Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 44
Filtrar
4.
JAMA Netw Open ; 3(12): e2025473, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33275151

RESUMO

Importance: Catheter ablation is effective in reducing atrial fibrillation (AF), but the association of ablation for AF with quality of life is unclear. Objective: To evaluate whether the procedural outcome of ablation for AF is associated with quality of life (QOL) measures. Design, Setting, and Participants: This was a prespecified secondary analysis of the Substrate and Trigger Ablation for Reduction of Atrial Fibrillation-Part II (STAR AF II) prospective randomized clinical trial, which compared 3 strategies for ablation of persistent AF. This analysis included 549 of the 589 patients enrolled in the trial who underwent ablation. Enrollment occurred at 35 centers in Europe, Canada, Australia, China, and Korea from November 2010 to July 2012. Data for the current study were analyzed on December 11, 2019. Interventions: Patients underwent AF ablation with 1 of 3 ablation strategies: (1) pulmonary vein isolation (PVI), (2) PVI plus complex fractionated electrograms, or (3) PVI plus linear lesions. Main Outcomes and Measures: Quality of life was assessed at baseline and at 6, 12, and 18 months after ablation for AF using the 36-Item Short Form Health Survey and the EuroQol Health-Related Quality of Life 5-Dimension 3-Level questionnaire. Scores were also converted to a physical health component score (PCS) and a mental health component score (MCS). Individual AF burden was calculated by the total time with AF from Holter monitors and the percentage of transtelephonic monitor recordings showing AF. Results: Among the 549 patients included in this secondary analysis, QOL was assessed in 466 (85%) at baseline and at 6, 12, and 18 months after ablation for AF. The mean (SD) age of the study population was 60 (9) years; 434 (79%) individuals were men, and 417 (76%) had continuous AF for 6 months or more before ablation. The AF burden significantly decreased from a mean (SD) of 82% (36%) before ablation to 6.6% (23%) after ablation (P < .001). Significant improvements in mean (SD) PCS (68.3 [20.7] to 82.5 [18.6]) and MCS (35.3 [8.6] to 37.5 [7.6]) occurred 18 months after ablation (P < .05 for both). Significant QOL improvement occurred in all 3 study arms and regardless of AF recurrence, defined as AF episodes lasting more than 30 seconds: for no recurrence, mean (SD) PCS increased from 66.5 (20.9) to 79.1 (19.4) and MCS from 35.3 (8.7) to 37.7 (7.7); for recurrence, mean (SD) PCS increased from 70.2 (20.4) to 86.4 (16.8) and MCS from 35.3 (8.6) to 37.1 (7.4) (P < .05 for all). When outcome was defined by AF burden reduction, in patients with less than 70% reduction in AF burden, the increase in PCS was significantly less than in those with greater than 70% reduction, and only 3 of 8 subscales showed significant improvement. Conclusions and Relevance: In this secondary analysis, decreases in AF burden after ablation for AF were significantly associated with improvements in QOL. Quality of life changes were significantly associated with the percentage of AF burden reduction after ablation. Trial Registration: ClinicalTrials.gov Identifier: NCT01203748.


Assuntos
Fibrilação Atrial/epidemiologia , Fibrilação Atrial/cirurgia , Ablação por Cateter , Qualidade de Vida , Fibrilação Atrial/psicologia , Austrália/epidemiologia , Canadá/epidemiologia , Ablação por Cateter/métodos , Ablação por Cateter/psicologia , China/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Qualidade de Vida/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , República da Coreia/epidemiologia , Resultado do Tratamento
6.
Pacing Clin Electrophysiol ; 43(7): 627-632, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32491200

RESUMO

BACKGROUND AND OBJECTIVE: Atrioesophageal fistula (AEF) is a rare but devastating complication with high mortality post atrial fibrillation (AF) ablation. The purpose of current study was to determine the epidemiology, clinical features, pathogenesis, and management of AEF after AF ablation. METHODS AND RESULTS: Patients with diagnosed AEF were included and retrospectively analyzed according to the registry of 11 centers in China from January 2010 to December 2019. A total of 16 AEF cases were identified from 44 794 patients who received a left atrial ablation procedure (0.035% per procedure). The interval from procedure to clinical onset of AEF averaged 18.3 days (3-39 days). The fever ranked the most common symptom, occurred in 14 of the 16 cases, followed by neurological deficits (n = 11), chest pain (n = 5), and hematemesis (n = 4). Patients undergoing surgical repair had a better prognosis compared to those receiving nonsurgical management ([4 of 8] 50.0% vs [8 of 8] 100%, P < .05) with an overall mortality rate of 75.0%. CONCLUSION: AEF is highly characterized by varied manifestations. Early diagnosis and urgent surgical repair are vital to those patients and associated with improved survival rates.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Fístula Esofágica , Fibrilação Atrial/cirurgia , Átrios do Coração/cirurgia , Humanos , Estudos Retrospectivos
7.
J Cardiovasc Electrophysiol ; 31(9): 2275-2283, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32584498

RESUMO

INTRODUCTION: The best management strategy for patients with atrial fibrillation (AF) with heart failure (HF) and preserved left ventricular ejection fraction (LVEF) is unknown. METHODS AND RESULTS: This cohort study was conducted in Olmsted County, Minnesota, with resources of the Rochester Epidemiology Project. Patients with incident AF occurring between 2000 and 2014 with a prior or concurrent HF were included. Patients with LVEF ≥ 50% were designated as HF and preserved ejection fraction (HFpEF) and those with LVEF < 50% were designated as HF and reduced ejection fraction (HFrEF). Rhythm control in the first year after AF diagnosis was defined as prescriptions for an antiarrhythmic drug, catheter ablation, or maze procedure. The primary endpoint was all-cause mortality. The secondary endpoints were cardiovascular death, cardiovascular hospitalization, and stroke or transient ischemic attack. Of 859 patients (age, 77.2 ± 12.1 years; 49.2%, female), 447 had HFpEF-AF, and 412 had HFrEF-AF. There was no difference in all-cause mortality (10-year mortality, 83% vs 79%; p = .54) or secondary endpoints between the HFpEF-AF and HFrEF-AF, respectively. Compared with the rate control strategy, rhythm control in HFpEF-AF patients (n = 40, 15.9%) offered no survival benefits (adjusted HR, 0.70; 95% CI, 0.42-1.16; p = .16), whereas rhythm control in HFrEF-AF patients (n = 52, 22.5%) decrease cardiovascular mortality (HR, 0.38; 95% CI, 0.17-0.86; p = .02). CONCLUSIONS: Patients with HFpEF-AF and HFrEF-AF had similar poor prognoses. Rhythm control strategy was seldom adopted in community care in patients with HF and AF. A rhythm control strategy may provide survival benefit for patients with HFrEF-AF and the benefit of rhythm control in patients with HFpEF-AF warrants further study.


Assuntos
Fibrilação Atrial , Insuficiência Cardíaca , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/terapia , Estudos de Coortes , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Masculino , Minnesota/epidemiologia , Prognóstico , Volume Sistólico , Função Ventricular Esquerda
8.
Postgrad Med ; 132(8): 756-763, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32396028

RESUMO

Objective: We study whether the carotid artery stenting (CAS) and carotid endarterectomy (CEA) differ from each other in postoperative ventricular arrhythmia, along with neurological complications (perioperative stroke and transient ischemic attack), in-hospital mortality, and estimated medical cost. Methods: This study used data of patients with carotid artery stenosis from the National Inpatient Sample (NIS) database (2011-2014) from the United States of America. Based on the procedure that patients received, individuals were categorized into groups of CAS and CEA. Multilevel analyses were conducted to examine the difference in the following outcomes: postoperative ventricular arrhythmia, neurological complications, in-hospital mortality, and medical costs between CAS and CEA. The patient age, gender, race, Charlson Comorbidity Index, primary payer, emergency department service record, bed size of hospital, region of the hospital, and location of the hospital were adjusted in each model. In addition, preexisting cardiovascular diseases (CVDs) were adjusted for when predicting postoperative ventricular arrhythmia; postoperative CVDs were adjusted for in the model of in-hospital mortality. Results: A total of 127,321 carotid artery stenosis hospitalizations were included in our analyses (n = 17,074 in CAS, n = 110,247 in CEA). Multivariate logistic regressions showed that compared with patients underwent CAS, those with CEA had a lower odds of postoperative ventricular arrhythmia (odds ratio [OR] = 0.81, 95% confidence interval [CI]: [0.66-0.98]), less neurological complications (OR = 0.55, 95% CI: [0.51-0.59] in general; OR = 0.63, 95% CI: [0.57-0.69] in ischemic stroke; OR = 0.26, 95% CI: [0.20-0.32] in hemorrhagic stroke; and OR = 0.58, 95% CI: [0.47-0.71] in transient ischemic attack), and in-hospital mortality (OR = 0.52, 95% CI: [0.42-0.64]). Generalized linear model indicated patients undergoing CEA had lower medical cost (ß = -4329.99, 95% CI: [-4552.61, -4107.38]) than patients undergoing CAS. Conclusions: In short-term outcomes, CEA was associated with a lower risk of postoperative ventricular arrhythmia, neurological complications, in-hospital mortality, and lower cost as compared with CAS.


Assuntos
Arritmias Cardíacas/epidemiologia , Estenose das Carótidas/cirurgia , Transtornos Cerebrovasculares/epidemiologia , Endarterectomia das Carótidas/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Stents/efeitos adversos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/mortalidade , Estenose das Carótidas/mortalidade , Transtornos Cerebrovasculares/mortalidade , Comorbidade , Estudos Transversais , Endarterectomia das Carótidas/mortalidade , Feminino , Gastos em Saúde , AVC Hemorrágico/epidemiologia , Número de Leitos em Hospital , Mortalidade Hospitalar , Humanos , AVC Isquêmico/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Complicações Pós-Operatórias/mortalidade , Características de Residência , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos/epidemiologia
9.
Pacing Clin Electrophysiol ; 43(7): 633-639, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32419141

RESUMO

BACKGROUND: During ablation for atrial fibrillation (AF), energy delivery toward the left atrial posterior wall may cause esophageal injury (EI). Ablation index (AI) was introduced to estimate ablation lesion size, however, the impact of AI technology on the risk of EI has not been explored. METHOD: From March 2019 to December 2019, 60 patients with paroxysmal AF undergoing first-time ablation were prospectively enrolled. The first 30 consecutive patients were ablated with the AI target value of 400 (AI-400 group), and the later 30 consecutive patients were ablated with the AI target value of 350 at the posterior wall (AI-350 group). Endoscopic ultrasonography was used to evaluate EI postablation. EI was classified as a category 1 (erythema or erosion) or a category 2 (hematoma or ulceration). RESULTS: Compared with the AI-400 group (59.9 ± 8.4 years; male, 60%), the AI-350 group (59.1 ± 9.9 years; male, 50%) had a lower incidence of EI (3.3% vs 26.7%, P = .03). There was no significant difference in the percentage of first-pass PVI between the AI-400 group and the AI-350 group (left PVI: 80% vs 73.4%, P = .54; right PVI: 80% vs 60%, P = .1). Neither ablation time nor fluoroscopy time was significantly different between the AI-400 group and the AI-350 group. CONCLUSIONS: AF ablation guide by AI target value of 350 may reduce esophageal thermal injury and has a similar efficiency on the acute success rate of first-pass PVI compared with an AI target value of 400 at the posterior wall.


Assuntos
Fibrilação Atrial/cirurgia , Queimaduras/etiologia , Ablação por Cateter/efeitos adversos , Esôfago/lesões , Endossonografia , Esôfago/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
10.
Math Biosci Eng ; 17(3): 2348-2360, 2020 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-32233539

RESUMO

The remodeling of the left atrial morphology and function caused by atrial fibrillation (AF) can exacerbate thrombosis in the left atrium (LA) even spike up the risk of stroke within AF patients. This study explored the effect of the AF on hemodynamic and thrombosis in LA. We reconstructed the patient-specific anatomical shape of the LA and considered the non-Newtonian property of the blood. The thrombus model was applied in the LA models to simulate thrombosis. Our results indicate that AF can aggravate thrombosis which mainly occurs in the left atrial appendage (LAA). Thrombosis first forms on the LAA wall then expands toward the internal LAA. The proposed computational model also shows the potential application of numerical analyses to help assess the risk of thrombosis in AF patients.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Trombose , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/epidemiologia , Átrios do Coração/diagnóstico por imagem , Hemodinâmica , Humanos , Trombose/epidemiologia
11.
Sci Rep ; 10(1): 2751, 2020 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066780

RESUMO

The close proximity of esophagus to the left atrial posterior wall predisposes esophagus to thermal injury during catheter ablation for atrial fibrillation (AF). In this retrospective study, we aimed to investigate risk factors of esophageal injury (EI) caused by catheter ablation for AF. Patients who underwent first-time AF ablation from July 2013 to June 2018 were included. The esophagus was visualized by oral soluble contrast during ablation for all patients and a subset of patients were selected to undergo endoscopic ultrasonography (EUS) to estimate EI post ablation. Degree of EI was categorized as Kansas City classification: type 1: erythema; type 2: ulcers (2a: superficial ulcers; 2b: deep ulcers); type 3: perforation (3a: perforation without communication with the atria; 3b: atrioesophageal fistula [AEF]). Of 3,852 patients, 236 patients (61.5 ± 9.7 years; male, 69%) received EUS (EUS group) and 3616 (63.2 ± 10.9 years; male, 61.1%) without EUS (No-EUS group). In EUS group, EI occurred in 63 patients (type 1 EI in 35 and type 2 EI in 28), and no type 3 EI was observed during follow up. In a multivariable logistic regression analysis, an overlap between the ablation lesion and esophagus was an independent predictor of EI (odds ratio, 21.2; 95% CI: 6.23-72.0; P < 0.001). In No-EUS group, esophagopericardial fistula (EPF; n = 3,0.08%) or AEF (n = 2,0.06%) was diagnosed 4-37 days after ablation. In 3 EPF patients, 2 completely recovered with conservative management and 1 died. Two AEF patients died. Ablation at the vicinity of the esophagus predicts risk of EI. EUS post ablation may prevent the progression of EI and should be considered in management of EI. It remains challenging to identify patients with high risk of EI.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Eritema/patologia , Perfuração Esofágica/patologia , Fístula/patologia , Complicações Pós-Operatórias/patologia , Úlcera/patologia , Idoso , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/instrumentação , Ablação por Cateter/métodos , Meios de Contraste/administração & dosagem , Endossonografia , Eritema/diagnóstico por imagem , Eritema/etiologia , Perfuração Esofágica/diagnóstico por imagem , Perfuração Esofágica/etiologia , Esôfago/diagnóstico por imagem , Esôfago/patologia , Feminino , Fístula/diagnóstico por imagem , Fístula/etiologia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Átrios do Coração/cirurgia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pericárdio/diagnóstico por imagem , Pericárdio/patologia , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Úlcera/diagnóstico por imagem , Úlcera/etiologia
12.
J Cardiovasc Electrophysiol ; 31(2): 401-409, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31828884

RESUMO

INTRODUCTION: Repeat ablation strategy for atrial fibrillation (AF) recurrence after multiple ablation procedures is known to be challenging. This study evaluated the insights of adjunctive ablation for epicardial arrhythmogenic substrates in those patients via a percutaneous epicardial approach. METHODS AND RESULTS: Thirty-five consecutive patients with AF/atrial tachycardia (AT) recurrence, who had two or more prior ablation procedures, were enrolled from September 2016 to December 2018. In addition to a standard endocardial approach, epicardial mapping and ablation were performed via a percutaneous subxiphoid access in the electrophysiology lab. Adjunctive epicardial ablations for left lateral ridge (LLR) were performed in 31 of 35 patients (88.6%) for efficient transmural lesions with pacing capture loss. Marshall Bundle (MB) potentials were documented on epicardial LLR in three patients and abolished by direct epicardial ablation. Bachmann's bundle (BB) was ablated as an epicardial conduction gap in four patients with a refractory anterior wall line. Two epicardial AT/AF triggers were detected followed by successful termination with epicardial ablation. No periprocedural complications occurred. About 23 of 35 patients (65.7%) remained free from AF/AT after 23.2 ± 9 months of the procedure. CONCLUSIONS: Patients with multiple failed prior AF procedures refractory to antiarrhythmic therapy might warrant a percutaneous epicardial mapping and ablation strategy, with adjunctive therapy for targeting LLR/MB, BB, and underlying epicardial triggers in addition to a standard endocardial approach.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Frequência Cardíaca , Pericárdio/cirurgia , Taquicardia Supraventricular/cirurgia , Potenciais de Ação , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pericárdio/fisiopatologia , Estudos Prospectivos , Recidiva , Reoperação , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
13.
J Interv Card Electrophysiol ; 58(2): 219-227, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31350643

RESUMO

PURPOSE: Radiofrequency ablation along the posterior wall of the left atrium may lead to atrioesophageal fistula due to esophageal thermal injury. The purpose of our study was to prospectively investigate whether ablation guided by soluble contrast esophageal visualization (SCEV) reduces injury during atrial fibrillation (AF) ablation. METHODS: Seventy-eight patients with paroxysmal AF undergoing circumferential pulmonary vein isolation (PVI) were randomized to a SCEV group (n = 39) and control group without visualization (n = 39). Cine imaging of the esophagus was performed during soluble contrast swallowing at the beginning of ablation, after adjacent ipsilateral PVI and at the end of the procedure. The ablation lesion set was modified to avoid radiofrequency delivery within the contrast esophagram boundaries. In the control group, a single final ingestion was performed at the end of the procedure. Esophageal injury was assessed by esophagogastroscopy within 24 h in all patients. RESULTS: In the control group, the ablation lesion crossed over the esophagus in 46.2% of patients, whereas in SCEV group, the ablation line violated the boundaries of the esophagus unavoidably in 15.4% of patients (confidence interval (CI); 1.61-13.98, p = 0.003). The incidence of esophageal injury was significantly lower in patients that underwent ablation with SCEV (5.1% vs. 20.5%, CI; 0.04-1.06, p = 0.042). Regardless of randomization group, patients who received ablation which overlapped the esophagus had a higher incidence of esophageal injury compared with those without overlap (37.5 vs. 1.9%, CI; 3.73-271.37, p = 0.000). CONCLUSIONS: Esophageal contrast visualization helps to reduce the potential for esophageal injury during paroxysmal AF ablation. This simple procedural adjunct has important implications to improve safety of paroxysmal AF ablation procedures globally.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Esôfago/diagnóstico por imagem , Esôfago/cirurgia , Átrios do Coração , Humanos , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Resultado do Tratamento
14.
Heart Rhythm ; 16(11): 1669-1675, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31201964

RESUMO

BACKGROUND: Heightened sympathetic nerve activity is associated with occurrence of ventricular arrhythmia (VA). OBJECTIVE: To investigate the association of skin sympathetic nerve activity (SKNA) and VA occurrence. METHODS: We prospectively enrolled 65 patients with severe cardiomyopathy. Of these, 39 had recent sustained VA episodes (VA-1 group), 11 had intractable VA undergoing sedation with general anesthesia (VA-2 group), and 15 had no known history of VA (VA-Ctrl group). All patients had simultaneous SKNA and electrocardiogram recording. SKNA was assessed using an average value (aSKNA), a variable value (vSKNA), and the number of bursts of SKNA (bSKNA). RESULTS: The VA-1 group had higher aSKNA and vSKNA compared with the VA-Ctrl group (aSKNA: 1.41 ± 0.53 µV vs 0.98 ± 0.41 µV, P = .003; vSKNA: 0.52 ± 0.22 µV vs 0.30 ± 0.16 µV, P < .001) and the VA-2 group (aSKNA: 0.83 ± 0.22 µV, P < .001; vSKNA: 0.23 ± 0.11 µV; P < .001). Although the VA-2 group had more VA episodes than the VA-1 group (median, 5 vs 2; P = .01), their SKNA was the lowest among the 3 groups. Multivariate Cox regression analysis showed that a higher aSKNA at baseline was an independent predictor of lower VA recurrence rate during a 417 ± 279-day follow-up (hazard ratio, 0.325; 95% confidence interval [CI], 0.119-0.883; P = .03). A >15% reduction in aSKNA after therapy was associated with a lower subsequent VA event rate (hazard ratio, 0.222; 95% CI, 0.057-0.864; P = .03). CONCLUSION: Patients with VA had increased SKNA as compared with control. Both SKNA and sustained VA could be suppressed by general anesthesia. The aSKNA at baseline was an independent predictor of VA recurrence.


Assuntos
Arritmias Cardíacas/fisiopatologia , Cardiomiopatias/fisiopatologia , Pele/inervação , Sistema Nervoso Simpático/fisiopatologia , Disfunção Ventricular/fisiopatologia , Idoso , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
15.
Pacing Clin Electrophysiol ; 42(9): 1276-1279, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31116434

RESUMO

We present the case of a 29-year-old man who developed ventricular tachycardia (VT) secondary to a cardiac lipoma located adjacent to the interventricular groove, which could not be fully resected. Antiarrhythmic drugs and endocardial and epicardial ablation failed to prevent VT recurrence. Finally, noninvasive stereotactic body radiation therapy (SBRT) targeting the lipoma was performed, with a total dose of 24 Gy delivered in three fractions. The number of VT episodes was reduced from 189/24 h before SBRT to 0 after the procedure. At 4-month follow-up, there were no signs of therapy-related complications. Our experience suggests that SBRT could emerge as a viable treatment option for patients with cardiac tumors who develop refractory ventricular arrhythmias.


Assuntos
Neoplasias Cardíacas/complicações , Lipoma/complicações , Radiocirurgia , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/radioterapia , Adulto , Humanos , Masculino
16.
Mol Med Rep ; 19(3): 2238-2244, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30664203

RESUMO

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disease that exhibits sex differences on clinical presentation. The present study aimed to investigate the sex differences associated with ARVC by conducting an integrated bioinformatics analysis. The GSE29819 gene expression dataset was downloaded from the Gene Expression Omnibus database. The online analytical tool GEO2R was then used to screen for differentially expressed genes (DEGs), which were subsequently processed using enrichment analysis and protein­protein interaction (PPI) network construction. Functional annotation of the DEGs was determined using ClueGO. The PPI network was constructed with Search Tool for the Retrieval of Interacting Genes, and was visualized with Cytoscape to identify the modules and hub genes. Compared with the female group, a total of 1,188 DEGs, of which 915 were upregulated and 273 were downregulated, were identified in the male group. The enrichment analysis revealed that in KEGG pathways, the upregulated DEGs were substantially enriched in the 'nicotine addiction' pathways, whereas the downregulated DEGS were mainly enriched in the 'ECM­receptor interaction' and 'protein digestion and absorption' pathways. The PPI network contained 899 nodes and 1,627 edges, among which four significant modules were identified. In addition, kininogen 1, lysophosphatidic acid receptor 5, formyl peptide receptor (FPR) 2, adenylate cyclase 2, γ­aminobutyric acid type B receptor subunit 2, FPR1, hydroxycarboxylic acid receptor 1, prostaglandin E receptor 3, cannabinoid receptor 1 and proenkephalin were identified as the top 10 hub genes. The key genes and related pathways identified in this study provide genetic insight into the diversity in phenotypes between female and male patients with ARVC, and may facilitate therapeutic individualization.


Assuntos
Displasia Arritmogênica Ventricular Direita/genética , Cardiomiopatias/genética , Biologia Computacional , Mapas de Interação de Proteínas/genética , Displasia Arritmogênica Ventricular Direita/fisiopatologia , Cardiomiopatias/fisiopatologia , Bases de Dados Genéticas , Feminino , Perfilação da Expressão Gênica , Redes Reguladoras de Genes/genética , Humanos , Masculino , Transdução de Sinais/genética , Transcriptoma/genética
17.
Medicine (Baltimore) ; 97(23): e10948, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29879040

RESUMO

BACKGROUND: Postoperative atrial arrhythmias (PAAs) are common complications after esophagectomy, however research findings are contradicted on the prognosis. Therefore this meta-analysis was conducted to determine whether PAAs after esophagectomy had an impact on prognosis. METHODS: Studies comparing prognosis between patients with and without PAAs after esophagectomy were searched in EMBASE, MEDLINE, and the Cochrane Register. Primary prognosis was perioperative mortality, and secondary prognoses were postoperative complications, length of stay (LOS). RESULTS: Ten studies including 2681 patients were included in this analysis, in which 508 patients (18.9%) experienced PAAs. Patients with PAAs resulted in significantly higher perioperative (odds ratio, OR 4.05[95% confidence interval, CI: 2.45-6.70], P = .40) mortality, longer hospital LOS (mean differences, MD: 1.49 [95% CI: 0.32-2.66]days, P = .01), more incidence of pulmonary pneumonia (OR 2.48 [95% CI: 1.71-3.59], P < .00001), and anastomotic leakage (OR 2.37 [95% CI: 1.39-4.03], P < .00001). CONCLUSIONS: Atrial arrhythmias (AAs) after esophagectomy are associated with higher perioperative mortality, longer hospital LOS, and more incidences of complications. Therapeutic strategies against PAAs are pending for further researches.


Assuntos
Fibrilação Atrial/epidemiologia , Flutter Atrial/epidemiologia , Esofagectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Fibrilação Atrial/etiologia , Flutter Atrial/etiologia , Feminino , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Razão de Chances , Complicações Pós-Operatórias/etiologia , Prognóstico , Resultado do Tratamento
19.
Biomed Res Int ; 2018: 4514178, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30627556

RESUMO

In order to identify potential biomarkers that distinguish the embolic stroke (ES) from thrombotic stroke (TS), a profile of microRNA expression was analyzed. The GSE60319 expression profile was downloaded from the Gene Expression Omnibus (GEO) database. The GEO2R was applied to screen for differentially expressed microRNAs (DEmiRNAs) between the embolic stroke group and thrombotic stroke group. The miRWalk was utilized to predict the target genes of DEmiRNAs. Genes associated with embolic stroke were downloaded from the Comparative Toxicogenomics Database. Cross reference of target genes to disease related genes was conducted to construct the DEmiRNA-gene network. The protein-protein interaction (PPI) network of overlapping genes was evaluated by STRING, using the MCODE and CytoHubba plugin of Cytoscape to identify the modules and hub genes. The enrichment of Kyoto Encyclopedia of Genes and Genomes (KEGG) in modules was performed. There were 30 microRNAs in total identified as DEmiRNAs between embolic stroke and thrombotic stroke groups, of which 8 were upregulated and 22 were downregulated. Among these differentially expressed miRNAs, miR-15a-5p, miR-17-5p, miR-19b-3p, and miR-20a-5p were significantly associated with an ES to TS. Using the miRWalk 3.0 online tool, target genes regulated by DEmiRNAs were predicted. In addition, disease related genes were predicted and compared with target genes of DEmiRNAs. 166 overlapped genes regulated by miR-15a-5p, miR-17-5p, miR-19b-3p, and miR-20a-5p were identified, suggesting their association with diseases that contributed to ES, mainly including atrial fibrillation, mitral valve stenosis, myocardial infarction, and aortic dissection. Therefore, miR-15a-5p, miR-17-5p, miR-19b-3p, and miR-20a-5p were promising candidate biomarkers for differentiating an ES from TS. The PPI network demonstrated that miR-15a-5p, miR-17-5p, miR-19b-3p, and miR-20a-5p were associated with an ES by mainly regulating "CCND1, E2F2, E2F3, ITCH, UBE4A, UBE3C, RBL2, FBXO31, EIF2C4, and EIF2C1". Furthermore, miR-15a-5p and miR-17-5p may function through "cell cycle, prostate cancer, and small cell lung cancer" while miR-19b-3p and miR-20a-5p function through "insulin resistance, hepatitis B, and viral carcinogenesis" and "vasopressin-regulated water reabsorption", respectively. However, these results were approached in the manner of bioinformatics analysis; therefore, further verification is required.


Assuntos
Biomarcadores/metabolismo , Regulação Neoplásica da Expressão Gênica/genética , MicroRNAs/genética , Acidente Vascular Cerebral/genética , Biologia Computacional , Regulação para Baixo/genética , Redes Reguladoras de Genes/genética , Humanos , Mapas de Interação de Proteínas/genética , Regulação para Cima/genética
20.
J Zhejiang Univ Sci B ; 18(11): 946-954, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29119732

RESUMO

BACKGROUND AND OBJECTIVE: Rivaroxaban is a new oral anticoagulant for stroke prevention in patients with non-valvular atrial fibrillation (NVAF), which has less drug-food interaction than warfarin. We conducted this prospective randomized study to evaluate the metabolic benefits as well as the safety and efficacy with rivaroxaban versus warfarin in patients with NVAF following radiofrequency catheter ablation (RFCA). METHODS: From April to July 2014, 60 patients with NVAF undergoing RFCA were prospectively enrolled in our study. Following RFCA, all patients were randomly assigned to receive rivaroxaban (Group R, n=30) or warfarin (Group W, n=30). Metabolic indices including serum total protein, albumin, globulin, and high-density lipoprotein (HDL) as well as bleeding, stroke, and systemic thromboembolism events were evaluated and compared during follow-up after 15, 30, 60, and 90 d of RFCA procedure. RESULTS: Serum total protein, albumin, globulin, and HDL levels were all significantly elevated at each follow-up stage in Group R when compared to the baseline (P<0.05 respectively). In Group W, the metabolic indices decreased at first and then had an increasing trend. There were no deaths or thromboembolic complications in each group. The prevalence of total bleeding complications was similar between Group R and Group W (11/30, 36.7% vs. 10/30, 33.3%, P=0.79). CONCLUSIONS: Patients with NVAF receiving rivaroxaban after RFCA procedures appear to benefit from a metabolic perspective compared with warfarin, providing practical clinical reference for the choice of the anticoagulant. Rivaroxaban seems to be as safe and effective in preventing thromboembolic events as warfarin for these patients.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/metabolismo , Ablação por Cateter , Rivaroxabana/uso terapêutico , Tromboembolia/prevenção & controle , Idoso , Albuminas/análise , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Feminino , Seguimentos , Globulinas/análise , Hemorragia/prevenção & controle , Humanos , Lipoproteínas HDL/sangue , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Prevalência , Estudos Prospectivos , Acidente Vascular Cerebral/prevenção & controle , Varfarina/uso terapêutico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...