Atrial fibrillation, as the most common arrhythmia currently, can lead to secondary post-stroke cognitive dysfunction and chronic brain damage through various pathways, increasing the risk of cognitive dysfunction and affecting patient prognosis. The prevention and treatment drugs for cognitive dysfunction associated with atrial fibrillation mainly include anticoagulants, heart rhythm and heart rate control drugs, statins, and antihypertensive drugs. At present, there is still some controversy over the medication for cognitive dysfunction associated with atrial fibrillation, lacking guidelines and expert consensus. It is urgent and necessary to find safe, economical, and effective drugs to improve the cognitive function of atrial fibrillation patients. This article summarizes the recent advances in drug therapy for cognitive dysfunction associated with atrial fibrillation, in order to provide a reference for the treatment of cognitive dysfunction associated with atrial fibrillation in clinical practice.
Objective To analyze the current status and hotspots of surgical transmural ablation of atrial fibrillation using CiteSpace and VOSviewer. MethodsThe Web of Science Core Collection database was used as the data source. The CiteSpace 5.8.R3 and VOSviewer software were used to analyze the related studies on surgical transmural ablation of atrial fibrillation about the authors, countries/institutions, literature co-citation and keywords. Results A total of 109 articles were enrolled. Damiano RJ was the most prolific researcher, while Cox JL was the author with the highest number of citations. The United States was the leading country in this research field. The University of Washington was an important institution in the study of atrial fibrillation transmural ablation. The main hotpots were the effectiveness of surgical ablation, especially Cox-maze procedure, selection of the energy source of surgical ablation, combination of surgical and catheter ablations, and pulmonary vein isolation. ConclusionThis study visualizes the current research status of surgical ablation of atrial fibrillation. How to improve the effectiveness and transmurality of surgical ablation is a hot research topic in the surgical treatment of atrial fibrillation. The combination of electrophysiology mapping and surgical ablation may be the development direction in the surgical treatment of atrial fibrillation.
ObjectiveTo study on the relationship of serum apelin level with inflammation in patients with atrial fibrillation (AF). MethodsWe recruited 58 patients with valvular heart disease who admitted in our hospital between October 2014 and December 2014 and planned to undergo surgery, including 29 patients with persistent AF (an AF group) and 29 patients with sinus rhythm (a SR group). There were 14 males and 15 females in the AF group at an average age of 57±8 years. There were 20 males and 9 females in the SR group at an average age of 54±10 years. The left atrial diameter (LAD) and ejection fraction (EF) were detected by echocardiography. The levels of serum apelin and interleukin-6 (IL-6) were measured by enzyme linked immuno sorbent assay, and the level of high-sensitivity C-reactive protein (hs-CRP) were determined by turbidimetric inhibition immuno assay. ResultsCompare with the SR group, the serum apelin level (201.94±71.96 pg/ml vs. 286.72±129.33 pg/ml) and EF (54.52%±3.94% vs. 56.41%±2.85%) were significantly lower in the AF group, while the hs-CRP (5.58±12.90 mg/L vs. 1.89±3.55 mg/L), IL-6 (2.59±0.64 pg/ml vs. 2.26±0.55 pg/ml) and LAD (57.10±11.69 mm vs. 43.07±5.31 mm) were significantly higher in the AF group (P<0.05). Correlation analysis showed that the apelin level was negatively correlated with hs-CRP and LAD (r=-0.308, P=0.019; r=-0.313, P=0.017), and were positively correlated with EF (r=0.265, P=0.044). ConclusionSerum apelin level is significantly lower in patients with AF and levels of inflammation makers are significantly higher. Apelin may be closely related to AF and inflammation, and may take part in the occurrence and maintenance of AF through the regulation of inflammatory processes.
ObjectiveTo explore the effect of pulmonary hypertension on the clinical efficacy of Cox Maze Ⅳ procedure in treating atrial fibrillation (AF) patients with valvular heart disease.MethodsThe clinical data of 84 patients who received cardiac valve replacement and Cox Maze Ⅳ ablation in our hospital from July 2017 to January 2020 were retrospectively analyzed. According to the estimation of pulmonary artery pressure (PAP) by ultrasound, the patients were divided into two groups: a group A (PAP<45 mm Hg, 20 males, 26 females with an average age of 59.1±7.8 years) and a group B (PAP≥45 mm Hg, 15 males and 23 females with an average age of 58.5±8.5 years). The PAP was less than 70 mm Hgin all patients. A systematic follow-up review was performed for 6 months after operation. The recovery and recurrence rate of sinus rhythm after surgical ablation were compared between the two groups, and the efficacy was analyzed.Results(1) All the patients completed the operation successfully, and there was no statistical difference in the ablation time between the two groups (P>0.05); no patients died of pulmonary infection after the operation, and one patient underwent implantation of a permanent pacemaker due to conduction block. (2) At the end of the operation and 3 months after the operation, the conversion rate of AF in the group A was 91.3% (42 patients) and 82.6% (38 patients), respectively, and in the group B was 89.5% (34 patients) and 73.7% (28 patients), respectively (P>0.05). The conversion rate of AF was 82.6% (38 patients) in the group A and 63.2% (24 patients) in the group B at 6 months after operation (P=0.043). Binary logistic regression analysis showed that PAP≥45 mm Hg had a significant effect on the long-term effect of surgical Maze procedure in treating AF patients with valvular heart disease [P=0.014, OR=5.661, 95%CI (1.429, 22.432)].ConclusionPAP may be an influencing factor for the long-term effect of surgical Maze procedure in treating AF patients with valvular heart disease. Although the long-term recurrence rate of AF in the moderate pulmonary hypertension group is higher than that in the group A, the overall effect is still safe and effective; therefore it is still worth promoting in clinical application.
ObjectiveTo assess the effect of a novel modified epicardial radiofrequency (RF) ablation for preoperative atrial fibrillation (AF) combined with aortic valve disease. MethodsWe retrospectively analyzed the clinical data of 28 patients with AF and aortic valve disease underwent the novel modified epicardial RF ablation combined with aortic valve replacement (AVR) in our hospital between December 2009 and December 2014. There were 18 males and 10 females at age of 53-73 (64.9±4.8) years. The patients were performed epicardial atrial fibrillation RF ablation plus aortic valve replacement. ResultsThe modified epicardial RF ablation and AVR were performed successfully in all the patients. The maintenance of sinus rhythm was 96.4% (27/28) at discharge. There were no early death and permanent pacemaker implantation in perioperation. At a mean following-up of 29.2±17.7 months, 26 of 28 (92.9%) patients were in sinus rhythm. Following-up transthoracic echocardiography(TTE) at 6 months postoperatively showed that left atrial diameter was significantly reduced and left ventricular ejection fraction was significantly increased. ConclusionThe novel modified epicardial RF ablation procedure is safe, feasible, and effective. It may be useful in selecting the best ablation approaches for patients with AF and aortic valve disease.
Patients with atrial fibrillation complicated with kidney disease have a high risk of stroke and bleeding, and have some limitations or contraindications to oral anticoagulants. Left atrial appendage closure has been used as an alternative to oral anticoagulation in patients with atrial fibrillation, but its efficacy and safety in patients with atrial fibrillation and chronic kidney disease need to be further confirmed. This paper intends to review the research progress of left atrial appendage occlusion in patients with atrial fibrillation complicated with chronic renal insufficiency.
ObjectiveTo systematically review the efficacy and safety of different low-molecular-weight heparins (LMWHs) for prevention of thromboembolic events in patients with atrial fibrillation (AF).MethodsPubMed, The Cochrane Library, EMbase, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized clinical trials (RCTs) on efficacy and safety of different low-molecular-weight heparins (LMWHs) in preventing thrombotic diseases in patients with atrial fibrillation from inception to March 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed by using Stata 16.0 software.ResultsA total of 11 RCTs involving 7 400 patients who were treated with enoxaparin, dalteparin, or tinzaparin to prevent thromboembolic events were included. The results of network meta-analysis showed that: in patients with AF and perioperative AF patients, there were no statistical differences in the incidence of stroke, TIA, major bleeding, minor bleeding, and all-cause mortality caused by dalteparin, enoxaparin, and tinzaparin. Furthermore, the surface under the cumulative ranking area (SUCRA) showed that enoxaparin was superior for prevention of stroke and TIA than dalteparin and tinzaparin. As for major bleeding, minor bleeding, and all-cause death, dalteparin treatment was superior than enoxaparin.ConclusionsCurrent evidence showed enoxaparin to be a viable option for high ischemic risk AF patients requiring LWMH treatment, while dalteparin to be a viable option for those with bleeding high risk. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
ObjectiveTo detect the expression of PITX2 and KCNQ1 in the left atrial appendage of patients with atrial fibrillation after modified mini-maze procedure, and to detect the clinical risk factors of different types of atrial fibrillation.MethodsWe collected left atrial appendage tissue of 59 atrial fibrillation patients who received modified mini-maze procedure and left atrial appendectomy from February 2017 to August 2018. The expression levels of PITX2 and KCNQ1 of left atrial appendage tissue were quantitatively analyzed by western blotting assay between paroxysmal attial fibrillation and persistent atrial fibrillation groups. The correlation between protein expression and prognosis after surgery was also analyzed based on clinical data.ResultsBinary-logistic regression analysis showed that KCNQ1 expression level was an independent risk factor for the progression from paroxysmal atrial fibrillation to persistent atrial fibrillation. Receiver operating characteristic (ROC) curve confirmed that KCNQ1 expression level (the ratio of KCNQ1 to actin in the analysis) was 0.60, which was the best cut-off point for the progression of paroxysmal atrial fibrillation to persistent atrial fibrillation.ConclusionHigh expression of KCNQ1 in left atrial appendage is a risk factor for progression from paroxysmal atrial fibrillation to persistent atrial fibrillation.
This article provides an interpretive review of the "2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation", which was updated and published by the American College of Cardiology (ACC), the American Heart Association (AHA), the American College of Chest Physicians (ACCP), and the Heart Rhythm Society (HRS) based on the latest clinical evidence. It delves into the classification and management strategies for atrial fibrillation (AF), grounded in the most current evidence-based medical research. The guideline offers significant updates in various aspects such as the definition and staging of AF, clinical evaluation and treatment, modification of risk factors, prevention of thromboembolism, and management of specific populations. Notably, the introduction of a new staging model for AF and corresponding management strategies stands out, underscoring the importance of prevention and early intervention. This article focuses on the three pillars of integrated AF management—stroke risk assessment, modification of risk factors, and management of specific patient groups, in addition to rate and rhythm control, analyzes their substantial significance in clinical practice and guides clinicians in providing more precise treatment.
ObjectivesTo systematically evaluate the efficacy and safety of dabigatran vs. rivaroxaban for perioperative anticoagulation in the ablation of nonvalvular atrial fibrillation. MethodsPubMed, EMbase, Web of Science, The Cochrane Library, WanFang Data, CNKI and VIP databases were electronically searched to collect cohort studies on the efficacy and safety of dabigatran vs. rivaroxaban for perioperative anticoagulation in the ablation of nonvalvular atrial fibrillation from inception to July 1st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by RevMan 5.3 and Stata 12.0 software. ResultsA total of 12 cohort studies involving 4 051 patients were included. The results of meta-analysis showed that: there were no differences in the rate of thromboembolic (OR=0.92, 95%CI 0.36 to 2.35, P=0.86), ischemic stroke (OR=1.15, 95%CI 0.22 to 6.07, P=0.87), major bleeding (OR=0.84, 95%CI 0.43 to 1.66, P=0.61), minor bleeding (OR=0.90, 95%CI 0.60 to 1.34, P=0.60) and pericardial tamponade (OR=1.05, 95%CI 0.45 to 2.47, P=0.90) between dabigatran and rivaroxaban groups. ConclusionsCurrent evidence shows that the efficacy and safety of dabigatran vs. rivaroxaban for perioperative anticoagulation in the ablation of nonvalvular atrial fibrillation are similar. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.