Is Pursuit of Termination of Atrial Fibrillation During Catheter Ablation of Great Value in Patients with Longstanding Persistent Atrial Fibrillation?

Termination of Atrial Fibrillation During Catheter Ablation Predicts Better Outcome . Background: The reliable endpoint for ablation of longstanding persistent atrial fibrillation (LPAF) has not been clearly established. Methods and Results: This study included 140 patients who underwent catheter ablation for drug‐refractory LPAF. A stepwise ablation approach included circumferential pulmonary vein isolation followed by left atrial and right atrial complex fractionated electrogram‐guided ablation. Atrial fibrillation (AF) was terminated by radiofrequency application during catheter ablation in 95 patients (67.9%). Among them, 33 patients (23.6%) converted to sinus rhythm directly, whereas 62 patients (44.3%) via atrial tachycardias (ATs). Patients in whom AF terminated during the index procedure had a lower recurrence rate of atrial arrhythmia than patients in whom AF did not terminate (45.3% vs 68.9%, P = 0.009, follow‐up 18.7 ± 7.6 months). Among patients in whom AF terminated, there was no significant difference in recurrence rate according to the termination mode, whether converted to AT or not (P = NS). However, patients who converted to AT had a higher recurrence rate of AT (54.8% vs 81%; P = 0.016). Multivariable logistic regression analysis demonstrated that termination of AF during ablation (HR 0.440; 95% CI: 0.200–0.969, P = 0.041) and structural heart disease (HR 2.633; 95% CI: 1.211–5.723; P = 0.015) were significant independent factors predicting the recurrence of atrial arrhythmia. Conclusions: Termination of AF during catheter ablation is associated with a better clinical outcome in patients with LPAF. (J Cardiovasc Electrophysiol, Vol. 23 pp. 1051‐1058, October 2012)     

Prediction of Long‐Term Outcomes of Catheter Ablation of Persistent Atrial Fibrillation by Parameters of Preablation DC Cardioversion

Prediction of Long‐Term Outcomes of Catheter Ablation of Persistent Atrial Fibrillation. Aim: It has been demonstrated that atrial fibrillation (AF) frequently recurred after cardioversion (CV) using direct current (DC) or radiofrequency catheter ablation (RFCA) in patients with persistent (PeAF) or longstanding persistent AF (LPAF). We hypothesized that the atrial substrate impeding successful CV would also produce difficulty in catheter ablation, and therefore, the outcomes of RFCA for PeAF and LPAF could be predicted by the parameters determined at the time of DC CV. Method: From 2006 to 2009, 94 patients with PeAF and LPAF who had undergone elective DC CV before RFCA were studied. The parameters associated with DC CV, including number of shocks, cumulative energy adjusted, highest energy adjusted, with or without intravenous amiodarone use, and other clinical parameters were assessed. Result: Thirty‐two out of the 94 patients (34%) experienced AF recurrence during the follow‐up of 19.8 ± 12.3 months after RFCA. The average time to recurrence of AF after RFCA was 9.2 ± 3.2 months. Of the 62 patients, 29 patients (31%) remained sinus rhythm (SR) without antiarrhythmic drug (AAD). The patients who maintained SR had smaller body mass index (BMI) (P = 0.048), shorter duration of AF (P = 0.012), and lower prevalence of diabetes mellitus (P = 0.023) compared with patients in whom AF recurred. Total number of shocks, total energy, and highest shock energy during CV were lower (P < 0.001, P = 0.002, P = 0.048, respectively) in patients with SR during the follow‐up. The outcome in patients who used amiodarone IV prior to CV, however, was not different from that in those who did not use amiodarone IV. Conclusion: DC energy parameters for successful CV before RFCA were useful to predict the long‐term outcome after RFCA in patients with PeAF and LPAF. The presence of the atrial substrate making DC CV difficult might reflect atrial substrate that subsequently related to the recurrence of AF after RFCA in chronic AF. These DC energy parameters may be related to the chronicity or electroanatomical remodeling of AF. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1165–1170, November 2012)     

2型糖尿病患者内皮一氧化氮合酶基因(CA)n多态性的分布及与糖尿病肾病的关系

目的探讨内皮一氧化氮合酶基因（CA）n多态性在新加坡2型糖尿病患者中的分布及与糖尿病肾病的关系。方法258例2型糖尿病患者入选。从全血中提取DNA，然后进行多聚酶链反应、凝胶电泳及测序。结果在新加坡的中国人、马来西亚人和印度人中各有23、22、20种（CA）n多态性，其基因型分布差异有统计学意义（P〈0．01）。新加坡中国人（CA）n的分布与欧洲白人差异有统计学意义。该基因多态性与糖尿病肾病无显著相关性。结论（CA）n多态性在新加坡3个种族中的分布差异有统计学意义，而且与欧洲白人的分布差异也有统计学意义，但与糖尿病肾病无显著相关性。     

Prospective Study Comparing the Suprapubic Arc (Sparc) Procedure and the Transobturator (Monarc) Procedure for Treating Female Stress Urinary Incontinence

Objectives: In a comparative trial we evaluated the efficacy and safety of the suprapubic arch (Sparc) and transobturator (Monarc) procedures for the treatment of female stress urinary incontinence (SUI). Methods: Between November 2003 and May 2004, 46 women with SUI who underwent the Sparc procedure and 42 women who underwent the Monarc procedure were analyzed. The preoperative evaluation included history taking, physical examination, voiding diary, stress and 1‐h pad tests and a comprehensive urodynamic examination. Postoperative evaluation included a stress test, 1‐h pad test, and uroflowmetry with postvoid residuals. Results: After 1 year of follow up, the rates of cure and satisfaction were 93.5 and 93.0%, respectively, in the Sparc group. The rates of cure and satisfaction were 95.2 and 85.7%, respectively, in the Monarc group. After 2 years of follow up, the rates of cure (93.5 vs 92.9%) and satisfaction (84.8 vs 83.3%) were similar between the two groups. No bladder injury occurred in the Monarc group. Bladder injury occurred in 6.5% (n = 3) of the patients in the Sparc group. Vaginal wall perforation occurred in 4.8% (n = 2) of the patients in the Monarc group (P > 0.05). Late complications included de novo urge symptoms (8.7 vs 11.9%) and voiding dysfunction (10.9 vs 9.5%). Conclusions: The transobturator Monarc procedure appears to be as efficient and safe as the retropubic Sparc procedure for the treatment of SUI.     

Szabo技术在口部病变经皮冠状动脉介入治疗中应用的安全性和可行性

背景和目的：冠状动脉口部病变的经皮冠状动脉介入（PCI）治疗手术操作难度大,易有并发症,既要支架准确植入口部病变,又要边支不受压。本研究探讨解决这一难题的Szabo技术的成功率、安全性和可行性。方法：Szabo技术是利用边支导丝（抛锚导丝）穿过支架最靠近边支的支架网眼,防止支架前进时停止在口部病变外,保证主支导丝穿过支架腔。作者回顾性分析利用Szabo技术治疗39例病人冠状动脉口部病变的结果。手术操作成功定义：支架没有脱落,边支导丝没有退出。造影成功定义：支架准确植入到口部,而边支没有受压。血管内超声定义成功：支架准确植入到口部,近段没有突出,支架完全覆盖病变。39例病人中,男性28例,女性11例,年龄43～79,平均（65±12）岁。6F和7F指引导管分别用于35例（89.7%）和4（10.3%）例病人。经桡动脉途径31（79.5%）例和经股动脉途径8（20.5%）例。病变相关血管：前降支（LAD）26（66.7%）例,右冠（RCA）5（12.8%）例,旋支及钝缘支（LCX-OM）3（7.7%）例,后降支（PDA）5（12.8%）例。支架植入后30（76.9%）例病变相关血管和9（23.1%）例边支血管经过了血管内超声（IVUS）检查。结果：手术操作成功：36例（92.3%）,这36例造影均成功（100%）。IVUS检测：支架准确植入口部者96.7%（29例/30例）,支架近段轻度凸出的只有1例（3.3%）。没有发生严重并发症。结论：结果说明Szabo技术用于冠状动脉口部病变PCI成功率很高,是安全和可行的,值得推广。