Left Atrial Electrophysiological Properties after Pulmonary Vein Isolation Predict the Recurrence of Atrial Fibrillation: A Cohort Study.

Background: The aim of this work was to investigate left atrial electrophysiological properties for their ability to predict the recurrence of atrial fibrillation (AF) following pulmonary vein isolation (PVI). Methods: The study comprised 53 patients with AF [62 (interquartile range (IQR): 52-68) years old; 47.2% females]. High-density, three-dimensional electro-anatomic mapping using PentaRay was conducted during sinus rhythm in the left atrium (LA) immediately after PVI. LA conduction time, conduction velocity in predefined anterior and posterior routes, low voltage area percentage and distribution were assessed. Results: The AF recurrence group had longer LA conduction time compared to the non-recurrence group [11 (IQR: 10-12) ms vs. 9 (IQR: 8-10) ms, p = 0.001). The percent low voltage area was greater in the recurrence group than the non-recurrence group [31.2 (IRQ: 7.1-49.3)% vs. 7.7 (IQR: 4.3-15.2)%, p = 0.008]. Multivariate Cox regression revealed that LA conduction time independently predicted AF recurrence following ablation over a median follow-up of 235 days [IQR: 154-382 days; hazard ratio (HR): 2.37, 95% confidence interval (CI): 1.08-5.23, p = 0.031]. The optimal cut-off for LA conduction time was 98 ms [area under curve (AUC): 0.926, sensitivity: 0.833, specificity: 0.894, p < 0.01]. Kaplan-Meier analysis revealed that patients with a conduction time > 98 ms had a higher rate of AF recurrence following ablation (p < 0.001). Conclusions: Patients with longer LA conduction time after PVI had more frequent AF recurrence.

Left Atrial Low Voltage Areas Predicts Recurrence of Atrial Fibrillation after Catheter Ablation: A Meta-Analysis.

BACKGROUND: Low voltage areas (LVAs) on left atrial (LA) voltage mapping correlate with atrial fibrosis. However, there is no uniform standard for the definition of LVAs, or mapping techniques and mapping rhythms, so that the predictive value of left atrial LVAs for recurrence of atrial fibrillation (AF) is uncertain. This study aimed to explore the relationship between the presence of pre-ablation left atrial LVAs and the risk of recurrent AF after catheter ablation. METHODS: The databases of PubMed, Embase, Web of science, Cochrane library, Scopus, Wanfang Datebase, China National Knowledge Infrastructure, China Biology Medicine and China Scientific Journal Datebase were searched from inception to 31 July 2023. Relevant studies regarding left atrial LVAs prior to ablation to predict postoperative recurrence of AF were identified and analyzed. The efficacy endpoints were defined as the recurrence of atrial arrhythmia lasting over 30 s. RESULTS: A total of 12 studies with 1070 patients were included. We found the presence of pre-ablation left atrial LVAs correlated with the risk of recurrent AF after ablation (hazard ratio (HR) = 2.87, 95% confidence interval (CI): 2.33-3.52). The presence of pre-ablation left atrial LVAs can predict the risk of recurrent AF after ablation both in the follow-up duration ≤12 months group and follow-up duration >12 months group (follow-up duration ≤12 months: HR = 2.93, 95% CI: 2.20-3.90; follow-up duration >12 months: HR = 2.80, 95% CI: 2.09-3.77). The presence of pre-ablation left atrial LVAs correlated with the risk of recurrent AF after ablation in paroxysmal AF (HR = 2.89, 95% CI: 1.97-4.24). CONCLUSIONS: The presence of pre-ablation left atrial LVAs correlate with the risk of recurrent AF after catheter ablation.

Research Progress of Low-Voltage Areas Associated with Atrial Fibrillation.

Atrial fibrosis is an independent predictor of the recurrence of atrial fibrillation (AF) after catheter ablation. Low-voltage areas (LVA) measured during catheter ablation for AF are a commonly used surrogate for the presence of atrial fibrosis. LVA are associated with clinical outcomes and comorbidities and have links to triggering sites for AF. Several trials have shown promising data of targeting ablation in LVA, however the results have been mixed. This article will review the role of LVA in the prediction of adverse events in AF patients, including stroke, how to predict the presence of LVA, and the impact of LVA ablation on the recurrence of AF.

Determination of Serum Homocysteine and Hypersensitive C-reactive Protein and Their Correlation with Premature Coronary Heart Disease.

BACKGROUND: This study aims to investigate the correlation between premature coronary heart disease (pCHD) and both serum homocysteine (Hcy) and hypersensitive C-reactive protein (hs-CRP). METHODS: A total of 170 patients with pCHD were enrolled in this study from June 2014 to April 2016 (including 52 patients with stable angina pectoris [SAP], 70 patients with unstable angina pectoris [UAP], and 48 patients with acute myocardial infarction [AMI]), together with 105 healthy controls (CON) selected at the same period, to observe the changes of Hcy and hs-CRP in CHD patients and those with different types of CHD. RESULTS: The levels of serum Hcy and hs-CRP in group pCHD were significantly higher than in group CON (P < .05). The levels of Hcy and hs-CRP in group AMI were significantly higher than in group UAP and group SAP (P < .05). The changes of serum Hcy and hs-CRP were significantly higher in patients with multi-vascular lesions and dual-vascular lesions than in those with single-vascular lesion (P < .05). CONCLUSION: The levels of serum Hcy and hs-CRP in CHD patients are positively correlated with the severity of CHD, which increase with the increase of lesion count. The combined detection of Hcy and hs-CRP can initially reflect the severity of coronary artery, thus better guiding treatment and predicting prognosis.

Relationship Between Polymorphism of Adiponectin Gene SNPS+276 and Coronary Heart Disease.

BACKGROUND: This study aims to investigate the relationship between polymorphism of adiponectin (ADIPOQ) gene SNPS+276 and the severity of coronary heart disease (CHD) and coronary artery disease (CAD). METHODS: A total of 582 inpatients were enrolled and divided into Group CHD (342 cases) and the control group (CON, 240 cases), according to their angiographic results from June 2014 to April 2016 for the genotype (G/T) analysis of ADIPOQ SNPs+276 by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: Group CHD: GG 110 (32%), GT 205 (59%), and TT27 (8%); Group CON: GG 36 (15%), GT 161 (67%), and TT 43 (18%) (P < .05). The frequency of allele G in group CHD was 62.1% and 48.5% in group CON (P < .05). The frequencies of genotype GG, GT, and TT were 67 (33.3%), 107 (53.2%), and 27 (13.5%), respectively, in the group with single vascular lesion, and 64 (45.4%), 53 (37.6%), and 24 (17%), respectively, in the group with multiple vascular lesions. There was statistical significance between the two groups (P < .05). CONCLUSIONS: The 276G gene of adiponectin may be a susceptibility gene of CHD, and the genotype GG may be related to the severity of this disease.