Atherosclerosis (AS) is a chronic inflammatory disease that underlies major cardiovascular disorders and necessitates early intervention. Central to its pathogenesis is reactive oxygen species-driven inflammation, which exacerbates plaque formation and progression. An ideal therapeutic strategy should simultaneously resolve lipid accumulation and suppress inflammatory pathways to restore homeostasis in the lesional microenvironment. Recently, the proliferation-inducing ligand (APRIL) has emerged as a promising therapeutic target for attenuating atherosclerotic plaque development. Here, we report a cyclodextrin-based, low-toxicity polyhydroxyl cationic vector (cyclodextrin-based ethanolamine-modified poly(glycidyl methacrylate), CD-PGEA-CD), engineered for efficient lipid scavenging and delivery of an APRIL-encoding plasmid (pAPRIL). This integrated nanoplatform (CD-PGEA-CD/pAPRIL) mediates robust APRIL overexpression in vitro concomitant with suppression of key pro-inflammatory cytokines (TNF-alpha and IL-6). In vivo, the system significantly reduced plasma low-density lipoprotein cholesterol (LDL-C) and total cholesterol levels by 40% and 46%, respectively, and achieved near-complete regression of advanced plaques. All-atom molecular dynamics simulations elucidated the strong cholesterol-binding affinity of the platform, demonstrating its superior lipid-clearing efficiency through selective cholesterol sequestration and enhanced membrane interaction dynamics. Together, these findings establish a molecular-to-tissue therapeutic paradigm offering a safe and effective strategy for the treatment of AS.

AIMS:Though pulsed-field ablation (PFA) has demonstrated an excellent safety profile in reducing collateral injury to the oesophagus and phrenic nerve, it is still associated with specific effects, including electrode heating, haemolysis, and electrolysis due to excessive energy dispersion. This study aims to assess whether saline irrigation during PFA application could mitigate these risks. METHODS AND RESULTS:To comprehensively evaluate the effect of irrigation with the variable-loop circular catheter (VLCC), the following experiments were performed: (i) ex-vivo potato model: to evaluate the lesion depth, bubble formation, and thermal effects in different irrigation regimens; (ii) in vitro blood pool and cardiac ablation: to determine the haemolysis status and tissue temperature change after PFA; (iii) in vivo swine ablation (n = 8), and (iv) clinical randomized trial (n = 25): to compare the efficacy and safety profile between low (4 mL/min) and high (30 mL/min) flow irrigation using the VLCC. Though peak core temperatures at 5 mm depth were all < 50°C under low- and high-irrigation, high irrigation significantly mitigated the instant electrode and deep tissue heating both in the potato and isolated cardiac models. Ex vivo potato slices showed that high-flow irrigation produced the deepest lesion sets when compared to low-flow irrigation (5.94 ± 0.29 mm vs. 5.36 ± 0.33 mm, P = 0.043). Assessment from a high-speed camera and bubble detector demonstrated that high-flow irrigation significantly reduced the total number of gaseous bubbles (54.50 IQR 53.00-56.75 vs. 82.00 IQR 72.00-83.00, P < 0.001) and eliminated the occurrence of larger bubbles. The high-flow irrigation group showed a smaller increase in the level of free haemoglobin immediately after the procedure across the blood pool, swine, and clinical models. Haptoglobin and lactate dehydrogenase levels were also attenuated by high irrigation in the in vivo swine model and clinical trial. One swine in the low-irrigation group developed an acute cerebral lesion (3 mm). The clinical trial confirmed that the incidence of silent cerebral lesions was significantly lower in the high-flow irrigation group (16.7% vs. 66.7%, P = 0.036). CONCLUSION:Proper saline irrigation during PFA with VLCC may mitigate electrode-associated haemolysis, reduce electrode and tissue temperature, limit bubble aggregation, and be associated with a lower incidence of silent cerebral lesions, the clinical significance of which remains unclear.

Aim: To evaluate the long-term impact of obstructive sleep apnea (OSA) risk profile on atrial fibrillation (AF) recurrence after catheter ablation in patients with paroxysmal AF. Methods: This prospective study enrolled 161 patients with paroxysmal AF undergoing initial ablation. Patients were stratified by the Berlin Questionnaire (BQ) into high-risk (n = 94) and low-risk (n = 67) OSA groups. Atrial tachyarrhythmias occurring within the initial three months were defined as early recurrence, whereas recurrence beyond three months was defined as late recurrence. A subgroup of 71 patients with recurrence underwent a redo ablation. Results: After 16.1 ± 0.4 years, multivariable models revealed that a BQ-defined high OSA risk was independently associated with early recurrence (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.02-3.86, P = 0.043), whereas it was not independently associated with late recurrence after the initial procedure (hazard ratio [HR] 1.05, 95%CI: 0.70-1.57, P = 0.810). Cox regression identified early recurrence (HR 2.95, 95%CI: 1.99-4.39, P < 0.001) and baseline high-sensitivity C-reactive protein (hs-CRP; HR 1.02, 95%CI: 1.00-1.03, P = 0.022) as independent predictors of late recurrence after the initial procedure. Following redo ablation, early recurrence remained a strong independent predictor (HR 5.93, 95%CI: 2.13-16.50, P < 0.001). Conclusions: The BQ-defined high OSA risk was an independent predictor of early recurrence; however, it was not significantly associated with late recurrence after AF ablation. Early recurrence was the strongest predictor of long-term outcome, highlighting the importance of management during the post-procedural blanking period.

BACKGROUND:Tumor necrosis factor superfamily 14 (TNFSF14) has been implicated in the pathogenesis of cardiovascular disease, including atrial fibrillation (AF). However, its role in predicting AF recurrence after catheter ablation (CA) remains unexplored. OBJECTIVE:This study aimed to evaluate the predictive value of TNFSF14 for AF recurrence post-ablation. METHODS:A total of 263 AF patients undergoing CA were enrolled and stratified into two groups based on AF recurrence during a mean follow-up of 363 ± 144 days. Plasma TNFSF14 levels were measured by enzyme-linked immunosorbent assay (ELISA). Cox proportional hazards models were employed to examine the association between TNFSF14 levels and AF recurrence, while Receiver Operating Characteristic (ROC) analysis was used to assess predictive performance. RESULTS:AF recurrence occurred in 81 patients (30.8%). Patients with recurrence exhibited significantly higher baseline TNFSF14 levels (1.21 ± 0.24 vs. 1.02 ± 0.29 ng/mL, p < 0.001). Elevated TNFSF14 levels were independently associated with AF recurrence (Adjusted hazard ratio (aHR): 3.65, 95% CI: 2.19-6.09, p < 0.001). ROC analysis demonstrated moderate predictive power for TNFSF14 (AUC: 0.70). Incorporating TNFSF14 levels into the ATLAS score and BNP significantly enhanced the predictive performance for recurrence, as evidenced by improved time-dependent AUC, decision curve analysis, net reclassification improvement (NRI: 0.36, p < 0.001) and integrated discrimination improvement (IDI: 0.08, p = 0.012). CONCLUSIONS:TNFSF14 is a promising biomarker for predicting AF recurrence after CA. It holds potential for inclusion in future personalized risk models for AF recurrence.

AIMS:Refractory ventricular tachycardia (VT) is a rare but lethal condition in the early phase of acute myocardial infarction (AMI). Its intracardiac mechanism and role of catheter ablation is under-determined. The current study aims to evaluate the feasibility and safety of catheter ablation for refractory ventricular tachycardia in early AMI. METHODS AND RESULTS:Between 2022 and 2024, 12 835 consecutive patients with AMI were screened, and VT/ventricular fibrillation (VF) was developed in 261 (2.0%) patients; among them 51 (19.5%) were identified as refractory VT storm necessitating intensive intervention, and finally 19 patients received bailout ablation for incessant VT. Their clinical and electrophysiological characteristics and outcomes were collected and analysed. For these, 19 patients underwent rescue ablation, VT was developed at a median of 4 days after the onset of AMI and became incessant 2 days after the first VT occurrence, despite revascularization, anti-arrhythmic agents, sedation, and haemodynamic support. Through intracardiac mapping, VTs were all identified as scar-related reentry within the territory of the culprit artery. The endocardial mappable cycle length (CL) was 65.3 ± 7.6% to the total CL. Energy delivery at either component of critical isthmus from the endocardium successfully eliminated VT, and no foci trigger was observed after VT termination. Subsequent substrate modification was performed around the termination site. After the index procedure, recurrent sustained VT was documented in two, and one patient received repeated ablation. After a total of 20 procedures, VTs were all well subsided after the index procedure in all except for one patient who died of cerebral haemorrhage. The remaining patients were discharged alive. After a median of 18-month follow-up, one patient developed recurrent VF, and no sudden cardiac death occurred. CONCLUSION:Scar-related reentry is responsible for refractory VT early after AMI, and ablation at critical isthmus is effective in VT suppression. Its indication and optimal timing of catheter ablation should be evaluated in prospective analysis.

Background and aims:Emerging evidence indicates a relationship between low-density lipoprotein cholesterol (LDL-C) levels and bleeding. However, data regarding the relationship between LDL-C levels and bleeding events in patients with atrial fibrillation (AF) remain unfilled. This study is aimed to examine the relationship between LDL-C levels and the risk of in-hospital bleeding in patients with AF. Methods and results:In this multi-centered observational study, 25,380 patients with AF were enrolled; 14,071 (55.4%) and 11 309 (44.6%) were men and women, respectively, and the mean age was 69.51 ± 11.88 years. After adjusting for covariates, with LDL-C ≥ 70 mg/dl as the reference, LDL-C < 70 mg/dl was associated with a higher risk of any bleeding event [adjusted odds ratio [aOR]: 1.63, 95% confidence interval [CI]: 1.12-2.35; P = 0.009], major bleeding events (aOR: 1.48, 95% CI: 0.99-2.20; P = 0.05), and gastrointestinal bleeding events (aOR: 2.11, 95% CI: 1.27-3.50; P = 0.004) in the multivariate logistic regression model. The restricted cubic spline model showed an L-shaped relationship for bleeding events, with a higher risk at lower LDL-C levels. The nonlinear relationship between LDL-C levels and the risk of bleeding persisted among the subgroups. Conclusions:This nationwide and multi-centered AF registry study found an L-shaped relationship between LDL-C levels at admission and in-hospital bleeding events, with a greater risk at lower LDL-C levels. Further studies are needed to establish LDL-C as a factor for risk stratification and management of bleeding events in patients with AF. Clinical Trial Registration:[http://www.clinicaltrials.gov], identifier [NCT02309398].

AIMS:Steam pops present a significant concern during radiofrequency (RF) ablation of atrial fibrillation (AF). It is crucial to analyse the incidence and ablation characteristics associated with steam pops. This study aims to investigate the occurrence and potential predictors of steam pops. METHODS AND RESULTS:This study included 3263 patients with AF who underwent RF ablation. Patients with paroxysmal AF received bilateral circumferential pulmonary vein (PV) ablation, while those with persistent AF underwent additional linear ablation. The ablation parameters at the sites of steam pops were compared to those at adjacent anatomical locations. A total of 81 steam pops (2.5%) with one pericardial tamponade were recorded. Steam pops were observed at liner ablation sites: 6 (0.4%) at the mitral isthmus, 16 (0.9%) at the tricuspid isthmus (CTI), and 7 (0.5%) along the roofline. The most common sites of steam pops were the anterior edge of the left superior PV and the inferior vena cava side of the CTI. The impedance drop was significantly higher (18.2 ± 9.5 Ω vs. 13.5 ± 4.8 Ω, P < 0.001) at steam pop sites. The optimal cut-off points of impedance drop for predicting steam pops were > 9.5 Ω within the first 3 s, > 10.5 Ω within the first 5 s, > 13.5 Ω within the first 10 s, and > 18.5 Ω in the whole ablation, respectively. CONCLUSION:The incidence of steam pops during ablation of AF is infrequent. Impedance drop is the only ablation parameter that could predict the occurrence of steam pops.

Background Studies on catheter ablation of hypertrophic cardiomyopathy (HCM)- ventricular tachycardia (VT) are relatively limited and mainly focused on feasibility and safety, whereas the VT distribution and electrophysiological properties remain insufficiently characterized. Objectives The aim of this study was to detail the site-specific electrophysiological properties and ablation outcomes in HCM-VT. Methods A total of 32 patients with HCM-VT who underwent catheter ablation were included. Through endocardial and epicardial mapping, their arrhythmogenic substrate and re-entrant circuit were identified and analyzed. Results Combined endocardial/epicardial mapping was performed in 29 of the 32 patients. Twenty-eight VTs were induced among 25 patients, including 25 scar-mediated re-entries, 2 focal origins, and one bundle branch re-entry. Twenty-five re-entries were localized to the left ventricular (LV) lateral wall (9 of 25), apical aneurysm (6 of 25), superior basal regions (8 of 25), interventricular septum (1 of 25), and papillary muscle (1 of 25), respectively. Incomplete activation sequences were recorded across regions: LV lateral wall (epicardium: 54.3% ± 11.7%; endocardium: 35.9% ± 15.5%), apical aneurysm (endocardium: 40.3% ± 25.0%; epicardium: 32.7% ± 22.6%), and superior basal regions (endocardium: 25.5% ± 7.7%; epicardium: 27.2% ± 11.4%). Over a median follow-up of 31 months, the long-term VT-free survival rate after the index procedure was 73.3% in the LV lateral wall, 83.3% in the apical aneurysm, and 0% in the LV superior basal region and septum, which was consistent with the extent of mid-myocardial involvement. The VT-free survival rate after multiple procedures was 71.9% in all patients. Conclusions HCM-VTs were primarily three-dimensional re-entrant circuits with mid-myocardial involvement. Procedural success largely depended on the origin and extent of intramural involvement of VT re-entry.

BACKGROUND:Although the electrocardiographic and electrophysiological properties of ventricular arrhythmias (VAs) from the vicinity of the lateral tricuspid annulus (TA) have been reported in previous studies, their precise site of origin have not been addressed. OBJECTIVE:The purpose of this study was to describe the precise origin of lateral TA-VA and the relevant anatomy. METHODS:Consecutive patients with idiopathic lateral TA-VAs were reviewed and analyzed. Three-dimensional mapping system combined with intracardiac echocardiography (ICE) was used for anatomic reconstruction, mapping, and ablation. RESULTS:During the study period, 63 patients with lateral TA-VAs were included. Under ICE view, a prominent enfoldment structure was observed under the valve along the lateral TA. The muscular bundle was documented in all patients (100%) within the subvalvular enfoldment with an average number and diameter of 4 ± 2 and 4.10 ± 0.73 mm, respectively. Initial ablation was attempted via the anterograde approach in 15 patients but succeeded in none. To reach the ventricular side of the TA, the catheter needed to enter the ventricular chamber and retroflexed toward the atrial side with a reverse curve. The earliest activation site was found at the valvular end of muscular bundles in 51 of the 63 patients (80.9%) with a local activation time of -26.78 ± 4.63 ms. The VAs were eliminated after an average of 4 ± 2 seconds of ablation. CONCLUSION:The ventricular side adjacent to the lateral TA exhibits a subvalvular enfoldment-like structure, which is rich in muscular bundles and serves as the origin of TA-VAs in most patients. To reach the origins, a reverse technique is required.

AbstractAimsFascicular ventricle tachycardia (FVT) arising from the proximal aspect of left His-Purkinje system (HPS) has not been specially addressed. Current study was to investigate its clinical, electrocardiographic, and electrophysiological characteristics.Methods and resultsEighteen patients who were identified as this rare FVT were consecutively enrolled, and their scalar electrocardiogram and electrophysiological data were collected and analysed. The ventricular tachycardia (VT) morphology was similar to sinus rhythm (SR) in eight patients, left bundle branch block type in one patient, right bundle branch block type in seven patients, and both narrow and wide QRS type in two patients. During VT, right-sided His potential preceded the QRS with His-ventricle (H-V) interval of 36.3 ± 12.4 ms, which was shorter than that during SR (−51.4 ± 8.6 ms) (P = 0.002). The earliest Purkinje potentials (PPs) were recorded within 7 ± 3 mm of left-side His and preceded the QRS by 49.1 ± 14.0 ms. Mapping along the left anterior fascicle and left posterior fascicle revealed an antegrade activation sequence in all with no P1 potentials recorded. In the two patients with two VT morphologies, the earliest PP was documented at the same site, and the activation sequence of HPS remained antegrade. Ablation at the earliest PP successfully eliminated the tachycardia, except one patient who developed complete atrial-ventricular block and two patients who abandoned ablations. After at least 12 months follow-up, 15 patients were free from any recurrences.ConclusionsFascicular ventricle tachycardia arising from the proximal aspect of left HPS was featured by recording slightly shorter H-V interval and absence of P1 potentials. Termination of VT requires ablation at the left-sided His or its adjacent region.

BACKGROUND:Oral anti-coagulants (OAC) are the intervention for the prevention of stroke, which consistently improve clinical outcomes and survival among patients with atrial fibrillation (AF). The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China. METHODS:Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation (CCC-AF) registry, guideline-recommended OAC use in eligible patients was assessed. RESULTS:A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019, of whom 38,203 were at a high risk of stroke, 9717 were at a moderate risk, and 4610 were at a low risk. On admission, only 20.0% (6075/30,420) of patients with a diagnosed AF and a high risk of stroke were taking OAC. The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population (adjusted odds ratio: 0.54, 95% confidence interval: 0.43-0.68; P <0.001). At discharge, the prescription rate of OAC was 45.2% (16,757/37,087) in eligible patients with high stroke risk and 60.7% (2778/4578) in eligible patients with low stroke risk. OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time (all P <0.001). Multivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies, including catheter ablation (adjusted odds ratio [OR] 11.63, 95% confidence interval [CI] 10.04-13.47; P <0.001), electronic cardioversion (adjusted OR 2.41, 95% CI 1.65-3.51; P <0.001), and anti-arrhythmic drug use (adjusted OR 1.45, 95% CI 1.38-1.53; P <0.001). CONCLUSIONS:In hospitals participated in the CCC-AF project, >70% of AF patients were at a high risk of stroke. Although poor performance on guideline-recommended OAC use was found in this study, over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration:ClinicalTrials.gov, NCT02309398.

AIMS:The electrocardiographic and electrophysiological characteristics of ventricular arrhythmia (VA) arising from the intramural basal inferior septum (BIS) have not been specifically addressed to date. The aim of the current study was to characterize intramural BIS-VA and distinguish it from those with endocardial origins besides clarifying the anatomical configurations of the pyramidal space. METHODS AND RESULTS:Fifty-five consecutive patients undergoing catheter ablation of VAs from BIS were identified and divided into three groups: the left ventricular (LV)-BIS group (n = 28), right ventricular (RV)-BIS group (n = 8), and intramural group (Intra, n = 19). Compared with the LV-BIS and RV-BIS groups, patients in the Intra group presented with no adequate earliest activation time at the two-sided BIS and epicardial coronary system [right: 7.79 ± 2.38 vs. left: 7.16 ± 2.59 vs. the middle cardiac vein (MCV): 6.26 ± 1.73 ms, P = 0.173] and poor-matched pacing-produced QRS at each site. Under the intracardiac echocardiography view, the pyramidal base was the broadest part of the septum and served as the division of the two-sided BIS. Focal ablation yielded promising acute-term and long-term procedural success in the LV-BIS and RV-BIS groups. But for the Intra group, VAs disappeared only after stepwise ablation successively targeted early preferential exit. After follow-up, three patients in the Intra group had recurrent VA, and all of them were treated well by a redo procedure or drug therapy. CONCLUSION:Intramural VAs were relatively common in the BIS region in our series. Intra-procedural mapping was important to distinguish the intramural VAs from other VAs by comparing the local activation time and pacing mapping. Procedural success could be achieved by stepwise ablation on the counterpart sides of the BIS and within the MCV.

Abstract Aims The clinical correlates and outcomes of asymptomatic atrial fibrillation (AF) in hospitalized patients are largely unknown. We aimed to investigate the clinical correlates and in-hospital outcomes of asymptomatic AF in hospitalized Chinese patients. Methods and results We conducted a cross-sectional registry study of inpatients with AF enrolled in the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation Project between February 2015 and December 2019. We investigated the clinical characteristics of asymptomatic AF and the association between the clinical correlates and the in-hospital outcomes of asymptomatic AF. Asymptomatic and symptomatic AF were defined according to the European Heart Rhythm Association score. Asymptomatic patients were more commonly males (56.3%) and had more comorbidities such as hypertension (57.4%), diabetes mellitus (18.6%), peripheral artery disease (PAD; 2.3%), coronary artery disease (55.5%), previous history of stroke/transient ischaemic attack (TIA; 17.9%), and myocardial infarction (MI; 5.4%); however, they had less prevalent heart failure (9.6%) or left ventricular ejection fractions ≤40% (7.3%). Asymptomatic patients were more often hospitalized with a non-AF diagnosis as the main diagnosis and were more commonly first diagnosed with AF (23.9%) and long-standing persistent/permanent AF (17.0%). The independent determinants of asymptomatic presentation were male sex, long-standing persistent AF/permanent AF, previous history of stroke/TIA, MI, PAD, and previous treatment with anti-platelet drugs. The incidence of in-hospital clinical events such as all-cause death, ischaemic stroke/TIA, and acute coronary syndrome (ACS) was higher in asymptomatic patients than in symptomatic patients, and asymptomatic clinical status was an independent risk factor for in-hospital all-cause death, ischaemic stroke/TIA, and ACS. Conclusion Asymptomatic AF is common among hospitalized patients with AF. Asymptomatic clinical status is associated with male sex, comorbidities, and a higher risk of in-hospital outcomes. The adoption of effective management strategies for patients with AF should not be solely based on clinical symptoms.

BACKGROUND:Due to the anatomically adjacent relationship between the left atrium (LA) and esophagus, energy delivery on the posterior wall of LA is limited. The aim of this study was to evaluate the feasibility of a novel esophageal retractor (SAFER) with an inflatable C-curve balloon during atrial fibrillation (AF) ablation. METHOD:Nine patients underwent AF ablation assisted with the SAFER. After inflation, the esophagus was deviated laterally away from the intended ablation site of the posterior wall under local anesthesia. The extent of mechanical esophageal deviation (MED) was evaluated under fluoroscopy, defined as the shortest distance from the trailing esophageal edge to the closest point of the ablation line. Gastroscopy was performed before and after ablation. The target ablation index used in all LA sites including the posterior wall was 400-450 after effective MED. All adverse events during the periprocedural period were recorded. RESULTS:The mean deviation distance achieved 16.2 ± 9.6 mm away from the closest ablation point of the pulmonary vein lesion set. With respect to the individual left and right pulmonary vein lesion sets, the deviation distance was 19.7 ± 11.5 and 12.7 ± 6.8 mm, respectively. The extent of deviation was 0 to 5 mm, 5.1 to 10 mm, or >10 mm in 0(0%), 7(38.9%), and 11(61.1%), respectively. Procedural success was achieved in all patients without acute reconnection. There was only one esophageal complication which manifested as esophageal erosion and this patient experienced throat pain possibly related to the SAFER retractor with no clinical sequelae. CONCLUSION:Esophageal deviation with the novel eccentric balloon is a novel feasible choice during AF ablation, enabling adequate energy delivery to the posterior wall of LA. Additional prospective randomized controlled studies are required for further validation.

Objective:To investigate the intracardiac electrophysiological properties of ventricular tachycardia (VT) only involving the right ventricular epicardium in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) .Methods:All consecutive ARVC patients with VT receiving catheter ablation in Center of Arrhythmia, Beijing Anzhen Hospital from January 2017 to December 2021 were retrospectively screened. Patients with VT only involved the epicardium were included for further analysis. The demographic, intracardiac electrophysiology intraprocedural, and follow-up data were collected.Results:Nineteen patients (male in 7, female in 12) were included, with mean age of (38.1±12.9) years. All patients met the criteria of ARVC, of which 7 patients had prior ablation. Simultaneous endocardial and epicardial activation mapping were completed in 6 patients. The reentrant circuit with full cycle length was recorded in epicardial surface. Substrate mapping was performed in all patients. Low-voltage zone was presented in the epicardial surface with an average area of (26.5±9.6) cm 2. Endocardial myocardium had no abnormal electrogram with bipolar voltage value over 1.5 mV. Homogeneous ablation targeting all delayed and fractioned potential was performed. During follow-up of (22.3±6.7) months, there was no documentation of recurrent VT. Conclusion:In the early stage of ARVC, the reentrant circuit might only harbor in the epicardial aspect. Dry epicardial access is needed to identify the potential arrhythmic substrate.

目的:探讨肥厚型心肌病患者心房颤动导管消融术后早期复发对远期预后的影响.方法:纳入2006年11月至2016年7月,于北京安贞医院行首次房颤导管消融术的肥厚型心肌病患者共91例(阵发性心房颤动/持续性心房颤动:60/31例).消融策略:阵发性心房颤动患者行双侧肺静脉隔离;持续性心房颤动患者行双侧肺静脉隔离加左心房顶、二尖瓣峡部和三尖瓣峡部线性消融.术后定期随访患者的心电图或动态心电图,早期复发定义为导管消融术后3个月内心电图或动态心电图记录的持续时间≥30s的任何类型的房性快速心律失常(房性心动过速/心房扑动/心房颤动).晚期复发定义为3个月后心电图或动态心电图记录的任何类型的≥30s的房性快速心律失常(房性心动过速/心房扑动/心房颤动).根据是否发生早期复发将研究对象分为早期复发组和无早期复发组,观察并记录两组有无晚期复发以及晚期复发的时间以比较两组有无差异.结果:91例心房颤动患者术后共有59例发生晚期复发,其中74.6％(44/59)发生在1年内.共有23(25.3％)例患者发生早期复发,早期复发组其中1例在术后第1个月内发生早期复发,22例在术后第3个月内发生早期复发.发生早期复发的23例患者心动过速呈持续发作,随访过程中未曾转复窦性心律.与无早期复发组相比,早期复发组的晚期复发率显著增高[100％(23/23)vs.52.9％(36/68),Log-Rank P＜0.001].多因素COX回归分析表明,早期复发是晚期复发的独立危险因素(HR=71.43,95％CI:9.71～512.13,P＜0.001).结论:合并肥厚型心肌病的心房颤动患者射频消融术后早期复发与晚期复发有显著相关性,合并肥厚型心肌病心房颤动导管消融术后早期复发鲜有延迟治愈.

Objective:To evaluate the safety and feasibility of catheter ablation in patients with atrial fibrillation(AF) and left atrial appendage(LAA) sludge.Methods:Patients with AF and LAA sludge who underwent catheter ablation were enrolled consecutively from 1st January, 2020 to 1st December, 2021 in Center of Atrial Fibrillation, Beijing Anzhen Hospital.The general clinical data, echocardiographic results, laboratory test results, drug therapy, catheter ablation and left atrial appendage occlusion(LAAO) were collected.Patients were followed up at 3, 6 and 12 months after the procedure by telephone or via outpatient service.We recorded the procedure-related complications both in-hospital and post-discharge, including death, thromboembolism, vascular access complications and so on.Results:Nine patients were included in the study, the average age was (68.8±10.2) years old, and eight were male.Nine patients were all diagnosed with persistent AF.The median duration of AF was 3(1, 5)years.The nine patients all achieved bilateral pulmonary veins electrical isolation and complete block of ablation lines.Among them, five patients underwent synchronous LAAO, there were no residual shunt and device translocations during operation.After a median follow-up of six months, there were no perioperative death, thromboembolism, vascular access complications, cardiac tamponade, atrial-esophageal fistula.Only one patient developed pericardial effusion, which was absorbed spontaneously.Conclusion:It may be safe and feasible for patients with AF and LAA sludge to undergo catheter ablation with/without synchronous LAAO.Further studies with larger patient cohort are warranted to confirm this conclusion.

Abstract Background  Left ventricular thrombus (LVT) is a common complication of dilated cardiomyopathy (DCM), causing morbidity and mortality. Methods  This study retrospectively analyzed patients with DCM from January 2002 to August 2020 in Beijing Anzhen Hospital. Clinical characteristics were compared between the LVT group and the age and sex 1:4 matched with the LVT absent group. The receiver operator characteristic (ROC) curve was plotted to evaluate the diagnostic value of D-dimer predicting LVT occurrence in DCM. Results  A total of 3,134 patients were screened, and LVT was detected in 72 (2.3%) patients on echocardiography. The patients with LVT had higher D-dimer, fibrinogen, and lower systolic blood pressure than those without LVT. The ejection fraction (EF) was lower and left ventricular end-systolic diameter was larger in the LVT group. Severe mitral regurgitation (MR) was more common in the LVT absent groups. The prevalence of atrial fibrillation was lower in the LVT group. The ROC curve analysis yielded an optimal cut-off value of 444 ng/mL DDU (D-dimer units) for D-dimer to predict the presence of LVT. Multivariable binary logistic regression analysis revealed that EF (OR = 0.90, 95% CI = 0.86–0.95), severe MR (OR = 0.19, 95% CI = 0.08–0.48), and D-dimer level (OR = 15.4, 95% CI = 7.58–31.4) were independently associated with LVT formation. Conclusion  This study suggested that elevated D-dimer levels (>444 ng/mL DDU) and reduced EF were independently associated with increased risk of LVT formation. Severe MR could decrease the incidence of LVT.

BACKGROUND:Atrial fibrillation (AF) and stable coronary artery disease (SCAD) frequently coexist.HYPOTHESIS:To investigate the prognosis of catheter ablation versus drug therapy in patients with AF and SCAD.METHODS:In total, 25 512 patients with AF in the Chinese AF Registry between 2011 and 2019 were screened for SCAD. 815 patients with AF and SCAD underwent catheter ablation therapy were matched with patients by drug therapy in a 1:1 ratio. Primary end point was composite of thromboembolism, coronary events, major bleeding, and all-cause death. The secondary endpoints were each component of the primary endpoint and AF recurrence.RESULTS:Over a median follow-up of 45 ± 23 months, the patients in the catheter ablation group had a higher AF recurrence-free rate (53.50% vs. 18.41%, p < .01). In multivariate analysis, there was no significant difference between the strategy of catheter ablation and drug therapy in primary composite end point (adjusted HR 074, 95%CI 0.54-1.002, p = .0519). However, catheter ablation was associated with fewer all-cause death independently (adjusted HR 0.36, 95%CI 0.22-0.59, p < .01). In subgroup analysis, catheter ablation was an independent risk factor for all-cause death in the high-stroke risk group (adjusted HR 0.39, 95%CI 0.23-0.64, p < .01), not in the low-medium risk group (adjusted HR 0.17, 95%CI 0.01-2.04, p = .17).CONCLUSIONS:In the patients with AF and SCAD, catheter ablation was not independently associated with the primary composite endpoint compared with drug therapy. However, catheter ablation was an independent protective factor of all-cause death.