Association between the Albumin-to-Globulin Ratio and Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy.

Background: Atrial fibrillation (AF), which occurs four to six times more frequently in hypertrophic cardiomyopathy (HCM) patients than in the general population, is the most common persistent arrhythmia and has a substantial therapeutic consequence. In HCM patients, there are currently no discovered signs that could be utilized to identify AF. Methods: From 2018 to 2022, 493 individuals with a continuous diagnosis of HCM were examined at Beijing Anzhen Hospital. AF was proven using routine electrocardiography (ECG), 24-hour Holter ECGs, or bedside ECGs. Echocardiography and blood tests were performed for all patients. Analysis and comparison of the traits were performed in HCM patients with AF (n = 77) and without AF (n = 416). Results: Age (p < 0.001), prevalence of ventricular tachycardia (VT, p < 0.001), prevalence of pulmonary artery hypertension (p = 0.027), and albumin-to-globulin ratio (AGR, p = 0.046) were all significantly higher in patients with AF, compared to patients without AF. In multivariate logistic analysis, age (odds ratio [OR], 1.063; 95% confidence interval [CI], 1.032-1.095; p < 0.001), history of VT (OR, 2.702; 95% CI, 1.007-7.255; p = 0.048), AGR (OR, 3.477; 95% CI, 1.417-8.536; p = 0.007), left atrial diameter (OR, 1.132; 95% CI, 1.073-1.194; p < 0.001), left ventricular end-diastolic diameter (OR, 0.861; 95% CI, 0.762-0.974; p = 0.017), left ventricular end-systolic diameter (OR, 1.239; 95% CI, 1.083-1.417; p = 0.002), and peak A wave velocity (OR, 0.983; 95% CI, 0.972-0.994; p = 0.002) were independently associated with AF in HCM patients. In the receiver operating characteristic curve analysis, the area under the curve for the established model was 0.819 (95% CI, 0.755-0.883, p = 0.033), with a sensitivity and specificity of 0.763 and 0.816, respectively, for AF occurrence in HCM patients. Conclusions: In individuals with HCM, a history of VT and a higher AGR are independently linked to AF. Further investigation is necessary to determine whether increased AGR represents a risk factor for embolic stroke or cardiovascular death.

Arrhythmia classification based on multi-feature multi-path parallel deep convolutional neural networks and improved focal loss.

Early diagnosis of abnormal electrocardiogram (ECG) signals can provide useful information for the prevention and detection of arrhythmia diseases. Due to the similarities in Normal beat (N) and Supraventricular Premature Beat (S) categories and imbalance of ECG categories, arrhythmia classification cannot achieve satisfactory classification results under the inter-patient assessment paradigm. In this paper, a multi-path parallel deep convolutional neural network was proposed for arrhythmia classification. Furthermore, a global average RR interval was introduced to address the issue of similarities between N vs. S categories, and a weighted loss function was developed to solve the imbalance problem using the dynamically adjusted weights based on the proportion of each class in the input batch. The MIT-BIH arrhythmia dataset was used to validate the classification performances of the proposed method. Experimental results under the intra-patient evaluation paradigm and inter-patient evaluation paradigm showed that the proposed method could achieve better classification results than other methods. Among them, the accuracy, average sensitivity, average precision, and average specificity under the intra-patient paradigm were 98.73%, 94.89%, 89.38%, and 98.24%, respectively. The accuracy, average sensitivity, average precision, and average specificity under the inter-patient paradigm were 91.22%, 89.91%, 68.23%, and 95.23%, respectively.

Biothiols-activated near-infrared frequency up-conversion luminescence probe for early evaluation of drug-induced hepatotoxicity.

A novel biothiols-sensitive near-infrared (NIR) fluorescent probe RhDN based on a rhodamine skeleton was developed for early detection of drug-induced hepatotoxicity in living mice. RhDN can be used not only as a conventional large stokes shift fluorescent (FL) probe, but also as a kind of anti-Stokes frequency upconversion luminescence (FUCL) molecular probe, which represents a long wavelength excitation (808 nm) to short wavelength emission (760 nm), and response to Cys/Hcy/GSH with high sensitivity. Compared with traditional FL methods, the FUCL method exhibited a lower detection limit of Cys, Hcy, and GSH in 75.1 nM, 101.8 nM, and 84.9 nM, respectively. We exemplify RhDN for tracking endogenously biothiols distribution in living cells and further realize real-time in vivo bioimaging of biothiols activity in mice with dual-mode luminescence system. Moreover, RhDN has been successfully applied to visualize the detection of drug-induced hepatotoxicity in living mice. Overall, this report presents a unique approach to the development of large stokes shift NIR FUCL molecular probes for in vitro and in vivo biothiols biosensing.

[Effect of distal ischemic preconditioning on cardiovascular events in adult patients with hip fracture one year after operation].

OBJECTIVE: To investigate the effect of remote ischemic preconditioning (RIPC) on major adverse cardiovascular events (MACE) in elderly patients with hip fracture 1 year after operation. METHODS: Total of 314 elderly patients with hip fracture of gradeⅡand Ⅲ for American Society of Anesthesiologists (ASA) were treated by surgical operation from April 2015 to May 2020 including 116 males and 198 females, the age ranged from 60 to 76 years old. The subjects were divided into intervention group and control group according to whether received RIPC. Among them, 157 cases in intervention group included 56 males and 101 females with an average age of (68.12±7.13) years old and 157 cases in control group included 60 males and 97 females with an average age of (68.24±7.05) years old. Both groups were given routine anesthesia. The intervention group was treated with RIPC on the basis of routine anesthesia. The MACE events 1 year after operation in two groups were compared and analyzed. RESULTS: The OR values of RIPC for myocardial infarction, heart failure, stroke, nonfatal cardiac arrest, coronary revascularization, severe arrhythmia, peripheral artery thrombosis, readmission of cardiovascular disease, and all-cause death in patients with hip fracture one year after operation were 1.269, 1.304, 0.977, 1.089, 1.315, 1.335, 0.896, 0.774, 1.191, respectively, but there was no significant difference (P>0.05). CONCLUSION: RIPC did not significantly affect and change the occurrence of major cardiovascular adverse events within 1 year after hip fracture surgery. The long term impact of RIPC on clinical cardiovascular outcomes in non cardiac surgery needs to be confirmed in appropriate randomized clinical trials.

Time-averaged atomic volume spectrum: locating and identifying vacancies.

Vacancies, as well as their derivatives, usually play a crucial role in many essential properties of materials. However, they always behave erratically, especially under universal thermal vibration, and are therefore difficult to accurately locate. Until now, the lack of an accurate and flexible method for locating and identifying vacancies has hampered the development of relative fields. In this paper, we present a new method to solve this problem. The strategy is to target the atomic cage enwrapping vacancies instead of the vacancies themselves. The core of the method is a time-averaged atomic volume spectrum (TAVS). The key to this method is to identify atoms using time-averaged rather than transient atomic volume, thereby simultaneously denoising intrinsic thermal vibration and avoiding vacancy migration jump. Using this method, we have succeeded for the first time in obtaining the panoramic maps of spontaneously trapped defects in quenched and annealed face-centered cubic aluminum and even the instantaneous images of a steady trapping process. All characteristics of each trapped vacancy, including location, dimension, volume and morphology, as well as aggregate statistical data such as vacancy amount and concentration, can be completely and accurately obtained. Furthermore, these first maps of defects (vacancies) revealed some surprising and interesting phenomena for future exploration. In conclusion, this method provides not only a means of locating and catching vacancies, but also a strategy for identifying and characterizing vacancies. On the basis of its successful application in FCC Al, the TAVS method can be easily extended to other systems as well.

Atrial lead perforation early after device implantation-a case report and literature review.

We report three patients with screw-in lead perforation in the right atrial free wall not long after device implantation. All the patients complained of intermittent stabbing chest pain associated with deep breathing during the implantation. The "dry" epicardial puncture was utilized to avoid hemopericardium during lead extraction in the first case. The atrial electrode was repositioned in all cases and replaced by a new passive fixation lead in two patients with resolution of the pneumothorax or pericardial effusion. A literature review of 50 reported cases of atrial lead perforation was added to the findings in our case report.

Performance of Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) in Chinese Population with Primary Prevention Indications: A Prospective Observational Cohort Study.

BACKGROUND International studies have shown that use of a subcutaneous implantable cardioverter defibrillator (S-ICD) could reduce lead-related complications while maintaining adequate defibrillation performance; however, data from the Chinese population or other Asian groups are limited. MATERIAL AND METHODS SCOPE is a prospective, multicenter, observational cohort study. Two hundred patients with primary prevention indication for sudden cardiac death (SCD), who are candidates for S-ICD, will be enrolled. From the same population, another 200 patients who are candidates for transvenous implantable cardioverter defibrillator (TV-ICD) will be enrolled after being matched for age, sex, SCD high-risk etiology (ischemic cardiomyopathy, and non-ischemic cardiomyopathy, ion channel disease, and other) and atrial fibrillation in a 1: 1 ratio with enrolled S-ICD patients. All the patients will be followed for 18 months under standard of care. RESULTS The primary endpoint is proportion of patients free from inappropriate shock (IAS) at 18 months in the S-ICD group. The lower 95% confidence bound of the proportion will be compared with a performance goal of 90.3%, which was derived from the previous meta-analysis. The comparisons between S-ICD and TV-ICD on IAS, appropriate shock, and complications will be used as secondary endpoints without formal assumptions. CONCLUSIONS This is the first prospective multicenter study focusing on the long-term performance of S-ICD in a Chinese population. By comparing with the data derived from international historical studies and a matched TV-ICD group, data from SCOPE will allow for the assessment of S-ICD in the Chinese population in a contemporary real-world implantation level and programming techniques, which will help us to further modify the device implantation and programming protocol in this specific population in the future.

A facile near-infrared xanthene fluorescence probe for visualizing of hypochlorous acid in vitro and in vivo.

BACKGROUND: Hypochlorous acid (HClO) is an important biomarker for inflammation, cardiovascular disease, and even cancer. It is of great significance to accurately monitor and quantitatively analyze the fluctuations of HClO to better understand their physiological functions. Traditional HClO detection methods such as high-performance liquid chromatography (HPLC), and mass spectrometry are preferred, but are costly and unsuitable in vivo. Near-infrared (NIR) fluorescence imaging has the advantages of high sensitivity, high temporal and spatial resolutions, minimal autofluorescence, and deep tissue penetration, which facilitates its application in biological systems. Therefore, the development of sensitivity and simple NIR fluorescence monitoring HClO methods in vivo and in vitro is essential and desirable. RESULTS: Herein, we present a NIR probe NOF3 by integrating the rhodamine scaffold and HClO-triggered moiety for the real-time detection of HClO in vitro and in vivo. NOF3 reacts with the HClO and releases the NOF-OH fluorophore of emitted signals at 730 nm, which is in the NIR region. The designed probe detected concentrations of HClO ranging from 0 to 17 µM with a low detection limit of 0.146 µM, presenting excellent sensitivity and selectivity toward HClO over other species. NOF3 manifests significantly turn-on NIR fluorescent signals in response to HClO concentration, which makes it favorable for monitoring dynamic HClO distribution in vivo. We exemplify NOF3 for the tracking of endogenously overexpressed HClO distribution in RAW 264.7 cells, and further realize real-time in vivo bioimaging of HClO activity in inflammation mice. SIGNIFICANCE: The facile NIR NOF3 probe was successfully applied to visualize endogenous and exogenous HClO in living cells and mice. This study provides not only an effective tool for spatial and temporal resolution HClO bioimaging in vivo but also possesses great potential for use in future research on HClO-related biology and pathology.

Photoelasticity of a MgO single crystal from polarized Brillouin scattering spectroscopy.

MgO is a crystalline solid with significant practical and theoretical value in many fields. Brillouin scattering has long been regarded as a reliable method for accurately measuring the elasticity and photoelasticity of crystals; however, its practical application in photoelasticity has been stagnant. In this paper, three independent photoelastic constants of MgO have been measured for the first time by polarized Brillouin scattering spectroscopy and we have defined a scattering factor containing three photoelastic constants to connect with the Brillouin peak intensity. Accordingly, the ratios of |p11/p44| = 2.87 (1), |p12/p44| = 0.53 (2), and |p12/p11| = 0.18 (1) were accurately determined by comparing the intensities of transverse and longitudinal acoustic modes within the same spectrum. Then, a standard sample of CaF2 crystals was adopted to calculate the corresponding peak intensity of MgO to achieve the absolute values (|p44| = 0.085 (1), |p11| = 0.244 (4) and |p12| = 0.045 (3)). Finally, all three constants were confirmed to be negative. These first-hand Brillouin scattering results can eliminate the long-standing discrepancies of the photoelastic constants of MgO. A standard process for the simultaneous measurement of elasticity and photoelasticity through Brillouin scattering was also constructed.

Near-Infrared BODIPY Photosensitizer for Modulating Mitochondrial Fusion Proteins and Inhibiting Choroidal Neovascularization.

Photosensitizers have emerged as cytotoxic reactive oxygen species (ROS) activators in photodynamic therapy (PDT), which induced cell apoptosis. As the major contributors to ROS and oxidative stress, mitochondria play an important role in cell apoptosis. Although there are many reports about near-infrared 4,4-difluoro-4-bora-3a,4a-diaza-s-indacene (BODIPY) as photosensitizers (PSs) for PDT, this kind of PS has rarely been used for treating mitochondrial function and choroidal neovascularization application at the same time. Herein, a novel near-infrared PS (BDP2) characterized by good water solubility, long wavelength excitation, and high ROS quantum yield has been made. Under near-infrared light irradiation, BDP2 would generate ROS with high yield, induce a mitochondrial morphology change, and trigger cell apoptosis by changing the fusion protein level. Deep investigation revealed that BDP2 can cause oxidative stress, break the balance between fusion and fission of mitochondrial dynamics protein through decreasing fusion protein MFN2 and OPA1 expression, and finally cause cell apoptosis. Due to these characteristics, the BDP2 PS was used to treat choroidal neovascularization in animal models and can inhibit neovascularization.

Comparative cost analysis of implanting devices in different cardiac resynchronization therapeutic strategies.

BACKGROUND: Cardiac resynchronization therapy (CRT) is an established treatment option for heart failure patients. However, the implementation of triple-chamber pacemakers can be cost-prohibitive. His-Purkinje system pacing (HPSP) can also enable cardiac resynchronization, and it can be achieved with relatively inexpensive conventional pacemakers. HYPOTHESIS: This article aims to comparatively evaluate the cost of implanting devices in different CRT strategies to provide meaningful guidance for clinical decision-making by electrophysiologists. METHODS: Data was collected on the prices, designed life, and price/designed life of multiple mainstream models of CRT-P, CRT-D, dual-chamber pacemakers, and single-chamber pacemakers that were sold in the Chinese market in 2022. The prices, designed lives, and price/designed life of different pacemaker models were then compared. RESULTS: The costs of CRT-P and CRT-D (13008.44 ± 2752.30 USD and 22043.36 ± 3676.25 USD) were significantly higher than those of conventional pacemakers (dual-chamber: 11142.39 ± 4273.85 USD and single-chamber: 5634.28 ± 2032.80 USD) (p < .05). Additionally, the price/designed life of conventional pacemakers (dual-chamber: 839.63 ± 258.62 US dollar/year and single-chamber: 435.86 ± 125.44 US dollar/year) was significantly better than that of CRT-P and CRT-D (1386.91 ± 266.73 and 2585.53 ± 520.27 US dollar/year, respectively) (p < .05). CONCLUSION: Conduction system pacing (CSP)-based CRT is more cost-effective than BVP-based CRT. Furthermore, CSP-based CRT can achieve cardiac resynchronization with conventional pacemakers and may be a good option for HF patients who do not need defibrillation.

A highly stable chain-based EuIII metal-organic framework as a turn-on and blue-shift luminescent sensor for dipicolinic acid.

The development of a rapid and selective method for the identification of dipicolinic acid (DPA), a specific biomarker in Bacillus anthracis spores, is of great importance for the avoidance of anthrax infection. Herein, a chain-based EuIII metal-organic framework with the formula {[Eu3(BTDB)3(µ3-OH)3(H2O)]·solvents}n (JXUST-38, H2BTDB = (benzo[c][1,2,5]thiadiazole-4,7-diyl)dibenzoic acid) was obtained using 2-fluorobenzoic acid as the pH regulator. JXUST-38 exhibits good chemical and thermal stability and can specifically recognize DPA in N,N-dimethylformamide solution through luminescence enhancement and blue-shift effects with a detection limit of 0.05 µM. Furthermore, the significant luminescence enhancement and blue shift under UV lamps are obviously observable by the naked eye. The luminescence sensing mechanism is attributed to absorbance-induced enhancement between JXUST-38 and DPA. Test paper and mixed-matrix membrane based on JXUST-38 are designed for DPA detection. In addition, the feasibility of using JXUST-38 in biosensing is discussed in detail.

An efficient ECG denoising method by fusing ECA-Net and CycleGAN.

For wearable electrocardiogram (ECG) acquisition, it was easy to infer motion artifices and other noises. In this paper, a novel end-to-end ECG denoising method was proposed, which was implemented by fusing the Efficient Channel Attention (ECA-Net) and the cycle consistent generative adversarial network (CycleGAN) method. The proposed denoising model was optimized by using the ECA-Net method to highlight the key features and introducing a new loss function to further extract the global and local ECG features. The original ECG signal came from the MIT-BIH Arrhythmia Database. Additionally, the noise signals used in this method consist of a combination of Gaussian white noise and noises sourced from the MIT-BIH Noise Stress Test Database, including EM (Electrode Motion Artifact), BW (Baseline Wander) and MA (Muscle Artifact), as well as mixed noises composed of EM+BW, EM+MA, BW+MA and EM+BW+MA. Moreover, corrupted ECG signals were generated by adding different levels of single and mixed noises to clean ECG signals. The experimental results show that the proposed method has better denoising performance and generalization ability with higher signal-to-noise ratio improvement (SNRimp), as well as lower root-mean-square error (RMSE) and percentage-root-mean-square difference (PRD).

Highly pH-Responsive Sensor Based on a EuIII Metal-Organic Framework with Efficient Recognition of Arginine and Lysine in Living Cells.

A lanthanide-based three-dimensional metal-organic framework with excellent water, acid/base, and solvent stability, namely {[(CH3)2NH2]0.7[Eu2(BTDBA)1.5(lac)0.7(H2O)2]·2H2O·2DMF·2CH3CN}n (JXUST-29, H4BTDBA = 4',4‴-(benzo[c][1,2,5]thiadiazole-4,7-diyl)bis([1,1'-biphenyl]-3,5-dicarboxylic acid), Hlac = lactic acid), has been synthesized and characterized. Since the N atoms of the thiadiazole group will not coordinate with lanthanide ions, JXUST-29 has a free basic N-site accessible to small H+ ions, which allows it to be used as a promising pH fluorescence sensor. Interestingly, the luminescence signal was significantly enhanced, with an approximately 54-fold enhancement in the emission intensity when the pH value was increased from 2 to 5, which is the typical behavior of pH probes. In addition, JXUST-29 can also be used as a luminescence sensor to detect l-arginine (Arg) and l-lysine (Lys) in an aqueous solution through fluorescence enhancement and the blue-shift effect. The detection limits were 0.023 and 0.077 µM, respectively. In addition, JXUST-29-based devices were designed and developed to facilitate detection. Importantly, JXUST-29 is also capable of detecting and sensing Arg and Lys in living cells.

Rare earth upconversion luminescent composite based on energy transfer for specific and sensitive detection of cysteine.

Abnormal levels of thiols in cysteine (Cys) have been shown to be associated with growth retardation, skin lesions, and neurotoxicity in humans. Herein, we designed and synthesized a rare earth upconversion luminescent (UCL) nanocomposite probe UCNP-PEG-NOF1 for the UCL detection of Cys using NOF1 developed by our group as a Cys probe. The core structure of rare earth nanoparticles can absorb light at 980 nm and convert it into visible light. The detection principle of Cys was based on the change in absorption peak before and after the reaction between NOF1 and Cys, as well as the change in UCL intensity. The rare earth nanocomposite in the probe could be excited by near-infrared light and had low background fluorescence and strong penetration ability; thus, the probe was successfully employed to specifically and sensitively detect Cys with a low background signal. Overall, the developed UCNP-PEG-NOF1 probe had good selectivity and high sensitivity for Cys; its detection limit was as low as 83 nM.

Risk factors and prognostic value of osteoporosis in hospitalized patients with bronchiectasis.

BACKGROUND: The risk factors for osteoporosis and its prognostic value in patients with bronchiectasis is not well characterized. We explored the risk factors for osteoporosis and its prognostic impact in hospitalized non-cystic fibrosis bronchiectasis (NCFB) patients in Southeast China. METHODS: This observational cohort study consecutively enrolled 179 hospitalized patients with NCFB bronchiectasis between 2017 and 2021. The risk factors and the impact of osteoporosis on all-cause mortality were assessed. RESULTS: 21.2% (38/179) of hospitalized NCFB patients were diagnosed with osteoporosis. Patients with osteoporosis had more severe symptoms (assessed by chronic airway assessment test, CAT, median 22 vs. 17, P = 0.017), poorer quality of life (assessed by St. George Respiratory Questionnaires, SQRC, median 42 vs. 27, P = 0.007), more severe disease stage (assessed by bronchiectasis severity index, BSI, median 14 vs. 11, P = 0.02), more comorbidities (assessed by Bronchiectasis Aetiology Comorbidity Index, BACI, median 5 vs. 4, P = 0.021) than patients without. Age, female sex, anemia, post-infection, and history of regular inhaled corticosteroid treatment were independent risk factors for osteoporosis in those patients. 21 patients (11.7%) died over a median follow-up period of 32 months. The all-cause mortality in NCFB patients with osteoporosis [28.94% (11/38)] was significantly higher than those without osteoporosis [7.09% (10/141)] [hazard ratio (HR) 5.34, 95% confidence interval (CI) 2.26-12.67, P < 0.001]. After adjusting for BSI and other confounding factors, osteoporosis was still independently associated with all-cause mortality in hospitalized NCFB patients (HR 4.29, 95% CI 1.75-10.49, P < 0.001). CONCLUSIONS: Osteoporosis had an independent effect on all-cause mortality in hospitalized NCFB patients. Management of comorbidities, including bone health, is a critical aspect of treating NCFB patients.

Assessment of Cardiac Function and Ventricular Mechanical Synchronization in Left Bundle Branch Area Pacing by Speckle Tracking and Three-Dimensional Echocardiography.

Real-time 3-dimensional echocardiography combined with speckle tracking was used in this study. A total of 90 patients with normal left ventricular ejection fraction were divided into 3 groups according to the pacing site: left bundle branch area pacing (LBBAP), right ventricular septal pacing (RVSP) or right ventricular apical pacing (RVAP). Procedure duration (90 ± 18 vs 61 ± 6.6 vs 58 ± 5.6 minutes, p = 0.015), Fluoroscopy duration (15.5 ± 5.4 vs 4.8 ± 2.2 vs 4 ± 1.9 minutes, p = 0.004), and ventricular capture threshold at implantation (0.8 ± 0.3 vs 0.6 ± 0.2 vs 0.6 ± 0.1 V, p = 0.002) were significantly increased in patients that received LBBAP compared with RVSP or RVAP. At 4 weeks of follow-up, brain natriuretic peptide levels were significantly lower (22 [12 to 59] vs 135 [86 to 231] vs 235 [147 to 428] pg/ml, p = 0.04), paced QRS duration was significantly shorter (115 ± 26 vs 134 ± 28 vs 157 ± 29 ms, p = 0.012), and global longitudinal strain (-19.4 ± 2.4 vs -19.3 ± 3.4 vs -17.3 ± 3.5%, p = 0.026) and systolic dyssynchrony index (2.5 ± 0.3 vs 5.9 ± 0.9 vs 7.7 ± 1.2, p = 0.001), longitudinal absolute maximum difference of time to peak strain (17 [6 to 68] vs 117 [71 to 173] vs 126 [79 to 178] ms, p <0.0001), and circumferential absolute maximum difference of time to peak strain (76 [32 to 129] vs 148 [117 to 208] vs 161 [118 to 266] ms, p = 0.005) were significantly lower in patients that received LBBAP compared with RVSP or RVAP. In conclusion, LBBAP can provide a more physiological ventricular activation pattern than RVSP or RVAP and results in good left ventricular electrical and mechanical synchronization.

Sinus node dysfunction after radiofrequency catheter ablation of atrial flutter: A case report.

Atrial flutter (AFL) is the second most common atrial tachyarrhythmia after atrial fibrillation. Catheter ablation (CA) for typical AFL is well-established and has a high success rate and adequate safety. However, sick sinus syndrome (SSS) occasionally occurs when long-term, persistent AFL is terminated by ablation. Sinus node function cannot be assessed during AFL, and the preoperative prediction of underlying SSS has not yet been investigated. When this situation occurs, pacemaker implantation is often necessary. Here, we report a case of SSS after persistent AFL CA.

Predictors of Low Voltage Zone and Sex Differences in Low Voltage Zone Distribution in Patients with Atrial Fibrillation.

Background: Previous studies have revealed the left atrial (LA) low voltage zone (LVZ) are tightly linked to the recurrence of atrial fibrillation (AF). Furthermore ablation that targets the LA LVZ can improve patient prognosis. The aim of this study was to identify potential clinical predictors of the LA LVZ, to investigate possible sex differences in the distribution of LA LVZ, and to examine the relationship between LA LVZ and AF recurrence. Methods: A total of 108 patients who underwent AF catheter ablation and LA high-density electro-anatomic mapping were enrolled in the study. Of these, 56 patients with LA LVZ ≥ 5% were assigned to the LVZ group, while the remaining 52 patients with LA LVZ < 5% were assigned to the non-LVZ group. Clinical characteristics and laboratory results for all patients were collected and compared between the two groups. Results: Multivariate logistic regression analysis revealed that persistent AF (odds ratio [OR] = 4.563, 95% confidence interval [CI]: 1.194-17.431, p = 0.026), left atrial volume (LAV, OR = 1.030, 95% CI: 1.001-1.061, p = 0.044) and brain natriuretic peptide (BNP, OR = 1.010, 95% CI: 1.002-1.019, p = 0.015) were independent predictors for the presence of LA LVZ. In addition, female sex (OR = 7.161, 95% CI: 1.518-33.792, p = 0.013), LAV (OR = 1.028, 95% CI: 1.002-1.055, p = 0.035) and BNP (OR = 1.009, 95% CI: 1.001-1.016, p = 0.018) were independent predictors of severe LA LVZ (LA LVZ > 20%). The extent of LVZ was significantly greater in females than in males (32.8% ± 15.5% vs. 23.5% ± 12.7%, p = 0.021), especially in the anterior (34.5% ± 16.7% vs. 20.0% ± 16.4%, p = 0.003) and septal (44.9% ± 17.1% vs. 29.0% ± 18.9%, p = 0.004) walls. During follow-up, AF recurrence was significantly higher in patients with LA LVZ than in those without LA LVZ (31.3% vs. 12.8%, respectively, p = 0.023). Conclusions: In this study cohort, persistent AF, LAV and BNP were independent predictors of LA LVZ. Furthermore, female sex, LAV and BNP were independent predictors of severe LA LVZ. Females had a significantly greater extent of LVZ than males, especially in the anterior and septal walls. Patients with LA LVZ had a higher risk of recurrent AF.