| Section Ⅰ Clinical study of optimizing ablation sequence strategy of single pulmonary vein isolation in paroxysmal atrial fibrillationObjective:The purpose of this study was to investigate whether optimizing ablation sequence of circumferential pulmonary vein(CPV)isolation had an effect on the acute pulmonary vein reconnection and long-term effect in patients with paroxysmal atrial fibrillation.Method:One hundred consecutive patients with paroxysmal atrial fibrillation who underwent circumferential pulmonary vein isolation in our hospital from January 2013 to December 2016 were enrolled.The above patients were randomly divided into two groups:In the optimized ablation group,the anterior/posterior carina and the ridge between the left atrial(LA)appendage and the left pulmonary vein(LPV)were firstly ablated,and then other areas were ablated;In the conventional sequential ablation group,started from the site of right inferior PV and continuous circular lesions were created counter-clockwise.The primary end point was the recurrence of atrial tachyarrhythmia lasting more than 30 seconds during the 1-year follow-up period after the blank period after PV isolation.The secondary end points were operation time,X-ray exposure time and safety.Results:49 patients in the optimized ablation group and 48 patients in the sequential ablation group were for analysis.LA dwelling time was 81.2±24.7 min in the optimized ablation group and 76.9±16.4 min in the sequential group.X-ray exposure time were 4.2±0.9 min in optimized group and 4.1±0.6 min in sequential group,respectively.Eight patients in sequential group and nine patients in optimized group experienced acute PV reconnection,which clustered at the ridge between,the LPV and the LAA,the roof of the left superior PV,left anterior and right posterior carina.During one-year follow up,25 patients(25.7%)developed AF recurrence,27.1%patients in the sequential group and 25.5%patients in the optimized group.There was no significant difference between the two groups(P=0.77).Cox regression analysis indicated that acute PV reconnection had the potential to predict long-term recurrence,but without significant difference(HR:1.152,p=0.065).Conclusion:Optimizing ablation sequence of pulmonary vein isolation did not show significant advantage during 1-year follow-up in this study,but it still needs to be further verified by large-sample randomized controlled studies.Section Ⅱ An alternately energy source strategy for re-ablation of patients with recurrent atrial fibrillation—cryoballoon or radiofrequency current energy ablation.Background:Pulmonary vein(PV)reconnection is the typical electrophysiological finding in the patients with recurrence of AF after index radio frequency current energy or cryoballoon ablation.Which ablation technique is better for repeat ablation in patients with recurrent atrial fibrillation(AF)remains unclear.We aimed to investigate long-term efficacy of repeat ablation using an alternately energy source sequence for re-ablation of patients with recurrent atrial fibrillationMethod:A total of 156 patients with recurrent AF after index radio frequency ablation or cryoballoon ablation from September 2016 to June 2021 received repeat ablation were enrolled into the study.Cryoballoon(CB)re-ablation for 96 patients with a failed index radiofrequency(RFC)ablation(RFC-CB-redo group);radiofrequency re-ablation for 60 patients with a failed index cryoballoon ablation(CB-RFC-redo group).Results:Early recurrence rates of atrial fibrillation following initial ablation were equal(CB-RFC-redo group vs RFC-CB-redo group,31.7%vs 27.1%,p=0.515).The number of reconnected PVs was significantly lower in the CB-RFC-redo group than the RFCCB-redo group(1.50±0.81vs 3.36 ± 0.95,p=0.01).More trigger foci of non pulmonary vein origin were found after index cryoablation than patients with index radiofrequency ablation.During the average follow-up of 10.7 ±2.41 months,40 patients develop AF recurrence and the overall AF recurrence rate was 25.6%((RFC-CB-redo:27.1%vs CB-RFC-redo:23.3%,P=0.594),there was no significant difference between the two groups.In the Cox multivariate analysis,AF type and early recurrence after the initial ablation were independent predictors of AF recurrence after re-ablation(HR=2.112,95%CI:1.082-4.091,P=0.029;HR=2.421,95%CI:1.259-4.612,P=0.008).Conclusions:The extent and distribution of PV reconnection was different between patients who firstly underwent cryoballoon ablation and radiofrequency catheter ablation.Alternately energy source sequence strategy for re-ablation of patients with recurrent atrial fibrillation was safe and effective,with similar results regardless the technique used for initial procedure.Section Ⅱ The pre-ablation triglyceride-glucose index predicts late recurrence of atrial fibrillation after radiofrequency ablation in non-diabetic adultsBackground:Current prognostic risk scoring systems and biomarkers have been routinely used as noninvasive methods for assessing late recurrence of atrial fibrillation(AF)in patients who have undergone radiofrequency catheter ablation(RFCA).This study aimed to investigate the predictive value of the triglyceride-glucose(TyG)index for late recurrence of AF after RFCA in non-diabetic patients.Methods:A total of 275 patients with AF,who underwent RFCA at our hospital between January 2016 and December 2018,were enrolled.During follow up,patients were divided into late and non-late AF recurrence groups based on whether they had experienced late AF recurrence determined by electrocardiography(ECG)examine or 48 h Holter monitoring.The TyG index was calculated using the equation:In[fasting triglycerides[mg/dL]×fasting glucose[mg/dL]/2].Results:During a mean follow-up of 26.1±9.1 months,late AF recurrence event rates significantly increased in the highest TyG index tertile group(tertile 3)compared to those in the lowest TyG index tertile group(tertile 1)(54%versus 12%,respectively;p<0.001).The mean TyG index was higher in the late AF recurrence group than non-late AF recurrence group(9.42±0.6 versus 8.68±0.70,respectively;p<0.001).On multivariate Cox regression analysis,the pre-ablation TyG index was an independent risk factor for late recurrence of AF after RFCA(hazard ratio[HR]1.478[95%confidence interval(CI):1.130-1.942];p=0.012).Receiver operating characteristic(ROC)curve analysis revealed that TyG index was a significant predictor of late AF recurrence after RFCA,at an area under the ROC curve(AUC)of 0.737(95%CI:0.657-0.816;p<0.001)and that of left atrial diameter(LAD)was 0.780(95%CI:0.703-0.857,p<0.001).Furthermore,TyG index was positively correlated with LAD(r=0.133,p=0.027),and high sensitivity C-reactive protein(r=0.132,p=0.028)and N-terminal pro b-type natriuretic peptide(r=0.291,p<0.001)levels.Conclusions:Based on observations,an elevated pre-ablation TyG index was associated with an increased risk for late AF recurrence after RFCA in non-diabetic patients.The TyG index may be useful as a potentially novel biomarker for the risk stratification of late AF recurrence in non-diabetic patients.Section Ⅳ Effectiveness and prognosis of catheter ablation of atrial fibrillation in obese populationObjective:To evaluate the efficacy and prognosis of catheter ablation of atrial fibrillation in obese population.Method:Patients with non valvular atrial fibrillation who received index radiofrequency catheter ablation in our hospital from January 2019 to December 2021 were enrolled.According to body mass index(BMI),they were divided into three groups:92 in normal weight group(BMI:18.5kg/m2 to 25kg/m2),86 in overweight group(BMI:25kg/m2 to<30kg/m2)and 52 in obese group(BMI≥30kg/m2).Results:Patients in three groups underwent bilateral pulmonary vein isolation successfully.The operation time of obese patients(85.6±18.5 minutes)was longer than that of the other two groups(P=0.035).Early recurrence occurred in 21 patients(39.5%)in obese group,17 patients(19.8%)in overweight group and 18 patients(19.6%)in normal weight group.After one-year follow-up,19 patients(37%)in the obese group developed late recurrence after RFCA,10 patients(11.6%)in the overweight group and 13 patients(14.1%)in the normal weight group developed late recurrence after RFCA.Cox regression analysis showed early recurrence after RFCA(HR=2.156,95%CI:1.259-3.728,P=0.001),body mass index(HR=1.038,95%CI:1.009-1.067,P=0.011),left atrial diameter(HR=1.184,95%CI:1.101-1.273,P=0.010),Triglyceride glucose index(HR=1.508,95%CI:1.924-2.461,P=0.025)and free fatty acids(HR=1.125,95%CI:1.115-1.425,P=0.02)were risk factors for late recurrence of atrial fibrillation.There were no serious complications during the perioperative period.Conclusion:Compared with normal weight patients,the early recurrence rate and late recurrence rate of obese patients after first AF radiofrequency ablation were significantly higher.Body weight control is helpful to maintain sinus rhythm after ablation.Section Ⅴ Electrophysiological characteristics,Ablation strategy and Outcome of Catheter Ablation Therapy for Ventricular Tachycardia in Ischemic and Nonischemic CardiomyopathyObjective:To evaluate electrophysiological characteristics of ventricular tachycardia(VT)and prognosis of radiofrequency catheter ablation in ischemic(ICM)and non-ischemic cardiomyopathy(NICM).Method:29 patients with organic heart disease(NICM,n=18;ICM,n=11)referred for catheter ablation of ventricular tachycardia in our hospital from June 2019 to May 2021 were studied.If ventricular tachycardia was induced,activation or entrainment mapping was used,combined with elimination of local ventricular abnormal potential(LAVPs);If electrophysiological stimulation cannot induce ventricular tachycardia,elimination of local ventricular abnormal potential under sinus rhythm was performed.The end point was ventricular tachycardia recurrence and death.Result:Of those 29 patients,27 underwent endocardium mapping and 2 underwent epicardium mapping.The mean low voltage area measured in the ischemic cardiomyopathy group(86±65cm2)was significantly larger than that in non-ischemic cardiomyopathy group(38±28cm2,p=0.001).Similarly,patients with ischemic cardiomyopathy had a greater proportion of the ventricular area occupied by dense scar areas(45±35%vs.26±15%;P=0.01).Of the 11 cases of ischemic cardiomyopathy,6 cases(54.5%)induced sustained ventricular tachycardia and 4 cases(36.3%)induced clinical ventricular tachycardia.Sustained ventricular tachycardia was induced in 9(50%)patients of non ischemic cardiomyopathy.84.2%of ventricular tachycardia induced in ischemic cardiomyopathy group was reentry,while 50%of ventricular tachycardia induced in non ischemic cardiomyopathy group was reentry.LAVPs were recorded in 10 patients with ischemic cardiomyopathy and 10 patients with non-ischemic cardiomyopathy.A total of 5 patients with ischemic cardiomyopathy were treated with combined LAVPs potential elimination+activation or entrainment mapping ablation during ventricular tachycardia.One patient was able to induce non-clinical ventricular tachycardia after ablation.Four patients with ICM were unable to induce ventricular tachycardia and were only performed with elimination of LAVPs under sinus rhythm.Ventricular tachycardia was induced in 9 NICM patients and 4 patients were treated with combined LAVPs potential elimination+activation or entrainment mapping ablation during ventricular tachycardia,and two patients were able to induce non-clinical ventricular tachycardia after ablation.Five patients in the NICM group could not record LAVPs,and was ablated by activation mapping during ventricular tachycardia.After ablation,one patient in the NICM group could induce non clinical ventricular tachycardia and one patients failed due to anatomical difficulties.Six patients with NICM were unable to induce ventricular tachycardia and were only performed with elimination of LAVPs under sinus rhythm,LAVPs disappeared in 5 patients and reduced in 1 patients after ablation.All patients were followed up after ablation,ventricular tachycardia occurred in 2 cases in the ischemic cardiomyopathy group and 4 cases in the non-ischemic cardiomyopathy group.The total long-term success rate was 76%(80%in ICM and 73.3%in NICM).Conclusions:For most organic heart disease patients with ventricular tachycardia,ischemic cardiomyopathy and non ischemic cardiomyopathy have different electrophysiological characteristics.The long-term success rate of ablation of VT in ischemic cardiomyopathy is higher than that of non ischemic cardiomyopathy. |
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