Rong-Hui Yu

Capital Medical University, Peping, Beijing, China

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Publications (48)143.13 Total impact

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    ABSTRACT: Intracardiac echocardiography is not routinely used to guide transseptal puncture (TP) in many centres. TP under fluoroscopy is still the common practice worldwide but remains challenging in difficult cases. This study aims to describe a simple technique to safely localize appropriate TP site during atrial fibrillation (AF) ablation procedure. Inferior vena cava (IVC) angiography was performed at RAO 45°. The IVC, right atrium (RA), right-ventricular inflow tract, and right-ventricular outflow tract were sequentially visualized while the aorta was visualized as non-opacified filling defect. The appropriate TP site was in the middle of the RA, inferoposterior to the non-coronary aortic sinus (NCAS) and superoposterior to coronary sinus ostium. The spatial relationship of these structures was studied in 81 patients. The distance between optimal TP site and surrounding landmarks was analysed. Out of 393 consecutive TPs performed from August 2011 to January 2012, this technique was applied in 17 patients. Under RAO 45° on IVC angiography, an imaginary horizontal line was drawn across the middle point between NCAS and the top of the coronary sinus ostium. The line was divided into four quarters. In 78 (96%) patients, the optimal TP site was identified in the second one. In 94% (16/17) of the patients, all above-mentioned structures were clearly visualized and TP was successfully performed in all of them without complications. IVC angiography is a simple and safe technique which can facilitate TP in difficult cases. Optimal TP site can be easily identified on IVC angiography.
    European Heart Journal Supplements 07/2015; 17(suppl C). DOI:10.1093/eurheartj/suv029 · 5.64 Impact Factor
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    ABSTRACT: Premature ventricular contractions (PVCs) originate from aortic sinus cusps (ASC) can exhibit preferential conduction to right ventricular outflow tract (RVOT). This study aimed to examine the electrophysiological characteristics for guiding catheter ablation in patients with two morphological types of PVCs that originate from aortic sinus cusps (ASC) or great cardiac vein (GCV). We analyzed ECG from 10 patients with PVCs of two QRS morphologies. The patients who exhibited dominant LBBB QRS morphology and less right bundle branch block (RBBB) morphology were designated as group 1 (n = 7), and those with dominant RBBB QRS morphology were designated as group 2 (n = 3). During PVCs, electro-anatomical mapping was performed in both RVOT and ASC in group 1 and only performed in ASC or GCV in group 2. In group 1, the earliest ventricular activation (EVA) preceding the onset of the QRS complex (V-QRS) was recorded for 27±6ms (range 18 to 36ms) in RVOT and 25±6ms (range 18 to 34ms) in the ASC, while V-QRS was recorded for 28ms, 42ms 42ms in the ASC or GCV in group 2. All patients were successfully ablated at one site finally, including LCC in seven, L-RCC in two, and GCV in one. None of the patients experienced recurrence or complications during the 18.4±5.1 (range 6 to 24 months) months of follow-up. Two QRS morphologies (LBBB and RBBB with inferior axis) in PVCs could be a predictor of PVCs originating from ASC or GCV. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Pacing and Clinical Electrophysiology 05/2015; DOI:10.1111/pace.12652 · 1.25 Impact Factor
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    ABSTRACT: Previous studies have described the impact of mitral isthmus (MI) anatomy on the likelihood of achieving MI linear block in patients with native mitral valves (NMV) who underwent atrial fibrillation (AF) ablation. However, none have investigated that issue in AF patients with mechanical mitral valve replacements (MMVR). Twenty-nine consecutive patients who developed symptomatic persistent AF post MMVR and referred for ablation were enrolled. Twenty-nine patients with NMV who underwent ablation of persistent AF during the same period were matched. With pre-procedural cardiac computed tomographic imaging, MI anatomical features of all the participants were analyzed. Pouched MI was observed in 19 (65.5%) MMVR patients, compared to 6 (20.7%) controls (P = 0.001). Bidirectional linear block across MI was achieved in 21 (72.4%) MMVR patients and 22 (75.9%) in the controls (P = 0.764). In the multivariable analysis, Pouched MI was an independent predictor of incomplete MI block. Pouched MI accounts for the majority of AF patients with MMVR and may be associated with incomplete bidirectional linear block of MI. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Journal of Cardiovascular Electrophysiology 02/2015; 26(5). DOI:10.1111/jce.12649 · 2.88 Impact Factor
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    ABSTRACT: Background:In hypertrophic cardiomyopathy (HCM) patients complicated with atrial fibrillation (AF), catheter ablation has been recommended as a treatment option. Meanwhile, prolongation of QTc interval has been linked to an increased AF incidence in the general population and to poor outcomes in HCM patients. However, whether QTc prolongation predicts arrhythmia recurrence after AF ablation in the HCM population remains unknown.Methods and Results:Thirty-nine HCM patients undergoing primary AF ablation were enrolled. The ablation strategy included bilateral pulmonary vein isolation (PVI) for paroxysmal AF (n=27) and PVI plus left atrial roof, mitral isthmus and tricuspid isthmus linear ablations for persistent AF (n=12). Pre-procedural QTc was corrected by using the Bazett's formula. At a 14.8-month follow up, 23 patients experienced atrial tachyarrhythmia recurrence. Recurrent patients had longer QTc than non-recurrent patients (461.0±28.8 ms vs. 434.3±18.2 ms, P=0.002). QTc and left atrial diameter (LAD) were independent predictors of recurrence. The cut-off value of QTc 448 ms predicted arrhythmia recurrence with a sensitivity of 73.9% and a specificity of 81.2%. A combination of LAD and QTc (global chi-squared=13.209) was better than LAD alone (global chi-squared=6.888) or QTc alone (global chi-squared=8.977) in predicting arrhythmia recurrence after AF ablation in HCM patients.Conclusions:QTc prolongation is an independent predictor of arrhythmia recurrence in HCM patients undergoing AF ablation, and might be useful for identifying those patients likely to have a better outcome following the procedure.
    Circulation Journal 02/2015; 79(5). DOI:10.1253/circj.CJ-14-1290 · 3.69 Impact Factor
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    ABSTRACT: Rheumatoid arthritis (RA) is associated with an increased incidence of atrial fibrillation (AF). This study evaluated the safety and efficacy of catheter ablation (CA) in the treatment of AF in patients with RA, which has not been previously reported. A total of 15 RA patients with AF who underwent CA were enrolled. For each RA patient, we selected 4 individuals (control group, 60 patients in total) who presented for AF ablation in the absence of structural heart or systemic disease and matched the RA patients with same gender, age (±2 years), type of AF, and procedure date. Patients with RA had a significantly higher C-reactive protein level (1.81±2.35mg/dl vs. 4.14±2.30mg/dl, p=0.0320), white blood cell count (5632±1200mm(3) vs. 6361±1567mm(3), p=0.0482), and neutrophil count (3308±973mm(3) vs. 3949±1461mm(3), p=0.0441). At 2-year follow-up, atrial tachyarrhythmia (ATa) recurrence rate in the RA group (33.3%, 5/15) was similar to that in the control group (31.7%, 19/60; p=0.579) after single procedure. In all the five patients from the RA group who developed recurrence, ATa relapsed within 90 days following index procedure (median recurrence time 18 days vs. 92 days in control group; p=0.0373). Multivariate Cox regression analysis showed that hypertension and left atrial diameter but not RA, C-reactive protein, white blood cell count, and neutrophil count were independent predictors of ATa recurrence. Catheter ablation of AF can be safely performed in patients with RA, with a success rate comparable to that of patients without RA. RA patients tend to develop early ATa recurrence after AF ablation. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
    Journal of Cardiology 01/2015; DOI:10.1016/j.jjcc.2014.12.003 · 2.57 Impact Factor
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    ABSTRACT: Anticoagulation of patients with cardiac tamponade (CT) complicating catheter ablation of atrial fibrillation (AF) is an ongoing problem. The aim of this study was to survey the clinical practice of periprocedural anticoagulation in such patients. This study analyzed the periprocedural anticoagulation of 17 patients with CT complicating AF ablation. Emergent pericardiocentesis was performed once CT was confirmed. The mean drained volume was 410.0 ± 194.1 mL. Protamine sulfate was administered to neutralize heparin (1 mg neutralizes 100 units heparin) in 11 patients with persistent pericardial bleeding and vitamin K1 (10 mg) was given to reverse warfarin in 3 patients with supratherapeutic INR (INR > 2.1). Drainage catheters were removed 12 hours after echocardiography confirmed absence of intrapericardial bleeding and anticoagulation therapy was restored 12 hours after removing the catheter. Fifteen patients took oral warfarin and 10 of them were given subcutaneous injection of LMWH (1 mg/kg, twice daily) as a bridge to resumption of systemic anticoagulation with warfarin. Two patients with a small amount of persistent pericardial effusion were given LMWH on days 5 and 13, and warfarin on days 6 and 24. The dosage of warfarin was adjusted to keep the INR within 2-3 in all patients. After 12 months of follow-up, all patients had no neurological events and no occurrence of delayed CT. The results showed that it was effective and safe to resume anticoagulation therapy 12 hours after removal of the drainage catheter. This may help to prevent thromboembolic events following catheter ablation of AF.
    International Heart Journal 12/2014; 56(1). DOI:10.1536/ihj.14-158 · 1.13 Impact Factor
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    ABSTRACT: Transient ST-T elevation (STE) is a rare complication that occurs during transseptal catheterization. This study aims to delineate the incidence and characteristics of transient STE during transseptal catheterization for atrial fibrillation (AF) ablation.
    Europace 10/2014; 17(4). DOI:10.1093/europace/euu278 · 3.05 Impact Factor
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    ABSTRACT: Objectives To address whether menopause affects outcome of catheter ablation (CA) for atrial fibrillation (AF) by comparing the safety and long-term outcome of a single-procedure in pre- and post-menopausal women. Methods A total of 743 female patients who underwent a single CA procedure of drug-refractory AF were retrospectively analyzed. The differences in clinical presentation and outcomes of CA for AF between the pre-menopausal women (PreM group, 94 patients, 12.7%) and the post-menopausal women (PostM group, 649 patients, 87.3%) were assessed. Results The patients in the PreM group were younger (P < 0.001) and less likely to have hypertension (P < 0.001) and diabetes (P = 0.005) than those in the PostM group. The two groups were similar with regards to the proportion of concomitant mitral valve regurgitation coronary artery disease, left atrium dimensions, and left ventricular ejection fraction. The overall rate of complications related to AF ablation was similar in both groups (P = 0.385). After 43 (16–108) months of follow-up, the success rate of ablation was 54.3% in the PreM group and 54.2% in the PostM group (P = 0.842). The overall freedom from atrial tachyarrhythmia recurrence was similar in both groups. Menopause was not found to be an independent predictive factor of the recurrence of atrial tachyarrhythmia. Conclusions The long-term outcomes of single-procedure CA for AF are similar in pre- and post-menopausal women. Results indicated that CA of AF appears to be as safe and effective in pre-menopausal women as in post-menopausal women.
    Journal of Geriatric Cardiology 06/2014; 11(2):120-5. DOI:10.3969/j.issn.1671-5411.2014.02.005 · 1.06 Impact Factor
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    ABSTRACT: Background Serum uric acid (SUA) is a simple and independent marker of morbidity and mortality in a variety of cardiovascular diseases. This study aimed to investigate SUA and the risk of left atrial (LA) thrombus in patients with nonvalvular atrial fibrillation (AF). Methods In this retrospective study, 1359 consecutive patients undergoing transesophageal echocardiography prior to catheter ablation of AF were enrolled. Sixty-one of the 1359 patients (4.5%) had LA thrombus. Results SUA levels in patients with LA thrombus were significantly higher (413.5±98.8μmol/L vs. 366.7±94.3μmol/L, P<0.001). Hyperuricemia was defined as SUA ≥ 359.8μmol/L in women and ≥445.6μmol/L in men determined by receiver operating characteristic curve. The incidence of LA thrombus was significantly higher in patients with hyperuricemia than those with normal SUA level both in women (12.1% vs. 1.9%, P <0.001) and in men (8.5% vs. 2.8%, P <0.001). Hyperuricemia had negative predictive value of 98.1% in women and 97.1% in men for identifying LA thrombus. Hyperuricemia was associated with significantly higher risk of LA thrombus among CHA2DS2VASc score =0, =1 and ≥2 groups with odds ratios 7.19, 4.05, 3.25, respectively. In multivariable analysis, SUA was an independent risk factor of LA thrombus (odds ratio: 1.004, 95% confidence interval: 1.000-1.008, P=0.028). Conclusions Hyperuricemia was a modest risk factor of LA thrombus, which might refine stratification of LA thrombus in patients with nonvalvular AF.
    The Canadian journal of cardiology 06/2014; 30(11). DOI:10.1016/j.cjca.2014.06.009 · 3.94 Impact Factor
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    Journal of the American College of Cardiology 04/2014; 63(12):A378. DOI:10.1016/S0735-1097(14)60378-8 · 15.34 Impact Factor
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    ABSTRACT: This study sought to explore the predictors of recurrence in patients with paroxysmal atrial fibrillation (AF) undergoing repeat catheter ablation, especially the impact of left atrial (LA) remodelling after the original procedure on the outcome of repeat procedure.METHODS AND RESULTS: Ninety-five patients undergoing repeat ablation were enroled in this study. Repeat procedure endpoints were pulmonary vein isolation, linear block when linear ablation is performed, and non-inducibility of atrial tachyarrhythmia by burst pacing. Patients with LA enlargement between the pre-original procedure and pre-repeat procedure were categorized as Group 1 (35 patients), while individuals with no change or decrease of LA diameter were categorized as Group 2 (60 patients). The mean duration from the original procedure to the repeat procedure was 12 months (1-40 months). After 29.6 ± 20.5 (3-73) months follow-up from the repeat procedure, 33 patients experienced recurrence (34.7%). The recurrence rate was significantly higher in Group 1 than in Group 2 (51.4 VS. 25.0%, P = 0.017). In univariate analysis, LA remodelling was the only predictor of recurrence. In multivariate analysis, after adjustment for age and LA diameter, Group 1 had a greater risk of recurrence after the repeat procedure (hazard ratio = 2.22, 95% confidence interval: 1.02-4.81, P = 0.043).CONCLUSIONS: Left atrial enlargement after undergoing the original catheter ablation of paroxysmal AF was an independent risk factor of recurrence after repeat ablation.
    Europace 04/2014; 16(11). DOI:10.1093/europace/euu013 · 3.05 Impact Factor
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    Journal of the American College of Cardiology 04/2014; 63(12):A376. DOI:10.1016/S0735-1097(14)60376-4 · 15.34 Impact Factor
  • 03/2014; 9(1):e265. DOI:10.1016/j.gheart.2014.03.2170
  • 03/2014; 9(1):e25. DOI:10.1016/j.gheart.2014.03.1305
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    ABSTRACT: Symptomatic prolonged sinus pauses on termination of atrial fibrillation (AF) are an accepted indication for pacemaker implantation. We evaluated the outcome of AF ablation in patients with paroxysmal AF-related tachycardia-bradycardia syndrome and compared the efficacy of catheter ablation with permanent pacing plus antiarrhythmic drugs (AADs). Patients with prolonged symptomatic sinus pauses on termination of AF were retrospectively analyzed. Forty-three consecutive patients who underwent catheter ablation (ABL group) were compared to 57 patients who underwent permanent pacing plus AADs (PM group). All 43 patients in the ABL group fulfilled Class I indication for pacemaker implantation at baseline but they actually underwent AF ablation. Reevaluation after 20.1 ± 9.6 months of follow-up showed that 41 patients (95.3%) did no longer need a pacemaker (Class III indication). Total cardiac-related rehospitalization was not significantly different between the two groups (P = 0.921). Tachycardia-related hospitalization was significantly higher in the PM group than the ABL group (14.0% and 0%, P = 0.029). More patients in the PM group were on AADs (PM 40.4%, ABL 4.7%, P < 0.001) while sinus rhythm maintenance was remarkably higher in the ABL group at the end of follow-up (83.7% vs 21.1% in PM group, P < 0.001). In patients with paroxysmal AF-related tachycardia-bradycardia syndrome, AF ablation seems to be superior to a strategy of pacing plus AAD. Pacemaker implantation can be waived in the majority of patients after a successful ablation.
    Pacing and Clinical Electrophysiology 01/2014; 37(4). DOI:10.1111/pace.12340 · 1.25 Impact Factor
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    International journal of cardiology 01/2014; 172(1). DOI:10.1016/j.ijcard.2013.12.081 · 6.18 Impact Factor
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    ABSTRACT: BACKGROUND: -Functionally, left His-Purkenje system (HPS) is insulated from the adjacent myocardium, and exhibits isolated conduction during sinus rhythm (SR), but in vivo human study is rare. Meanwhile, whether the isolated conduction also exists during idiopathic left ventricle tachycardia (ILVT) is not clearly defined. Current study aimed to delineate the activation sequence and gross anatomy of left HPS during SR and ILVT. METHODS AND RESULTS: -The study involved 25 consecutive patients with ILVT. During SR, left HPS exhibited antegrade activation sequence, and its surrounding myocardium depolarized after HPS in an apical to base direction. During ILVT, the earliest retrograde PPs were mainly located at the middle portion of left posterior fascicle (LPF) [0.5±0.1(0.46~0.58, CI: 95%) of its full length] with an average of 29.5±6.0 mm (19.8~41.5) away from the His position. LPF was depolarized from the earliest retrograde PPs via two opposite wavefronts with significantly shorter activation time than that during SR (15.1±2.1 VS 30.0±3.2ms P<0.001). The left anterior fascicle was depolarized after LPF with an antegrade activation sequence and comparable activation time to that during SR (21.9±2.9 VS 22.0±4.1ms P=0.932). The depolarization of ventricle septum occurred after HPS in an apical to base direction too. CONCLUSIONS: -During SR, isolated conduction within the HPS is demonstrated by documenting the reverse activation sequence with its surrounding myocardium. During ILVT, the earliest retrograde PPs were usually recorded at the middle segment of LPF, and the isolated conduction within the HPS remained.
    Circulation Arrhythmia and Electrophysiology 05/2013; 6(3). DOI:10.1161/CIRCEP.113.000293 · 5.42 Impact Factor
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    ABSTRACT: Major atrial coronary arteries, including the sinus node artery (SNA), were commonly found in the areas involved in atrial fibrillation (AF) ablation and could cause difficulties in achieving linear block at the left atrial (LA) roof. The SNA is a major atrial coronary artery of the atrial coronary circulation. This study aimed to determine impact of the origin of SNA on recurrence of AF after pulmonary vein isolation (PVI) in patients with paroxysmal AF. Seventy-eight patients underwent coronary angiography for suspected coronary heart disease, followed by catheter ablation for paroxysmal AF. According to the origin of SNA from angiographic findings, they were divided into right SNA group (SNA originating from the right coronary artery) and left SNA group (SNA originating from the left circumflex artery). Guided by an electroanatomic mapping system, circumferential pulmonary vein ablation (CPVA) was performed in both groups and PVI was the procedural endpoint. All patients were followed up at 1, 3, 6, 9 and 12 months post-ablation. Recurrence was defined as any episode of atrial tachyarrhythmias (ATAs), including AF, atrial flutter or atrial tachycardia, that lasted longer than 30 seconds after a blanking period of 3 months. The SNA originated from the right coronary artery in 34 patients (43.6%) and the left circumflex artery in 44 patients (56.4%). Freedom from AF and antiarrhythmic drugs (AADs) at 1 year was 67.9% (53/78) for all patients. After 1 year follow-up, 79.4% (27/34) in right SNA group and 59.1% (26/44) in left SNA group (P = 0.042) were in sinus rhythm. On multivariate analysis, left atrium size (HR = 1.451, 95%CI: 1.240 - 1.697, P < 0.001) and a left SNA (HR = 6.22, 95%CI: 2.01 - 19.25, P = 0.002) were the independent predictors of AF recurrence. The left SNA is more frequent in the patients with paroxysmal AF. After one year follow-up, the presence of a left SNA was identified as an independent predictor of AF recurrence after CPVA in paroxysmal AF.
    Chinese medical journal 05/2013; 126(9):1624-9. DOI:10.3760/cma.j.issn.0366-6999.20123413 · 1.02 Impact Factor
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    ABSTRACT: This prospective clinical trial was designed to evaluate the efficacy of an ablation strategy, namely '2C3L', in the treatment of persistent atrial fibrillation (AF); and to compare its efficacy with that of the 'stepwise' approach, which has been acknowledged as a promising ablation technique for persistent AF. The '2C3L' technique is a fixed ablation approach consisting of bilateral circumferential pulmonary vein antrum isolation (PVAI) and three linear ablation lesion sets across the mitral isthmus, left atrial roof, and cavo-tricuspid isthmus. One hundred and forty-six patients with persistent AF were randomized to undergo ablation by using the '2C3L' or the 'stepwise' technique (n = 73, respectively). The primary endpoint was freedom from any atrial tachyarrhythmia off antiarrhythmic drug (AAD) after a single procedure at follow-up. Twelve months after a single procedure, there was no difference in sinus rhythm (SR) maintenance rate between the two groups (67% for '2C3L' vs. 60% for 'stepwise', P = 0.394; 95% confidence interval of between-group difference -8.7 to 22.4%). The procedure (222 ± 42 vs. 263 ± 41 min), fluoroscopy (41 ± 9 vs. 55 ± 8 min), and radiofrequency (RF) (107 ± 32 vs. 128 ± 38 min) time were significantly shorter in the '2C3L' group (all P < 0.001). At 25 ± 5 months after the first procedure, 57.5 and 52.1% of patients from the '2C3L' group and the 'stepwise' group were in SR off AAD (P = 0.494), respectively. For catheter ablation of persistent AF, the '2C3L' strategy is a fixed approach associated with clinical efficacy similar to that of the 'stepwise' approach but with less RF delivery, fewer X-ray exposure, and shorter procedural time. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.
    Journal of the American College of Cardiology 03/2013; 61(10). DOI:10.1016/S0735-1097(13)60356-3 · 15.34 Impact Factor
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    ABSTRACT: BACKGROUND: Recently there has been a great deal of interest in the role of serum uric acid (SUA) in atrial fibrillation (AF). The objective of this study was to establish whether there is a relationship between levels of SUA and recurrence of paroxysmal AF after catheter ablation. METHODS: Three hundred and thirty patients diagnosed with paroxysmal AF were analyzed. Patients were categorized into quartiles on the basis of their pre-operative SUA measurement and follow-up, and Kaplan-Meier estimation with a Log-rank test was used for the analysis of the influence of SUA on the recurrence of AF. Pre-procedural clinical variables were correlated with the clinical outcome after ablation using multivariate Logistic analysis. A Cox proportional hazards model was used to estimate the relationship between SUA and the recurrence of AF. RESULTS: After a mean follow-up of (9.341 ± 3.667) (range 3.0 - 16.3) months, recurrence rates from the lowest SUA quartile to the highest SUA quartile were 16.0%, 26.4%, 28.3%, and 29.3% respectively (P = 0.014). After adjustment for gender, body mass index (BMI), hypertension, serum levels of high sensitivity C-reactive protein (hsCRP), triglyceride (TG), left atrial diameter (LA), estimated glomerular filtration rate (eGFR), and SUA, there was an increased risk of recurrence in subjects in the highest SUA quartile compared with those in the lowest quartile (hazard ratio 2.804, 95% confidence interval 1.466 - 5.362, P = 0.002). Following multivariate Logistical analysis, SUA was found to be an independent predictor of recurrence (hazard ratio 1.613, 95% confidence interval 1.601 - 1.625, P = 0.014). CONCLUSION: In a retrospective study of patients with paroxysmal AF undergoing catheter ablation, elevated preoperative SUA levels were associated with a higher rate of recurrence of AF.
    Chinese medical journal 03/2013; 126(5):860-864. DOI:10.3760/cma.j.issn.0366-6999.20122154 · 1.02 Impact Factor