Identification of pleiotropic and specific therapeutic targets for cardio-cerebral diseases: A large-scale proteome-wide mendelian randomization and colocalization study.

BACKGROUND: The cardiac-brain connection has been identified as the basis for multiple cardio-cerebral diseases. However, effective therapeutic targets for these diseases are still limited. Therefore, this study aimed to identify pleiotropic and specific therapeutic targets for cardio-cerebral diseases using Mendelian randomization (MR) and colocalization analyses. METHODS: This study included two large protein quantitative trait loci studies with over 4,000 plasma proteins were included in the discovery and replication cohorts, respectively. We initially used MR to estimate the associations between protein and 20 cardio-cerebral diseases. Subsequently, Colocalization analysis was employed to enhance the credibility of the results. Protein target prioritization was based solely on including highly robust significant results from both the discovery and replication phases. Lastly, the Drug-Gene Interaction Database was utilized to investigate protein-gene-drug interactions further. RESULTS: A total of 46 target proteins for cardio-cerebral diseases were identified as robust in the discovery and replication phases by MR, comprising 7 pleiotropic therapeutic proteins and 39 specific target proteins. Followed by colocalization analysis and prioritization of evidence grades for target protein, 6 of these protein-disease pairs have achieved the highly recommended level. For instance, the PILRA protein presents a pleiotropic effect on sick sinus syndrome and Alzheimer's disease, whereas GRN exerts specific effects on the latter. APOL3, LRP4, and F11, on the other hand, have specific effects on cardiomyopathy and ischemic stroke, respectively. CONCLUSIONS: This study successfully identified important therapeutic targets for cardio-cerebral diseases, which benefits the development of preventive or therapeutic drugs.

A nomogram for predicting choledochal cyst with perforation.

BACKGROUND: Choledochal cyst with perforation (CC with perforation) rarely occurs, early diagnosis and timely treatment plan are crucial for the treatment of CC with perforation. This study aims to forecast the occurrence of CC with perforation. METHODS: All 1111 patients were conducted, who underwent surgery for choledochal cyst at our hospital from January 2011 to October 2022. We conducted univariate and multivariate logistic regression analysis to screen for independent predictive factors for predicting CC with perforation, upon which established a nomogram. The predictive performance of the nomogram was evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA) curves. RESULTS: The age of children with choledochal cyst perforation is mainly concentrated between 1 and 3 years old. Logistic regression analysis indicates that age, alanine aminotransferase, glutamyl transpeptidase, C-reactive protein, vomiting, jaundice, abdominal distension, and diarrhea are associated with predicting the occurrence of choledochal cyst perforation. ROC curves, calibration plots, and DCA curve analysis curves demonstrate that the nomogram has great discriminative ability and calibration, as well as significant clinical utility. CONCLUSION: The age of CC with perforation is mainly concentrated between 1 and 3 years old. A nomogram for predicting the perforation of choledochal cyst was established.

Prediction of early recovery of graft function after living donor liver transplantation in children.

For end-stage liver disease in children, living donor liver transplantation (LDLT) is often the important standard curative treatment. However, there is a lack of research on early recovery of graft function after pediatric LDLT. This is a single-center, ambispective cohort study. We collected the demographic and clinicopathological data of donors and recipients, and determined the risk factors of postoperative delayed recovery of hepatic function (DRHF) by univariate and multivariate Logistic analyses. 181 cases were included in the retrospective cohort and 50 cases in the prospective cohort. The incidence of DRHF after LDLT in children was 29.4%, and DRHF could well evaluate the early recovery of graft function after LDLT. Through Logistic analyses and AIC score, preoperative liver function of donors, ischemia duration level of the liver graft, Ln (Cr of recipients before operation) and Ln (TB of recipients on the 3rd day after operation) were predictive indicators for DRHF after LDLT in children. Using the above factors, we constructed a predictive model to evaluate the incidence of postoperative DRHF. Self-verification and prospective internal verification showed that this prediction model had good accuracy and clinical applicability. In conclusion, we pointed many risk factors for early delayed recovery of graft function after LDLT in children, and developed a visual and personalized predictive model for them, offering valuable insights for clinical management.

Genetically predicted osteoprotegerin levels and the risk of cardiovascular diseases: A Mendelian randomization study.

PURPOSE: The relationship between circulating osteoprotegerin (OPG) levels and the risk of cardiovascular diseases (CVDs) has been the subject of conflicting results in previous observational and experimental studies. To assess the causal effect of genetically predicted OPG levels on the risk of a wide range of CVDs, we used the Mendelian randomization design. DESIGN: We initially extracted information of genetic variants on OPG levels and their corresponding effect values from the summary data based on the European ancestry genome-wide association study. Subsequently, we performed two-sample Mendelian randomization analyses to assess the causal effect of genetically predicted OPG levels on CVDs by using inverse variance weighting (IVW), MR-Egger, weighted median, and MR-PRESSO methods. We also conducted sensitivity analyzes as well as complementary analyses with a more relaxed threshold for the exposure genetic instrumental variable (P < 5 × 10-6) to test the robustness of our results. RESULTS: Our results indicated that genetically predicted OPG levels causally reduce the risk of atrial fibrillation (IVW OR = 0.84; 95% CI = 0.72-0.98; P = 0.0241), myocardial infarction(IVW OR = 0.89; 95% CI = 0.80-0.98; P = 0.0173) and coronary heart disease (IVW: OR = 0.90; 95% CI = 0.82-0.99; P = 0.0286). Further complementary analyses also confirmed the above results remain robust and we also identified a potential causal association of OPG levels with a reduced risk of hypertensive diseases(IVW OR = 0.94;95% CI = 0.88-1.00; P = 0.0394). CONCLUSION: This study provides compelling evidence for a causal relationship between genetically predicted OPG levels and risk reduction of coronary heart disease, myocardial infarction, and atrial fibrillation, indicating that OPG could potentially serve as a cardiovascular risk marker in clinical practice.

High expression of RPL27A predicts poor prognosis in patients with hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common cancers in the digestive system with rapid progression and poor prognosis. Recent studies have shown that RPL27A could be used as a biomarker for a variety of cancers, but its role in HCC is not clear. METHOD: We analyzed the expression of RPL27A in the pan-cancer analysis and analyzed the relationship between the expression of RPL27A and the clinical features and prognosis of patients with HCC. We evaluated the expression difference of RPL27A in HCC tissues and paired normal adjacent tissues using immunohistochemistry. Furthermore, we analyzed the co-expression genes of RPL27A and used them to explore the possible mechanism of RPL27A and screen hub genes effecting HCC. In addition, we studied the role of RPL27A in immune infiltration and mutation. RESULTS: We found that the expression level of RPL27A increased in a variety of cancers, including HCC. In HCC patients, the high expression of RPL27A was related to progression and poor prognosis as an independent predictor. We also constructed a protein interaction network through co-expression gene analysis of RPL27A and screened 9 hub genes. Enrichment analysis showed that co-expression genes were associated with ribosome pathway, viral replication, nuclear-transcribed mRNA catabolic process, and nonsense-mediated decay. We found that the expression level of RPL27A was closely related to TP53 mutation and immune infiltration in HCC. CONCLUSION: RPL27A might become a biomarker in the diagnosis, treatment, and follow-up of patients with HCC.

Quercetin prevents isoprenaline-induced myocardial fibrosis by promoting autophagy via regulating miR-223-3p/FOXO3.

Atrial fibrillation (AF) is the common arrhythmias. Myocardial fibrosis (MF) is closely related to atrial remodeling and leads to AF. MF is the main cause of cardiovascular diseases and a pathological basis of AF. Thus, the underlying mechanism in MF and AF development should be fully elucidated for AF therapeutic innovation. Autophagy is a highly conserved lysosomal degradation pathway, and the relationship between autophagy and MF has been previously shown. Moreover, research reported that quercetin (Que) could ameliorate MF. The current study aimed to explore the mechanism of Que in MF. The results in this study showed that in clinical AF patients and in aged rats, miR-223-3p was high-expressed, while FOXO3 and autophagy pathway related proteins, such as ATG7, p62/SQSTM1 and the ratio of LC3B-II/LC3B-I were significantly inhibited. In vivo and in vitro studies, we found that Que can effectively inhibit the expression of miR-223-3p in AF model cells and rats myocardial tissues, and meanwhile enhance the expression of FOXO3 and activate the autophagy pathway, and significantly inhibit myocardial fibrosis, and improve myocardial remodeling in atrial fibrillation. All in all, in this study, we found that Que prevents isoprenaline-induced MF by increasing autophagy via regulating miR-223-3p/FOXO3.

Surface porous poly-ether-ether-ketone based on three-dimensional printing for load-bearing orthopedic implant.

Poly-ether-ether-ketone (PEEK) possesses excellent biocompatibility and similar elastic modulus as bones but yet suffers from poor osseointegration. In order to balance PEEK's mechanical and osseointegration properties, a novel surface porous PEEK (SP-PEEK) is successfully fabricated by fused deposition modelling three-dimensional printing (FDM 3DP) and characterized by mechanical and osteogenesis in vitro tests. Moreover, the effects of pore diameter and pore layer number on the mechanical behaviors of SP-PEEK are investigated by theoretical model and numerical simulation. Comparison among experimental, theoretical and simulation results show good agreement. As pore diameter decreases, the equivalent strength and modulus become more sensitive to the decrease of pore layer number. In addition, the SP-PEEK exhibits the mechanical properties within the range of human trabecular bone and cortical bone, and thus can be tailored to mimic human bone by adjusting the pore diameter and pore layer number, which is benefit to mitigate stress shielding. The effects of pore diameter on the cell proliferation and osteogenic differentiation of SP-PEEK are tested by the co-culture of osteoblast precursor cells (MC3T3-E1) and SP-PEEK round discs. Results showcase that porous surface improves the osteogenesis in vitro, and the SP-PEEK group that the pore diameter is 0.6 mm exhibits optimal-performance osteogenesis in vitro.

Astragaloside IV protects human cardiomyocytes from hypoxia/reoxygenation injury by regulating miR-101a.

Astragaloside IV (AS/IV) is one of the extracted components from the traditional Chinese medicine Astragalus which has been demonstrated to have potential capacity for anti-inflammation activity and for treating cardiovascular disease. Our purpose was to determine the function and underlying molecular mechanism of AS/IV in hypoxia/reoxygenation (H/R) injured in cardiomyocytes. Differentially expressed genes (DEGs) were screened using bioinformatic analysis, and the molecular targeting relationship was verified by the dual-luciferase report system. H/R injured cardiomyocytes were employed to explore the effect of AS/IV. QRT-PCR and Western blot analysis were applied to detect the expression of mRNA and proteins, respectively. Additionally, superoxide dismutase (SOD), lactic dehydrogenase (LDH) and MDA (malondialdehyde) levels were detected to determine the oxidative damage. Cell viability was assessed by CCK-8, and flow cytometry was used to evaluate cell apoptosis ratio. TGFBR1 and TLR2 were selected as DEGs. Additionally, AS/IV could enhance cell proliferation and upregulated miR-101a expression, which suppressed TGFBR1 and TLR2 expression in H/R injured cardiomyocytes. Moreover, the results of Western blot exhibited that the downstream genes (p-ERK and p-p38) in the MAPK signaling pathway were suppressed, which meant AS/IV could inhibit this pathway in H/R injured cardiomyocytes. Overall, this study demonstrated AS/IV could attenuate H/R injury in human cardiomyocytes via the miR-101a/TGFBR1/TLR2/MAPK signaling pathway axis, which means that it could serve as a possible alternate for H/R treatment.

Diagnosis of myocardial infarction with nonobstructive coronary arteries in a young man in the setting of acute myocardial infarction after endoscopic retrograde cholangiopancreatography: A case report.

BACKGROUND: Acute myocardial infarction (AMI) is characterized by chest pain as well as cardiac troponin I (cTnI) and electrocardiography (ECG) changes. Recently, clinical researchers have used the term "MINOCA" to indicate myocardial infarction with nonobstructive coronary arteries. To the best of our knowledge, no report has documented MINOCA in a young patient after choledocholithiasis by endoscopic retrograde cholangiopancreatography (ERCP). CASE SUMMARY: An 18-year-old Chinese man presented to the cardiac intensive care unit with chest pain radiating to the left shoulder for 1 h after choledocholithiasis by ERCP and the following treatment. ECG showed a sinus rhythm with ST-segment elevation in the II, III, and aVF leads compared with the baseline. Laboratory data revealed cTnI levels of 67.55 ng/mL and 80 ng/mL at the peak (relative index below 0.034 ng/mL) and creatine kinase-MB levels of 56 U/L and 543 U/L at the peak (relative index below 24 U/L). AMI was suspected, and coronary angiography was performed the second day. The results revealed a smooth angiographic appearance of all arteries. The patient had been diagnosed with gallstones and cholecystitis for four years but had not accepted treatment. He had abdominal pain and bloating a week previously and underwent ERCP and subsequent treatments on the second day of admission; 1.4 cm × 1.6 cm of stones were removed from his common bile duct during surgery. The results of his laboratory tests at admission revealed abnormal alanine aminotransferase, aspartate aminotransferase, glutamyl transpeptidase, total bile acid, total bilirubin, direct bilirubin, and indirect bilirubin levels. His temperature, heart rate, blood pressure, and body mass index were normal. His echocardiographic examination revealed no obvious abnormalities in the structure and movement of the ventricular wall and an estimated left ventricular ejection fraction of 57% after the heart attack. His cholesterol and triglycerides were within normal ranges, and his low-density lipoprotein cholesterol was 2.23 mmol/L (normal range 2.03-3.34 mmol). Further testing after AMI revealed nothing remarkable in his erythrocyte sedimentation rate, thyroid function, and tumour markers. CONCLUSION: We ultimately made a diagnosis of MINOCA caused by coronary artery spasm, which seemed to be the most suitable diagnosis of this young patient. We are concerned that the heart attack may have been induced by the ERCP rather than occurred coincidentally afterward, so we should investigate the timing of the event further. Additional studies are needed to unravel the underlying pathophysiology.

Concealed Pulmonary Vein Bigeminy during Sinus Rhythm in Patients with Paroxysmal Atrial Fibrillation: A Useful Marker for Pulmonary Vein Firing.

INTRODUCTION: A concealed pulmonary vein (PV) bigeminy (cPVB) may be found in some patients with atrial fibrillation (AF) during sinus rhythm (SR). The aim of this study was to investigate whether the presence of cPVB during SR is associated with a higher PV firing. METHODS AND RESULTS: Seven hundred seventy-six PVs (excluding 5 right middle PVs and 8 left common trunks) were mapped in 198 patients with paroxysmal AF (PAF) who underwent circumferential PV isolation. cPVB with a mean coupling interval of 136 ± 16 ms during SR was observed prior to ablation in 22 (11%) patients. Focal firing was provoked prior to ablation in 144 (19%) PVs. The incidence of focal firing was greater in PVs exhibiting cPVB compared with PVs without cPVB (89% vs. 16%; P < 0.001). Also, the number of radiofrequency applications required for isolation was greater in ipsilateral PVs, exhibiting cPVB compared with ipsilateral PVs without cPVB (21.6 ± 6.8 vs. 18.2 ± 5.6; P=0.024). During a follow-up of 32 ± 20 months, the single ablation success rate was 82%. Compared with patients without cPVB, patients with cPVB were associated with higher recurrence rate of AF (27% vs. 17%; p=0.032). CONCLUSION: cPVB during SR was observed prior to index ablation in 11% of PAF patients. Such a potential itself may be a PV firing in a concealed manner, which does not reactivate LA. The PV exhibiting cPVB required a greater number of radiofrequency applications for isolation. Compared to patients without cPVB, the recurrence rate of AF in patients with cPVB was greater.

Very long-term outcome of catheter ablation of post-incisional atrial tachycardia: Role of incisional and non-incisional scar.

BACKGROUND: The arrhythmogenicity of right atrial (RA) incisional scar after cardiac surgery could result in atrial tachycardia (AT). Radiofrequency catheter ablation is effective in the treatment of such tachycardia. However, data regarding long-term outcomes are limited. METHODS AND RESULTS: A total of 105 patients with prior RA incision who underwent radiofrequency catheter ablation of AT were included. In the first procedure, electroanatomic mapping (EAM) revealed a total of 139 ATs in 105 patients, including 88 cavotricuspid isthmus dependent atrial flutters (IDAFs), 5 mitral annulus reentrant tachycardias (MARTs), 44 intra-atrial reentrant tachycardias (IARTs) and 2 focal ATs (FATs). AT was successfully eliminated in 101 (96.1%) patients. During a mean follow-up period of 90 ± 36 months, recurrent AT was observed in 23 patients and 21 underwent a second ablation. A total of 23 ATs were identified in redo procedures including 4 IDAFs, 2 MARTs, 12 IARTs and 5 FATs. The time to recurrence was significantly different among various AT types. Acute success was achieved in 20 of 23 redo procedures. Taking a total of 21 patients presenting atrial fibrillation during follow-up into account, 85 patients (81.9%) were in sinus rhythm. No complications except for a case of RA compartmentation occurred. CONCLUSION: RA incisional scar played an essential role in promoting both IDAF and IART, while non-incisional scar contributed to a substantial rate of late recurrent AT in forms of both macroreentry and small reentry. Catheter ablation using EAM system resulted in a high success rate during long-term follow-up.

Atrioventricular node reentrant tachycardia in patients with congenitally corrected transposition of the great arteries and results of radiofrequency catheter ablation.

BACKGROUND: We sought to investigate the feasibility of radiofrequency catheter ablation of atrioventricular node reentrant tachycardia and the ideal site for slow pathway (SP) ablation in congenitally corrected transposition of the great arteries. METHODS AND RESULTS: Nine patients with congenitally corrected transposition of the great arteries referred for catheter ablation of atrioventricular node reentrant tachycardia were studied. A single His potential was recorded in 8 patients (89%, 6 {S,L,L} and 2 {I,D,D}). The earliest atrial activation during retrograde atrioventricular node conduction occurred at His bundle region (HBE; n=7) or shifting from HBE to coronary sinus ostium (n=1, {S,L,L}). Two anatomically separate His potentials were recorded in 1 patient (11%, {S,L,L}), one at the anteroseptum (HBE-1) and the other at the confluence of the pulmonary and mitral annulus (HBE-2). In 8 cases with a single His potential recorded, SP was abated at the posterior-midseptum, 2 ({S,L,L}) at the right posteroseptum, 1 ({S,L,L}) at the left posteroseptum, and 5 (3 {S,L,L} and 2 {I,D,D}) at the midseptum after failure of energy application at the posteroseptum. Junctional rhythm was observed during radiofrequency catheter ablation in all 8 of the cases. In the remaining patient with 2 anatomically separate His potentials recorded, SP was successfully ablated from the confluence of the pulmonary and mitral annulus, slightly below the HBE-2. Junctional rhythm was also induced during radiofrequency catheter ablation. CONCLUSIONS: In {S,L,L} or {I,D,D}, radiofrequency catheter ablation of atrioventricular node reentrant tachycardia is feasible. SP input region can mainly be found in the posterior midseptum, especially in patients with single penetrating atrioventricular nodes. SP could usually be successfully ablated in these regions.

[Water-soluble non-alkaloid chemical constituents contained in Corydalis yanhusuo by trimethylsilyl derivatization GC-MS].

OBJECTIVE: To study the water-soluble non-alkaloid chemical constituents of Corydalis yanhusuo. METHOD: The 80% alcohol extracts of C. yanhusuo passed through DA201 macroporous resin. Eluted fractions were collected and passed though 732 # cation exchange resin. Water eluate was collected, dried and derived with trimethylsilane. Gas Chromatography/Mass Spectrometry and NIST 2005 library were adopted for MS/MS mass spectrogram to infer the compound structure. RESULT: Sixteen compounds were tentatively identified from about fifty peaks detected by GC-MS and identified as hydroxyl and carboxyl polar compounds. CONCLUSION: These sixteen compounds were found for the first time in C. yanhusuo. The results provide scientific basis for in-depth development of C. yanhusuo.

Is selective ipsilateral PV isolation sufficient for focally triggered paroxysmal atrial fibrillation? Comparison of selective ipsilateral pulmonary vein isolation versus bilateral pulmonary vein isolation.

INTRODUCTION: Selective ipsilateral pulmonary vein isolation (SIPVI) has shown comparable efficacy in focal triggered atrial fibrillation (AF) versus isolation of all pulmonary veins (PVs), yet the sufficiency for such an ablation strategy to all patients is unclear. This study sought to identify a subgroup of patients for SIPVI and a subgroup of patients for bilateral PV isolation (BiPVI) with long-term success by comparing the clinical efficacy of SIPVI and BiPVI on PV-triggered AF. METHODS AND RESULTS: One hundred and forty-two patients (106 males; mean age 51 ± 13 years) with focal PV triggered paroxysmal AF (PAF) were studied. Seventy patients underwent SIPVI and 72 patients underwent BiPVI. After the first ablation, 44 patients (44/70) in the SIPVI group and 54 patients (54/72) in the BiPVI group were free of AF without antiarrhythmic drugs, after a follow-up period of 36 ± 12 months (log-rank test P = 0.1594). In patients younger than 50 years of age with a left atrium (LA) diameter <40 mm, SIPVI had a high success rate (15/18, 83%) of freedom from AF. However, for patients aged ≥50 years with an LA diameter ≥40 mm, 10 of the 12 patients in the SIPVI group and only 5 of the 15 patients in the BiPVI group had a recurrence of AF (log-rank test P = 0.0173). CONCLUSIONS: For focally triggered PAF, in patients aged <50 years with an LA diameter <40 mm, SIPVI of triggering PV had a high success rate of freedom from AF. However, in patients aged ≥50 years with an LA diameter ≥40 mm, BiPVI achieved a higher success rate.

Focal atrial tachycardia originating from the distal portion of the left atrial appendage: characteristics and long-term outcomes of radiofrequency ablation.

AIMS: The characteristics and response to ablation therapy of focal atrial tachycardia (AT) originating from the distal portion of left atrial appendage (LAAd) are still not quite clear up to now. The goal of this study is to characterize electrocardiographic and electrophysiological features and radiofrequency ablation (RFA) outcomes in patients with focal AT originating from the LAAd. METHODS AND RESULTS: Fourteen patients (2.1%) (mean age, 25 ± 10 years; nine women; mean symptom duration, 5 ± 5 years) undergoing RFA of focal AT originating from the LAAd were included out of 668 RFA patients. Activation mapping was performed. P waves were classified as negative, positive, isoelectric, or biphasic. Tachycardia that was incessant in all, demonstrated a characteristic P-wave morphology and endocardial activation pattern: P wave was negative in leads I and aVL, highly positive in the inferior leads, and broad and positive in lead V1. Radiofrequency ablation was acutely successful in 13 of 14 patients. The endocardial activation time of the successful RFA sites was 47.1 ± 4.3 ms before the onset of P wave. There were no complications in any of the 14 patients and long-term success was achieved in 13 of 13 successful RFA patients during follow-up (5 ± 2 years). CONCLUSION: The LAAd is an uncommon site of origin for focal AT (2.1% incidence). In this case series, focal ATs originating from the LAAd had typical electrophysiological and electrocardiographic characteristics. Focal ablation yielded high acute success rate with low rate of recurrence during follow-up.

The characteristics of verapamil-sensitive idiopathic left ventricular tachycardia combined with a left accessory pathway and the effect of radiofrequency catheter ablation.

AIMS: Verapamil-sensitive idiopathic left ventricular tachycardia (ILVT) combined with a left accessory pathway (AP) is a relatively rare condition. This study examines the characteristics of patients with this condition and the effect of radiofrequency catheter ablation (RFCA). METHODS AND RESULTS: Catheter ablation was performed on 140 ILVT patients at a single centre from January 2004 to December 2009. A concealed left AP was found in seven patients (5%), all of whom were male, with an average age of 21 ± 9 years. Sustained ILVT and orthodromic atrioventricular reentrant tachycardia (AVRT) were induced in all seven patients. Retrograde activation through a bystander AP occurred concomitantly with ILVT, with an average tachycardia length of 346 ± 29 ms (range 310-400 ms). The location of the APs in four patients was left posterior, two of which showed a slow and decremental property, while in three it was left lateral. Ablation via a retrograde transaortic approach was performed in the seven patients. The left AP was ablated first in six patients, but ILVT was no longer induced in one and became non-sustained in another. In the seventh patient, ILVT was ablated first and this proved successful. CONCLUSIONS: Among patients with IVLT, 5% had a concomitant left AP, most of who were young men. The location of the left AP was mainly posterior and lateral, with 30% showing a slow and decremental property. Idiopathic left ventricular tachycardia and AP should be ablated simultaneously.

New observation of electrocardiogram during sinus rhythm on the atriofascicular and decremental atrioventricular pathways/clinical perspective: [corrected] terminal QRS [corrected] complex slurring or notching.

BACKGROUND: Atriofascicular and decremental atrioventricular pathways are variants of accessory pathways with anterograde decremental conduction properties. They result in typical wide Quantronic Resonance System (QRS) tachycardia of left bundle branch block morphology. Data on the sinus rhythm electrocardiographic characteristics are limited. METHODS AND RESULTS: Thirty patients with accessory pathways of anterograde decremental conduction properties were studied retrospectively (10 atriofascicular pathways and 20 decremental atrioventricular pathways). All patients had a pre-excited atrioventricular tachycardia with anterograde conduction over anterograde decrementally conducting fiber. Eighteen patients fulfilled criteria of minimal pre-excitation during sinus rhythm before ablation. In 10 patients (33%), delta wave was absent, and the only abnormality was terminal QRS slurring or notching on the ECG. It was mainly in leads I, V5, and V6. After ablation, terminal QRS slurring or notching disappeared in all 10 patients. We also did a survey in a control group comprised of 200 subjects without structural heart disease who were matched for age and sex. Terminal QRS slurring or notching was found in 3%. CONCLUSIONS: This study showed a high prevalence of terminal QRS slurring or notching in patients with atriofascicular or decremental atrioventricular pathways. It can be the sole manifestation of such accessory pathways during sinus rhythm, and disappearance of terminal slurring or notching can be the only hallmark of successful ablation visible on the surface ECG.

Single dose of ibutilide for conversion of persistent atrial fibrillation after radiofrequency ablation.

BACKGROUND: Patients with persistent or permanent atrial fibrillation (AF) often need direct current cardioversion after radiofrequency ablation. The aim of this study was to investigate the effectiveness and safety of ibutilide for cardioversion of persistent or permanent atrial fibrillation after radiofrequency ablation and the factors related to conversion. METHODS: Patients with persistent or permanent atrial fibrillation were treated with combined ablation strategy including circumferential pulmonary vein isolation, linear ablation and CAFÉ potential ablation. If AF was not terminated after ablation, ibutilide was used for cardioversion (1 mg, intravenous injection in 10 minutes). These patients were divided into a conversion group and a non-conversion group according to whether AF was converted to sinus rhythm within 30 minutes after administration. ECG monitoring was performed during the injection of ibutilide. Atrial waves recorded by coronary sinus electrodes were measured for calculating average wavelength of AF waves in six seconds. The QT interval was measured immediately after conversion and 2 hours after injection of ibutilide. RESULTS: Forty patients whose AF was not converted to sinus rhythm after radiofrequency ablation were given an intravenous injection of ibutilide. Of the 40 patients, 29 cases were converted to sinus rhythm, with a conversion rate of 72.5%. The average conversion time was (13.2 ± 5.5) minutes. Compared with the conversion group, patients in the non-conversion group had a longer history of AF (9.4 ± 5.3) years vs. (4.3 ± 2.8) years, P < 0.05), and a markedly enlarged left atrium (47.3 ± 2.9) mm vs. (42.1 ± 4.5) mm, P < 0.05). There were no significant differences in gender, age, body mass index and left ventricular function between the two groups. Ibutilide significantly prolonged the average wavelength of the AF wave (171.8 ± 29.5) ms vs. (242.0 ± 40.0) ms, P < 0.001). Two hours after ibutilide treatment, the QT interval was significantly shortened (421.0 ± 24.7) ms vs. (441.0 ± 37.4) ms, P < 0.05). No cases of serious arrhythmias or other adverse reactions were found. CONCLUSIONS: A single dose of ibutilide for conversion of persistent or permanent AF after radiofrequency ablation is safe and effective.