| BackgroundAtrial fibrillation(AF)is the most common arrhythmia associated with an adverse prognosis,contributing excess risk of stroke.Several studies have shown that alcohol consumption is associated with an increased risk in the occurrence of AF and its progression.And several studies have evaluated the role of modifiable risk factors which increase the occurrence and progression of AF,such as systemic arterial hypertension,heart failure,prior myocardial infarction,sleep apnea,obesity and excess alcohol consumption among many others.Mechanistic pathways underlying the increased risk of AF due to alcohol consumption may be due to the indirect effects of alcohol consumption such as increased risk of hypertension,left ventricular hypertrophy,obstructive sleep apnea and cardiomyopathy,or as a result of a direct role leading to structural and electrical remodeling of atrial cardiomyocytes.However,from a clinical perspective,the exact mechanisms are not well known.Echocardiography has been well applied in clinical medicine,which can estimate atrial electric and structure remodeling.At the same time,electrophysiologic study can reveal the electrophysiological changes,including shortening of the effective refractory period(ERP)and slowing of conduction.ObjectiveTo investigate the echocardiographic and electrophysiologic changes caused by alcohol consumption in patients with AF.MethodsAll participants were informed of the study and provided consent.The study was approved by the institutional Ethics Committee and registered in the Chinese Clinical Trial Registry(ChiCTR2000041575).The study consecutively recruited 134 non-valvular AF patients who underwent radiofrequency catheter ablation(RFCA)in Qilu Hospital of Shandong University from April 1.2019 to June 30,2020.The alcohol consumption,baseline demographics,complications and medical history of patients were obtained by reviewing electronic medical files and supplemented with questionnaire before the RFCA.According to alcohol consumption status,patients were categorized into no-alcohol and alcohol groups.According to patients self-reported average alcohol consumption per week,the alcohol group was further classified into three subgroups:light(<7 standard drinks/week),moderate(7 to 21 standard drinks/week)and heavy(>21 standard drinks/week),where 1 standard drink is equivalent to 12 g of alcohol.For paroxysmal AF patients,transthoracic echocardiography was performed before RFCA,and for persistent AF patients,within 48 hours after the RFCA procedure and in sinus rhythm.Left atrium(LA)diameter,left ventricle diameter,right ventricle diameter,interventricular septum,left posterior ventricular wall and ascending aorta diameters were measured on the parasternal long-axis view.The main pulmonary artery diameter was measured on the parasternal short-axis view and right atrial(RA)diameter,the mitral annulus inflow velocities E-wave and e’-wave were measured on the apical 4-chapter views.The left ventricular ejection friction(LVEF),E/e’ and pulmonary artery pressure were calculated.An electrocardiograph(ECG)monitor channel was displayed on the screen of the machine during these measurements.On the apical 4-chapter views,Doppler Tissue sample volume was placed at the lateral mitral annulus,septal mitral annulus and the lateral tricuspid annulus in that order.Doppler echocardiography was characterized by a positive(i.e.,at baseline)systolic wave and two negative(i.e.,below baseline)diastolic waves:early and atrial.T1 was the time interval from the beginning of the P-wave on the ECG to the beginning of the late diastolic wave of the lateral mitral annulus.T2 was the time interval from the beginning of the P-wave on the ECG to the beginning of the late diastolic wave of the septal mitral annulus.T3 was the time interval from the beginning of the P-wave on the ECG to the beginning of the late diastolic wave of the lateral tricuspid annulus.Inter-atrial conduction delay was represented as T1-T3 and intra-atrial conduction delay was represented as T1-T2.All the echocardiography indices were documented for 5 consecutive beats,then averaged over all the results.For speckle tracking analysis of the LA,the software Qlab 13 generated curves for each LA segment.The mean values of peak left atrial longitudinal strain(pLALS)and peak left atrial contraction strain(pLACS)were independently calculated by two reviewers.During the RFC A,effective refractory period(ERP)was measured before the ablation in paroxysmal AF patients and after ablation in persistent AF patients.And it was measured at cycle lengths of 600ms with a train of 8 stimuli followed by an extra stimulus,beginning with a coupling interval of 150ms,which was increased by amounts of 10ms,The ERP dispersion(dERP)was considered as the biggest difference of the following points:1)distal coronary sinus;2)proximal coronary sinus;3)low-lateral RA;4)high-lateral right atrium;5)high-septal RA;6)LA appendage;7)mid-posterior LA;8)inferior LA;9)junction of the left superior pulmonary vein with LA roof;and 10)junction of the right superior pulmonary vein with LA roof.All indexes were measured 5 times and the average was taken.All patient information and the relation between echocardiography and electrophysiologic indexes with chronic alcohol consumption pattern were investigated with SPSS.ResultsThere were 72 patients in the no-alcohol group and 62 patients in the alcohol group(34,11 and 17 patients in the light,moderate and heavy groups,respectively).1.(1)There were more males in alcohol group than in no-alcohol group,and the proportion of males increased with alcohol consumption(Male%:41.67 vs 90.63 vs 100 vs 100%,p=0.000);(2)The average age is various between different groups(63.91±10.39 vs 58.28±11.64 vs 57.45±10.30 vs 55.76±10.51,p=0.007);(3)The CHA2DS2-VASc score of patient decreased with alcohol consumption increasing(2.61±1.68 vs 1.53±1.59 vs 1.73±1.27 vs 1.29±1.36,p=0.003);(4)Body Mass Index(BMI)of patients was increased with alcohol consumption(25.43±3.33 vs 26.02±2.83 vs 27.66±1.79 vs 27.84±2.05,p=0.007);(5)high density lipoprotein increased with alcohol consumption(1.17±0.26 vs 1.15±0.19 vs 1.02±0.20 vs 1.03±0.24mmol/L,p=0.045);2.The comparison of transthoracic echocardiography:(1)The left ventricular diameter was lager when alcohol consumption increasing(45.83±4.37 vs 48.92±4.41 vs 48.92±4.38 vs 50.20±3.49mm,p<0.001).(2)Intra-atrial conduction delay was longer in alcohol group than no-alcohol group(31.58±8.16 vs 36.13±18.68ms,p=0.018),and inter-atrial conduction delay increased when patients drank heavy(14.65±9.62 vs 22.70±9.48 vs 22.53±4.85 vs 37.12±8.48,p=0.000);(3)Patients with alcohol consumption had impaired pLALS(29.67±14.57 vs 25.86±11.40%,p=0.006).But there was no difference between two groups in pLACS(8.70±6.18 vs 10.78±7.64%,p=0.230).(5)An increase in dERP was observed in patients with alcohol consumption(58.95±12.76 vs 72.06±8.1±ms,p=0.042).3.The comparison of electrophysiologic study:An increase in dERP was observed in patients with alcohol consumption(58.95±12.76 vs 72.06±8.11ms,p=0.042),and it was increasing with more alcohol consumption(58.95±12.76 vs 71.43±9.45 vs 74.00±9.62 vs 71.00±5.48ms,p=0.013).4.The comparison of recurrence after RFCA:There was no difference in recurrence between patients without alcohol and with alcohol(22.64%vs 15.38%,p>0.05).5.Regression analysis:In multivariable linear regression analyses,the independent predictors of echocardiography and electrophysiologic changes included the following:(i)for intra-atrial conduction delay:alcohol(p<0.001);(ii)for pLALS:alcohol(p=0.019),CHA2DS2-VASc score(p=0.042)and left ventricular diameter(p=0.015);(iii)for pLACS:alcohol(p=0.041)and BMI(p=0.027);and(iv)for dERP:alcohol(p=0.021).ConclusionConduction abnormalities characterized by inter-atrial conduction delay,impaired pLALS and increasing dERP were observed in patients with alcohol consumption.And heavy drinkers had increasing intra-atrial conduction delay.All alternations may contribute to the predisposition and perpetuation of AF.BackgroundAlthough epicardial adipose tissue(EAT)has been proved to be associated with atrial fibrillation(AF)and post-ablation AF recurrence,the relationship between EAT and AF after cardiac surgery(AFACS)remains unclear.ObjectiveThe aim of this study was to perform a systematic review and meta-analysis to assess the association between EAT and AFACS.MethodsThe search was performed using the PubMed,Cochrane,and Embase databases with the start date prior to May 30,2020.And it was systematically searched for"atrial fibrillation" and "epicardial adipose tissue".Additionally,hand searches of the reference list of the included studies were performed.The literature search was independently reviewed by two assessors to ensure full compliance with the study inclusion criteria.If no agreement could be reached,it was decided by a third senior author.The extracted data includes the baseline characteristics(The first author,the year of publication,area of sample,sample size,research methods,the volume or thickness of EAT,ending indicator).The analysis was stratified according to the EAT measurement into three meta-analyses on(1)total EAT volume,(2)left atrial(LA)-EAT volume,and(3)EAT thickness;standardized mean difference(SMD)was estimated using a random effects model.Considering the small sample size,we used sensitivity analysis to explore the probable sources of heterogeneity.The possibility of publication bias was evaluated using funnel plots and Egger’s regression test.ResultsEight articles with 10 studies(546 patients)were included.The meta-analysis revealed that EAT was higher in those with AFACS irrespective of the EAT measurement(total EAT volume:SMD=0.56 mL,95%confidence interval,CI=0.56-1.10 mL,I2=0.90,P=0.04;EAT thickness:SMD=0.85 mm,95%CI=0.04-1.65 mm,I2=0.90,P--0.04;LA-EAT volume:SMD=0.57 mL,95%CI=0.23-0.92 mL,I2=0.00,P=0.001).ConolusionEAT was higher in patients with AFACS,which can be measured either as volume or thickness. |
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