Noninvasive electrocardiography monitoring for very early recurrence predicts long-term outcome in patients after atrial fibrillation ablation.

BACKGROUND: Atrial fibrillation (AF) is the most common sustained arrhythmia, and catheter ablation has been shown to be a highly effective treatment for patients with symptomatic AF. Very early recurrence (VER) of AF within 7 days after catheter ablation is common, but the clinical significance of VER remains unclear. We have examined the usefulness of the noninvasive electrocardiography monitor for the detection of VER and the relationship between VER and late recurrence (LR). METHODS: Eighty-eight patients with paroxysmal or persistent atrial fibrillation were retrospectively included. All patients underwent primary catheter ablation at a large general hospital between March 2016 and August 2018. All patients were followed up in atrial fibrillation clinic at an interval of every 3 months for late recurrence of AF. VER was evaluated by one-lead continuous noninvasive electrocardiography monitoring device for 7 days after ablation. The association between VER and LR was analyzed by univariate and multivariate Cox regression model. RESULTS: Mean age was 62.9 ± 9.7 years, and 39.8% were female. Thirty-two patients (36.4%) experienced VER. After a mean follow-up of 539.36 ± 211.66 days, 17 patients (19.3%) experienced LR. Multivariate Cox regression analysis revealed VER was an independent predictor of LR: HR 3.6 (95% CI, 1.2-10.8), p = .020. In addition, diabetes was also associated with LR of atrial fibrillation. CONCLUSIONS: Noninvasive electrocardiography monitoring was a useful tool for detecting VER and VER after catheter ablation was associated with LR.

[Causes of insufficient anticoagulation in Chinese patients with non-valvlar atrial fibrillation].

OBJECTIVE: To evaluate the factors responsible for the insufficient application of oral anticoagulation (OAC) in Chinese patients with non-valvular atrial fibrillation. METHODS: The research is a single center registration study in a tertiary referral hospital in Beijing. The general characteristics, history of atrial fibrillation, comorbidities and anticoagulation treatment were obtained from all patients.Factors affecting the oral Walfarin use were evaluated by univariable and multivariable regression analysis. RESULTS: OAC therapy with Walfarin was applied on Only 214(39.4%) out of 576 consecutive patients with non-valvular atrial fibrillation. The OAC rate was 30.3% among non-ablation patients. Patients with persistent atrial fibrillation, diabetes, chronic heart failure, history of ischemic stroke/TIA and higher CHA2DS2-VASc score were more likely prescribed with Walfarin. Multivariable regression analysis showed that persistent fibrillation, history of chronic heart failure, ischemic stroke/TIA and non-coronary heart disease predicted the treatment with Walfarin. CONCLUSIONS: OAC use is extremely low in Chinese patients with non-valvular atrial fibrillation. More efforts are warranted to improve OAC use in these patients.

[Clinical analysis of 120 cases of infective endocarditis].

OBJECTIVE: To improve the diagnosis and treatment of infective endocarditis (IE) by exploring its causes, pathogenic microorganism and clinical characteristics. METHODS: The clinical data of 120 IE patients treated in Peking Union Medical College Hospital from October 1997 to September 2007 were analyzed retrospectively. RESULTS: Of the 120 consecutive cases diagnosed as IE according to the Duke's new criteria, 79 were male and 41 female with a average age of (43.2 +/- 16.7) years old. Twelve cases were prosthetic valve endocarditis (PVE) and 108 cases native valve endocarditis (NVE) and there were no previously known heart diseases in 29 of the cases. Seventy-nine of the 108 (73.1%) NVE patients had basic cardiac abnormalities before IE diagnosis, such as congenital cardiovascular disease (30 cases), idiopathic mitral valve prolapse (23 cases) and rheumatic heart disease (11 cases). Fever (100.0%), anemia (54.2%) and embolism (48.3%) were the most common clinical manifestations in the IE development. Of the 83 patients who had a positive blood culture result, Streptococcus viridans (51.8%) was the most common isolated microorganism. CONCLUSIONS: Congenital cardiovascular diseases and idiopathic mitral valve prolapse are the two most commonly heart diseases in IE. Blood culture and echocardiogram should always be done to exclude IE, especially presenting with fever of unknown reasons.