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.
ObjectiveTo investigate the technique and efficacy of left atrial appendage (LAA) occlusion during off-pump coronary artery bypass grafting (OPCABG) in elderly patients with coronary artery disease (CAD) and atrial fibrillation (AF).MethodsFrom 2013 to 2018, 84 elderly patients with CAD and AF with reduced left ventricular ejection fraction (LVEF< 50%) underwent OPCABG in our department. There were 54 males and 30 females at age of 70-82 years. They were divided into a left atrial appendage (LAA) occlusion group (n=56) and a non-LAA occlusion group (n=28). Postoperative antithrombotic therapy: the LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic therapy” for 3 months after operation, then was changed to aspirin + clopidogrel “dual antiplatelet” for long-term antithrombotic; the non-LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic” for long-term antithrombotic after operation. The clinical effectiveness of the two groups was compared.ResultsAll patients underwent the surgery successfully. There were 56 patients in the LAA occlusion group, including 44 patients of LAA exclusion and 12 patients of LAA clip. The time of LAA occlusion was 3 to 8 minutes. There was no injury of graft vessels and anastomotic stoma. Early postoperative death occurred in 2 patients (2.4%). There was no statistical difference between the two groups in postoperative hospital stay (P=0.115). Postoperative LVEF of the two groups significantly improved compared with that before operation (P<0.05). There was no stroke or bleeding in important organs during hospitalization. During follow-up of 1 year, no cerebral infarction occurred in both groups, but the incidence of bleeding related complications in the LAA occlusion group was significantly lower than that in the non-LAA occlusion group (3.6% vs. 18.5%, P=0.036).ConclusionFor elderly patients with CAD and AF with reduced LVEF, LAA occlusion during OPCABG can effectively reduce the risk of stroke and bleeding related complications, and without increasing the risk of surgery.
Objective To investigate the relationship between miR-3187-5p in peripheral blood and pericardial drainage after coronary artery bypass grafting (CABG) and postoperative atrial fibrillation (POAF). Methods Patients who underwent CABG in the Heart Center of Beijing Chao-Yang Hospital from March to May 2022 were enrolled. Peripheral blood and pericardial drainage were collected at 0 h after surgery (immediate time for patients to return to ICU from operating room) to detect miR-3187-5p, and perioperative confounding factors were also collected. The miR-3187-5p was measured by quantitative real-time PCR and its regulated target genes were analyzed by bioinformatics. Results A total of 15 patients were enrolled, including 9 males and 6 females with an average age of 65.6±8.2 years. The incidence rate of POAF was 40.0%. miR-3187-5p in pericardial drainage at 0 h after surgery was an independent predictor for POAF. A total of 1 642 target genes of miR-3187-5p were predicted. GO function enrichment analysis and KEGG signal pathway enrichment analysis showed that target genes of miR-3187-5p were enriched in TGF-β, MAPK, Wnt and other classical collagen metabolic signal pathways, which might activate collagen metabolism by negatively regulating SMAD6 and other inhibitors of the pathways. Conclusion This study is the first to find that miR-3187-5p in pericardial drainage at 0 h after surgery is a potential, novel, and predictive factor for POAF, which may be related to the regulation of myocardial fibrosis signal pathways like TGF-β, MAPK and Wnt pathways, promoting the early collagen metabolism imbalance after CABG, increasing the collagen deposition in the atrium, and then promoting the early structural reconstruction after CABG and leading to the occurrence of POAF. The result provides a research basis for the accurate prediction and prevention of clinical POAF.
ObjectiveTo study the clinical results of Mini Maze procedure in atrial fibrillation patients with impaired left ventricular systolic function.MethodsFrom June 2010 to December 2017, 86 atrial fibrillation patients with impaired left ventricular systolic function received Mini Maze procedure including 54 males and 32 females, with an average age of 60.7±5.9 years. Among them, 12 were with paroxysmal, 27 were with persistent and 47 were with long-standing persistent atrial fibrillation. The mean atrial fibrillation duration was 6.5±4.8 years. CHA2DS2-VASc score was 2.2±1.1. The mean diameter of left atrium was 46.9±3.8 mm. The mean diameter of left ventricle was 51.7±4.6 mm. The preoperative ejection fraction was 42.2%±4.7%. All patients received Mini Maze procedure after general anesthesia. The ablation included 3 annular ablations and 3 linear ablations. The left atrial appendage was excised by Endo-Gia. Ablation of Marshall ligament and epicardial autonomic ganglions were made by an ablation pen.ResultsEighty-six patients successfully completed the procedure without transition to thoracotomy. There was no death during the perioperative period. Seventy-seven patients (89.5%) maintained sinus rhythm at discharge. Eighty patients were followed up for 27.2±12.1 months and 72 patients maintained sinus rhythm. The overall postoperative left ventricular ejection fraction was 47.1%±6.2%. The ejection fraction of the postoperative sinus rhythm group was 48.2%±5.8%, and the ejection fraction of the non-sinus group was 41.6%±5.8% (P<0.05). Multivariate regression analysis showed a left atrial diameter (HR=1.485, 95%CI 1.157-1.906, P<0.05) and an increase in ejection fraction over 10% (HR=18.800, 95%CI 1.674-189.289, P<0.05) were closely related to postoperative recurrence. Kaplan-Meier curve analysis showed that the recurrence rate of atrial fibrillation was significantly lower in patients with an increase in postoperative ejection fraction over 10% (P<0.05).ConclusionMini Maze procedure is safe and effective in the treatment of atrial fibrillation patients with left ventricular systolic dysfunction, which helps to improve left ventricular function to prevent the vicious circle of atrial fibrillation and heart failure.
Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. The existing treatment of postoperative AF mainly focuses on preoperative prevention, intraoperative protection and postoperative treatment for factors prone to AF before, during and after surgery, but the postoperative treatment in various areas and hospitals is different. This article combines the latest literature published in Europace about the practice guidance of cardioversion of AF and atrial flutter, and summarizes the treatment of electrical cardioversion, in order to provide clinical guidance for electrical cardioversion of AF after cardiac surgery.
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. The metabolic changes of atrial myocytes, especially lipid metabolism, have a significant impact on the electrical signals and structural remodeling of atrial tissue, and play an important role in the occurrence and development of AF. The reduction of fatty acid oxidation ratio and increased aerobic glycolysis ratio are characteristic changes of tissue metabolic remodeling in AF. In this review, we will introduce the latest research status of lipid metabolism in AF from aspects of AF metabolism, clinical treatment and diagnosis and prognosis.
Objective To report the preliminary results of intraoperative saline-irrigated radiofrequency modified maze procedure for chronic atrial fibrillation (AF) in mitral valve diseases. Methods From May 2003 to April 2004 forty-one patients underwent intraoperative saline-irrigated modified maze procedure. The patients included 13 male and 28 female. Their age ranged from 27-65 years (46±10 years). The duration of AF varied from 5 months to 15 years (4.5±3.6 years).The left atrial diameter varied from 37-93 mm (54±11mm). There were mitral stenosis 20, mitral regurgitation 1 and mitral stenosis with regurgitation 20 cases. Cardiopulmonary bypass (CPB) was established as usual. Ablation lines were made with Cardioblate (Medtronic, 25-30 W, 180-240ml/h). Having finished right-sided maze procedure, the aorta was cross-clamped and cold crystalloid or blood cardioplegia were used for myocardial protection. Left atrial incision was performed through the interatrial groove. The ablation lines were created to encircle the orifices of the left and right pulmonary veins respectively. The ablation lines were also performed from the left encircling line to the posterior mitral valvular annulus and to the orifice of left atrial appendage respectively. A ablation line was used to connect left and right pulmonary veins circumferential line. Concomitant procedures were performed (there were double valve replacement 10 cases, mitral valve replacement 31 cases, tricuspid annuloplasty 6 cases, removing the left atrial thrombi 6 cases). Results CPB time varied from 71-160 min (105±24 min) and cross-clamping time varied from 32-106 min (62±20 min). The ablation time varied from 4-22 min (11±4 min). One patient died during hospitalization and the death was caused by acute mechanic valve obstruction. During follow-up at discharge and 3 months 35% patients (14/40) were free of AF and the others were not. But at 6 months 67% patients (10/15) were free of AF. Conclusion The intraoperative saline-irrigated radiofrequency modified maze procedure is comparatively simpler and its efficacy is satisfactory.
This study was aimed to evaluate the relationship between the changes of plasma intermedin (IMD) and atrial fibrosis in hypertensive patients with atrial fibrillation. During the period from 2010 to 2011, appropriate 150 subjects of out-patients (female 50%,male 50%) were selected in West China Hospital, Sichuan University, and were divided into three groups: the hypertension-only group, the hypertension combined with paroxysmal atrial fibrillation group and the hypertension combined with persistent atrial fibrillation group. Firstly, we collected the Physical examination results and medical history records of the patients. We then performed ultrasound cardiogram and blood biochemical tests on the patients. We also detected the plasma IMD and transforming growth factor β1(TGF-β1) using ELISA. The results showed that compared with the hypertensive group, the plasma level of IMD, TGF-β1 and left atrium director (LAD) in the hypertensive combined with atrial fibrillation group were higher significantly. Compared with the paroxymal atrial fibrillation group, the levels of IMD, TGF-β1 and LAD were higher significantly in persistent atrial fibrillation group. Analysis of correlation and partial correlation showed that IMD was positively correlated with TGF-β1 (r=0.51, P<0.001), IMD was positively correlated with LAD(r=0.59, P<0.001), and TGF-β1 was positively correlated with LAD (r=0.57, P<0.001). The results suggest that IMD might suppress the pathophysiological process of atrial fibrillation.
Atrial fibrillation (AF) and breast cancer are common diseases with high incidence, which can be promoted and maintained by a wide range of regulatory factors (changes of hormone secretion, chronic inflammation, dysfunctions in autonomic nervous system, coagulation system and endothelia). There may be a consistent pathophysiological link between the increased incidence of breast cancer and AF, which is currently seldomly reported. The development process of these two diseases are complex, and the occurrence of breast cancer may increase the incidence of AF. In this paper, we reviewed the relationship between breast cancer and AF based on the latest reports.
Atrial fibrillation is one of the most common arrhythmia. Cardiac mapping technology, an important method to study the electrophysiological mechanism of atrial fibrillation, can determine the abnormal origin and record the distribution and transmission way of these atrial electrical signals. This technology offers a new way for research the electrophysiological mechanism of atrial fibrillation. The purpose of this study is to review the research progress of cardiac mapping in the electrophysiological mechanism of atrial fibrillation and clinical application.