Gene Expression of Atrial Calcium-Handling Proteins in Patients with Rheumatic Heart Disease and Atrial Fibrillation

Objectives To investigate the gene expression of calcium - handling proteins in patients with rheumatic heart disease (RHD) and atrial fibrillation (AF) . Methods A total of 50 patients with rheumatic mitral valve disease were included. According to cardiac rhythm and duration of episode of AF, patients were divided into four groups: sinus rhythm group, paroxysmal AF group, persistent AF for less than 6 months group and persistent AF for more than 6 months group. Atrial tissue was obtained from the right atrial appendage, the right atrial free wall and the left atrial appendage respectively during open heart surgery. Total RNA was isolated and reversly transcribed into cDNA. In a semi - quantitative polymerase chain reaction the cDNA of interest and of glyceralde-hyde3 - phosphate dehydrogenase (GAPDH) were amplified and separated by ethidium bromide - stained gel electrophoresis. Multiple liner regress was used for correlation between the mRNA amount and age, sex, right atrial diameter (RAd) and left a     

Short-term outcome of chronic heart failure with atrial fibrillation in two hospitals cohort study

Background The epidemiologic features and outcomes of chronic heart failure(CHF) patients with atrial fibrillation(AF) remain not clear in China.We aim to evaluate the epidemiologic features and outcomes of CHF patients with AF,compared by those CHF patients with sinus rhythm(SR),which is still not clear in China.Methods From January 2005 to December 2008,1161 patients were admitted to the PLA general hospitals and First Affiliated Hospital of Shantou University Medical College with a discharge diagnosis of CHF were enrolled in the study.The patients were divided into two groups according to the presence or absence of AF.The main outcomes were defined as death within one year and readmission to the hospital for heart failure.Results The rate of CHF patients with AF was 36 %.During 1 year follow-up,the overall main outcomes was higher in AF patients than in those with SR(P = 0.02).After adjusting for other covariables,including age,gender,left ventricular ejection fraction(LVEF),NYHA classification,et al,AF was no longer related to increased the risk of main outcomes during 1 year follow-up(RR:1.052,CI:0.938 ± 1.165,P = 0.629).A Cox model showed that risk of main outcomes were associated with NYHA Ⅳ(P 0.001),age(P = 0.022),left atrial dimension(P = 0.020).Conclusion The generally observed higher adverse outcome during 1-year follow-up in patients with AF thus seems to be related to other factors,such as NYHA Ⅳ,age,left atrial dimension,but not AF.     

Clinical efficacy of rivaroxaban and Warfarin in patients with atrial fibrillation complicated with left atrial thrombosis

正Objective To observe the clinical efficacy and safety of rivaroxaban and warfarin in patients with atrial fibrillation(AF)complicated with left atrial(LA)thrombosis.Methods A total of 40 patients with confirmed diagnosis of non-valvular AF in our hospital were studied.According to drug therapy at admission,the patients were divided into 2 groups:Rivaroxaban group and Warfarin     

Ionic Remodeling and Direct Effects of Valsartan on Ionic Currentsin Human Atrial Myocytes with Atrial Fibrillation

Objectives Previous studies demonstrated that angiotensin receptor antagonists had effects on some potassium channels in guinea pig myocytes and cloned channels that expressed in human cardiac myocytes. This study determined the direct effects of Valsartan on I caL, INa, IKur, IK1 and Ito1 in isolated human atrial myocytes. Methods and Results Specimens of right atrial appendage tissue were obtained from 39 patients with coronary artery and valvular heart diseases during cardiopulmonary bypass procedure. Pre- operation cardiac rhythm was sinus (SR)in 19 patients and was atrial fibrillation (AF) in the others. Single atrial myocyte was isolated by enzymatic dissociation with the chunk method. The ionic currents were recorded using the whole cell coffiguration of the voltage clamp technique. ICaL and Ito1 densities in AF patients were significantly lower than those in SR patients by 74% and 60%, respectively, while IK1density was significantly higher by 34% at command potential of - 120 mV. With 10 μmol/L Valsartan, INa density was significantly decreased by 59% in SR patients and by 66% in AF patients. IKur and IKl density were significantly decreased in only AF patients by 31% and23%, respectively. Conclusions Conclusions Decreased IcaL and Itol and increased IKl at hyperpolarizing potentials in AF patients‘ atrial myocytes may result from the electrophysiological remodeling by AF. Valsartan significantly decreases INa, IK1 and IKur current densities in AF patients‘ myocyte, but decreases only INa in SR patients‘ myocyte, suggesting that Valsartan may be beneficial to the recovering of remolded atria.     

Left atrial dimension and atrial fibrillation in surgical heart disease patients

Objective The effect of left atrial (LA) dimension on the occurrence of atrial fibrillation (AF) has been examined in some small studies.Less is known about the relationship of LA dimension,hemodynamic with AF during echocardiographic evaluation,especially,the flow dynamics in LA poorly described.The objective of this study was to investigate the relationship between LA dimension and the occurrence of AE Methods Two hundred and forty-five consecutive patients with heart disease scheduled to undergo open heart surgery were prospectively enrolled in the study.Patients were divided into 2 groups according to atrial fibrillation:AF group (n=148,99 men and 49 women,with a mean age 59.3+8.4 years),and no-AF group (n= 97,60 men and 37 womem).Echocardiography was performed before surgery.All measurements were performed following the American Society of Echocardiography recommendations.Results There were more patients with congestive heart failure in AF group than in no-AF group (45.9% vs 39.1%,P ＜0.05).The mean LA volume was 49.2±12.2 ml/m2 in AF group and 33.1±10.8 ml/m2 in no-AF group.There were also significant differences between two groups in left atrial end systolic dimension (LAESD) (50±13mm vs 27±14mm),left atrial end diastolic dimension (LAEDD) (79±17mm vs 53±13mm),PA pressure ( 41.3+11.6 mmHg vs 37.5±10.4 mmHg),and ratio of mitral E velocity and septal mitral annulus motion velocity (E/E') .The percentage of abnormal diastolic function grades (DGF) was also higher in AF than in no-AF group (89.9% versus 59.8% );.Conclusion Atrial fibrillation is associated more frequently with an increased LA dimension and more severe atrial hemodynamics disorder.(J Geriatr Cardiol 2008;5:11-4)     

Long-term effects of simvastatin on protection against atrial fibrillation in patients with acute myocardial infarction

Objective To investigate the impact of simvastatin on blood lipid and the incidence of atrial fibrillation and ischemic-related events in patients with acute myocardial infarction accompanied by paroxysmal atrial fibrillation. Methods One hundred and three patients with acute myocardial infarction and paroxysmal atrial fibrillation were selected as subjects,and were divided into a simvastatin group and a control group. Forty-five patients were in the simvastatin group,who took simvastatin 20mg/d orally for 18 months;fifty-eight patients were in the control group,and received conventional therapy except for statins. All patients were followed up for 18 months. The level of blood lipid,recurrence rate of paroxysmal atrial fibrillation,incidence rate of persistent or permanent atrial fibrillation,and the ischemic-related events were investigated and compared between the two groups. Results ① The levels of blood lipids did not change significantly in the control group(P>0.05) ;concentrations of total cholesterol(TC) and low density lipoprotein cholesterol(LDL-C) decreased significantly after treatment of simvastatin(P<0.05) . ② Recurrence of atrial fibrillation was observed in five patients during 18 months follow-up in the simvastatin group(11.1%) ,whereas it occurred in 14 patients of the control group(24. 1%,P<0.05) ;the occurrence rate of persistent or permanent atrial fibrillation in the simvastatin group was 4.4%,which was lower than that of control(12.1%,P<0.05) . ③ Nine patients had ischemic-related events in the simvastatin group(20.0%) ,with three heart failures(6.6%) ,two rehospitalizations for deterioration of coronary heart diseases(4.4%) ,three cardiac deaths(6.6%) ,and one cerebral stroke(2.2%) ,which was lower evidently than in the control group(41.4%,P<0.05) . Conclusions Simvastatin can not only decrease the levels of serum TC and LDL-C but also prevent the occurrence of atrial fibrillation and ischemic-related events.     

Relationship between FGF23/FGFR4 expression in atrial tissue and atrial fibrosis in patients with atrial fibrillation

正Objective To observe the expression of fibroblast growth factor 23(FGF23)and FGFR4 in patients with atrial fibrillation(AF)and its relationship with atrial fibrosis.Methods Fifty-one patients with rheumatic heart disease undergoing cardiac surgery in the Second Affiliated Hospital of Nanchang University from October 2016     

Mapping and ablation of atrial arrhythmia after valve surgery plus mini-maze procedure

Background Recurrent atrial arrhythmia is very common in patients after mitral valve surgery plus mini-maze procedure.Investigation about the mechanism for these patients may have important implication to improve the surgery strategy.Methods Mini-maze procedure was defined as follow: Pulmonary vein encircling incision and roof line connecting the two circles lesion,left atrial isthmus lesion,and the right atrial isthmus lesion.There were 517 patients with rheumatic valvular disease and pre-operative atrial fibrillation (AF) undergoing valve surgery plus mini-maze procedure in our hospital in the last 3 years,and 93 patients(18%) had recurrent atrial arrhythmia.Twelve patients(6 males and 6 females,mean age 53.8±7.8 ys) underwent electrophysiological study using 3-D mapping system(10 pts) or conventional mapping method(2 pts).Results The first recurrent time from surgery was 4.4±2.2 months.The mean follow-up time after catheter ablation was(12.0±6.0) months.One patient with sinus bradycardia had recurrent incessant atrial tachycardia (AT),but the AT was terminated by catheter position and never could be induced any more.She underwent a repeat procedure but failed just as the course in the first time, and was treated with DDDR pacemaker plus amiodarone.Six patients had 10 kinds of stable AT,including 5 at right atrial isthmus,2 at roof line,1 related to right atrial incision, 1 at anterior wall of left atrial,and 1 related to left superior pulmonary vene.All the stable AT were eliminated and remained sinus rhythm.Three patients had ATs with variable cycle length and the 3-D mapping suggested macro-reentry AT around mitral annulus.We tried to ablate at routine mitral isthmus and also in coronary sinus,but could not reach bi-directional conduction blocking.The other 2 patients were AF with reconnection at all previous ablation sites.Ablation strategy for AF included lesion at re-conduction sites and complex fractionated atrial electrogram.The patients with AF and mitral isthmus related AT were administrated with     

Effect of propranolol on the splanchnic and peripheral renin angiotensin system in cirrhotic patients

AIM： To evaluate the effect of β-blockade on angiotensins in the splanchnic and peripheral circulation of cirrhotic patients and also to compare hemodynamic parameters during liver transplantation according to propranolol pre-treatment or not. METHODS： Patients were allocated into two groups： outpatients with advanced liver disease（LD） and during liver transplantation（LT）. Both groups were subdivided according to treatment with propranolol or not. Plasma was collected through peripheral venipuncture to determine plasma renin activity（PRA）, Angiotensin（Ang） Ⅰ, Ang Ⅱ, and Ang-（1-7） levels by radioimmunoassay in LD group. During liver transplantation, hemodynamic parameters were determined and blood samples were obtained from the portal vein to measure renin angiotensin system（RAS） components.RESULTS： PRA, Ang Ⅰ, Ang Ⅱ and Ang-（1-7） were significantly lower in the portal vein and periphery in all subgroups treated with propranolol as compared to non-treated. The relationships between Ang-（1-7） and Ang Ⅰ levels and between Ang Ⅱand Ang Ⅰ were significantly increased in LD group receiving propranolol. The ratio between Ang-（1-7） and Ang Ⅱ remained unchanged in splanchnic and peripheral circulation in patients under β-blockade, whereas the relationship between Ang Ⅱ and Ang Ⅰ was significantly increased in splanchnic circulation of LT patients treated with propranolol. During liver transplantation, cardiac output and index as well systemic vascular resistance and index were reduced in propranolol-treated subgroup. CONCLUSION： In LD group, propranolol treatment reduced RAS mediators, but did not change the ratio between Ang-（1-7） and Ang Ⅱ in splanchnic and peripheral circulation. Furthermore, the modification of hemodynamic parameters in propranolol treated patients was not associated with changes in the angiotensin ratio.