Outcomes of catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy: a systematic review and meta-analysis.

AIMS: Over the past decade, catheter ablation (CA) has become an established therapy for symptomatic atrial fibrillation (AF). Atrial fibrillation is common in hypertrophic cardiomyopathy (HCM) patients, and restoring sinus rhythm is of great clinical benefit to them. Therefore, we conducted a systematic review and meta-analysis of the available data to evaluate the effectiveness and safety of CA for AF in patients with HCM. METHODS AND RESULTS: Six databases were searched to identify studies describing outcomes of CA of AF in HCM patients with a mean follow-up of ≥12 months after the index procedure. The following data were extracted: (i) single-procedure success, (ii) multiple-procedure success, and (iii) drug-free success. Fifteen studies involving 531 patients were included. Single-procedure freedom from atrial arrhythmia at the latest follow-up was 45.5% [95% confidence interval (CI): 34.8-56.2%]. With multiple procedures, the final success rate was 66.1% (95% CI: 55.3-76.9%) overall, 71.8% (95% CI: 61.6-82.0%) in paroxysmal AF, and 47.5% (95% CI: 36.0-59.0%) in non-paroxysmal AF. Without anti-arrhythmic drugs (AADs), single-procedure success rate at latest follow-up was 32.9% (95% CI: 21.7-41.1%); after multiple procedures, this raised to 50.4% (95% CI: 39.2-61.6%). The incidence of serious periprocedural complications was acceptable [5.1% (95% CI: 2.8-9.6%)]. Substantial heterogeneity (I(2)> 50%) was noted in the above groups. CONCLUSIONS: Catheter ablation of AF in patients with HCM is feasible, although more repeat procedures and AAD are needed to prevent AF recurrence.

Hippocampal miR-124 Participates in the Pathogenesis of Depression via Regulating the Expression of BDNF in a Chronic Social Defeat Stress Model of Depression.

OBJECTIVE: As one of the most prevalent psychiatric disorders, the exact pathogenesis of depression remains elusive. Therefore, there is an urgent need to identify novel antidepressants for effective treatment. MicroRNA-124 (miR-124), the most abundant miRNA in brain tissue, plays a key effect on adult neurogenesis and neuronal differentiation. However, the mechanism of miR-124 in depression has not been clarified so far. The aim of this study is to provide broad insight into the mechanisms underlying depression. METHODS: In the study, we used the forced swim test (FST), the tail suspension test (TST), and a Chronic Social Defeat Stress (CSDS) mice model of depression. Quantitative real-time reverse transcription PCR (qRT-PCR), western blotting, immunofluorescence and virus-mediated gene transfer were used together. The level of plasma corticosterone in mice was analyzed by Enzyme Linked Immunosorbent Assay (ELISA). RESULTS: It was found that CSDS robustly increased the level of miR-124 in the hippocampus. Genetic knockdown of hippocampal miR-124 produced significant antidepressant-like effects in the CSDS model of depression. Furthermore, AAV-siR-124-EGFP treatment increased the level of plasma corticosterone in CSDS-induced mice. Moreover, it was found that the antidepressant-like effects induced by miR-124 inhibition required the hippocampal BDNF-TrkB system. CONCLUSION: Hippocampal miR-124 participated in the pathogenesis of depression by regulating BDNF biosynthesis and was a feasible antidepressant target.

Ginsenoside Rh2 administration produces crucial antidepressant-like effects in a CUMS-induced mice model of depression.

INTRODUCTION: The most striking feature of depression is sadness and a loss of interest in activities, which represents a major cause of disability globally. Therefore, it is necessary to identify novel antidepressants for clinical practice. Ginsenoside Rh2 (Rh2) is one of the major bioactive ginsenosides that can be extracted from Panax ginseng and has been demonstrated to improve both memory and learning. The purpose of this study was to provide broad insight into the mechanisms underlying depression and gain greater insights into antidepressant therapy. METHODS: In this study, we first established an effective and feasible depression animal model of chronic unpredictable mild stress (CUMS) and behavioral testing was evaluated by the forced swim test (FST), the tail suspension test (TST) and the sucrose preference test. Following pretreatment with Rh2 (10 and 20 mg/kg), the immobility time of mice was reduced without affecting locomotor activity in both the FST and TST. Western blotting and immunofluorescence were used to investigate the activation of the hippocampal BDNF signaling pathway and hippocampal neurogenesis. RESULTS: Different concentrations of Rh2 significantly reduced depressive-like symptoms in CUMS-induced mice and downregulated the effects of the BDNF signaling cascade and neurogenesis in the hippocampus. Furthermore, the administration of K252a completely prevented the antidepressant-like activity of Rh2 in mice. CONCLUSION: The results indicated that Rh2 possesses the antidepression action via the positive regulation of the BDNF-TrkB pathway.

Meta-analysis of the therapeutic effects of various methods for the treatment of chronic atrial fibrillation.

The aim of this study was to analyze the therapeutic effects of various methods for the treatment of chronic atrial fibrillation (AF). Randomized controlled trials (RCT) concerning drug therapy and catheter ablation for the treatment of chronic AF were retrieved. The RevMan 5.1 software package was used for the meta-analysis. A total of 20 papers were assessed in this study. The results of the analysis indicated that the success rate was lower [odds ratio (OR), 8.94; 95% confidence interval (CI), 4.70-17.02; P<0.0001] and the relapse rate was higher (OR, 0.07, 95% CI, 0.05-0.10; P<0.0001) for drug therapy compared with that for catheter ablation. With regard to different catheter ablation procedures, the success rate for pulmonary vein antrum isolation (PVAI) was lower compared with that for PVAI plus complex fractionated atrial electrogram (CFAE; OR, 0.53; 95% CI, 0.37-0.78; P=0.0001). Pulmonary vein isolation (PVI) plus left atrial ablation (LAA) had a higher success rate compared with PVI alone (OR, 2.79; 95% CI, 1.59-4.88, P=0.0003). There was not identified to be a significant difference in the success rates between PVAI and CFAE (OR, 2.05; 95% CI, 0.06-205.74; P=0.76) or between PVI and circumferential pulmonary vein isolation (CPVI; OR, 0.94; 95% CI, 0.29-3.00; P=0.91). All the funnel plots of publication bias were essentially symmetrical. In conclusion, the success rate was higher and the relapse rate was lower for catheter ablation compared with drug therapy. Among the different procedures of catheter ablation, there were no significant differences in success rate between two single procedures; however, the success rates were higher for the combined methods compared with those for the single methods.

Relation between projection positions and X-ray radiation doses during placement of the coronary sinus mapping electrode.

PURPOSE: To reduce X-ray radiation injury, we investigated the relation between projection positions and X-ray radiation doses when a coronary sinus mapping electrode was placed. METHODS: There were 400 patients in whom a coronary sinus mapping electrode was placed for intracardiac electrophysiologic examination or radio-frequency catheter ablation in our hospital between 1 June 2008 and 31 May 2011. The doctors who placed the coronary sinus mapping electrode and the projection positions including posteroanterior, left anterior oblique 45°, and right anterior oblique 30° projection positions were randomly selected. X-ray doses were recorded when the coronary sinus mapping electrode was placed, and then, these were compared between the three projection positions. RESULTS: The X-ray dose was significantly lower in the right anterior oblique 30° projection position (50.01 ± 11.38 mGy) than in the posteroanterior projection position (68.05 ± 18.85 mGy, q = 12.924, p = 0.000) and the left anterior oblique 45° projection position (71.66 ± 16.95 mGy, q = 15.214, p = 0.000). There were no statistical significances in X-ray doses between the posteroanterior and the left anterior oblique 45° projection positions (p = 0.066) and different operators (p = 0.985). CONCLUSION: Based on the results of this study, we suggest that in placing the coronary sinus mapping electrode, the right anterior oblique 30° projection position should be first adopted because it can allow the electrode to be easily placed and reduce the X-ray radiation dose as much as possible.