BACKGROUND & AIMS: :The incidence of thromboembolism is higher in mitral regurgitation. Mean platelet volume (MPV), which is calculated automatically in the complete blood count tests, indicates platelet production, function and activation. Elevated MPV levels in cardiovascular diseases and some heart valve diseases have been shown before. We aimed to investigate the relationship between MPV and mitral regurgitation, and to evaluate the MPV levels according to the presence of atrial fibrillation or left atrial appendage thrombus in patients with mitral regurgitation for the first time. The study included 57 patients who had undergone transthoracic and transesophageal echocardiography for the classic symptoms and diagnosed with primary (organic) mitral regurgitation. The control group was composed of 46 age, sex and BMI-matched healthy individuals who had undergone transthoracic echocardiography and obtained normal findings. Echocardiographic evaluation was performed according to the recommendations of the American Echocardiography Society. Mean MPV values in patients with mitral regurgitation were significantly higher than the control group (P < 0.001). MPV levels and the thrombus risk were correlated with the severity of the disease. When the patients with mitral regurgitation were classified according to the presence of atrial fibrillation and left atrial appendage thrombus, patients with atrial fibrillation had higher MPV levels compared to patients with normal sinus rhythm (P < 0.001). In addition, highest MPV levels were found in patients with both atrial fibrillation and thrombosis (P < 0.001). In conclusion, measurement of MPV may be considered as a quick and reliable guide in the assessment of mitral regurgitation and thrombus, without any cost or any advanced expensive technology.

背景与目标： : 二尖瓣反流中血栓栓塞的发生率较高。在整个血液计数测试中自动计算的平均血小板体积 (MPV) 表示血小板的产生，功能和激活。以前已显示心血管疾病和某些心脏瓣膜疾病中的MPV水平升高。本研究旨在探讨MPV与二尖瓣反流的关系，并根据首次发生二尖瓣反流的患者是否存在心房颤动或左心耳血栓来评估MPV水平。该研究包括57例经胸和经食管超声心动图检查经典症状并被诊断为原发性 (器质性) 二尖瓣反流的患者。对照组由46名年龄，性别和BMI相匹配的健康人组成，他们接受了经胸超声心动图检查并获得了正常的发现。根据美国超声心动图学会的建议进行超声心动图评估。二尖瓣反流患者的平均MPV值明显高于对照组 (p  <  0.001)。MPV水平和血栓风险与疾病的严重程度相关。根据是否存在心房颤动和左心耳血栓对二尖瓣关闭不全患者进行分类时，心房颤动患者的MPV水平高于窦性心律正常患者 (p  <  0.001)。此外，房颤和血栓形成患者的MPV水平最高 (p  <  0.001)。总之，MPV的测量可以被认为是评估二尖瓣反流和血栓的快速可靠的指南，而无需任何成本或任何先进的昂贵技术。

BACKGROUND & AIMS: :Forty patients were catheterized for closure of atrial septal defects with the Rashkind patent ductus arteriosus umbrella device, a modified Rashkind umbrella device, and the newly designed Lock Clamshell Occluder. Patients weighed 8 kg or more (a requirement for transvenous access with the 11F delivery sheath) and had defects suitable for closure based on two-dimensional echocardiography. The new device was at least 1.6 times the diameter of the atrial septal defect as determined by balloon sizing at catheterization. Patients were followed up by telephone, clinical examination, and echocardiography at 6 months. We attempted closure in 34 patients, with atrial septal defects ranging in diameter from 3 to 22 mm; device sizes ranged from 17 to 33 mm. Initial device position immediately after release was correct in all patients. A cerebral embolus occurred in one elderly patient before device placement--the patient died 1 week later. Two instances of early device embolization occurred, and devices were retrieved by catheter without complication. Follow-up of 31 patients discharged with devices in place, for a total of 31 patient-years, has yielded no umbrella-related complications. Adequate imaging studies in 19 patients 6.5 months after device placement revealed no atrial shunt in 12; residual flow through separate, previously unrecognized atrial septal defects occurred in two; and small residual leaks (less than 3 mm) around devices were present in five patients. This initial success indicates that double-umbrella closure of atrial septal defects will aid in the treatment of intracardiac defects.

背景与目标： : 用Rashkind动脉导管未闭伞装置，改良的Rashkind伞装置和新设计的锁翻盖封堵器对40例患者进行了房间隔缺损的导管插入术。患者体重8千克或更多 (需要通过11F递送鞘的静脉通路)，并且具有适合基于二维超声心动图闭合的缺陷。根据导管插入时的球囊大小确定，新装置的直径至少是房间隔缺损直径的1.6倍。6个月时，对患者进行电话、临床检查和超声心动图随访。我们尝试对34例房间隔缺损的患者进行封堵，其直径范围为3至22毫米; 设备尺寸范围为17至33毫米。在所有患者中，释放后立即的初始设备位置正确。一名老年患者在设备放置前发生了脑栓塞-该患者在1周后死亡。发生了两次早期器械栓塞，并且通过导管取回了器械，没有并发症。对31例使用设备出院的患者进行了随访，共31个患者年，没有产生与伞相关的并发症。设备放置后6.5个月对19名患者进行了充分的影像学研究，发现12名患者没有心房分流; 两名患者发生了通过单独的，以前未识别的房间隔缺损的残留血流; 五名患者存在设备周围的小残留泄漏 (小于3毫米)。最初的成功表明，房间隔缺损的双伞闭合将有助于治疗心内缺损。

BACKGROUND & AIMS: :1. The beta-adrenoceptor stimulant properties of 5-(1-hydroxy-2-isopropylaminobutyl)-8-hydroxy-carbostyril hydrochloride hemihydrate (OPC-2009) were compared with those of isoprenaline and salbutamol on guinea-pig isolated tissues. 2. In producing tracheal relaxation, OPC-2009 was approximately 7 times more potent and salbutamol 5 times less potent than isoprenaline. Both compounds were less potent than isoprenaline in increasing either the rate of beating of isolated right atria or the contractile force of left atria, OPC-2009 being 4 and 127 times and salbutamol being 100 and 700 times less potent on the respective preparations. 3. Selectivity calculated from EC50 ratio indicates that OPC-2009 was approximately 26 times and salbutamol approximately 21 times more selective than isoprenaline for tracheal smooth muscle as compared to right atrial muscle, whereas OPC-2009 was approximately 850 times and salbutamol 140 times more selective than isoprenaline for tracheal smooth muscle as compared to left atria. 4. The responses to OPC-2009 on trachea and right atria were not altered by treatment of animals with reserpine 24 h previously. Propranolol was a competitive antagonist of OPC-2009 on these tissues. 5. OPC-2009 at high concentrations competitively antagonized the positive chronotropic and inotropic responses to isoprenaline, indicating that OPC-2009 like salbutamol, may be classified as a partial agonist. 6. The results indicate that the action of OPC-2009 is more selective for tracheal smooth muscle than cardiac muscle and are interpreted in the light of subdivisions of beta-adrenoceptors.

背景与目标： : 1。比较了5-(1-羟基-2-异丙基氨基丁基)-8-羟基-卡百利酯盐酸盐半水合物 (OPC-2009) 与异丙肾上腺素和沙丁胺醇在豚鼠分离组织上的 β-肾上腺素受体刺激性能。2.在产生气管松弛时，OPC-2009的效力约为异丙肾上腺素的7倍，沙丁胺醇的效力约为异丙肾上腺素的5倍。两种化合物在增加分离的右心房的跳动速率或左心房的收缩力方面均不如异丙肾上腺素，OPC-2009在相应制剂上的效力为4倍和127倍，沙丁胺醇的效力为100和700倍。3.根据EC50比率计算的选择性表明，与右心房肌相比，气管平滑肌的OPC-2009约为26倍，沙丁胺醇约为21倍，而与左心房相比，气管平滑肌的OPC-2009约为850倍，沙丁胺醇约为140倍。4.对气管和右心房OPC-2009的反应没有通过24 h前用利血平治疗动物而改变。普萘洛尔是这些组织上OPC-2009的竞争性拮抗剂。5.高浓度OPC-2009竞争性拮抗异丙肾上腺素的正变时性和正性肌力反应，表明沙丁胺醇等OPC-2009可被归类为部分激动剂。6.结果表明，OPC-2009的作用对气管平滑肌比心肌更具选择性，并根据 β-肾上腺素受体的细分进行解释。

BACKGROUND & AIMS: INTRODUCTION:The objective of the present study was to evaluate, from an economic perspective, dabigatran etexilate in comparison to existing pharmaceutical therapeutic options available for the protection of moderate-to-high risk patients with non-valvular atrial fibrillation from cardioembolic risk. METHODS:An existing Markov model was adapted to the Greek setting to reflect the natural course of the disease and the management of patients with different therapies. The model predicts health and economic outcomes and the implications for the social security system during the course of a patient's lifetime. The data for the population of the model were derived from the international literature and local economic databases. RESULTS:The incremental cost per quality-adjusted life year (QALY) of dabigatran 150 mg twice daily relative to the other therapies varied from €5547 to €11,762 and that of dabigatran 110 mg twice daily from €7398 to €16,437. The incremental cost per QALY of dabigatran 150 mg relative to aspirin, the least costly option, was €11,762 and relative to warfarin and acenocoumarol, the local standards of care, it was €11,400 and €11,224 respectively, well below the local thresholds of acceptance. CONCLUSION:Dabigatran etexilate may represent a cost-effective option for the prevention of thromboembolic events in AF patients at moderate-to-high risk of stroke or systemic embolism.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Previous studies in implantable cardioverter-defibrillator (ICD) patients demonstrated the efficacy and safety of antitachycardia pacing (ATP) for rapid ventricular tachycardias (VT). To prevent shock delay in case of ATP failure, a new feature (ATP during charging) was developed to deliver ATP for rapid VT while charging for shock. OBJECTIVE:The purpose of this study was to determine the efficacy and safety of this new feature. METHODS:In a prospective, nonrandomized trial, patients with standard ICD indication received an EnTrust ICD. VT and ventricular fibrillation (VF) episodes were reviewed for appropriate detection, ATP success, rhythm acceleration, and related symptoms. RESULTS:In 421 implanted patients, 116 VF episodes occurred in 37 patients. Eighty-four (72%) episodes received ATP during or before charging. ATP prevented a shock in 58 (69%) of 84 episodes in 15 patients. ATP stopped significantly more monomorphic (77%) than polymorphic VTs (44%, P = .05). Five (6%) episodes accelerated after ATP but were terminated by the backup shock(s). No symptoms were related to ATP during charging. In four patients, 38 charges were saved by delivering ATP before charging. Of 98 induced VF episodes, 28% were successfully terminated by ATP versus 69% for spontaneous episodes (P <.01). CONCLUSION:Most VTs detected in the VF zone can be painlessly terminated by ATP delivered during charging, with a low risk of acceleration or symptoms. ATP before charging allows delivery of two ATP attempts before shock in the same time that would otherwise be required to deliver only one ATP plus a shock. It also offers potential battery energy savings.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:There are several risk factors for the initiation of paroxysmal atrial fibrillation (PAF) and the underlying mechanisms are multifactorial. Our study aims to explore the echocardiographic parameters that can identify in patients with PAF compared to normal subjects. METHODS:Eighty consecutive patients who were with PAF detected by 24-h Holter monitoring (HM) were assigned in our study. The control group (n = 80) consisted individuals with no PAF on HM. Indication for HM was palpitations at rest. All patients underwent routine echocardiographic evaluation. Patients with aortic and mitral stenosis, hyperthyroidism, and hypothyroidism were excluded from the study. Comprehensive clinical data were collected. RESULTS:Mean age of the patients with PAF was 63 +/- 11 years and of those 42% were male subjects. There was no difference in the prevalence of hypertension in both groups. Mean left ventricular ejection fraction (LVEF) was 57 +/- 15% in PAF group and 64 +/- 2% in control subjects (p < 0.001). Mean values of left atrial (LA) diameter for PAF and control groups were 3.7 +/- 0.6 cm vs. 3.1 +/- 0.4 cm (p < 0.001), respectively. Patients with PAF had more severe valve insufficiency, higher values of mean pulmonary artery systolic pressures (PAP) (29 +/- 10 mmHg vs. 25 +/- 2 mmHg, respectively; p = 0.001) and deteriorated MV inflow velocities (E:A ratio 0.9 +/- 0.4 vs. 1.1 +/- 0.3, respectively; p = 0.008) when compared to control group. In multivariate logistic regression analysis, LA diameter predicted the development of PAF after adjusted for age and gender. CONCLUSION:Our results indicate that LA diameter predicts the development of PAF.

背景与目标：

BACKGROUND & AIMS: :Esophageal stimulation was performed in 40 patients who had spontaneous paroxysmal supraventricular tachycardias (SVTs). The purpose of this study was to look for the most sensitive stimulation protocol and criteria that would help to define the mechanism of reentry. In 20 patients (group I) atrial pacing up to second-degree atrioventricular block was performed under control conditions and isoproterenol, and SVT was induced in 14 patients (70%), 11 in the control state and 3 while receiving isoproterenol. In 20 patients (group II) atrial pacing and programmed atrial stimulation using 1 and 2 extrastimuli delivered at 2 cycle lengths (600 and 500 ms) was performed in the control state and while receiving isoproterenol. SVT was induced in all patients, in 13 patients in the control state and in 7 while receiving isoproterenol. Programmed stimulation always induced SVT and was the only method capable of tachycardia induction in 14 patients. The mechanism of SVT could be established in 91%. The measurement of the ventriculoatrial interval was the most useful sign to define the site of reentry. Occurrence of a bundle branch block helped to delineate the mechanism in 4 patients. When a positive P wave in V1 preceded the esophageal atrial electrocardiogram, it suggested that there was reentry through a left-sided accessory atrioventricular connection in 6 patients. SVT could always be induced by programmed atrial stimulation in the control state and under isoproterenol. The location of the P wave in V1 compared to the ventriculogram and the esophageal electrocardiogram helped to define the mechanism of tachycardia.

背景与目标： : 对40例自发性阵发性室上性心动过速 (SVTs) 的患者进行了食管刺激。这项研究的目的是寻找最敏感的刺激方案和标准，以帮助定义折返的机制。在20例患者 (I组) 中，在控制条件和异丙肾上腺素下进行心房起搏至二度房室传导阻滞，并在14例患者 (70% 例) 中诱导SVT，在控制状态下11例，在接受异丙肾上腺素的同时诱导3例。在20例患者 (II组) 中，在对照状态下并接受异丙肾上腺素时，使用以2个周期长度 (600和500 ms) 递送的1个和2个外刺激进行心房起搏和程序化心房刺激。在接受异丙肾上腺素的所有患者中，在控制状态下的13例患者和在接受异丙肾上腺素的7例患者中诱导了SVT。程序性刺激总是引起SVT，并且是14例患者中唯一能够诱导心动过速的方法。SVT的机制可以在91% 中建立。测量心室间隔是定义折返部位的最有用标志。束支阻滞的发生有助于描述4例患者的机制。当在食管心房心电图之前出现V1阳性P波时，提示6例患者通过左侧副房室连接折返。在控制状态和异丙肾上腺素下，总是可以通过程序性心房刺激诱导SVT。与心室图和食管心电图相比，V1中P波的位置有助于确定心动过速的机制。

BACKGROUND & AIMS: :Left atrial-esophageal fistula is a highly lethal complication of ablative therapy for atrial fibrillation. Because of its unusual rate of occurrence, there has not been a uniform approach to either the diagnosis or corrective therapy. We offer 1 such surgical option based on presumptive and early diagnosis-left atrial repair with cardiopulmonary bypass followed by repair of the esophagus with an omental wrap and supported with decompressive gastrostomy and feeding jejunostomy.

背景与目标： 左心房-食管瘘是房颤消融治疗的高致死性并发症。由于其异常的发生率，因此没有一种统一的方法来进行诊断或纠正治疗。我们提供1种基于推定和早期诊断的手术选择-体外循环左心房修复，然后用网膜包裹修复食道，并辅以减压胃造口术和喂养空肠造口术。

BACKGROUND & AIMS: :Warfarin decreases risk of stroke for patients with atrial fibrillation (AF) dependent on percent time in the therapeutic range (TTR) with an international normalized ratio (INR) of 2 to 3. We hypothesized that gender differences in ischemic stroke risk are related to TTR. From the AFFIRM database of 4,060 patients with AF, we determined the incidence of ischemic stroke by gender. We evaluated the INR at time of ischemic stroke and calculated TTR. We determined the relation between gender and ischemic stroke by TTR. Women had CHADS(2) Scores (3.7 ± 1.3 vs 2.5 ± 1.3, p <0.0001) and more ischemic strokes than men (5% vs 3%, odds ratio 1.6, 95% confidence interval 1.19 to 2.26, p = 0.002). Mean INR near time of ischemic stroke was 2 for women and men; median values were subtherapeutic (1.7 and 1.8, respectively). Women spent more time outside the therapeutic range (40 ± 0.7% vs 37 ± 0.5%, p = 0.0001), with more time below the therapeutic range (29 ± 0.7% vs 26 ± 0.5%, p = 0.0002). A higher TTR protected against ischemic stroke for women but not for men. Women who had a comparably high TTR (≥66%) still had more ischemic strokes (p = 0.009). A fitted Cox proportional hazard regression model showed that gender, TTR <46% versus >80%, age, and previous stroke were significantly related to stroke incidence. In conclusion, women in AFFIRM were at greater risk of ischemic stroke than men, in part related to differences in TTR. Women with AF may benefit from more aggressive or novel anticoagulation to decrease their risk of stroke.

背景与目标： : 华法林可降低房颤 (AF) 患者的中风风险，这取决于治疗范围 (TTR) 内的时间百分比，国际标准化比率 (INR) 为2至3。我们假设缺血性卒中风险的性别差异与TTR有关。从4,060例AF患者的AFFIRM数据库中，我们确定了按性别划分的缺血性中风的发生率。我们评估缺血性卒中时的INR并计算TTR。我们通过TTR确定了性别与缺血性中风之间的关系。女性的CHADS(2) 得分 (3.7 ± 1.3 vs 2.5 ± 1.3，p <0.0001) 和较男性的缺血性卒中 (5% vs 3%，优势比1.6，95% 置信区间1.19至2.26，p = 0.002)。女性和男性的平均INR接近缺血性卒中时间为2; 中值为亚治疗 (分别为1.7和1.8)。女性在治疗范围外花费的时间更多 (40 ± 0.7% vs 37 ± 0.5%，p = 0.0001)，而在治疗范围以下的时间更多 (29 ± 0.7% vs 26 ± 0.5%，p = 0.0002)。较高的TTR可防止女性缺血性中风，但男性则不能。TTR相对较高 (≥ 66%) 的女性仍有更多的缺血性中风 (p = 0.009)。拟合的Cox比例风险回归模型显示，性别、TTR <46% vs> 80% 、年龄和既往卒中与卒中发生率显著相关。总之，AFFIRM中的女性比男性患缺血性中风的风险更高，部分原因与TTR的差异有关。房颤妇女可能受益于更积极的或新的抗凝治疗，以降低中风风险。

BACKGROUND & AIMS: AIMS:Reduced forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) have been associated with increased incidence of cardiovascular diseases. However, whether reduced lung function is also a risk factor for incidence of atrial fibrillation (AF) is still unclear. We aimed to determine whether lung function predicted AF in the Malmö Preventive Project, a large population-based cohort with a long follow-up. METHODS AND RESULTS:The study population consisted of 7674 women and 21 070 men, mean age 44.6 years. The cohort was followed on average for 24.8 years, during which time 2669 patients were hospitalized due to AF. The incidence of AF in relationship to quartiles of FEV1 and FVC and per litre decrease at baseline was determined using a Cox proportional hazards model adjusted for age, height, weight, current smoking status, systolic blood pressure, erythrocyte sedimentation rate, and fasting blood glucose. Forced expiratory volume in one second was inversely related to incidence of AF (per litre reduction in FEV1) hazard ratio (HR): 1.39 [95% confidence interval (CI): 1.16-1.68; P = 0.001] for women, and HR: 1.20 (95% CI: 1.13-1.29; P < 0.0001) for men. Forced vital capacity was also inversely related to incidence of AF (per litre reduction in FVC) HR: 1.20 (95% CI: 1.03-1.41; P = 0.020) for women, and HR: 1.08 (95% CI: 1.02-1.14; P = 0.01) for men. This relationship was consistent in non-smokers as well as smokers, and among individuals younger than the median age of 45.8 years or normotensive subjects. CONCLUSION:Impaired lung function is an independent predictor of AF. This may explain some risk of AF that is currently unaccounted for.

背景与目标：

BACKGROUND & AIMS: INTRODUCTION:Totally thoracoscopic ablation for symptomatic atrial fibrillation (AF) refractory to drug or catheter based therapy is indicated as a Class 2A recommendation according to latest guidelines. Evidence for long-term rhythm control and stroke reduction is limited. The aim of this study was to report on long-term outcome after totally thoracoscopic ablation. METHODS AND RESULTS:In total 82 consecutive patients were included that underwent totally thoracoscopic ablation including left appendage closure (2012-2013). The primary outcome was freedom from atrial arrhythmia recurrence. Secondary outcomes were survival, freedom from cerebrovascular events, freedom from reablation and definite pacemaker implantation. The mean age was 59.9 ± 8.6 years and 71% were male. The mean CHA2 DS2 -VASc score was 1.2 ± 1.0. The overall freedom from atrial arrhythmia was 60% after a mean follow up of 4.0 ± 0.6 years. Freedom from cerebrovascular events was 98.8% after mean follow-up of 4.4 ± 0.3 years and overall survival was 98.8%, with one noncardiac related death. The observed rate of ischemic stroke, hemorrhagic stroke or transient ischemic attack was 0.3 per 100 patient-years. CONCLUSIONS:Totally thoracoscopic ablation is an effective sustainable rhythm control therapy for AF with a reasonable recurrence rate and low stroke rate when performed in dedicated AF centers.

背景与目标：

BACKGROUND & AIMS: :Background and Objectives: Prior studies have identified a number of predictors for Atrial fibrillation (AF) ablation success, including comorbidities, the type of AF, and left atrial (LA) size. Ectopic foci in the initiation of paroxysmal AF are frequently found in pulmonary veins. Our aim was to assess how pulmonary vein anatomy influences the recurrence of atrial fibrillation after radiofrequency catheter ablation. Materials and Methods: Eighty patients diagnosed with paroxysmal or persistent AF underwent radiofrequency catheter ablation (RFCA) between November 2016 and December 2017. All of these patients underwent computed tomography before AF ablation. PV anatomy was classified according to the presence of common PVs or accessory PVs. Several clinical and imagistic parameters were recorded. After hospital discharge, all patients were scheduled for check-up in an outpatient clinic at 3, 6, 9, and 12 months after RFCA to detect AF recurrence. Results: A total of 80 consecutive patients, aged 53.8 ± 9.6 years, 54 (67.5%) men and 26 (32.5%) women were enrolled. The majority of patients had paroxysmal AF 53 (66.3%). Regular PV anatomy (2 left PVs, 2 right PVs) was identified in 59 patients (73.7%), a left common trunk (LCT) was detected in 15 patients (18.7%), an accessory right middle pulmonary vein (RMPV) was found in 5 patients (6.25%) and one patient presented both an LCT and an RMPV. The median follow-up duration was 14 (12; 15) months. Sinus rhythm was maintained in 50 (62.5%) patients. Age, gender, antiarrhythmic drugs, and the presence of cardiac comorbidities were not predictive of AF recurrence. The diagnosis of persistent AF before RFCA was more closely associated with an increase in recurrent AF after RFCA than after paroxysmal AF (p = 0.01). Longer procedure times (>265 minutes) were associated with AF recurrence (p = 0.04). Patients with an LA volume index of over 48.5 (mL/m2) were more likely to present AF recurrence (p = 0.006). Multivariate analysis of recurrence risk showed that only the larger LA volume index and variant PV anatomy were independently associated with AF recurrence. Conclusion: The study demonstrated that an increased volume of the left atrium was the most important predictive factor for the risk of AF recurrence after catheter ablation. Variant anatomy of PV was the only other independent predictive factor associated with a higher rate of AF recurrence.

背景与目标： 背景和目的: 先前的研究已经确定了心房颤动 (AF) 消融成功的许多预测因素，包括合并症，AF的类型和左心房 (LA) 大小。在肺静脉中经常发现阵发性房颤的异位灶。我们的目的是评估肺静脉解剖结构如何影响射频导管消融后房颤的复发。材料和方法: 80例确诊为阵发性或持续性房颤的患者在2016年11月和2017年12月之间进行了射频导管消融 (RFCA)。所有这些患者在AF消融前均接受了计算机断层扫描。根据常见PVs或辅助PVs的存在对PV解剖进行分类。记录了几个临床和影像学参数。出院后，所有患者都计划在RFCA后3、6、9和12个月在门诊进行检查，以检测AF复发。结果: 共纳入80例连续患者，年龄53.8 ± 9.6岁，54 (67.5%) 名男性和26 (32.5%) 名女性。大多数患者有阵发性AF 53 (66.3%)。在59例患者 (73.7%) 中发现了常规的PV解剖 (2个左PVs，2个右PVs)，在15例患者 (18.7%) 中发现了左总干 (LCT)，在5例患者 (6.25% 例) 中发现了右中肺静脉 (RMPV)，一名患者同时出现了LCT和RMPV。中位随访时间为14 (12; 15) 个月。50 (62.5%) 例患者维持窦性心律。年龄，性别，抗心律失常药物和心脏合并症的存在不能预测AF复发。与阵发性房颤相比，RFCA前持续性房颤的诊断与RFCA后复发性房颤的增加更密切相关 (p = 0.01)。较长的手术时间 (>265分钟) 与房颤复发相关 (p = 0.04)。LA体积指数超过48.5 (mL/m2) 的患者更有可能出现AF复发 (p = 0.006)。复发风险的多因素分析表明，只有较大的LA体积指数和变异的PV解剖结构与AF复发独立相关。结论: 研究表明，左心房体积增加是导管消融后房颤复发风险的最重要预测因素。PV的变异解剖结构是与更高的AF复发率相关的唯一其他独立预测因素。

BACKGROUND & AIMS: :To compare outcomes of mitral valve surgery through conventional left atriotomy and transeptal approach (TS). Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Primary outcomes were operative mortality and permanent pacemaker (PPM) implantation; secondary outcomes were new onset of atrial fibrillation (AF), stroke and operative times. Sixteen articles met the inclusion criteria with 4537 patients. Cardiopulmonary bypass was longer with TS (weighted mean differences - 16.44 minutes [-29.53, -3.36], P = 0.01). Rates of PPM implantation (risk ratio 0.65 [0.47, 0.89], P = 0.007) and new onset AF (risk ratio 0.87 [0.78, 0.97], P = 0.02) were higher with TS. Subgroup analysis of isolated mitral valve surgery cohort showed no difference in operative times, mortality, new onset of AF, stroke, and PPM implantation. There is equal outcomes between both approaches during isolated mitral valve surgery; however, TS was associated with longer operative times and higher postoperative AF and PPM rates when pooling combined procedures. A large randomized controlled trial is required to confirm those findings.

背景与目标： : 比较通过常规左心房切开术和经间隔入路 (TS) 进行二尖瓣手术的效果。遵循系统评价和荟萃分析指南的首选报告项目。主要结果是手术死亡率和永久性起搏器 (PPM) 植入; 次要结果是新发房颤 (AF)，中风和手术时间。16篇文章符合纳入标准，4537例患者。TS的体外循环时间更长 (加权平均差异-16.44分钟 [-29.53，-3.36]，P = 0.01)。PPM植入率 (风险比0.65 [0.47，0.89]，P = 0.007) 和新发AF (风险比0.87 [0.78，0.97]，P = 0.02) 在TS中较高。对孤立的二尖瓣手术队列进行的亚组分析显示，手术时间，死亡率，新发AF，中风和PPM植入没有差异。在单独的二尖瓣手术中，两种方法之间的结果相同; 但是，合并联合手术时，TS与更长的手术时间以及更高的术后AF和PPM率相关。需要一项大型随机对照试验来证实这些发现。

BACKGROUND & AIMS: :Implantable cardioverter defibrillators (ICDs) are indicated in patients with Brugada syndrome with resuscitated ventricular arrhythmias. When these patients have atrial septal defects, they also need closure to prevent paradoxic embolism of thrombus from the defibrillator leads. A 15-year-old boy with Brugada syndrome had transvenous ICD placement along with device closure of a large atrial septal defect. When the defibrillation threshold was checked during device testing, a shock was delivered to terminate the induced ventricular fibrillation. The sudden jerk during this shock resulted in device embolization into the left atrium. The device was successfully retrieved and the defect closed with a larger device. This report discusses this extremely rare association of Brugada syndrome with atrial septal defect, unreported complications after device closure, and successful management of the problem.

背景与目标： : 植入心律转复除颤器 (icd) 适用于复苏的室性心律失常Brugada综合征患者。当这些患者患有房间隔缺损时，他们还需要闭合以防止除颤器导线引起的血栓的矛盾栓塞。一名患有Brugada综合征的15岁男孩经静脉ICD放置，并关闭了大型房间隔缺损的装置。在设备测试期间检查除颤阈值时，休克以终止诱发的心室纤颤。休克过程中的突然跳动导致装置栓塞到左心房。成功检索了该设备，并用较大的设备关闭了缺陷。本报告讨论了Brugada综合征与房间隔缺损，设备关闭后未报告的并发症以及成功解决该问题的这种极为罕见的关联。

BACKGROUND & AIMS: AIMS:Cerebral and microvascular perfusion is reduced in atrial fibrillation (AF). Maintenance of brain perfusion is important in acute disease and long-term course. Assessment of brain perfusion and oxygenation is difficult in clinical practice. Our study aimed to determine changes in cerebral tissue oxygen saturation (SctO2) with bedside near-infrared spectroscopy (NIRS). METHODS AND RESULTS:Twenty patients (mean age 67.7 ± 10.2 years, 50% men) in whom electrical cardioversion (CV) was successful were prospectively studied. Ten patients (mean age 64.2 ± 7.7 years, 80% men) in whom CV was not successful served as control group. Bilateral SctO2, mean arterial pressure (MAP), arterial oxygen saturation (SaO2), and heart rate were recorded and changes of all parameters before and after CV were compared between the groups. Our results show an increase in SctO2 after successful CV that was significantly higher compared with patients who remained in AF (right SctO2 3.25 ± 2.5 vs. -0.13 ± 0.52%, P = 0.001; left SctO2 4.27 ± 3.56 vs. -0.38 ± 2.4%, P < 0.001). Neither arterial blood pressure nor SaO2 changes differed significantly between the two groups. No correlation could be detected between the significant increase of SctO2 after successful CV and arterial blood pressure, SaO2, or heart rate. CONCLUSION:Cerebral tissue oxygen saturation increases significantly after restoration of sinus rhythm. Near-infrared spectroscopy monitoring can identify changes of SctO2 after successful CV of AF independent from standard monitoring parameters (MAP, SaO2). Near-infrared spectroscopy can be used to detect cerebral oxygen saturation deficits in AF patients or patients at high risk for AF. Clinical applications may include monitoring during ablation procedures and in critical care.

背景与目标：