Clinical Study on Long-Term Sinus Reversion Rate and Left Atrial Function Recovery of Mitral Valve Disease with Atrial Fibrillation under Modified Surgical Radiofrequency Ablation

We aimed to study the long-term sinus reversion rate and recovery of left atrial function after modified surgical radiofrequency ablation for permanent atrial fibrillation caused by mitral valve disease. From March 2014 to May 2020, 35 patients who underwent modified surgical radiofrequency ablation during cardiac valve surgery in our hospital were selected as the study group, and 25 normal individuals without cardiac structural changes were selected as the control group. The time of modified surgical radiofrequency ablation and long-term sinus reversion rate were measured, and left atrial anteroposterior, superoinferior, left and right diameters, left atrial ejection fraction, left atrial filling index, and left atrial ejection force were measured before and 6 months after surgery. The mean ablation time was 23.2 min, and the long-term sinus reversion rate was 80.0%. The left atrium diameter decreased and the left atrium ejection fraction increased after the operation ( P < 0.05 ). The left atrium filling index and ejection force were significantly increased in 28 patients with sinus reversion ( P < 0.05 ). The decrease in left atrial diameter and the increase in left atrial ejection fraction were correlated with sinus conversion after surgery ( P < 0.05 ). The modified operation is simple, the curative effect is definite, and the sinus reversion rate is high, which is beneficial to the restoration of left atrial structure, ejection function, and hemodynamic function.

Evaluation of p-wave Dispersion and Left Atrium Ejection Fraction in Patients with Cardioembolic Ischemic Stroke

Introduction: Studies show that p-wave dispersion and left atrial ejection fraction are predictors of cardiovascular events. Purpose: To verify the association of p-wave dispersion and left atrial ejection fraction with cardioembolic ischemic stroke. Methods: This is an observational, cross-sectional, case-control study with 61 patients, mean age of 65.6, with sinus rhythm ischemic stroke who underwent clinical evaluation with CHA2DS2-VASc score, electrocardiogram, echocardiogram and ultrasonography with Doppler of both carotid and vertebral arteries. The groups were divided into cardioembolic (cases) and non-cardioembolic (controls). The p-wave dispersion was obtained with a 12-lead electrocardiographic tracing at 50 mm/s by subtracting the largest p-wave by the smallest one. Left atrial ejection fraction was obtained using the modified biplane Simpson method. This study was approved by the UERN Research Ethics Committee (# 2,536,483). Results: Mean values for p-wave dispersion were 62.5 ms for cases and 49 ms for controls (p = 0.025). For left atrial ejection fraction, the cases presented a mean of 42.9% and the controls a mean of 55.8% (p = 0.003). For the CHA2DS2-VASc score, the mean values were 3.6 and 3.1 for cases and controls, respectively (p = 0.35). Cardiovascular risk factors showed similar distribution in both groups. Conclusion: p-wave dispersion and left atrial ejection fraction were associated with the cardioembolic patients with sinus rhythm that have gone through ischemic stroke.

The influence of iatrogenic atrial septal defect on the prognosis of patients with atrial fibrillation between cryoablation and radiofrequency ablation

Objective: The present study was to compare the incidence of septal defect (SD) in patients with atrial fibrillation (AF) who received radiofrequency ablation or cryoablation. Methods: A total of 293 AF patients were performed with radiofrequency ablation and cryoablation. Cardiac ultrasonography was performed to calculate left atrial diameter (LAD), left atrial ejection fraction (LAEF%), strain rate (SR), left ventricular systolic (SRs), left ventricular diastolic (SRe), and left atrial systole (SRa) before surgery, 3 months and 1 year after surgery. The patients were followed up to observe statin and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) medication, AF recurrence, 6-min walk test, stroke, any symptoms caused by arrhythmia, and re-hospitalization. Results: The levels of LAD and SD were higher, while SRe and SRa were lower in the cryoablation group in the comparison with the radiofrequency ablation group after surgery (P&lt;0.05). LAEF was lower in the cryoablation group than the radiofrequency ablation group after 3 months (P&lt;0.05). After 1-year follow-up, no right-to-left shunt occurred in all patients with SD. The AF recurrence rate in SD group was higher than that in the normal group (P&lt;0.05). The use of statin and the application of ACEI/ARB were protective factors, whereas hypertension, LAD, left atrial operation time, and surgical plan were risk factors. Conclusion: SD affects left atrial function and increases the risk of AF recurrence. Hypertension, LAD, and left atrial operation time are risk factors for SD, whereas statin and ACEI/ARB drugs can reduce SD.

Abstract 17313: Myocardial Remodeling in Atrial Fibrillation is Not Associated With Supraventricular or Ventricular Ectopic Activity: Results From a Cardiac Imaging Study

Background: Myocardial remodeling in atrial fibrillation (AF) is a continuum of structural, hemodynamic, and electrophysical changes that often coexist in a complex pathophysiological interplay. Purpose: The aim of this study was to evaluate whether cardiac magnetic resonance imaging (CMR) derived myocardial strain, by tracking subtle alterations in myocardial function, was associated with premature atrial (PAC) and ventricular (PVC) complexes, detected by 7-day Holter-monitoring. Methods: A total of 95 patients (mean age 63±8.5 years, 52% male) with a history of paroxysmal (51%) or persistent AF (49%) underwent CMR and 7-day Holter-monitoring during sinus rhythm. Left atrial measures, including volume, ejection fraction, peak systolic longitudinal, radial and circumferential strain were assessed using cine CMR feature tracking by commercially available software (Circle, Calgary, Canada). Holter-monitoring was used to determine heart rate and rhythm, including the presence of PACs and PVCs. The associations between strain variables and Holter-variables were examined using multivariable linear regression, adjusted for age, sex, and AF type. Results: Left atrial end-diastolic volume was significantly increased, particularly in patients with persistent AF, when compared with healthy controls (persistent AF 132±32 ml vs. healthy 77±14 ml). Similarly, left atrial ejection fraction was significantly reduced in persistent AF as compared with normal reference values (48±10 ml vs. 54±10 ml). There were no significant associations between CMR strain parameters and average PACs per hour, average PVCs per hour, average PACs per sinus beats per hour or average PVCs per sinus beats per hour. These associations remained unaltered after adjusting for age, sex, and AF type. Finally, no significant interactions with AF type were found. Conclusions: Despite significant myocardial remodeling in left atrium shown by increased end-diastolic volume and decreased left atrial ejection fraction, there was no correlation with increased ectopic activity as assessed by 7-day ambulatory Holter monitoring. Image