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Bucci T, Romiti GF, Shantsila A, Teo WS, Park HW, Shimizu W, Corica B, Proietti M, Tse HF, Chao TF, Frost F, Lip GYH. Risk of Death and Cardiovascular Events in Asian Patients With Atrial Fibrillation and Chronic Obstructive Pulmonary Disease: A Report From the Prospective APHRS Registry. J Am Heart Assoc 2024; 13:e032785. [PMID: 38533983 DOI: 10.1161/jaha.123.032785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/27/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of adverse events in patients with atrial fibrillation (AF); however, few data are available on this topic in Asian populations. METHODS AND RESULTS Prospective observational study conducted on patients with AF enrolled in the Asia-Pacific Heart Rhythm Society (APHRS) AF Registry. The diagnosis of COPD was based on data reported in the case report form by the investigators. Cox-regression models were used to assess the 1-year risk of a primary composite outcome of all-cause death, thromboembolic events, acute coronary syndrome, and heart failure. Analysis on single outcomes and cardiovascular death was also performed. Interaction analysis was used to assess the risk of composite outcome and all-cause death in different subgroups. The study included 4094 patients with AF (mean±SD age 68.5±12 years, 34.6% female), of whom 112 (2.7%) had COPD. Patients with COPD showed a higher incidence of the primary composite outcome (25.1% versus 6.3%, P<0.001), all-cause death (14.9% versus 2.6%, P<0.001), cardiovascular death (2.0% versus 0.6%, P<0.001), and heart failure (8.3% versus 6.0%, P<0.001). On multiple Cox-regression analysis, COPD was associated with a higher risk of the primary composite outcome (hazard ratio [HR], 3.17 [95% CI, 2.05-4.90]), all-cause death (HR, 3.59 [95% CI, 2.04-6.30]), and heart failure (HR, 3.32 [95% CI, 1.56-7.03]); no statistically significant differences were found for other outcomes. The association between COPD and mortality was significantly modified by the use of beta blockers (Pint=0.018). CONCLUSIONS In Asian patients with AF, COPD is associated with worse prognosis. In patients with AF and COPD, the use of beta blockers was associated with a lower mortality. REGISTRATION INFORMATION clinicaltrials.gov Identifier: NCT04807049.
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Affiliation(s)
- Tommaso Bucci
- Liverpool Centre of Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool UK
- Department of General and Specialized Surgery Sapienza University of Rome Rome Italy
| | - Giulio Francesco Romiti
- Liverpool Centre of Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool UK
- Department of Translational and Precision Medicine Sapienza University of Rome Rome Italy
| | - Alena Shantsila
- Liverpool Centre of Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool UK
| | - Wee-Siong Teo
- Department of Cardiology National Heart Centre Singapore Singapore
| | - Hyung-Wook Park
- Department of Cardiovascular Medicine Chonnam National University Hospital Gwangju Korea
| | - Wataru Shimizu
- Department of Cardiovascular Medicine Nippon Medical School Tokyo Japan
| | - Bernadette Corica
- Liverpool Centre of Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool UK
- Department of Translational and Precision Medicine Sapienza University of Rome Rome Italy
| | - Marco Proietti
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
- Division of Subacute Care IRCCS Istituti Clinici Scientifici Maugeri Milan Italy
| | - Hung-Fat Tse
- Department of Medicine, School of Clinical Medicine; Queen Mary Hospital The University of Hong Kong Hong Kong SAR China
| | - Tze-Fan Chao
- Institute of Clinical Medicine, and Cardiovascular Research Center National Yang Ming Chiao Tung University Taipei Taiwan
- Division of Cardiology, Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
| | - Frederick Frost
- Liverpool Centre of Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool UK
| | - Gregory Y H Lip
- Liverpool Centre of Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart & Chest Hospital Liverpool UK
- Danish Center for Health Services Research, Department of Clinical Medicine Aalborg University Aalborg Denmark
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The effects of medications for treating COPD and allied conditions on stroke: a population-based cohort study. NPJ Prim Care Respir Med 2022; 32:4. [PMID: 35039513 PMCID: PMC8764093 DOI: 10.1038/s41533-021-00267-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) are at higher risk of stroke. This study aimed to investigate the clinical factors of stroke risk in COPD and allied conditions patients and associations between medications for treating COPD and allied conditions. The population-based study cohort comprised 24,173 patients diagnosed with COPD and allied conditions between 2000 and 2013, and 24,170 selected matched patients without COPD comprised the comparison cohort from a nationwide database. Cox-proportional hazard regression was performed to determine the impact of medical therapies, comorbidities, and other clinical factors on stroke risk. Of the 48,343 included patients, 1394 (2.9%) experienced stroke during follow-up, with a significant difference between COPD and allied conditions cohort (1003/4.2%) and comparison cohort (391/1.6%) (adjusted hazard ratio [aHR]: 2.72, p < 0.001). Cox-regression analysis revealed that COPD and allied conditions patients who were older (>65 years) (HR: 1.06); male (HR: 1.39); with hypertension (HR: 1.46), diabetes mellitus (HR: 1.33) and atrial fibrillation (HR: 1.63) had increased stroke risk. Mucolytics (HR: 0.44) and combination therapy with inhaled corticosteroids (ICS) and long-acting β2-agonists (LABA) (HR: 0.75) were associated with decreased stroke risk in COPD and allied conditions patients. Among COPD and allied conditions patients, major comorbidities increase risk of stroke. Therapy with mucolytic agents and combination ICS/LABA is associated with risk reduction.
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Ye J, Yao P, Shi X, Yu X. A systematic literature review and meta-analysis on the impact of COPD on atrial fibrillation patient outcome. Heart Lung 2021; 51:67-74. [PMID: 34740082 DOI: 10.1016/j.hrtlng.2021.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND COPD is often accompanied by extra-pulmonary manifestations such as thrombo-embolic and hemorrhagic events, the disease is linked with atrial fibrillation (AF). OBJECTIVE The objective of the current review was to assess the impact of chronic obstructive pulmonary disease (COPD) on outcomes of atrial fibrillation (AF). METHODS PubMed, Scopus, Embase, and Web of Science databases were searched for studies comparing overall mortality, cardiovascular death, and other outcomes for AF patients with and without COPD. The data retrieved were subjected to both qualitative and quantitative analyses. The hazard ratios (HR) obtained for mortality in presence of COPD were pooled to meta-analyze using generic inverse variance function of RevMan 5.3 software. The association of various risk factors and HRs were pooled with 95% confidence interval (CI). The quality of the included studies was assessed using Newcastle Ottawa scale (NOS). RESULTS The hazard ratios (HR) were calculated with 95% confidence intervals (CIs). A total of seven studies were included. The pooled HR for the impact of COPD on overall mortality and cardiovascular mortality in AF patients was found to be 1.70 (95% CI: 1.47, 1.97; p<0.0001) and 1.80 (95% CI: 1.29, 2.52; p = 0.0005), respectively. Hemorrhagic events were significantly higher in AF patients with COPD (Odds ratio (OR): 1.84; 95% CI: 1.58, 2.14; p<0.00001). CONCLUSION COPD has a deleterious impact on AF progression in terms of overall mortality, cardiovascular death, stroke and hemorrhagic complications.
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Affiliation(s)
- Jiale Ye
- Department of respiratory and critical care medicine, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, Huzhou City, Zhejiang Province 313000, P.R China
| | - Pingli Yao
- Department of respiratory and critical care medicine, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, Huzhou City, Zhejiang Province 313000, P.R China
| | - Xuefei Shi
- Department of respiratory and critical care medicine, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, Huzhou City, Zhejiang Province 313000, P.R China
| | - Xiaojun Yu
- Department of critical care medicine, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, Huzhou City, Zhejiang Province 313000, PR China.
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Romiti GF, Corica B, Pipitone E, Vitolo M, Raparelli V, Basili S, Boriani G, Harari S, Lip GYH, Proietti M. Prevalence, management and impact of chronic obstructive pulmonary disease in atrial fibrillation: a systematic review and meta-analysis of 4,200,000 patients. Eur Heart J 2021; 42:3541-3554. [PMID: 34333599 DOI: 10.1093/eurheartj/ehab453] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/07/2021] [Accepted: 06/29/2021] [Indexed: 11/12/2022] Open
Abstract
AIM Prevalence of chronic obstructive pulmonary disease (COPD) in atrial fibrillation (AF) patients is unclear, and its association with adverse outcomes is often overlooked. Our aim was to estimate the prevalence of COPD, its impact on clinical management and outcomes in patients with AF, and the impact of beta-blockers (BBs) on outcomes in patients with COPD. METHODS AND RESULTS A systematic review and meta-analysis was conducted according to international guidelines. All studies reporting the prevalence of COPD in AF patients were included. Data on comorbidities, BBs and oral anticoagulant prescription, and outcomes (all-cause death, cardiovascular (CV) death, ischaemic stroke, major bleeding) were compared according to COPD and BB status. Among 46 studies, pooled prevalence of COPD was 13% [95% confidence intervals (CI) 10-16%, 95% prediction interval 2-47%]. COPD was associated with higher prevalence of comorbidities, higher CHA2DS2-VASc score and lower BB prescription [odds ratio (OR) 0.77, 95% CI 0.61-0.98]. COPD was associated with higher risk of all-cause death (OR 2.22, 95% CI 1.93-2.55), CV death (OR 1.84, 95% CI 1.39-2.43), and major bleeding (OR 1.45, 95% CI 1.17-1.80); no significant differences in outcomes were observed according to BB use in AF patients with COPD. CONCLUSION COPD is common in AF, being found in 13% of patients, and is associated with increased burden of comorbidities, differential management, and worse outcomes, with more than a two-fold higher risk of all-cause death and increased risk of CV death and major bleeding. Therapy with BBs does not increase the risk of adverse outcomes in patients with AF and COPD.
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Affiliation(s)
- Giulio Francesco Romiti
- Department of Translational and Precision Medicine, Sapienza-University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Bernadette Corica
- Department of Translational and Precision Medicine, Sapienza-University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Eugenia Pipitone
- Ospedale Regionale "Beata Vergine", Via Turconi 23, 6850 Mendrisio, Switzerland
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, via Giuseppe Campi 287, 41125, Modena, Italy.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Brownlow Hill, L69 7TX Liverpool, UK.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, via Giuseppe Campi 287, 41125 Modena, Italy
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Via Luigi Borsari, 46, 44121 Italy.,University of Alberta, Faculty of Nursing, 11405-87 Avenue, T6G 1C9 Edmonton, Alberta, Canada
| | - Stefania Basili
- Department of Translational and Precision Medicine, Sapienza-University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, via Giuseppe Campi 287, 41125, Modena, Italy
| | - Sergio Harari
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria-Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore 12, 20123 Milan, Italy.,Department of Medical Sciences, San Giuseppe Hospital MultiMedica IRCCS, Via San Vittore 12, 20123 Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Brownlow Hill, L69 7TX Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Brownlow Hill, L69 7TX Liverpool, UK.,Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Via Camaldoli 64, Milano 20138, Italy
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Celik Y, Yıldırım N, Demir V, Alp C, Sahin O, Tolga Doğru M. Atrial electromechanical delay and p wave dispersion associated with severity of chronic obstructive pulmonary disease. Afr Health Sci 2021; 21:140-149. [PMID: 34394291 PMCID: PMC8356573 DOI: 10.4314/ahs.v21i1.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study was to evaluate atrial electromechanical delay (AEMD) with both electrocardiography (ECG) and echocardiography in patients with Chronic Obstructive Pulmonary Disease (COPD). Methods Total of 110 patients were included in this cross-sectional case-control study. P-wave dispersion (PWD) was measured on a 12-lead ECG. Atrial electromechanical intervals (PA) were measured as the time interval between the onset of the P wave on the ECG and the beginning of the late diastolic A wave. Results PWD was found to be 40.9±9.2 ms in the healthy control group, 45.6±8.2 ms in the mild COPD and 44.8±8.7 ms in the severe COPD group (p<0.05). Intra-right atrial EMD was found to be 10.7±5.8 ms in mild COPD, 11.0±7 ms in severe COPD, and it was 16.4±7.3 ms in healthy control group (p<0.001). Interatrial EMD was detected to be 29.5±9.1 ms in the control group, 24.1±9 ms in mild COPD group, and 23.9±11.1 ms in the severe COPD group (p<0.001). Conclusion Both mild and severe COPD groups decreased PWD, increased tricuspid PA and significantly decreased interand right intra-AEMD times in comparison to the control group.
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Fumagalli S. It is all in rhythm. Would Shakespeare's masterpieces have existed if atrial fibrillation had been the poet's dominant rhythm? Intern Emerg Med 2020; 15:553-555. [PMID: 32248404 DOI: 10.1007/s11739-020-02328-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Stefano Fumagalli
- Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, University of Florence and AOU Careggi, Largo Brambilla 3, 50134, Florence, Italy.
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Proietti M. Management of peripheral arterial disease in the modern era: an internist "Cup of Tea". Intern Emerg Med 2020; 15:195-197. [PMID: 31768934 DOI: 10.1007/s11739-019-02236-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/14/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Geriatric Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy.
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.
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Satoh A, Hayashi-Nishino M, Shakuno T, Masuda J, Koreishi M, Murakami R, Nakamura Y, Nakamura T, Abe-Kanoh N, Honjo Y, Malsam J, Yu S, Nishino K. The Golgin Protein Giantin Regulates Interconnections Between Golgi Stacks. Front Cell Dev Biol 2019; 7:160. [PMID: 31544102 PMCID: PMC6732663 DOI: 10.3389/fcell.2019.00160] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/29/2019] [Indexed: 12/14/2022] Open
Abstract
Golgins are a family of Golgi-localized long coiled-coil proteins. The major golgin function is thought to be the tethering of vesicles, membranes, and cytoskeletal elements to the Golgi. We previously showed that knockdown of one of the longest golgins, Giantin, altered the glycosylation patterns of cell surfaces and the kinetics of cargo transport, suggesting that Giantin maintains correct glycosylation through slowing down transport within the Golgi. Giantin knockdown also altered the sizes and numbers of mini Golgi stacks generated by microtubule de-polymerization, suggesting that it maintains the independence of individual Golgi stacks. Therefore, it is presumed that Golgi stacks lose their independence following Giantin knockdown, allowing easier and possibly increased transport among stacks and abnormal glycosylation. To gain structural insights into the independence of Golgi stacks, we herein performed electron tomography and 3D modeling of Golgi stacks in Giantin knockdown cells. Compared with control cells, Giantin-knockdown cells had fewer and smaller fenestrae within each cisterna. This was supported by data showing that the diffusion rate of Golgi membrane proteins is faster in Giantin-knockdown Golgi, indicating that Giantin knockdown structurally and functionally increases connectivity among Golgi cisternae and stacks. This increased connectivity suggests that contrary to the cis-golgin tether model, Giantin instead inhibits the tether and fusion of nearby Golgi cisternae and stacks, resulting in transport difficulties between stacks that may enable the correct glycosylation of proteins and lipids passing through the Golgi.
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Affiliation(s)
- Ayano Satoh
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
| | | | - Takuto Shakuno
- Graduate School of Natural Science and Technology, Okayama University, Okayama, Japan
| | - Junko Masuda
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
| | - Mayuko Koreishi
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
| | - Runa Murakami
- Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama University, Okayama, Japan
| | - Yoshimasa Nakamura
- Graduate School of Environmental and Life Science, Okayama University, Okayama, Japan
| | - Toshiyuki Nakamura
- Graduate School of Environmental and Life Science, Okayama University, Okayama, Japan
| | - Naomi Abe-Kanoh
- Graduate School of Environmental and Life Science, Okayama University, Okayama, Japan.,Department of Public Health and Applied Nutrition, Institute of Biomedical Sciences, Graduate School Tokushima University, Tokushima, Japan
| | - Yasuko Honjo
- Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Joerg Malsam
- Center for Biochemistry (BZH), Heidelberg University, Heidelberg, Germany
| | - Sidney Yu
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Kunihiko Nishino
- Institute of Scientific and Industrial Research, Osaka University, Osaka, Japan
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Innocenti F, Pini R. Atrial fibrillation in organ transplant recipients: only a marker of the underlying disease? Intern Emerg Med 2019; 14:11-15. [PMID: 30499072 DOI: 10.1007/s11739-018-1985-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Francesca Innocenti
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy.
| | - Riccardo Pini
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy
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Zhou W, Wang L, Zhou B, Wu L. Catheter ablation of paroxysmal atrial fibrillation using high-density mapping-guided substrate modification. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1630-1634. [PMID: 30353561 DOI: 10.1111/pace.13524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/13/2018] [Accepted: 09/30/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to evaluate the effect of substrate modification in paroxysmal atrial fibrillation (AF) patients prior to circumferential pulmonary vein isolation (CPVI). METHODS Patients without left atrial low-voltage and/or scar areas were defined as Group A. Patients with left atrial low-voltage and/or scar areas underwent regular CPVI (Group B) or substrate modification after CPVI (Group C). The procedural success rate and differences in the left atrial diameter (LAD) among groups were compared at 1 year postoperatively. RESULTS The procedural success rate in Group C was comparable to that in Group A (P > 0.05) and was significantly higher than that in Group B (P < 0.01). The LAD of patients in Groups A and C significantly decreased at 1 year postoperatively compared to that prior to the surgery (P < 0.05). However, no significant difference was noted in Group B. CONCLUSIONS Our study demonstrated that substrate modification could contribute to the single catheter ablation surgery success rate in patients with paroxysmal AF and narrow LAD.
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Affiliation(s)
- Wei Zhou
- Cardiovascular Department, Affiliated Hospital of GuiZhou Medical University, Guiyang, China
| | - Long Wang
- Cardiovascular Department, Affiliated Hospital of GuiZhou Medical University, Guiyang, China
| | - Bo Zhou
- Cardiovascular Department, Affiliated Hospital of GuiZhou Medical University, Guiyang, China
| | - Lirong Wu
- Cardiovascular Department, Affiliated Hospital of GuiZhou Medical University, Guiyang, China
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