BackgroundAcute pericardial tamponade (APT) is one of the most serious complications of catheter ablation for atrial fibrillation (AF-CA). Direct autotransfusion (DAT) is a method of reinjecting pericardial blood directly into patients through vein access without a cell-salvage system. Data regarding DAT for APT are rare and provide limited information. Our present study aims to further investigate the safety and feasibility of DAT in the management of APT during the AF-CA procedure.Methods and resultsWe retrospectively reviewed 73 cases of APT in the perioperative period of AF-CA from January 2014 to October 2021 at our institution, among whom 46 were treated with DAT. All included patients successfully received emergency pericardiocentesis through subxiphoid access guided by X-ray. Larger volumes of aspirated pericardial blood (658.4 ± 545.2 vs. 521.2 ± 464.9 ml), higher rates of bridging anticoagulation (67.4 vs. 37.0%), and surgical repair (6 vs. 0) were observed in patients with DAT than without. Moreover, patients with DAT were less likely to complete AF-CA procedures (32/46 vs. 25/27) and had a lower incidence of APT first presented in the ward (delayed presentation) (8/46 vs. 9/27). There was no difference in major adverse events (death/disseminated intravascular coagulation/multiple organ dysfunction syndrome and clinical thrombosis) (0/0/1/0 vs. 1/0/0/0), other potential DAT-related complications (fever/infection and deep venous thrombosis) (8/5/2 vs. 5/3/1), and length of hospital stay (11.4 ± 11.6 vs. 8.3 ± 4.7 d) between two groups.ConclusionDAT could be a feasible and safe method to deal with APT during AF-CA procedure.

目的 探讨心房颤动(房颤)合并永久性下腔静脉滤器置入患者经股静脉路径导管消融的可行性与操作策略.方法 纳入首都医科大学附属北京安贞医院自2016年8月至2020年4月接受导管消融的房颤合并永久性下腔静脉滤器置入患者5例.所有患者术前影像学评估滤器和血栓相关情况,术中经股静脉路径行导管消融治疗,术后评估下腔静脉滤器的移位、围术期并发症、术后窦性心律维持情况.结果 5例患者术前影像学评估未发现滤器血栓形成、断裂及移位等情况,均顺利完成导管消融治疗,手术时间为(114.0±21.9)min,X线曝光时间为(8.4±6.5)min,术后未发现滤器明显移位、倾斜.随访19.0(13.5,43.0)个月后,3例患者维持窦性心律,无血栓栓塞、死亡等并发症发生.结论 经充分评估滤器以及优化操作策略后,永久性下腔静脉滤器置入患者经股静脉路径行导管消融安全可行.

Abstract Background Patients with atrial fibrillation (AF) underwent a high risk of hospitalization, which has not been paid much attention to in practice. Therefore, we aimed to assess the incidence, causes and predictors of hospitalization in AF patients. Methods From August 2011 to December 2017, a total number of 20,172 AF patients from the Chinese Atrial Fibrillation Registry (China-AF) Study were prospectively selected for this study. We described the incidence, causes of hospitalization by age groups and sex. The Fine-Gray competing risk model was employed to identify predictors of first all-cause and first cause-specific hospitalization. Results After a mean follow-up of 37.3 ± 20.4 months, 7,512 (37.2%) AF patients experienced one or more hospitalizations. The overall incidence of all-cause hospitalization was 24.0 per 100 patient-years. Patients aged < 65 years were predominantly hospitalized for AF (42.1% of the total hospitalizations); while patients aged 65–74 and ≥ 75 years were mainly hospitalized for non-cardiovascular diseases (43.6% and 49.3%, respectively). We found patients complicated with heart failure (HF)[hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.02–1.18], established coronary artery disease (CAD) (HR 1.24, 95%CI 1.17–1.33), ischemic stroke/transient ischemic attack (TIA) (HR 1.22, 95%CI 1.15–1.30), diabetes (HR 1.14, 95%CI 1.08–1.20), chronic obstructive pulmonary disease (COPD) (HR 1.28, 95%CI 1.02–1.62), gastrointestinal disorder (HR 1.37, 95%CI 1.21–1.55), and renal dysfunction (HR 1.24, 95%CI 1.09–1.42) had higher risks of hospitalization. Conclusions More than one-third of AF patients included in this study were hospitalized at least once during over 3-year follow-up. The main cause for hospitalization among the elderly patients (≥ 65 years) is non-cardiovascular diseases rather than AF. Multidisciplinary management of comorbidities should be advocated to reduce hospitalization in AF patients older than 65 years old. Clinical Registry http://www.chictr.org.cn/showproj.aspx?proj=5831 . Unique identifier: ChiCTR-OCH-13003729. The registration date is October 22, 2013.

INTRODUCTION:Catheter ablation for atrial fibrillation (AF-CA) in patients with situs inversus dextrocardia (SID) can be challenging because of the contrary anatomy and associated anomalies. Cases and literature regarding AF-CA in SID are rare and provide little information. Our study aims to present an improved procedure, ablation strategies, and evaluate the safety and outcomes of AF-CA in patients with AF and SID. METHODS:A total of 10 patients with AF-SID (mean age, 60.4 ± 15.7 years; six paroxysmal AF, four persistent atrial fibrillation [PeAF]) were enrolled. For the improved procedure, images obtained by preacquired computed tomography and three-dimensional electroanatomical mapping, integrating intracardiac echocardiography, and x-ray imaging data are necessary to optimize the transseptal puncture and ablation procedure. RESULTS:All patients successfully underwent 13 AF-CA procedures without complications, including three patients received repeat procedures. However, two PeAF patients presented sick sinus syndrome (SSS) after the AF-CA procedure, and one underwent permanent pacemaker implantation therapy during hospitalization. During the follow-up period (6-72 months), the outcomes were not favorable: three patients (30%) maintained sinus rhythm (SR) after the initial procedure; after repeated procedures, the overall SR rate was 40% (four patients). CONCLUSION:With the improved strategy, AF-CA can be safely and effectively performed with low radiation exposure in patients with SID. However, the long-term outcomes were not favorable, even when managed at a tertiary center by a team of specialists. Moreover, patients with PeAF might also have masked SSS, which should be carefully considered.

Background: Few data have reported the prevalence of depressive and anxiety symptoms in patients with cardiovascular disease (CVD) in China. Our study aimed to estimate the prevalence and related risk factors of these mental health symptoms. Methods: A total of 47841 participants from seven regions of China were enrolled by a two-stage, stratified, community-based, clustering sampling strategy between 2014 and 2016. Data of sociodemographic status and medical history were collected through a standard questionnaire. The Center for Epidemiologic Studies Depression Scale and Zung's self-rating anxiety scale were used to screen depressive and anxiety symptoms. Results: Among 47588 individuals who completed the self-report questionnaires, the weighted prevalence of depressive symptom was 2.9% and that of anxiety symptom was 1.5%. In females with heart failure (HF) and stroke, prevalence of either depressive and anxiety symptoms were 15.1% and 13.8%, respectively; while 9.4% and 8.4% for the male counterparts. Among patients with >= any 3 specific CVDs, the prevalence of having either depressive or anxiety symptoms were 13.1% and 6.8% for females and males, respectively. Younger age, female, unmarried, lower income, and disease history of atrial fibrillation, HF and stroke tend to link with higher risks of mental health symptoms. Limitations: Cross-sectional study. Conclusion: A high proportion of patients with CVD had depressive and anxiety symptoms. Screening for mental health symptoms is more important in higher-risk populations who are at younger age, being female, unmarried, with low income, and with diagnoses of atrial fibrillation, HF, and stroke.

Hepatitis C virus infection (HCV) may be associated with a greater risk of cardiovascular disease (CVD), and the evidence for whether antiviral therapy for HCV could reduce the risk of CVD events is inconsistent. The aim of this meta‐analysis was to investigate the association between anti‐HCV treatment and the risk of CVD. We searched PubMed, EMBASE and Cochrane Library databases from inception to 20 August 2020. The pooled hazard ratio (HR) with 95% confidence interval (CI) of the risk of CVD events [any CVD, coronary artery disease (CAD) and stroke] was calculated using the random‐effects model. A total of eleven studies, including 309,470 subjects, were enrolled in this meta‐analysis. Among those, four studies reported on any CVD between anti‐HCV–treated and anti‐HCV–untreated patients, five studies reported on CAD, and five studies reported on stroke. Also, five studies reported on any CVD between patients with sustained virological response (SVR) and without SVR. Overall, antiviral therapy for HCV was associated with a reduced risk of any CVD (HR = 0.64, 95% CI: 0.50–0.83), CAD (HR = 0.73, 95% CI: 0.55–0.96) and stroke (HR = 0.74, 95% CI: 0.64–0.86). Besides, we found that SVR was associated with a significant decrease in any CVD compared with non‐SVR (HR = 0.74, 95% CI: 0.60–0.92). In conclusion, this meta‐analysis demonstrated that antiviral therapy for HCV was associated with a reduced risk of CVD events. In addition, the risk of CVD events was lower in individuals with SVR compared with those without SVR.

目的:初步探讨既往心房颤动导管消融术中心包压塞患者再次接受导管消融治疗的可行与有效性.方法:回顾分析北京安贞医院自2016年4月至2019年8月间,既往心房颤动导管消融术中心包压塞并再次接受导管消融治疗的患者10例.收集患者临床基线数据、消融参数,随访临床事件与窦律维持情况.结果:10例患者平均年龄为(63.6±11.4)岁,男6例,3例复发为阵发性心房颤动、心房扑动,7例复发为持续性心房颤动;围术期8例应用华法林桥接抗凝,2例应用不间断达比加群酯抗凝.所有患者顺利完成再次导管消融治疗,1例患者术后因继发肺部感染死亡,其余患者围术期均未发生心脏压塞、其他出血及死亡事件.随访期间(30.0± 14.4)个月,6例(6/10)患者维持窦性心律.结论:既往心房颤动导管消融术中心包压塞患者再次行导管消融治疗安全及可行.

目的:初步探讨心房颤动合并帕金森病(PD)患者导管消融治疗可行性、潜在获益.方法:纳入北京安贞医院自2017年3月至2019年9月,接受导管消融的心房颤动合并PD患者8例.记录患者基线数据,术中消融情况、围术期并发症,随访患者术后心房颤动复发情况、症状改善、临床事件、抗心律失常与抗凝性药物停药情况.结果:患者中男性居多(7例,87.5％),平均年龄(68.3±9.0)岁,其中阵发性心房颤动/心房扑动(PAF/AFL)4例,持续性心房颤动(PeAF)4例,心房颤动平均病史为(5.2±4.7)年.8例患者共计完成9次导管消融治疗(其中1例2次消融),围术期均未发生卒中、心脏压塞、血管并发症和大出血事件.随访期间(9～ 39个月)患者总体窦律维持率为75％(PAF/AFL,100％;PeAF,50％)、症状较术前明显改善,1例(12.5％)死亡.术后6例(75％)暂停抗心律失常药物,7例(87.5％)暂停抗凝药物治疗.结论:心房颤动合并帕金森病患者行导管消融治疗安全、可行,术后多数患者症状改善明显,维持窦律(尤其PAF患者).

To investigate theoptimal idarucizumab (dabigatran antagonist) usage strategy for patients with acute pericardial tamponade receiving uninterrupted dabigatran during catheter ablation for atrial fibrillation (AF).

Atrial fibrillation (AF) is common in abdominal solid organ transplant recipients and a cause of morbidity and mortality in this population. However, the outcomes of catheter ablation (CA) in transplant recipients with AF remain unclear. This study aimed to elucidate the outcomes of CA in renal and hepatic transplant recipients.

目的 评估轻度血小板减少对非瓣膜性心房颤动(房颤)患者导管消融术中肝素用量与激活全血凝固时间(ACT)的影响,指导轻度血小板减少患者房颤导管消融术中肝素的合理使用与指标监测.方法 选取北京安贞医院2015-2019年接受房颤消融且合并轻度血小板减少症的非瓣膜性房颤患者14例,同时按照1∶2比例匹配年龄±2岁、性别相同、房颤类型相同且同期入院行房颤消融的28例血小板正常的非瓣膜性房颤患者作为对照组.所有患者均接受了导管消融治疗,术中经房间隔穿刺后给予肝素70～100 IU/kg,每隔30 min测定ACT,并根据ACT调整肝素用量,使ACT控制在300～450 s.采用SPSS 23.0进行独立样本t检验、Mann-Whitney U检验和x2检验.结果 两组患者在体质指数、既往病史、围手术期药物应用、肝功能、肾功能、消融术式、手术时间、X线暴露时间方面的差异均无统计学意义(P＞0.05).房颤合并轻度血小板减少患者肝素用量(6 000.00 IU,四分位数间距0.00 IU)低于对照组(7 000.00 IU,四分位数间距2000.00 IU),平均ACT(385.00 s,四分位数间距25.00 s)高于对照组(330.00 s,四分位数间距40.50 s),差异均有统计学意义(P＜0.01);两组患者术中首次ACT达标时间,ACT最大值以及ACT达标率差异均无统计学意义(P＞0.05).结论 轻度血小板减少的非瓣膜性房颤患者减少导管消融手术中肝素用量不影响ACT达标时间与达标率.

目的:评估心房颤动合并肾透析患者接受导管消融的安全与有效性.方法:纳入北京安贞医院自2015年6月至2019年6月,接受导管消融的心房颤动合并肾透析患者9例,按照1∶4比例匹配年龄、性别、心房颤动类型相同的同期住院接受心房颤动导管消融治疗且无肾透析病史患者36例作为对照组.所有患者均进行导管消融治疗,透析组围术期均不间断华法林抗凝,随访导管消融术后心律失常复发情况和临床预后.结果:透析组高血压患病率较对照组高(100.0％vs.63.9％,P=0.042),华法林应用率较对照组高(100.0％ vs.19.4％,P＜0.001),且透析组HAS-BLED评分较对照组高[3(2,3)vs.1(1,1),P＜0.001].围手术期透析组未发生并发症,对照组出现1例血管并发症(零vs.2.8％,P=1.000).平均随访时间(19.4±7.1)个月,初次消融及二次消融后透析组窦性心律维持率均略低于对照组(初次55.6％vs.66.7％,P=0.577;二次66.7％vs.75.0％,P=0.701),但差异无统计学意义.透析组2例患者随访期间出现心力衰竭症状加重,其中1例出现死亡.结论:心房颤动合并肾透析患者导管消融是安全的,一次手术成功率不能令人满意,再次消融后窦性心律维持率较高,仍可以将其视为治疗选择之一.

Background It is unclear whether catheter ablation (CA) for atrial fibrillation (AF) affects the long-term prognosis in the elderly. This study aims to evaluate the relationship between CA and long-term outcomes in elderly patients with AF. Methods Patients more than 75 years old with non-valvular AF were prospectively enrolled between August 2011 and December 2017 in the Chinese Atrial Fibrillation Registry Study. Participants who underwent CA at baseline were propensity score matched (1:1) with those who did not receive CA. The outcome events included all-cause mortality, cardiovascular mortality, stroke/transient ischemic attack (TIA), and cardiovascular hospitalization. Results Overall, this cohort included 571 ablated patients and 571 non-ablated patients with similar characteristics on 18 dimensions. During a mean follow-up of 39.75 +/- 19.98 months (minimum six months), 24 patients died in the ablation group, compared with 60 deaths in the non-ablation group [hazard ratio (HR) = 0.49, 95% confidence interval (CI): 0.30-0.79, P = 0.0024]. Besides, 6 ablated and 29 non-ablated subjects died of cardiovascular disease (HR = 0.25, 95% CI: 0.11-0.61, P = 0.0022). A total of 27 ablated and 40 non-ablated patients suffered stroke/TIA (HR = 0.79, 95% CI: 0.48-1.28, P = 0.3431). In addition, 140 ablated and 194 non-ablated participants suffered cardiovascular hospitalization (HR = 0.84, 95% CI: 0.67-1.04, P = 0.1084). Subgroup analyses according to gender, type of AF, time since onset of AF, and anticoagulants exposure in initiation did not show significant heterogeneity. Conclusions In elderly patients with AF, CA may be associated with a lower incidence of all-cause and cardiovascular mortality.

目的:探讨心房颤动合并潜在食道损伤高危患者射频消融治疗的可行性与消融策略.方法:纳入北京安贞医院自2016年5月至2018年5月,接受射频消融的潜在食道损伤高危患者7例.收集患者基线数据、消融术中参数,并随访导管消融术后心律失常复发情况和临床预后.结果:患者平均年龄(65.4±8.7)岁,女性居多(4例,57.0％),其中6例(85.7％)阵发性心房颤动/心房扑动,1例(14.3％)持续性心房颤动.7例患者中3例(43.0％)为食道静脉瘤,1例(14.3％)为食道早期癌症内膜剥脱术后,2例(28.6％)为肝硬化食道静脉曲张套扎术后,1例(14.3％)为食道中段憩室.所有患者均顺利完成消融,围术期均采用低分子肝素桥接抗凝,且均未发生卒中、心脏压塞、血管并发症和大出血事件.平均随访时间为(33.0±9.4)个月,术后12个月内窦律维持率为57.0％(4例),总体窦性心律维持率为43.0％(3例),随访期间无食道瘘、消化道出血事件.结论:通过结合影像融合技术以及优化消融策略,心房颤动合并潜在食道损伤道高危患者进行射频消融是可行的,但仍需进一步探讨.