiographic examination by means of the LA ejection fraction, LA strain (Ƹ), and LA strain rate (SR). Results. (1) The BNP levels decreased acutely after the procedure, rose at day 3 postoperation, but trended downwards at 3 months postoperation in both groups. No significant difference was observed between the two groups. (2) LA ejection fraction, LA Ƹ, and SR exhibited a continuous upward trend over a 3-month follow-up in both groups. There was no significant difference in LA ejection fractions, SRe (the parameter of LA conduit function), and SRa (the parameter of LA booster pump function) between the two groups. However, the Ƹ and SRs (the parameters of LA reservoir function) improved in patients treated with CA alone. Conclusions. The combined procedure of LAAC and CA significantly improved the endocrine and mechanical function of the heart. Compared to simple CA, based on CA with LAAC intervention, it does not significantly change LA endocrine function but may lead to a decline in the LA reservoir function.

BACKGROUND:Catheter ablation has emerged as a major strategy for paroxysmal atrial fibrillation (PAF). Atrial electrical remodeling (AER) plays a critical role in the recurrence of PAF after ablation.HYPOTHESIS:To characterize the immediate trends of AER during ablations in patients with PAF, and assess the relationship between immediate trends and recurrence.METHODS:We performed this prospective observational study of 135 patients to investigate AER following three ablation modes: radiofrequency ablation (RFA), cryoablation (CA) and 3D mapping-guided cryoablation (3D-CA). The atrial effective refractory period (AERP) and atrial conduction time (ACT) were measured via electrophysiology before and immediately after ablation, and P-wave indices were measured via electrocardiography before and within 24 h after ablation. Follow-up visits were conducted for at least 1 year or until relapse.RESULTS:Different approaches of ablation caused a fairly significant increase in the shortest P-wave duration and AERP in both the proximal coronary sinus (PCS) and distal coronary sinus (DCS) but caused a shortened P-wave dispersion. No different effect was found at the AERP among the three modes. Compared to patients who received CA, among patients who received RFA, a significant reduction in total ACT and right ACT was seen. Statistically, there was a weakly positive association between changes in total ACT and early recurrence.CONCLUSIONS:Injury during ablation for PAF was associated with an increase in the AERP but not in the ACT. Total ACT and right ACT were shorter after RFA than after CA. The increase in total ACT were slightly predictive of early recurrence.

目的:探讨纤维蛋白原(Fib)与非瓣膜性心房颤动(NVAF)患者左心耳血栓状态(LAATM)之间的相关性.方法:连续入选2016年1月—2020年1月于河北医科大学第二医院心内科符合标准的NVAF患者696例,根据术前经食管超声心动图结果将患者分为LAATM组(88例)和无LAATM组(608例).采用单因素及多因素logistic回归分析Fib是否与NVAF患者LAATM具有相关性,并利用受试者工作特征(ROC)曲线评估Fib对于判断是否存在LAATM的效能.结果:与无LAATM组相比,LAATM组的年龄、舒张压、心率、心房颤动类型、心房颤动病史＞1年、饮酒、高血压、心力衰竭、脑卒中、CHA2DS2-VASc、D-二聚体、Fib、脑钠肽(BNP)、中性粒细胞/淋巴细胞比值(NLR)、左心耳排空速度、e'、左房直径、左室收缩末期容积、左室射血分数经单因素分析,其差异有统计学意义(P＜0.05).且LAATM组患者的Fib水平高于无LAATM组(P＜0.001).多因素回归分析显示Fib仍是NVAF患者LAATM的独立危险因素(OR =2.23,95％CI1.297～3.833,P=0.004).ROC曲线下面积为0.63(95％CI0.56～0.70,P＜0.001);当Fib=2.825 g/L时,患者可能存在LAATM(敏感度为77.27％,特异度为44.74％).结论:在NVAF患者中,Fib是存在LAATM的独立危险因素,在评估LAATM是否存在时,Fib具有一定参考价值.