老年心房颤动不同方式的经导管射频消融治疗

目的研究不同方式经导管射频消融治疗对老年房颤的治疗效果。方法53例房颤患者，男性38例，女性15例，年龄60-83岁。按接受不同的经导管消融方法将上述患者分为3组：消融隔离肺静脉治疗阵发性房颤组20例、消融典型房扑治疗房颤合并房扑组26例、消融房室传导加植入永久性起搏器治疗持续性房颤伴药物难以控制的快速心室率和（或）心力衰竭组7例。结果消融隔离肺静脉组中15例采用环状标测电极导管引导电隔离3～4根肺静脉成功，术后无房颤发作8例（53％），房颤发作明显减少4例（27％）；采用电解剖系统引导下环双侧肺静脉线性消融隔离肺静脉5例，无房颤发作4例（80％）。消融房扑组26例典型房扑均消融成功，随访中15例（58％）无房颤发作，8例（31％）房颤发作较前减少。经导管消融房室传导组7例全部成功，4例行右心室、3例行双心室VVI模式起搏，随访中生活质量和（或）心力衰竭症状明显改善。结论针对不同类型的老年房颤患者采用不同的经导管消融方法可以取得较好的临床效果。     

中老年心房颤动患者轻度认知功能障碍的影响因素分析

目的：分析中老年非瓣膜性心房颤动（Atrial Fibrillation）患者轻度认知功能障碍（Mild Cognitive Impairment）的状况及其影响因素。方法：纳入自2019年10月至2020年6月就诊于应急总医院心内科及干部医疗科的非瓣膜性心房颤动患者106例,完成记忆、注意、语言、执行、视空间功能五大认知域的神经精神量表的筛查,分为轻度认知功能障碍组和认知功能正常组。采用多因素logistic分析探讨非瓣膜性心房颤动患者轻度认知功能障碍的影响因素。结果：106例患者中有58例为轻度认知功能障碍,平均年龄63岁,MCI组的房颤类型（持续/永久房颤）（P=0.017）、高血压病史比例（P=0.002）,CHA2DS2-VASc评分（P=0.047）,左房前后径（P=0.038）较正常认知组高,血红蛋白在MCI组偏低（P=0.034）,logistic回归分析发现非瓣膜性房颤人群的认知功能障碍与房颤类型、高血压、糖尿病病史、血红蛋白量相关。结论：房颤和认知功能障碍的发生都随着年龄增大而增加,房颤患者的发病类型、高血压、糖尿病病史和血红蛋白水平是发生轻度认知功能障碍的危险因素,早期识别轻度认知功能障碍对缓解认知进一步下降至关重要。     

老年慢性心房颤动患者发生血栓栓塞性中风的危险因素

目的　探讨老年慢性心房颤动患者发生血栓栓塞性中风的危险因素。方法　对 42 0例 (>6 0岁 )资料完整的慢性心房颤动患者进行统计分析 ,其中发生血栓栓塞性中风 83例 (19.8% ) ;死亡 71例 (16 .9% )。结果　 (1)单变量分析老年慢性心房颤动患者发生血栓栓塞性中风最有意义的危险因素 :高血压、糖尿病、心肌梗死、心力衰竭、左室射血分数降低、胆固醇及甘油三酯增高、高密度脂蛋白降低 (P<0 .0 5 ) 。年龄、性别对血栓栓塞性中风无明显影响 (P >0 .0 5 ) ,胆固醇、甘油三酯与血栓栓塞性中风有明显关系 (P <0 .0 1)。 (2 )Cox回归显示 :高血压、胆固醇水平增高是老年慢性心房颤动患者发生血栓栓塞性中风的独立危险因素。结论　老年慢性心房颤动患者发生血栓栓塞性中风危险因素众多 ;有效控制血压、积极降脂治疗是预防血栓栓塞性中风的关键。     

Healthcare resource utilization and costs associated with recurrent episodes of atrial fibrillation: the FRACTAL registry

Introduction: Drivers of cost in the atrial fibrillation (AF) population are not fully understood. We sought to characterize the resource utilization and costs of treating new-onset AF, with emphasis on the incremental costs associated with recurrent episodes of AF over time.
Methods and Results: An inception cohort of 973 AF patients was followed at 3–6 month intervals in an observational registry over a mean of 24 ± 9 months. AF therapies, clinical outcomes, and both inpatient and outpatient medical resource utilization were tracked at each follow-up interval. Registry patients were managed primarily with cardioversion and pharmacological therapy. Direct healthcare costs were calculated from a U.S. perspective by multiplying measures of resource utilization by representative price weights. Costs were compared among patients in whom the initial episode of AF became permanent and patients who initially achieved sinus rhythm and had either 0, 1–2, or ≥3 documented recurrences during follow-up. Mean annual costs for these four groups were $2,372, $3,385, $6,331, and $10,312 per patient per year, respectively (P < 0.001 for trend), with the largest variation related to hospital costs. In multivariable analysis controlling for demographic characteristics and baseline cardiac and comorbid conditions, each documented recurrence of AF was found to increase annual healthcare costs by ∼$1,600.
Conclusion: Following initial diagnosis, patients with AF treated with traditional therapies incur $4,000–$5,000 in annual direct healthcare costs. Costs are markedly higher in patients with multiple AF recurrences. These data may be helpful in evaluating the economic impact of new technologies for treating AF.     

Surface atrial frequency analysis in patients with atrial fibrillation: assessing the effects of linear left atrial ablation

INTRODUCTION: Our group has shown previously that measurements of atrial frequency can be obtained from surface 12-lead ECG recordings of patients during atrial fibrillation (AF), using a combination of principal component and Fourier transform algorithms. Such measurements are reproducible over time and change with drug manipulation of the arrhythmia. AIMS: To determine whether linear left atrial ablation, using a combination of "roof" and "mitral isthmus" lines results in changes in surface atrial frequency during AF and to assess the contribution of each individual line when sited sequentially. METHODS AND RESULTS: Computerized recordings from 26 patients, who had undergone linear ablation procedures for AF, were reviewed. The atrial signal was extracted from the 12-lead ECG data by principal component analysis and the main frequency component identified using Fourier analysis. Atrial frequency before and after these two standard ablation lines was compared. Atrial frequency decreased significantly after the combination of roof and mitral isthmus lines (5.66 vs 5.15 Hz) and when either roof (5.61 vs 5.13 Hz) or mitral isthmus (5.89 vs 5.75 Hz) lines were sited first. However, only the roof line led to a significant reduction in atrial frequency when sited second (5.64 vs 5.49 Hz). CONCLUSIONS: Measurements of atrial frequency can be obtained from surface 12-lead ECG recordings during AF and change as predicted in response to linear left atrial ablation. This technique may be useful in assessing antiarrhythmic treatments for AF.     

心房颤动病人转律前AFW的临床应用

目的:为帮助选择可以成功转律的心房颤动患者,研究转律前心房颤动病人房颤波谱分析(a spectra analysissystem for atrial fibrillation waves,AFW)的价值。方法:所有病人在转律前均行AFW研究,成功转律的患者为A组,转律不成功的患者为B组,对两组进行比较研究。结果;当房颤小波的峰频率F_(0 max),F_(1 max),F_(2 max),P4明显减少,而对应的主导心房周长MACL0,MACL1,MACL2明显的延长时.特别是F_(0 max)<3、51±O.17Hz.MACL0>315±15.09ms,P4<3.21±0.63pw时转律的成功率较高(p均<0.01)。结论:AFW信号分析技术中F_(0 max_,MACL0,P4是指导临床医师成功进行房颤转律的较好指标。     

立体心电图分析阵发性房颤患者心房的电生理特性

目的应用立体心电图(three-dimensional electrocardiogram,3D-ECG)分析阵发性房颤患者心房传导时间、心房除极角度和振幅的变化。方法入选在住院的阵发性房颤患者13例,对照组患者15例。分别应用立体心电图仪记录窦律下的立体心电图,分析后比较两组患者心房传导时间,P波除极振幅及角度。同时记录患者入院时超声心动图中左心房内径数值进行比较。结果两组患者比较左心房内径无显著差异。阵发性房颤组与对照组心房传导时间分别为123.75±11.67msvs.111.39±13.52ms,两组比较有显著性差异(p<0.05)。而在心房除极角度、振幅上,两组无显著差异。与对照组比较,阵发性房颤组患者P环初始部的运行方向与泪点疏密程度无明显变化,但在P环中间至终末部分,P环运行方向及泪点疏密出现明显变化,并且可看到明显的曲折、弯曲。但在除极末20ms的振幅,房颤患者较对照组明显降低(0.05±0.013mvvs.0.036±0.014mv,p<0.05),除极末30ms、40ms处两组振幅无显著差异。结论阵发性房颤患者可以出现心房传导时间延长、心房除极末振幅的改变和立体三维P环运行方向及泪点疏密程...     

瓣膜置换、房颤射频消融术治疗房颤的临床护理研究

目的：分析探讨瓣膜置换 房颤射频消融术治疗房颤患者的临床护理方法与效果。方法：选择我院2014年1月-2014年12月之间收治的行瓣膜置换 房颤射频消融术治疗的36例患者作为观察对象,采用随机的方式将其分为观察组和对照组各18例。对照组患者采取常规的护理干预;观察组患者应用系统护理方法。分析对比两组患者的临床治疗效果及患者满意度。结果：观察组患者术后出现并发症的比例小于对照组,差异具有统计学意义(P＜0.05);同时观察组患者对护理服务的满意度显著高于对照组,差异同样具有统计学意义(P＜0.05)。结论：对瓣膜置换 房颤射频消融术治疗房颤患者应用系统的护理干预具有很好的改善效果,构建和谐的护患关系,值得在临床中推广。     

Surface atrial frequency analysis in patients with atrial fibrillation: a tool for evaluating the effects of intervention

INTRODUCTION: The aims of this study were to evaluate (1) principal component analysis as a technique for extracting the atrial signal waveform from the standard 12-lead ECG and (2) its ability to distinguish changes in atrial fibrillation (AF) frequency parameters over time and in response to pharmacologic manipulation using drugs with different effects on atrial electrophysiology. METHODS AND RESULTS: Twenty patients with persistent AF were studied. Continuous 12-lead Holter ECGs were recorded for 60 minutes, first, in the drug-free state. Mean and variability of atrial waveform frequency were measured using an automated computer technique. This extracted the atrial signal by principal component analysis and identified the main frequency component using Fourier analysis. Patients were then allotted sequentially to receive 1 of 4 drugs intravenously (amiodarone, flecainide, sotalol, or metoprolol), and changes induced in mean and variability of atrial waveform frequency measured. Mean and variability of atrial waveform frequency did not differ within patients between the two 30-minute sections of the drug-free state. As hypothesized, significant changes in mean and variability of atrial waveform frequency were detected after manipulation with amiodarone (mean: 5.77 vs 4.86 Hz; variability: 0.55 vs 0.31 Hz), flecainide (mean: 5.33 vs 4.72 Hz; variability: 0.71 vs 0.31 Hz), and sotalol (mean: 5.94 vs 4.90 Hz; variability: 0.73 vs 0.40 Hz) but not with metoprolol (mean: 5.41 vs 5.17 Hz; variability: 0.81 vs 0.82 Hz). CONCLUSION: A technique for continuously analyzing atrial frequency characteristics of AF from the surface ECG has been developed and validated.     

肥厚型心肌病伴心房颤动患者临床特点分析

目的分析32例肥厚型心肌病伴心房颤动患者的临床特点。方法选择1994-2005年在解放军总医院心脏中心就诊的肥厚型心肌病患者158例，平均随访（4．2±2．8）年，按病史、心电图、动态心电图是否记录到心房颤动分为房颤组和非房颤组，观察并比较2组患者的临床特点。结果（1）肥厚型心肌病伴房颤患者共32例，占全部肥厚型心肌病患者的20．3％，其中阵发性房颤14例（43．7％），持续性房颤18例（57．3％），无症状性房颤5例（15．6％）；（2）与非房颤组患者比较，房颤组患者平均年龄偏大（58±10．4vs46±12．6）岁（P〈0．01），左房直径大（42±3．5vs34±5．3）mm（P〈0．01）；（3）房颤组12例（心力衰竭8例，猝死4例）发生心血管事件，非房颤组9例（心力衰竭6例，猝死3例）发生心血管事件。房颤组患者中，房颤引发室颤1例（3％），脑栓塞2例（6．3％），下肢动脉栓塞2例（6．3％）。结论（1）20．3％肥厚型心肌病患者伴心房颤动，其中43．7％为阵发性房颤，57．3％为持续性房颤，15．6％为无症状性房颤；（2）与肥厚型心肌病不伴房颤患者相比，伴房颤患者年龄偏大，心血管事件发生率高。     

老年心房颤动患者左心房内径及其电活动变化的临床研究

目的探讨老年心房颤动(房颤)患者左心房内径、电活动变化及其意义。方法142例老年非瓣膜性房颤患者(房颤组)进行彩色多普勒超声心动图仪及三导心电图仪检查,测定左心房内径(LAD)、左心室舒张期末内径、左心室后壁厚度、室间隔厚度、左心室射血分数(LVEF)及房颤的检出。采用食管调搏的方法测定左心房电生理特性,以400ms起搏周长(PCL)对左心房进行S1S2扫描,测定基础状态左心房有效不应期(LAERP);以3种不同起搏周长(400、500、600ms)对左心房进行S1S2扫描,观察LAERP频率适应性。150例健康体检者为正常对照组。结果房颤组患者LAD较正常对照组显著增加,其中左心房扩大(LAD>32mm)者占95.07%,且持续性房颤患者LAD较阵发性房颤患者显著增加。左心室肥厚患者LAD较无左心室肥厚患者显著扩大,左心房扩大与心功能降低有关,其中左心房显著扩大者(LAD≥40mm)其LVEF、每搏输出量下降最明显。房颤组患者LAERP较正常对照组显著缩短,LAERP频率适应性较正常对照组减退。结论LAD扩大及其电重构与房颤发生密切相关,LAD扩大与左心室肥厚及心功能减退有关。     

导管射频消融治疗高龄心房颤动患者的临床评价

目的评价高龄心房颤动(AF)患者接受导管射频消融治疗的有效性和安全性。方法纳入2008年1月至2014年8月在大连医科大学附属第一医院行房颤射频消融(RA)的877例患者,按年龄分为老年组(≥75岁)68例、年轻老年组(65～74岁)320例及对照组(65岁)489例。记录3组患者的临床资料,分析对比3组患者术中并发症、手术时间、X线曝光时间,比较术后血栓栓塞率、再住院率、二次手术率、术后抗心律失常药物服用率以及术后缓慢心室率比例。消融成功的定义:术后心电图或动态心电图未再出现持续时间超过30 s的房颤。采用SPSS 19.0统计软件,根据数据类型分别采用x~2检验、方差分析或LSD检验进行分析。应用Kaplan-Meier分析分别比较持续性AF和阵发性AF不同年龄患者的导管消融成功率。结果消融过程及安全性评价:3组患者术中并发症(5.9%vs 3.1%vs 2.9%)、手术时间[(196.65±34.45)vs(196.03±40.02)vs(194.36±37.89)min]、X射线曝光时间[(19.81±6.73)vs(19.44±6.45)vs(18.69±6.00)min],差异均无统计学意义。疗效评价:3组患者随访(21.45±6.31)个月,其术后血栓栓塞率(4.4%vs 3.4%vs 2.5%)、再住院率(23.5%vs 22.2%vs18.0%)及二次手术率(11.8%vs 12.8%vs 12.3%),差异无统计学意义。但是,老年组患者在术后长期使用抗心律失常药物的比例相对较低(13.2%vs 29.4%vs 20.0%,P=0.001),术后动态心电图出现缓慢心室率的比例较高(23.5%vs 15.6%vs12.3%,P=0.033)。Kaplan-Meier生存分析结果显示持续性AF和阵发性AF不同年龄患者的导管消融成功率差异无统计学意义。结论老年心房颤动患者的导管消融成功率和安全性与年轻患者相似。     

Increased mortality in paroxysmal atrial fibrillation: report from the Stockholm Cohort-Study of Atrial Fibrillation (SCAF).

AIMS: Whether paroxysmal atrial fibrillation (PxAF) affects survival is poorly recognized. Results have been conflicting in the few previously published studies. To describe mortality in patients with PxAF and to identify risk factors amenable to treatment. METHODS AND RESULTS: All patients (n=2824) treated for atrial fibrillation during 2002 at one of Scandinavia's largest hospitals were followed prospectively for a mean of 4.6 years. Information about type of AF, comorbidity, and medication was acquired from medical records and national registers. Information about deaths was obtained from the National Cause of Death Register. One-third (n=888) of the patients had PxAF (mean age 73 years). During follow-up, 267 of them died. The mean annual mortality rate was 7%. Compared with the general population, the standardized mortality ratio (SMR) was 1.6 (95% CI 1.4-1.8) for all-cause mortality, 2.4 (95% CI 1.4-3.7) for death from myocardial infarction, and 2.6 (95% CI 1.3-5.2) for death from heart failure. Warfarin treatment was associated with improved survival both in comparison with the general population (SMR 1.1 with warfarin, SMR 2.2 without warfarin) and after propensity score matching for odds to receive warfarin (HR 0.5, 95% CI 0.3-0.9). The improvement of survival could not be explained by stroke reduction alone. CONCLUSION: PxAF is associated with increased mortality, which mostly appears to be related to concomitant cardiovascular risks. Treatment with warfarin is associated with improved survival in PxAF patients.     

Atrial fibrillation: mechanistic insights from biatrial (and triatrial) mapping

Percutaneous radiofrequency ablation of pulmonary vein potentials has been shown to eliminate atrial fibrillation in a subset of patients characterized by frequent and repetitive paroxysms of atrial fibrillation. However, pulmonary vein disconnection has had only limited success at curing patients with persistent atrial fibrillation. In those patients, left atrial substrate modification and linear ablation strategies have had substantially higher success rates. Furthermore, in other patients, elimination of right atrial triggers (superior vena cava) or modification of right atrial substrate has been required for elimination of atrial fibrillation. Finally, the realization that the coronary sinus is a third atrial chamber that can both initiate and maintain atrial fibrillation has provided new understanding to the pathogenesis of atrial fibrillation. From a clinical perspective, only careful anatomic and mapping strategies specifically aimed at each subset of patients with atrial fibrillation will allow for pattern recognition and establish which mechanisms are responsible for initiation and maintenance of atrial fibrillation. Only the latter will allow for increased long-term success rates of ablation of atrial fibrillation.     

老年非瓣膜性房颤患者华法林抗凝强度的研究进展

流行病学调查显示房颤的发病率逐年上升,尤其在老年人中,年龄越大,其发病率和死亡率越高。多个临床试验显示,目前华法林仍是治疗房颤的主要药物。欧美国家的房颤指南建议将国际标准化比值(INR)控制在2.0～3.0,但亚洲和欧美人群之间存在种族差异,应适当降低华法林抗凝强度,尤其是对于有高卒中、高出血风险的老年非瓣膜性房颤(NVAF)患者,INR控制在1.5～2.5是安全有效的,但这一结论仍缺乏大量的临床试验及循证医学依据。     

慢性心房颤动伴晕厥患者心电图回顾性分析

目的 回顾性分析19例慢性心房颤动（房颤）伴晕厥患者的心电图及动态心电图资料，探讨心电图特点，以及与临床转归的重要关系。方法 分析两年来入组患者的心电资料及晕厥发作时的相关心电图。结果 全组19例患者，16例晕厥系房颤伴缓慢心室率引起，平时就有房颤伴二度房室阻滞的心电图表现；2例晕厥为突发室颤所致；1例晕厥原因不明。心率缓慢组脑梗死的发生率明显增多。结论 本文资料显示，房颤伴心室率缓慢的患者有较高的晕厥及脑梗死的发生危险，房颤是室颤发生的重要原因之一，提示房颤不是一种良性心律失常。     

Anxiety is associated with higher recurrence of atrial fibrillation after catheter ablation: A meta‐analysis

Previous studies that evaluated the influence of anxiety on recurrence of atrial fibrillation (AF) after catheter ablation showed inconsistent results. We performed a meta‐analysis of cohort study to systematically evaluate the association between anxiety and AF recurrence after catheter ablation. Electronic databases of PubMed, Embase, and Web of Science were searched for relevant cohort studies from inception to January 20, 2021. We applied the random‐effect model to combine the results to incorporate the potential influence of heterogeneity among studies. Five cohort studies were eligible for the meta‐analysis, which included 549 patients with AF that received catheter ablation. No significant heterogeneity was observed among the included studies (I ² = 7%, P for Cochrane''s Q test = 0.37). During a mean follow‐up of 9.7 months, 216 (39.3%) cases of recurrent AF occurred. Results of the meta‐analysis showed that anxiety was independently associated with an increased risk of AF recurrence after catheter ablation (adjusted relative risk: 2.36, 95% confidence interval: 1.71–3.26; p < .001). Subgroup analyses did not show that differences in study characteristics including study design, ethnicity of the patients, sample size, AF type, anxiety evaluation method, follow‐up duration, or adjustment of LAD may significantly affect the association between anxiety and AF recurrence (p for subgroup difference all > .10). Anxiety may be an independent risk factor for AF recurrence after catheter ablation. Whether alleviating anxiety mood could reduce the risk of AF recurrence after catheter ablation should also be investigated.     

Stroke risk in an elderly population with atrial fibrillation

Patients with nonvalvular atrial fibrillation (AF) have an increased risk of stroke, but the absolute rate of stroke varies widely depending on coexistent vascular disease. We assessed the stroke rate and predictive value of two published schemes for stroke risk stratification in a population-derived cohort of 259 elderly people with nonvalvular AF followed for a median of 5.3 years. The rate of ischemic stroke was 2.8% per year (95% confidence interval [CI] 1.9, 3.9). Thirty-one percent were predicted to be at low risk, and their stroke rate was 1.7% per year (95% CI 0.6, 3.8). Many people with AF in this population-derived cohort had relatively low rates of stroke. Further studies to reliably stratify stroke risk in patients with AF are needed.     

Effect of inotropic stimulation on left atrial appendage function in atrial myopathy of chronic atrial fibrillation

Atrial fibrillation (AF) leads to remodeling of the left atrium (LA) and left atrial appendage (LAA), resulting in atrial myopathy. Reduced LA and LAA function in chronic AF leads to thrombus formation and spontaneous echo contrast (SEC). The effect of inotropic stimulation on LAA function in patients with chronic AF is unknown. LAA emptying velocity (LAAEV) and maximal LAA area at baseline and after dobutamine were measured by transesophageal echocardiography in 14 subjects in normal sinus rhythm (NSR) and 6 subjects in AF. SEC in the LA was assessed before and after dobutamine. LAAEV increased significantly in both groups. However, the LAAEV at peak dobutamine in patients with AF remained significantly lower than the baseline LAAEV in patients who were in NSR (P = 0.009). Maximal LAA area decreased significantly with dobutamine in both groups, but LAA area at peak dose of dobutamine in patients with AF remained greater than baseline area in those in NSR (P = 0.01). Despite the increase in LAAEV, SEC improved in only two of five patients. We conclude that during AF, the LAA responds to inotropic stimulation with only a modest improvement in function.