ObjectiveTo investigate the changes of fibrinogen and classical markers of collagen metabolism [carboxy-terminal propeptide of type Ⅰ procollagen (PICP) and carboxy-terminal cross-linked peptide of type Ⅰ collagen (ICTP)] in peripheral blood and pericardial drainage after coronary artery bypass grafting (CABG) and/or heart valve replacement (VR), and to evaluate their relationship with postoperative atrial fibrillation (POAF) after cardiac surgery. MethodsPatients who underwent CABG and/or VR in the Heart Center of Beijing Chao-Yang Hospital from March to June 2021 were included. Peripheral blood and pericardial drainage fluid samples were collected before surgery and at 0 h, 6 h, 24 h and 48 h after surgery to detect PICP, ICTP and fibrinogen levels, and preoperative, intraoperative and postoperative confounding factors were also collected. PICP, ICTP and fibrinogen levels were measured by enzyme-linked immunosorbent assay (ELISA). ResultsA total of 26 patients with 125 blood samples and 78 drainage samples were collected. There were 18 males and 8 females with an average age of 64.04±7.27 years. The incidence rate of POAF was 34.6%. Among the factors, the fibrinogen level in pericardial drainage showed two peaks within 48 h after operation (0 hand 24 h after operation) in the POAF group, while it showed a continuous downward trend in the sinus rhythm (SR) group, and the change trend of fibrinogen in pericardial drainage was significantly different over time between the two groups (P=0.022). Fibrinogen in blood, PICP and ICTP in blood and drainage showed an overall decreasing trend, and their trends over time were not significantly different between the two groups of patients (P>0.05). Univariate analysis showed that fibrinogen at 24 h and 48 h after pericardial drainage, fibrinogen in preoperative blood, PICP immediately after surgery and right atrial long axis diameter were significantly higher or longer in the POAF group than those in the SR group. Multiple regression showed that fibrinogen≥11.47 ng/mL in pericardial drainage 24 h after surgery (OR=14.911, 95%CI 1.371-162.122, P=0.026), right atrial long axis diameter≥46 mm (OR=10.801, 95%CI 1.011-115.391, P=0.049) were independent predictors of POAF. ConclusionThis study finds the regularity of changes in fibrinogen and collagen metabolic markers after CABG and/or VR surgery, and to find that fibrinogen in pericardial drainage 24 h after surgery is a potential novel and predictive factor for POAF. The results provide a new idea for exploring the mechanism of POAF, and provide a research basis for the accurate prediction and prevention of clinical POAF.
Objective To evaluate the efficacy of Radiofrequency （RF） modified maze procedure combined with open-heart surgery for atrial fibrillation （AF）. Methods From January 2003 to October 2004, 66 patients underwent the RF modified maze Ⅲ procedure for AF combined with open-heart surgery. The preoperative and postoperative indexes of electrocardiogram and echoeardiogram were compared through retrospective analysis and follow-up. Postoperative cardiac function and thromboembolie events were evaluated through telephone and mail. Results The time needed for RF modified maze Ⅲ was 18.61±3.56 min. There were no hospital deaths and the complications was 15.15%（10/66）. Follow-up duration was 14.25±6.47 months with 95.45%（63/66） completion. At the lastest follow-up, the rate of freedom from AF was 80.95% （51/63）and the rate of restoration to sinus rhythm was 74.60%（47/63）. No thromboembolic events was seen. 77.78%（49/63） of patients were in NYHA class Ⅰ. Significant decrease was seen in both left atrial dimension （LAD） and left ventricular dimension （LVD）（P〈0.01） more than 6 months after operation. Conclusion RF modified maze Ⅲ procedure as an adjunctive procedure is safe, time-sparing and effective in eliminating AF.
ObjectiveTo evaluate the efficacy of hybrid ablation through compared with thoracoscopic epicardial ablation.MethodsIn this study, 108 patients with all long-standing persistent atrial fibrillation (LSPAF) received thoracoscopic epicardial ablation (TEA) after enrollment. There were 82 males and 26 females at age of 56.5±9.4 years. After blanking-period, patients off antiarrhythmic therapy with sinus rhythm were divided into a hybrid ablation (HA) group (50 patients) and a TEA group (58 patients). Only patients in the HA group received catheter ablation after randomization subsequently. In at least two-year observation period, cardiovascular risk factors were observed in all groups’ patients.ResultsThe mean follow-up duration was 17.3-41.8 (26.9±6.1) months and there was no significant difference between two groups [8.2-40.6 (27.5±5.7) months in the HA group and 17.3-41.8 (26.4±6.7) months in the TEA group]. The off antiarrhythmic agents (AADs) sinus rhythm rate was significantly higher in the HA group than that in the TEA group at the time of postoperative 6, 12, 24 and 36 months ［96.0%, 90.0%, 83.7%, 83.7% versus 79.3%, 75.9%, 67.3%, 63.1%, HR=0.415 (95%CI 0.206-0.923)].ConclusionWe can conclude that the efficacy of two-staged hybrid ablation for LSPAF is superior to thoracoscopic epicardial ablation alone. Patients can obtain benefit from a supplemental radiofrequency catheter ablation after blanking-period of surgical ablation, instead of those without a supplemental ablation.
ObjectiveTo evaluate whether atrial fibrillation could predict poor outcomes in stroke patients receiving thrombolysis by meta-analysis. MethodsWe searched MEDLINE, the Cochrane Library and EMbase databases for cohort studies concerning the effect of atrial ribrillation on prognosis of stroke patients receiving thrombolysis up to March 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of nine retrospective cohort studies involving 6 313 patients were included. The results of meta-analysis showed that:atrial fibrillation could increase the risk of symptomatic intracerebral hemorrhage (OR=1.51, 95%CI 1.15 to 1.99, P=0.003) and mortality (OR=1.90, 95%CI 1.29 to 2.80, P=0.001) of ischemic stroke patients receiving thrombolysis; the early improvement rate (OR=0.74, 95%CI 0.60 to 0.90, P=0.002) and later improvement rate (OR=0.50, 95%CI 0.39 to 0.64, P<0.000 01) of the atrial fibrillation group were lower than that of the non-atrial fibrillation group. ConclusionAtrial fibrillation could be a risk factor of poor outcome in ischemic stroke patients receiving thrombolysis. Due to the limitation of quantity and quality of the included studies, large-scale, multi-central and high quality clinical studies are needed.
ObjectiveTo analyze the clinical characteristics of stiff left atrial syndrome (SLAS) after Mei mini maze procedure for atrial fibrillation (AF), and to explore its risk factors and treatments. Methods We retrospectively analyzed the clinical data of the patients who underwent Mei mini maze procedure in Xinhua Hospital between 2010 and 2020. According to whether SLAS occurred in the early postoperative period, patients were divided into a SLAS group and a non-SLAS group. The basic data, perioperative echocardiogram and laboratory test indexes of the two groups were compared. Results A total of 1 056 patients were collected. There were 672 (63.6%) males with an average age of 63.6±9.3 years, including 489 patients with persistent AF and 567 patients with paroxysmal AF. Fourteen (14/1 056, 1.3%) patients developed SLAS, with an average occurrence time of 2.1±1.1 days after the surgery. The average follow-up time of the whole group was 21.4±7.8 months. Two patients in the SLAS group developed SLAS again after discharge, and the occurrence time was 3 weeks and 4 weeks after the operation, respectively; while no SLAS occurred after discharge in the non-SLAS group. Diabetes and small preoperative left atrial diameter were risk factors for SLAS after surgery. Patients with SLAS had a good prognosis after adequate diuretic therapy. Conclusion The incidence of SLAS after Mei mini maze procedure for AF is low, and it mostly occurs in the early postoperative period. After adequate diuretic treatment, the prognosis is good.
ObjectiveTo investigate the high risk factors for perioperative atrial fibrillation (AF) and its effect on the postoperative short term outcome in esophageal carcinoma patients. MethodsSixty three patients with AF after esophagectomy (AF group) and 126 patients without AF after esophagectomy in control group were analyzed by χ 2, and logistic regression, and compare with patient the postoperative mortality and duration hospitalization in two groups.ResultsThe rates of age above 65 (χ 2=7.02, P lt;0.01), male sex (χ 2=4.06, P lt;0.05), history of cardiac disease (χ 2=6 03, P lt;0.05), history of chronic obstructive pulmonary disease (COPD, χ 2=29.14, P lt;0 01), postoperative thoracic gastric dilatation ( P lt;0.01), and postoperative lower oxygen saturation ( P lt;0.01) in AF group were significantly higher than those in control group. No significant relevance was found between history of diabetes or hypertension, choice of operative approach, site of stoma and postoperative AF. 1 in 15 AF patients regain sinus rhythm after remove the pathological factors, and the others resumed after antiarrhythmic drug therapy. The postoperative hospitalization time was 10.65±0.87 d in patients developing AF group and 9.98±0.96 d in control group ( P gt;0.05). No difference was observed between two groups with regard to mortality ( P gt;0.05).ConclusionAF occurs more frequently after esophagectomy in aged and male sex. Other factors contributing to AF are history of cardiac disease, COPD and lower oxygen saturation. And in this study, early occurrence of AF after operation for esophageal carcinoma does not show any negative impact on mortality or on postoperative duration hospitalization.
ObjectiveTo explore the changes of focal adhesion kinase (FAK) in the fibrotic atrium of patients with valvular atrial fibrillation and explore its downstream signaling pathways.MethodsA total of 45 patients with mitral valve disease were included in this study and were divided into a valvular atrial fibrillation group (VAF, ≥6 months, 25 patients) and a sinus rhythm group (SR, 20 patients) based on having atrial fibrillation or not. The atrial appendage tissue was obtained during the operation , histopathological examination and Western blotting were performed. The degree of atrial fibrosis and changes in FAK and its downstream pathways in fibrotic myocardium were observed.ResultsThis study revealed a higher degree of atrial fibrosis in valvular atrial fibrillation and disordered cell arrangement. Expression of fibroblast differentiation marker alpha smooth muscle actin (α-SMA) was significantly increased in atrial fibrillation, and the expression of FAK and downstream AKT/S6K pathway proteins was up-regulated, while the other signal was observed, there was no significant change in ERK1/2 signaling pathway.ConclusionAtrial fibrosis in valvular atrial fibrillation is an important feature of atrial structural remodeling. We found overproduction of collagen fibers disrupted the continuity of atrial myocytes, leading to abnormal conduction and providing a matrix environment for the development of atrial fibrillation. The expression of focal adhesion kinase and downstream AKT/S6K signaling pathway in fibrotic myocardium may be involved in the process of atrial fibrosis, providing a basis for the study of its mechanism.
Abstract： Objectives To determine the atrial expression of the collagen Ⅰ, collagen Ⅲ and the transforming growth factorbeta 1 (TGF-β1) in patients with rheumatic heart disease (RHD) and permanent atrial fibrillation(PAF) and to investigate the relationship between the extent of atrial fibrosis and the effectiveness of radiofrequency maze procedure in patients with RHD and PAF. Methods A total of 40 patients with RHD and PAF (≥6 months) who underwent a radiofrequency maze procedure with concomitant valvular surgery were collected for the experimental group. We acquired 100 mg of the left auricle tissue in each patient and followed up these patients after 3, 6 months of [CM(158mm]surgery. Then we assigned these patients to nonAF group and persistent AF group according to the results of the 6month followup. Another 10 patients with RHD and sinus rhythm(SR) who underwent valvular surgery alone were assigned to SR group and their left auricle tissue was also obtained. In order to determine the extent of atrial fibrosis, we observed the amount of collagen volume fraction Ⅰ，Ⅲ(CVF-Ⅰ,CVF-Ⅲ) by semiquantitative analysis with picrosirius red staining method. Using the β actin protein as the endogenous reference gene, we detected the expressions of TGF-β1 mRNA by semiquantitative reverse transcriptionpolymerase chain reaction(RT-PCR) technique. Results Each group has the same clinical baseline. At 6month follow-up, 28 among the 40 patients were categorized into the nonAF group and 12 into the AF group. (1) Patients in the nonAF group and the AF group had higher mRNA expressions of TGF-β1, CVF-Ⅰ and CVF-Ⅰ/CVF-Ⅲ compared with the SR group (F=6.487, P=0.003; F=3.711, P=0.032; F=3.697, P=0.032). The AF group had higher mRNA expressions of TGF-β1, CVF-Ⅰ and CVF-Ⅰ/CVF-Ⅲ than the nonAF group (t=4.372, P=0.043; t=4.603, P=0.038; t=4.776, P=0.035). But the CVFⅢ had no significant differences among the three groups (P＞0.05). (2) The patients whose left atrial function recovered after Maze procedure had lower mRNA expression than those patients whose left atrial function did not recover in the nonAF group (t=5.570, P=0.027). (3) The TGF-β1 mRNA expression has a positive correlation with both the contents of CVF-Ⅰ and left atrial diameter (r=0.786, Plt;0.05; r=0.858, Plt;0.05). Multiple logistic regression analysis revealed that the mRNA expression levels of TGF-β1, CVF-Ⅰ and left atrial diameter were independently associated with the postoperative persistence of atrial fibrillation. Conclusion The extent of atrial fibrosis in patients with RHD and PAF may be related to the sinus rhythm restoration and maintenance after AF surgical radiofrequency ablation and the resumption of atrial function.
Objective To evaluate the value of preoperative B-type natriuretic peptide （BNP） level in predicting new onset atrial fibrillation （AF） in patients after coronary artery bypass grafting （CABG）. Methods We electronically searched PubMed，EMbase，Cochrane library，CNKI and VIP databases from the establishment of those databases to November 2012. Evaluation standard of diagnostic tests was used to identify and screen literatures which investigated correlations between preoperative BNP levels and new onset AF of patients after CABG. Quality Assessment of Diagnostic Accuracy Studies （QUADAS） was used to evaluate study quality of included literatures. RevMan 5.0 was used for heterogeneity test. Meta-Disc 1.4 software was used for meta-analysis. Included studies were weighted and then combined. Sensitivity，specificity，diag- nostic odds ratio （DOR），positive likelihood ratio，negative likelihood ratio and corresponding 95% confidence interval（95% CI）were calculated. Summary receiver operating characteristic （SROC） curve was drawn，and the area under the SROC curve （AUC） was analyzed. Results A total of 236 studies were identi?ed，and 5 studies met the eligibility criteria including 802 patients for analysis. There were 228 patients with postoperative new onset AF，and 574 patients without postoperative AF. The quality of the included literature was relatively high. DOR of preoperative elevated BNP level with postoperative new onset AF was 4.15 with 95% CI 2.90 to 5.95. Pooled sensitivity was 0.78 with 95% CI 0.72 to 0.83，pooled specificity was 0.58 with 95% CI 0.54 to 0.58，pooled positive likelihood ratio was 1.91 with 95% CI 1.42 to 1.56，pooled negative likelihood ratio was 0.42 with 95% CI 0.32 to 0.54，and the AUC of SROC was 0.79 （Q=0.72）. Conclusion Preoperative elevated BNP level is significantly correlated with new onset AF after CABG，is a powerful predictor of postoperative AF，and can be used to predict new onset AF after CABG to a certain extent of reliability.
Atrial fibrillation(AF) is the most common disorder of cardiac rhythm. It has a high morbidity, mortality and disability, and serious impact on quality of life of patients. It is demonstrated that atrial remodeling which includes atrial electrical remodeling and structural remodeling,are the central contributors to the development and selfperpetuating of AF. However, The mechanisms that underlie the atrial remodeling process in AF have not yet been completely elucidated. New strategies for the prevention and termination of AF should build on our knowledge of the mechanisms of atrial remodeling. Medication for the reversal of atrial remodeling may be the new target for the treatment of AF. At present, drugs that target atrial remodeling have already obtained fruitful results in the experimental and clinical investigations. Now some recent advancements of this area is reviewed in this article.