Experiences of clinical nurses with medication interruption: A systematic review and qualitative meta-synthesis.

BACKGROUND: Managing medication interruptions is considered one of the biggest dilemmas for nurses in clinical settings. To improve medication safety, it was imperative to conduct a systematic review to get a deeper understanding of nurses' experiences with medication interruptions. AIMS: A systematic review and qualitative meta-synthesis aimed to explore clinical nurses' experiences of interruption during medication in hospitals. METHODS: Systematic searches were conducted in PubMed, CINAHL, Ovid Medline, Embase, Web of Science, and The Cochrane Library from inception to January 2024. The search strategy included four groups of keywords: (1) qualitative research, (2) nurses, (3) medication interruption, and (4) experience. Critical Appraisal Skills Programme was used to assess the quality of the studies. Meta-ethnography was utilized to synthesize the findings of the included studies. RESULTS: Nine articles published between 2012 and 2023 were included; the number of participants varied from 5 to 40, aged 20-68 years, and the majority were female. Four synthesized findings were identified as follows: (1) an inevitable part of the routine, (2) a decision-making process, (3) working in a minefield, and (4) coping with interruption. LINKING EVIDENCE TO ACTION: Nurses embraced interruptions as an inherent component of clinical care. Previous experience and nursing culture, encompassing personal and professional aspects, significantly influence nurses' attitudes toward medication interruptions. It is crucial to incorporate the distinctive work experiences of nurses into techniques aimed at efficiently handling interruptions in future research. The registration number in PROSPERO is CRD42023470276.

Reshaped commensal wound microbiome via topical application of Calvatia gigantea extract contributes to faster diabetic wound healing.

Background: Calvatia gigantea (CG) is widely used as a traditional Chinese medicine for wound treatment. In this study, we aimed to determine the effects of CG extract (CGE) on diabetic wound healing and the commensal wound microbiome. Method: A wound model was established using leptin receptor-deficient db/db mice, with untreated mice as the control group and CGE-treated mice as the treatment group. The wound healing rate, inflammation and histology were analyzed. Additionally, wound microbiome was evaluated via 16S ribosomal RNA (rRNA) gene sequencing. Results: CGE significantly accelerated the healing of diabetic ulcer wounds, facilitated re-epithelialization, and downregulated the transcription levels of the inflammatory cytokines, interleukin-1ß and tumor necrosis factor-α. Furthermore, CGE treatment positively affected the wound microbiome, promoting diversity of the microbial community and enrichment of Escherichia-Shigella bacteria in the CGE-treated group. Conclusions: Overall, CGE enhanced diabetic wound healing by modulating the wound microbiome and facilitating macrophage polarization during inflammation. These findings suggest modulation of the commensal wound microbiome using medicinal plants as a potential therapeutic strategy for diabetic wounds.

Effects of self-perception of aging interventions in older adults: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Self-perception of aging (SPA) is associated with various health outcomes in the aging process. This study aimed to conduct a systematic review of existing interventions targeting SPA among older adults, and to synthesize their effects on self-perception of aging, physical performance, and mental health. RESEARCH DESIGN AND METHODS: A systematic search was performed in PubMed, Embase, PsycINFO, CINAHL, Web of Science, CENTRAL, CNKI, SinoMed, VIP, and WanFang databases for randomized controlled trials that reported intervention effects on self-perception of aging, physical performance, and mental health in older adults. Two researchers independently conducted study selection, data extraction and quality assessment. RESULTS: A total of 16 studies were included for qualitative analysis, and 12 studies of them were included for meta-analysis. The results showed a significant impact of interventions on self-perception of aging, with the effect size of -0.56 (95% CI -1.06 to -0.07, P=0.03). And the results also supported a significant improvement in physical performance and mental health among older adults. DISCUSSION AND IMPLICATIONS: Self-perception of aging interventions present a promising approach to enhance positive aging perception for older adults, with potential benefits extending to physical performance and mental health. However, larger-scale and more robust trials are still required to validate these findings and obtain more accurate conclusions.

Research hotspots and nursing inspiration in research of older adults with subjective cognitive decline from 2003 to 2023: A bibliometric analysis.

Objectives: There has been a significant increase in subjective cognitive decline (SCD) studies in older adults over the years. A bibliometric analysis was conducted to demonstrate the current hotspots and emerging trends in SCD research in older adults and provide references for further research in this field. Methods: The study conducted a bibliometric analysis based on co-citation analysis. From the Web of Science Core Collection database, this study obtained 1,436 manuscripts regarding SCD in older adults published from 2003 to 2023. Software CiteSpace was used to analyse the results for countries, institutions, authors, journals, keywords, top-cited papers, and burst citations scientifically and intuitively. Results: Our result showed an overall upward trend in the volume of publications on SCD in the elderly population, suggesting that the study of SCD in older adults has attracted the attention of researchers. The United States dominates this research field, followed by China and France. The top three institutions were the University of California System, Institut National de la Sante et de la Recherche Medicale (Inserm), and UDICE-French Research Universities. Frank Jessen, Han Ying, and Kathryn Ellis were the top three researchers. The top three cited journals were Neurology, Alzheimers & Dementia, and Journal of Alzheimer's Disease. The keywords clustering were "depression", "functional connectivity", "cognitive reserve", "cognitive function", "physical activity", "recommendations", "dementia prevention", " behavioral disorders", "primary care", "early diagnosis", and "community-based study". Keywords with the highest citation bursts include "physical activity", "framework", "preclinical Alzheimer's disease", "future dementia", and "late life depression". Conclusions: Parallel to the growth trend, the range of research scopes and topics is expanding steadily, focusing on early screening and prevention, negative emotion, and symptom management, broadening researchers' perspectives, which can provide reference and guidance for nursing researchers to conduct research.

Influence of stress-specific interventions on biomarker levels and cognitive function in cancer patients: Systematic review and meta-analysis.

PURPOSE: Cancer patients' psycho-physiological health is seriously affected by long-term exposure to stress. Many studies have explored the impact of stress-specific interventions on cancer patients' biomarker levels and cognitive functions. However, the current research findings are inconsistent, and their statistical power is limited by the small samples. Therefore, we conducted this meta-analysis to verify the effect of stress-specific interventions on cancer patients. METHODS: The literature involved nine databases from the inception until January 13, 2024, extracted 19 randomized controlled trials (RCTs). Review Manager (RevMan) 5.4 software was used to perform a meta-analysis, and the revised Cochrane risk of bias tool (RoB2) was utilized for quality evaluation. RESULTS: Nine RCTs were assessed as having a low risk of bias, and others had a moderate risk. The results showed that stress-specific interventions had beneficial effects on patients' subjective cognition but uncertain impacts on their executive function, tumour necrosis factor-α level, morning cortisol level, and no effect on cortisol at other times, interleukin (IL)-10, IL-8, IL-6, IL-1, and C-reactive protein. CONCLUSION: More rigorous studies are required to elucidate the influence of stress-specific interventions on biomarker levels. The potential mechanism by which stress-specific interventions affect the cancer patient's cognitive function remains unclear.

Effects of interventions for enhancing resilience in cancer patients: A systematic review and network meta-analysis.

BACKGROUND: Various interventions appear to enhance cancer patients' resilience. However, the best intervention options are still unknown. This systematic review and network meta-analysis aimed to examine the impact of different interventions on resilience and identify the most effective interventions. METHODS: Nine major English and Chinese databases were systematically retrieved for randomized controlled trials (RCTs) published from inception to 13 November 2023. The outcome was resilience. The analysis was conducted using Software Review Manager 5.4, R 4.2.3, and STATA 14.0. RESULTS: The network meta-analysis included 32 RCTs and evaluated 12 interventions. Regarding effectiveness, compared to routine care, the relative effect sizes of attention and interpretation therapy, cyclic adjustment training, cognitive intervention, expressive therapy, positive psychological intervention, social support intervention, and work-environment therapy had statistically significant enhancing resilience, with the SMD (95%CI) of 1.42 (0.75, 2.07), 1.97 (0.76, 3.18), 1.26 (0.76, 1.77), 0.93 (0.08, 1.78), 1.02 (0.55, 1.50), 1.01 (0.48, 1.56), 1.65 (0.94, 2.37), respectively. Considering the rank probability, statistical power, and efficacy, the most effective interventions for improving resilience were attention and interpretation therapy, cognitive intervention, and positive psychological intervention. With the limited quantity of RCTs, the effectiveness of cyclic adjustment training and work-environment therapy still needs to be explored. CONCLUSIONS: Attention and interpretation therapy was the first best choice for boosting resilience out of the 12 interventions. Cognitive intervention and positive psychological intervention were also better choices for improving cancer patients' resilience. Due to the low quality and quantity of included RCTs, the need for multi-center, higher-quality trials with larger samples should be carried out. PROSPERO ID: CRD42023434223. The study did not receive funding support.

A systematic review and meta-analysis of interventions to reduce perceived stress in breast cancer patients.

PURPOSE: Breast cancer (BC) patients commonly face stress that causes severe psychological and physiological problems. The main objective of the review was to confirm the effect of interventions on breast cancer patients' perceived stress, and the secondary objective was to explore the impact of interventions on anxiety, depression, and inflammatory markers. METHODS: A systematic and comprehensive search for randomized controlled trials (RCTs) that reported interventions' effects on perceived stress in breast cancer patients was performed in nine databases. RESULTS: Twenty-four RCTs, including 1887 participants, met the inclusion criteria, summarizing six categories for the intervention group: mindfulness and yoga, exercise, cognitive-behavioral stress management, self-regulation, relaxation training, and acupuncture. Compared with usual care or other types of care, mindfulness and yoga had excellent effects against perceived stress, anxiety, and depression; self-regulation could reduce perceived stress and anxiety; exercise could reduce perceived stress; acupuncture could reduce the level of depression; mindfulness could improve the TNF-α level, and yoga can reduce the level of salivary cortisol and DNA damage. CONCLUSION: This systematic review indicated that nondrug interventions, such as mindfulness and yoga, effectively reduce perceived stress, anxiety, and depression. Rigorous studies with large sample sizes are needed to address the limitations of small sample sizes and shortcomings in methodology in this area.

Association between self-perception of aging and cognitive function in Chinese older adults: The mediation effect of health behaviors.

OBJECTIVE: To investigate the association between self-perception of aging (SPA) and cognitive function in Chinese older adults, and to explore the mediating role of health behaviors. METHODS: This study included 5,445 Chinese older adults from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Correlation, linear regression and mediation effect analysis were employed to evaluate the association. RESULTS: SPA is significantly related to the health behaviors (r = 0.160, P < 0.01) and cognition (r = 0.086, P < 0.01), and health behaviors exhibited a positive correlation with cognition (r = 0.179, P < 0.01). SPA and health behaviors significantly impacted cognition (ß = 0.032, P = 010; ß = 0.103, P < 0.001). Health behaviors partially mediated the effect of SPA on cognitive function, accounting for 27.12 % of the total effect. CONCLUSION: Health behaviors mediate the association between SPA and cognitive function. Healthcare providers should prioritize addressing SPA of older adults and encourage them to engage in health behaviors for cognitive health.

Using Computer Graphics to Make Science Visible in Engineering Education.

Science plays a crucial role in engineering. But science tends to be obscure to students, especially when they are overwhelmed by complex engineering design challenges that involve many variables. This article shows how computer graphics can be used to visualize science concepts and operationalize inquiry practices in engineering design to support integrated learning and teaching of science and engineering. Based on these graphical capabilities, generative design driven by evolutionary computation can also be visually illustrated to give students a glimpse into how artificial intelligence is transforming engineering design. The article provides real-world examples in the field of sustainable energy engineering based on Aladdin, an open-source design and analysis Web app. It also presents evidence of learning from pilot tests at culturally diverse high schools. Science educators interested in incorporating engineering design into their lesson plans may find this article helpful.

Study of MI-BCI classification method based on the Riemannian transform of personalized EEG spatiotemporal features.

Motor imagery (MI) is a traditional paradigm of brain-computer interface (BCI) and can assist users in creating direct connections between their brains and external equipment. The common spatial patterns algorithm is the most popular spatial filtering technique for collecting EEG signal features in MI-based BCI systems. Due to the defect that it only considers the spatial information of EEG signals and is susceptible to noise interference and other issues, its performance is diminished. In this study, we developed a Riemannian transform feature extraction method based on filter bank fusion with a combination of multiple time windows. First, we proposed the multi-time window data segmentation and recombination method by combining it with a filter group to create new data samples. This approach could capture individual differences due to the variation in time-frequency patterns across different participants, thereby improving the model's generalization performance. Second, Riemannian geometry was used for feature extraction from non-Euclidean structured EEG data. Then, considering the non-Gaussian distribution of EEG signals, the neighborhood component analysis (NCA) algorithm was chosen for feature selection. Finally, to meet real-time requirements and a low complexity, we employed a Support Vector Machine (SVM) as the classification algorithm. The proposed model achieved improved accuracy and robustness. In this study, we proposed an algorithm with superior performance on the BCI Competition IV dataset 2a, achieving an accuracy of 89%, a kappa value of 0.73 and an AUC of 0.9, demonstrating advanced capabilities. Furthermore, we analyzed data collected in our laboratory, and the proposed method achieved an accuracy of 77.4%, surpassing other comparative models. This method not only significantly improved the classification accuracy of motor imagery EEG signals but also bore significant implications for applications in the fields of brain-computer interfaces and neural engineering.

Skin 11ß-hydroxysteroid dehydrogenase type 1 enzyme expression regulates burn wound healing and can be targeted to modify scar characteristics.

Background: Excessive scarring and fibrosis are the most severe and common complications of burn injury. Prolonged exposure to high levels of glucocorticoids detrimentally impacts on skin, leading to skin thinning and impaired wound healing. Skin can generate active glucocorticoids locally through expression and activity of the 11ß-hydroxysteroid dehydrogenase type 1 enzyme (11ß-HSD1). We hypothesised that burn injury would induce 11ß-HSD1 expression and local glucocorticoid metabolism, which would have important impacts on wound healing, fibrosis and scarring. We additionally proposed that pharmacological manipulation of this system could improve aspects of post-burn scarring. Methods: Skin 11ß-HSD1 expression in burns patients and mice was examined. The impacts of 11ß-HSD1 mediating glucocorticoid metabolism on burn wound healing, scar formation and scar elasticity and quality were additionally examined using a murine 11ß-HSD1 genetic knockout model. Slow-release scaffolds containing therapeutic agents, including active and inactive glucocorticoids, were developed and pre-clinically tested in mice with burn injury. Results: We demonstrate that 11ß-HSD1 expression levels increased substantially in both human and mouse skin after burn injury. 11ß-HSD1 knockout mice experienced faster wound healing than wild type mice but the healed wounds manifested significantly more collagen deposition, tensile strength and stiffness, features characteristic of excessive scarring. Application of slow-release prednisone, an inactive glucocorticoid, slowed the initial rate of wound closure but significantly reduced post-burn scarring via reductions in inflammation, myofibroblast generation, collagen production and scar stiffness. Conclusions: Skin 11ß-HSD1 expression is a key regulator of wound healing and scarring after burn injury. Application of an inactive glucocorticoid capable of activation by local 11ß-HSD1 in skin slows the initial rate of wound closure but significantlyimproves scar characteristics post burn injury.

Attenuating endothelial leakiness with self-assembled DNA nanostructures for pulmonary arterial hypertension.

Vascular endothelium dysfunction plays an important role in oncological and pulmonary diseases. Endothelial barrier dysfunction is the initial step of pulmonary vascular remodeling (PVR) and pulmonary arterial hypertension. Upregulation of a pro-autophagy protein Atg101 in the endothelial cells triggered a cascade of intracellular events that leads to endothelial dysfunction through apoptosis. Herein, we proposed a strategy that used endothelial targeting DNA nanostructures to deliver Atg101 siRNA (siAtg101) as a safe, biocompatible "band-aid" to restore pulmonary arterial endothelial barrier integrity within the intricate milieu of pulmonary cells and the pulmonary vasculature. The siAtg101 and aptamer conjugated DNA nanostructures were found to attenuate hypoxia-induced pulmonary endothelial leakiness with surprisingly high selectivity and efficacy. Further in vivo study revealed that functionalized DNA nanostructures likewise attenuated the vascular remodeling in a monocrotaline-induced PVR mouse model. Mechanistically, functionalized DNA nanostructures suppressed PVR by knocking down Atg101, which in turn, downregulated Beclin-1 and subsequently upregulated VE-cadherin to restore endothelial cells' adherin junctions. This work opened a new window for future nanomaterial design that directly addresses the interfacial endothelial cell layer that often stands between the blood and many diseased sites of nanotherapeutic interest.

Role of wound microbiome, strategies of microbiota delivery system and clinical management.

Delayed wound healing is one of the most global public health threats affecting nearly 100 million people each year, particularly the chronic wounds. Many confounding factors such as aging, diabetic disease, medication, peripheral neuropathy, immunocompromises or arterial and venous insufficiency hyperglycaemia are considered to inhibit wound healing. Therapeutic approaches for slow wound healing include anti-infection, debridement and the use of various wound dressings. However, the current clinical outcomes are still unsatisfied. In this review, we discuss the role of skin and wound commensal microbiota in the different healing stages, including inflammation, cell proliferation, re-epithelialization and remodelling phase, followed by multiple immune cell responses to commensal microbiota. Current clinical management in treating surgical wounds and chronic wounds was also reviewed together with potential controlled delivery systems which may be utilized in the future for the topical administration of probiotics and microbiomes. This review aims to introduce advances, novel strategies, and pioneer ideas in regulating the wound microbiome and the design of controlled delivery systems.

Occluding morphologically complicated left atrial appendage using the small-umbrella LAmbre device.

BACKGROUND: Percutaneous left atrial appendage (LAA) occlusion is effective for stroke prevention in patients with atrial fibrillation. LAA can have a complex anatomy, such as multiple lobes or a large orifice, which may render it unsuitable for occlusion using regular devices. We aimed to investigate the feasibility, safety, and short-term efficacy of the small-umbrella LAmbre device for morphologically complicated LAA. METHODS: We retrospectively enrolled 129 consecutive patients who underwent LAA occlusion using the LAmbre device; the small-umbrella LAmbre device was used in 30 of these patients. We analyzed patients' characteristics, procedural details, and outcomes. RESULTS: Twenty-two patients (73.3%) had multilobed (≥ 2) LAA. The umbrella of the occluder was anchored in the branch in 9 patients and in the common trunks of branches in 13 patients. The landing zone and orifice diameters were 19.0 ± 4.39 mm and 27.4 ± 3.95 mm, respectively. The sizes of the umbrella and occluder cover were 22.0 ± 3.42 mm and 34.3 ± 2.75 mm, respectively. At 3-month follow-up transesophageal echocardiography in 24 patients, no peri-device residual flow was reported. Device thrombosis was detected in one patient at 3 months and disappeared after 3 months of anticoagulation. Ischemic stroke occurred in one patient; no other adverse events were reported. CONCLUSIONS: Occlusion of morphologically complicated LAA using the small-umbrella LAmbre device was feasible, safe, and effective in patients with atrial fibrillation in this study. This occluder provides an alternative for patients who cannot be treated with regular-sized LAA occlusion devices.

A study of character strengths, work engagement and subjective well-being in Chinese registered nurses.

BACKGROUND: Nurses displayed low levels of subjective well-being and high turnover intention. How to enhance the subjective well-being and decrease the turnover rate of nurses is of great importance. However, little is known about whether work engagement mediates between character strengths and subjective well-being. The study aims to explore character strengths, work engagement and subjective well-being in nurses, and to determine whether work engagement plays a mediating role between the relationship. MATERIAL AND METHODS: From December 2017 to December 2018, 450 Chinese registered nurses completed the character strengths scale, work engagement scale, and subjective well-being scale. The relationship between study variables was tested by Pearson correlation. The mediating effect of work engagement was tested by the bootstrap method. RESULTS: The results indicated the following: (1) the 4 elements of character strengths and work engagement were significantly and positively correlated with subjective well-being; (2) character strengths could significantly predict both work engagement and subjective well-being; (3) work engagement played a mediating role in this relationship. CONCLUSIONS: Character strengths affect subjective well-being in Chinese registered nurses, and work engagement plays a mediating variable among the relations. Therefore, nurses are encouraged to foster their character strengths and improve their level of work engagement for their subjective well-being. Following the results, the study recommends that nursing managers be aware of the importance of using character strengths in nursing work, taking actions to excavate nurses' character strengths and encouraging nurses to use character strengths in clinical work to promote engagement and well-being. In the meantime, interventions to improve the level of subjective well-being based on nurses' character strengths should be considered. Med Pr. 2022;73(4):295-304.

Challenges and innovations in treating chronic and acute wound infections: from basic science to clinical practice.

Acute and chronic wound infection has become a major worldwide healthcare burden leading to significantly high morbidity and mortality. The underlying mechanism of infections has been widely investigated by scientist, while standard wound management is routinely been used in general practice. However, strategies for the diagnosis and treatment of wound infections remain a great challenge due to the occurrence of biofilm colonization, delayed healing and drug resistance. In the present review, we summarize the common microorganisms found in acute and chronic wound infections and discuss the challenges from the aspects of clinical diagnosis, non-surgical methods and surgical methods. Moreover, we highlight emerging innovations in the development of antimicrobial peptides, phages, controlled drug delivery, wound dressing materials and herbal medicine, and find that sensitive diagnostics, combined treatment and skin microbiome regulation could be future directions in the treatment of wound infection.

Protein-mediated DNA self-assembly by controlling the surface charge in a molecular crowding environment.

Designing and building artificial nanodevices and nanoarchitectures in living systems are extremely intriguing subjects in nanotechnology and synthetic biology. Taking advantage of cellular machinery and endogenous biomacromolecules, such as proteins, is key to achieving the precise and sophisticated manipulation of nanoarchitectures. In this study, we proposed a protein-mediated DNA self-assembly strategy in a molecular crowding environment. By carefully controlling the surface charge of basic nuclear proteins in a crowding environment that mimicked the intracellular environment, we demonstrated that highly positively charged protamine can assemble individual DNA strands into defined structures similar to a catalytic process manner. Successful self-assembly required an optimized protamine surface charge and a crowding environment; otherwise, this self-assembly was impossible. Polyacrylamide gel electrophoresis (PAGE), atomic force microscopy (AFM), and dynamic light scattering (DLS) results showed that tile-based DNA tubular structures, tetrahedra, and two dimensional DNA origami structures were successfully assembled. We inferred that the assembly process occurred between the arginine-rich domain of protamine and DNA strands that repeatedly interacted with each other in the viscous system. The current study provides a potential strategy to construct nanodevices in living systems and presents an alternative protein-DNA interaction for the potential fabrication of protein-DNA hybrid nanomaterials.

Test-retest reliability and practice effect of the Leuven Perceptual Organisation Screening Test.

AbstractVisual diagnostic tests must have a high degree of consistency in their measurements (high reliability) to ensure accurate assessment of perceptual abilities. The current study assessed test-retest reliability and practice effects in the Leuven Perceptual Organisation Screening Test (L-POST) in 144 healthy volunteers, with time intervals between 0 and 756 days. We used Pearson's and intraclass correlation analysis, Bland-Altman analysis and multilevel modelling. Results from our analyses converged and supported an adequate reliability of the L-POST. Multilevel modelling demonstrated an absence of practice effect, suggesting that the L-POST is suitable for repeat administration. This study suggests that the L-POST has adequate reliability and is suitable for repeat administration even at short intervals. This study provides the basis for a more systematic evaluation for neuropsychological assessments, which can lead to the development of more reliable assessment batteries.

Modulation of Sleep Architecture by Whole-Body Static Magnetic Exposure: A Study Based on EEG-Based Automatic Sleep Staging.

A steady increase in sleep problems has been observed along with the development of society. Overnight exposure to a static magnetic field has been found to improve sleep quality; however, such studies were mainly based on subjective evaluation. Thus, the presented data cannot be used to infer sleep architecture in detail. In this study, the subjects slept on a magneto-static mattress for four nights, and self-reported scales and electroencephalogram (EEG) were used to determine the effect of static magnetic field exposure (SMFE) on sleep. Machine learning operators, i.e., decision tree and supporting vector machine, were trained and optimized with the open access sleep EEG dataset to automatically discriminate the individual sleep stages, determined experimentally. SMEF was found to decrease light sleep duration (N2%) by 3.51%, and sleep onset latency (SOL) by 15.83%, while it increased deep sleep duration (N3%) by 8.43%, compared with the sham SMFE group. Further, the overall sleep efficiency (SE) was also enhanced by SMFE. It is the first study, to the best of our knowledge, where the change in sleep architecture was explored by SMFE. Our findings will be useful in developing a non-invasive sleep-facilitating instrument.

Characteristics and Long-Term Ablation Outcomes of Supraventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 10-Year, Single-Center Experience.

Background: A variety of supraventricular arrhythmias (SVAs) may occur in patients with hypertrophic cardiomyopathy (HCM). The characteristics and long-term ablation outcomes of different types of SVAs in HCM have not been comprehensively investigated. Methods: We retrospectively enrolled 101 consecutive patients with HCM who were referred to the electrophysiology and arrhythmia service from May 2010 to October 2020. The clinical features and ablation outcomes were analyzed. Results: Seventy-eight patients had SVAs, which comprised 50 (64.1%) cases of atrial fibrillation (AF), 16 (20.5%) of atrial flutter (AFL), 15 (19.2%) of atrioventricular reentrant tachycardia (AVRT), 11 (14.1%) of atrial arrhythmia (AT), and 3 (3.8%) of atrioventricular nodal reentrant tachycardia (AVNRT). Thirty-four patients underwent catheter ablation and were followed up for a median (interquartile range) of 58.5 (82.9) months. There was no recurrence in patients with non-AF SVAs. In patients with AF, the 1- and 7-year AF-free survival rates were 87.5 and 49.5%, respectively. A receiver operator characteristic analysis showed that a greater left ventricular end-diastolic dimension (LVEDD) was associated with a higher recurrence of AF, with an optimum cutoff value of 47 mm (c-statistic = 0.91, p = 0.011, sensitivity = 1.00, specificity = 0.82). In Kaplan-Meier analysis, patients with a LVEDD ≥ 47 mm had worse AF-free survival than those with a LVEDD <47 mm (log-rank p = 0.014). Conclusions: In this unique population of HCM, AF was the most common SVA, followed in order by AFL, AVRT, AT, and AVNRT. The long-term catheter ablation outcome for non-AF SVAs in HCM is satisfactory. A greater LVEDD predicts AF recurrence after catheter ablation in patients with HCM.