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Yu-Feng Hu,
Tzu-Chi Chen,
Gar-Yang Chau,
Tsung-Lin Yang,
Chia-Jen Liu,
Ming-Huang Chen,
Peter Mu-Hsin Chang,
Tzeng-Ji Chen,
Michael Hsiao,
Chi-Ying F Huang,
Shih-Ann Chen
International journal of cardiology 05/2013; · 7.08 Impact Factor
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Hung-Yu Chang,
Wei-Hsian Yin,
Li-Wei Lo,
Yenn-Jiang Lin,
Shih-Lin Chang, Yu-Feng Hu,
An-Ning Feng,
Meng-Cheng Chiang,
Mason-Shing Young,
Chong-Yi Chang,
Yi-Cheng Chuang,
Eric Chong,
Shih-Ann Chen,
Jeng Wei
[show abstract]
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ABSTRACT: BACKGROUND: Sudden cardiac death (SCD) occurs commonly after heart transplantation (HTX). The utilization of surface electrocardiography (ECG) to assess post-HTX SCD has not been investigated thoroughly. This study aimed to investigate the specific changes in surface ECG in HTX patients with SCD. METHODS: A total of 227 HTX patients (age 48±14y/o, mean donor age 34±14y/o, 173males) were followed up regularly at the outpatient clinic. Twelve-lead ECG's were recorded during 1-2 monthly visits. Serial ECG parameters and relevant clinical data were collected and analyzed. RESULTS: During the follow-up period of 96±51months, SCD occurred in 28 (12.3%) patients. The baseline ECG parameters were comparable between patients with and without SCD. Important ECG trends of rising rest heart rates and prolongation of corrected QT (QTc) and JT (JTc) intervals were observed prior to development of SCD. After adjustment for other clinical variables, the independent predictors for SCD were older donor age (p=0.014, OR 1.05, 95% CI 1.01-1.09), faster heart rate (p=0.006, OR 1.06, 95% CI 1.02-1.1) and longer JTc interval (p=0.015, OR 1.03, 95% CI 1.01-1.06). SCD occurred in 71.4% patients presenting with all three risk predictors. CONCLUSIONS: Besides older donor age, important ECG signs, including prolongation of the JTc interval and increased heart rate during post HTX follow up, could predict SCD.
International journal of cardiology 04/2013; · 7.08 Impact Factor
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Chung-Lieh Hung,
Tze-Fan Chao,
Yau-Huei Lai,
Chih-Hsuan Yen,
Kang-Ling Wang,
Hsuan-Ming Tsao,
Yenn-Jiang Lin,
Shih-Lin Chang,
Li-Wei Lo, Yu-Feng Hu,
Jen-Yuan Kuo,
Hung-I Yeh,
Shih-Ann Chen
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Metabolic syndrome (MS) is an important risk factor of atrial fibrillation. However, an understanding of the adverse effects of MS on left atrial (LA) functional assessment in terms of electromechanical interval, a convenient parameter that can reflect the process of LA remodelling, has been lacking. The goal of this study was to investigate the association between electromechanical interval and MS. METHODS: In all, 337 patients (91 with MS) with mean age of 51.9 ± 9.0 years were enrolled. Metabolic syndrome was defined by National Cholesterol Education Program-Adult Treatment Panel III score. Insulin resistance was assessed by the homeostasis model assessment-insulin resistance method. The electromechanical interval, defined as the time from initiation of P wave deflection to peak of mitral inflow Doppler A wave (PA-PDI), was measured. RESULTS: Patients with MS had significantly longer PA-PDI intervals compared with those of patients without MS (131.0 ± 12.4 milliseconds vs 123.2 ± 14.0 milliseconds, P < 0.001). Longer PA-PDI intervals were observed in subjects with higher metabolic scores (P < 0.05). In patients with small LA size, PA-PDI intervals, but not LA dimensions, were significantly different between groups with and without MS (P < 0.05). Additionally, PA-PDI interval was positively correlated with insulin resistance (r = 0.267, P < 0.001). CONCLUSIONS: PA-PDI intervals were longer in patients with MS compared with those of patients without MS and tracked with insulin resistance. PA-PDI may be a useful clinical parameter to represent the degree of atrial remodelling in subjects with metabolic derangements.
The Canadian journal of cardiology 03/2013; · 3.36 Impact Factor
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Li-Wei Lo,
Chuen-Wang Chiou,
Yenn-Jiang Lin,
Shih-Lin Chang, Yu-Feng Hu,
Hsuan-Ming Tsao,
Tze-Fan Chao,
Cheng-Hung Li,
Hung-Yu Chang,
Fa-Po Chung,
Shih-Ann Chen
[show abstract]
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ABSTRACT: INTRODUCTION: Autonomic modulation of the cardiac activity plays an important role in the pathogenesis of atrial fibrillation (AF). The aim of this study was to assess the differences in the atrial electrical and structural properties between patients with vagal and sympathetic AF. METHODS: The study included 30 patients (53 ± 12 years old, male 26) with frequent attacks of symptomatic paroxysmal AF. All cases underwent 24-hour ambulatory Holter monitoring before the catheter ablation. The onset of AF accompanied with an increased HF component and decreased L/H ratio was designated as a vagal type (group 1, n = 12), whereas a decreased HF component and increased L/H ratio was classified as a sympathetic type (group 2, n = 18). Electrical and structural properties were evaluated during the ablation procedure. RESULTS: All patients had AF originating from PVs. There was a higher incidence of non-PV triggers in group 2 patients than that in group 1 (44% vs 8%, P = 0.04). Group 1 had a higher bipolar peak-to-peak voltage and mean DF of the global left atrium (LA), shorter total activation time, and smaller LA volume than group 2, whereas the electrical and structural properties in the right atrium were similar. After a follow-up of 15 ± 7 months, there was a lower incidence of AF recurrence in group 1 than that in group 2 (0% vs 28%, P = 0.02). CONCLUSION: There are better electrical properties and a smaller LA volume in patients with vagal-type AF. In contrast, the LA substrate is worse, and coexisting non-PV triggers and recurrence following ablation are more prevalent in patients with the sympathetic-type AF.
Journal of Cardiovascular Electrophysiology 01/2013; · 3.06 Impact Factor
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Yu-Feng Hu,
Kun-Tai Lee,
Hsueh-Hsiao Wang,
Kwo-Chang Ueng,
Hung-I Yeh,
Tze-Fan Chao,
Jo-Nan Liao,
Yenn-Jiang Lin,
Shih-Lin Chang,
Li-Wei Lo,
Ta-Chuan Tuan,
Cheng-Hung Li,
Fa-Po Chung,
Chiao-Po Hsu,
Hsiao-Huang Chang,
Cheng-Hsiung Huang,
Shih-Ann Chen
[show abstract]
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ABSTRACT: A length polymorphism of GT repeats in the promoter region of the human heme oxygenase-1 (HO-1) gene modulates its gene transcription to protect against myocardial injury. The present study investigated the association between HO-1 promoter polymorphisms and the outcomes of catheter ablation of atrial fibrillation (AF). The allelic frequencies of GT repeats in the HO-1 gene promoter were screened in 205 random individuals who underwent catheter ablation for drug refractory AF.In the patients who received catheter ablation, those with AF recurrence had fewer GT repeats (53.4±7.1 vs. 56.1±6.5, p = 0.004), a lower incidence of hyperlipidemia, more non-paroxysmal AF, and a larger left atrial diameter. After conducting a multivariate logistic analysis, the number of GT repeats (Odds ratio: 0.94, 95% CI 0.90-0.99, p = 0.01) and the diameter of the left atrium (Odds ratio: 1.08, 95% CI 1.02-1.15, p = 0.01) remained independent predictors. The carriers of GT repeats, which were <29 in both alleles, were associated with a lower sinus maintenance rate after catheter ablation (38.5% vs. 60.1%, p = 0.003). The patients were divided into paroxysmal and non-paroxysmal AF groups; the number of GT repeats was associated with AF recurrence only in the patients with paroxysmal AF. The number of GT repeats, combined with LAD, was significant for predicting AF recurrence after catheter ablation (p = 0.01). The number of GT repeats was not found to be associated with differences in the left atrial diameter, the biatrial voltage, or the levels of bilirubin, ferritin, iron, C-reactive protein, or von-Willibrand factor. In conclusions, HO-1 gene promoter polymorphisms were associated with AF recurrence after catheter ablation.
PLoS ONE 01/2013; 8(2):e56440. · 4.09 Impact Factor
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Tze-Fan Chao,
Chia-Jen Liu,
Su-Jung Chen,
Kang-Ling Wang,
Yenn-Jiang Lin,
Shih-Lin Chang,
Li-Wei Lo, Yu-Feng Hu,
Ta-Chuan Tuan,
Tsu-Juey Wu,
Tzeng-Ji Chen,
Shih-Ann Chen
[show abstract]
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ABSTRACT: BACKGROUND: The components of CHADS(2) score were reported to be important risk factors for the development of atrial fibrillation (AF). The goal of the current study was to investigate whether the CHADS(2) score was a useful scheme in predicting new-onset AF. Furthermore, we aimed to use the CHADS(2) scoring system to estimate the individual risk in developing AF for patients with different comorbidities. METHODS: From January 1, 2000 to December 31, 2001, a total of 702,502 patients older than 18years old and who had no history of cardiac arrhythmias were identified from the "National Health Insurance Research Database" released by the Taiwan National Health Research Institutes. The CHADS(2) score was calculated for every patient. Finally, 628,807 (score 0), 47,039 (score 1), 15,655 (score 2), 6843 (score 3), 3315 (score 4), 790 (score 5) and 53 (score 6) patients were studied and followed for the occurrences of AF. RESULTS: During a follow-up of 9.0±2.2years, there were 9187 (1.3%) patients experiencing new-onset AF. The incidence of AF was 1.5 per 1000 patient-years. The incidence increased from 0.8 per 1000 patient-years for patients with a CHADS(2) score of 0 to 34.6 per 1000 patient-years for those with a CHADS(2) score of 6. After an adjustment for the gender and comorbidities, the hazard ratio (95% confidence interval) of each increment of the CHADS(2) score in predicting AF was 2.342 (2.309-2.375; p<0.001). CONCLUSIONS: The CHADS(2) score, consisting of an age >75 and several clinical risk factors was useful in risk estimation and stratification of new-onset AF.
International journal of cardiology 12/2012; · 7.08 Impact Factor
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Jo-Nan Liao, Yu-Feng Hu,
Tsu-Juey Wu,
Ann-Ning Fong,
Wei-Shiang Lin,
Yenn-Jiang Lin,
Shih-Lin Chang,
Li-Wei Lo,
Ta-Chuan Tuan,
Hung-Yu Chang, [......],
Tze-Fan Chao,
Fa-Po Chung,
Dicky Armein Hanafy,
Wen-Yu Lin,
Jin-Long Huang,
Chin-Chou Huang,
Hsin-Bang Leu,
Pi-Chang Lee,
Chern-En Chiang,
Shih-Ann Chen
[show abstract]
[hide abstract]
ABSTRACT: The present study investigated the incidence and predictors of permanent pacemaker (PPM) implantation for late atrioventricular block (AVB) in patients with atrioventricular nodal reentrant tachycardia (AVNRT) who received ablation. The data from 3,442 patients with AVNRT who received ablation were analyzed. Those who developed late AVB (>1 month after ablation) and received a PPM were identified. The incidence of PPM implantation in 1,148 matched patients with Wolff-Parkinson-White syndrome and in the whole population of Taiwan were compared. Of the patients with AVNRT receiving ablation (mean follow-up duration 128.3 ± 62.5 months), 15 (0.4%) received PPM implantation for late AVB (mean interval after catheter ablation 95.4 ± 55.0 months). Only age (odds ratio 1.05, p = 0.02) and transient AVB (odds ratio 8.55, p = 0.01) during the procedure were independently associated with PPM implantation for late AVB. The patients with AVNRT had a greater incidence of PPM implantation due to late AVB compared to the matched patients with Wolff-Parkinson-White syndrome. The annual incidence of PPM implantation for AVB was also greater in the patients with AVNRT than in the general population. In conclusion, the incidence of PPM implantation for late AVB in patients with AVNRT who received catheter ablation was low but still greater than that in patients with Wolff-Parkinson-White syndrome and the general population in Taiwan.
The American journal of cardiology 12/2012; · 3.58 Impact Factor
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Yenn-Jiang Lin,
Tze-Fan Chao,
Hsuan-Ming Tsao,
Shih-Lin Chang,
Li-Wei Lo,
Chern-En Chiang, Yu-Feng Hu,
Pai-Feng Hsu,
Shao-Yuan Chuang,
Cheng-Hung Li,
Fa-Po Chung,
Yun-Yu Chen,
Tsu-Juey Wu,
Ming-Hsiung Hsieh,
Shih-Ann Chen
[show abstract]
[hide abstract]
ABSTRACT: AIMS: It is not known if successful catheter ablation for atrial fibrillation (AF) improves the patient's long-term cardiovascular outcomes. This study investigated the long-term outcomes and mortality of AF patients at high risk who received antiarrhythmic medication and catheter ablation.METHODS AND RESULTS: The propensity scores for AF were calculated for each patient and were used to assemble a cohort of 174 AF patients with ablation who were compared with an equal number of AF patients without ablation. Composite cardiovascular end points (major adverse cardiovascular event, MACE), including mortality and vascular events in the medically treated patients representing the control group (group 1), were compared with those in the ablation-treated patients (group 2). The rates of the total mortality (2.95% vs. 0.74% per year; P < 0.01), cardiovascular death (1.77% vs. 0% per year; P = 0.001), and ischaemic stroke/transient ischaemic attack (2.21% vs. 0.59% per year; P = 0.02) were higher in group 1 than group 2, respectively. A multivariate Cox regression analysis of the MACE scores showed that a higher CHA(2)DS(2)-VASc score [hazard ratio (HR) = 1.309 per increment of score, 95% confidence interval (CI) = 1.06-1.617; P = 0.01] and the performance of the ablation procedure (HR = 0.225, CI = 0.076-0.671; P = 0.007) were independent predictors of a MACE. In patients who received catheter ablation, recurrence of any atrial arrhythmia was a predictor of vascular events and total mortality (P < 0.05).CONCLUSION: In AF patients with CHA(2)DS(2)-VASc score ≥1, catheter ablation of AF reduced the risk of the total/cardiovascular mortality and total vascular events. Atrial fibrillation recurrence predicts long-term cardiovascular outcomes, as well as the CHA(2)DS(2)-VASc score.
Europace 11/2012; · 1.98 Impact Factor
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Tze-Fan Chao,
Yenn-Jiang Lin,
Hsuan-Ming Tsao,
Shih-Lin Chang,
Li-Wei Lo, Yu-Feng Hu,
Ta-Chuan Tuan,
Cheng-Hung Li,
Hung-Yu Chang,
Tsu-Juey Wu,
Wen-Chung Yu,
Shih-Ann Chen
[show abstract]
[hide abstract]
ABSTRACT: Electromechanical Interval and Strokes After Ablations of AF. Introduction: Atrial fibrillation (AF) is associated with increased risk of embolic stroke. Catheter ablation of AF provides an effective therapy for patients with symptomatic and drug-refractory AF. The aim of this study was to evaluate whether the atrial electromechanical interval is useful in identifying patients at risk of stroke after successful catheter ablation. Methods and Results: A total of 279 AF patients who received catheter ablation and showed no evidence of recurrences were enrolled. Electromechanical interval (PA-PDI) was determined as the time interval from the initiation of P wave deflection to the peak of mitral inflow A wave on pulse wave Doppler imaging. The PA-PDI interval was measured for each patient after the 3-month blanking period of catheter ablation. The clinical endpoint was the occurrence of ischemic stroke. During the follow-up of 46.5 ± 17.2 months, 6 patients suffered from ischemic strokes. Patients with strokes had higher CHA(2) DS(2) -VASc scores and longer PA-PDI intervals (138.7 ± 12.4 ms vs 161.2 ± 7.7 ms, P value < 0.001) compared to those without strokes. At a cutoff point of 150 ms identified by ROC curve, the positive and negative predictive values of the PA-PDI interval to predict stroke were 86.7% and 100%, respectively. The PA-PDI interval improved the predictive performance of the CHA(2) DS(2) -VASc score, and the area under the ROC curve increased from 0.75 to 0.85. Conclusions: Our results suggest that the PA-PDI interval is a useful tool to identify patients with high risk of stroke after successful catheter ablation of AF. (J Cardiovasc Electrophysiol, Vol. pp. 1-6).
Journal of Cardiovascular Electrophysiology 11/2012; · 3.06 Impact Factor
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Yenn-Jiang Lin,
Men-Tzung Lo,
Chen Lin,
Shih-Lin Chang,
Li-Wei Lo, Yu-Feng Hu,
Tze-Fan Chao,
Cheng-Hung Li,
Yi-Chung Chang,
Wan-Hsin Hsieh,
Fa-Po Chung,
Hsuan-Ming Tsao,
Hung-Yu Chang,
Norden E Huang,
Shih-Ann Chen
[show abstract]
[hide abstract]
ABSTRACT: Nonlinear Analysis of Atrial Fibrillation. Introduction: Currently, the identification of complex fractionated atrial electrograms (CFEs) in the substrate modification is mostly based on cycle length-derived algorithms. The characteristics of the fibrillation electrogram morphology and their consistency over time are not clear. The aim of this study was to optimize the detection algorithm of crucial CFEs by using nonlinear measure electrogram similarity. Methods and Results: One hundred persistent atrial fibrillation patients that underwent catheter ablation were included. In patients who required CFE ablation (79%), the time-domain fibrillation signals (6 seconds) were acquired for a linear analysis (mean fractionation interval and dominant frequency [DF]) and nonlinear-based waveform similarity analysis of the local electrograms, termed the similarity index (SI). Continuous CFEs were targeted with an endpoint of termination. Predictors of the various signal characteristics on the termination and clinical outcome were investigated. Procedural termination was observed in 39% and long-term sinus rhythm maintenance in 67% of the patients. The targeted CFEs didn't differ based on the linear analysis modalities between the patients who responded and did not respond to CFE ablation. In contrast, the average SI of the targeted CFEs was higher in termination patients, and they had a better outcome. Multivariate regression analysis showed that a higher SI independently predicted sites of termination (≥0.57; OR = 4.9; 95% CI = 1.33-18.0; P = 0.017). Conclusions: In persistent AF patients, a cycle length-based linear analysis could not differentiate culprit CFEs from bystanders. This study suggested that sites with a high level of fibrillation electrogram similarity at the CFE sites were important for AF maintenance. (J Cardiovasc Electrophysiol, Vol. pp. 1-10).
Journal of Cardiovascular Electrophysiology 11/2012; · 3.06 Impact Factor
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Hung-Yu Chang,
Li-Wei Lo,
Yenn-Jiang Lin,
Shih-Lin Chang, Yu-Feng Hu,
Cheng-Hung Li,
Tze-Fan Chao,
Fa-Po Chung,
Trung LE Ha,
Rahul Singhal,
Eric Chong,
Wei-Hsian Yin,
Hsuan-Ming Tsao,
Ming-Hsiung Hsieh,
Shih-Ann Chen
[show abstract]
[hide abstract]
ABSTRACT: Long-Term Outcome of NPV AF Ablation. Introduction: Data regarding the long-term outcome of catheter ablation in patients with nonpulmonary vein (NPV) ectopy initiating atrial fibrillation (AF) are limited. We aimed to evaluate the long-term result of patients with AF who had NPV triggers and underwent catheter ablation. Methods and Results: The study included 660 consecutive patients (age 54 ± 11 years old, 477 males) who had undergone catheter ablation for AF. Group 1 consisted of 132 patients with AF initiating from the NPV, and group 2 consisted of 528 patients with AF initiating from pulmonary vein (PV) triggers only. Patients from Group 1 were younger than those from Group 2 (51 ± 12 years old vs 54 ± 11 years old, P = 0.001) and were more likely to be females (34.4% vs 25.8%, P = 0.049). The incidences of nonparoxysmal AF (36.4% vs 16.3%, P < 0.001) and right atrial (RA) enlargement (31.3% vs 19%, P = 0.004) were higher, and the biatrial substrates were worse in Group 1 than those in Group 2 (left atrial voltage 1.5 ± 0.7 mV vs 1.9 ± 0.7 mV, P < 0.001, RA voltage 1.6 ± 0.5 mV vs 1.8 ± 0.6 mV, P = 0.014). During a follow-up period of 46 ± 23 months, there was a higher AF recurrence rate in Group 1 than in Group 2 (57.6% vs 38.8%, P < 0.001). The independent predictors of AF recurrence were NPV trigger (P < 0.001, HR 2, 95% CI 1.4-2.85), nonparoxysmal AF (P = 0.021, HR 1.55, 95% CI 1.07-2.24), larger left atrial diameter (P = 0.002, HR 1.04, 95% CI 1.02-1.07) and worse left atrial substrate (P = 0.028, HR 1.3, 95% CI 1.03-1.64). Conclusion: Compared to AF originating from the PV alone, AF originating from the NPV ectopy showed a worse outcome. (J Cardiovasc Electrophysiol, Vol. pp. 1-9).
Journal of Cardiovascular Electrophysiology 10/2012; · 3.06 Impact Factor
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Tze-Fan Chao,
Chia-Jen Liu,
Su-Jung Chen,
Kang-Ling Wang,
Yenn-Jiang Lin,
Shih-Lin Chang,
Li-Wei Lo, Yu-Feng Hu,
Ta-Chuan Tuan,
Tsu-Juey Wu,
Tzeng-Ji Chen,
Hsuan-Ming Tsao,
Shih-Ann Chen
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The goal of the present study was to investigate whether exposure to non-steroidal anti-inflammatory drugs (NSAIDs) was a risk factor for AF, and to discern which patients were at the highest risk for AF due to NSAID use. METHODS: A total of 7280 patients with newly diagnosed AF from 2000 to 2009 were identified from the National Health Insurance Research Database. On the same date of enrollment, 10 patients without AF, who were matched for age, sex, and underlying disease for each study patient, were selected to be the control group. The relationship between NSAID exposure before enrollment and AF risk was analyzed. RESULTS: The NSAID use was associated with an increased AF risk, especially for new users (odds ratio [OR]=1.651). Among new users, subgroup analysis revealed that patients with heart failure were at the highest risk for AF (OR=1.920). For patients who were only exposed to selective cyclooxygenase 2 (COX2) inhibitors, no significant associations were found between AF and selective COX2 inhibitor use, except for patients with chronic kidney or pulmonary disease (OR=1.656 and 1.707, respectively). CONCLUSIONS: New NSAID use may predispose patients to AF, and the risk is almost doubled in heart failure patients. Use of selective COX2 inhibitors was not significantly related to AF occurrence, except in patients with chronic kidney or pulmonary disease.
International journal of cardiology 10/2012; · 7.08 Impact Factor
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Yu-Feng Hu,
Chia-Jen Liu,
Peter Mu-Hsin Chang,
Hsuan-Ming Tsao,
Yenn-Jiang Lin,
Shih-Lin Chang,
Li-Wei Lo,
Ta-Chuan Tuan,
Cheng-Hung Li,
Tze-Fan Chao,
Fa-Po Chung,
Jo-Nan Liao,
Tzeng-Ji Chen,
Shih-Ann Chen
International journal of cardiology 09/2012; · 7.08 Impact Factor
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Cheng-Hsueh Wu, Yu-Feng Hu,
Chia-Yu Chou,
Yenn-Jiang Lin,
Shih-Lin Chang,
Li-Wei Lo,
Ta-Chuan Tuan,
Cheng-Hung Li,
Tze-Fan Chao,
Fa-Po Chung,
Jo-Nan Liao,
Shih-Ann Chen
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Atrial fibrosis plays a role in the development of a vulnerable substrate for atrial fibrillation (AF). Transforming growth factor (TGF)-ß1 is related to the degree of atrial fibrosis and the recurrence of AF after surgical maze procedures. Whether TGF-ß1 is associated with the outcome after catheter ablation for AF remains unclear. OBJECTIVE: We aimed to investigate whether plasma TGF-ß1 was an independent predictor of AF recurrence after catheter ablation. METHODS: Two hundred consecutive AF patients (154 with paroxysmal AF, and 46 with non-paroxysmal AF) underwent catheter ablation. Their TGF-ß1 levels, clinical and echocardiographic data were collected before ablation. RESULTS: Thirty patients (65%) with non-paroxysmal AF and 57 (37%) with paroxysmal AF had AF recur after catheter ablation. Among patients with non-paroxysmal AF, those experiencing recurrence had higher TGF-ß1 levels than those who did not experience recurrence (34.63±11.98ng/ml vs. 27.33±9.81ng/ml, p=0.026). In patients with paroxysmal AF, recurrence was not associated with different TGF-ß1 levels. In patients with non-paroxysmal AF, TGF-ß1 levels and left atrial diameter (LAD) were independent predictors of AF recurrence after catheter ablation. Moreover, TGF-ß1 levels had an incremental value over LAD to predict AF recurrence after catheter ablation (global χ2 of LAD alone: 6.3; LAD and TGF-ß1 levels: 11.9, increment in global χ2=5.6, p=0.013). The patients with small LAD and low TGF-ß1 levels had the lowest AF recurrence rate at 11%. CONCLUSION: TGF-ß1 level is an independent predictor of AF recurrence in patients with non-paroxysmal AF and might be useful for identifying the patients likely to have better outcomes after catheter ablation.
Heart rhythm: the official journal of the Heart Rhythm Society 09/2012; · 4.56 Impact Factor
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Tze-Fan Chao,
Chia-Jen Liu,
Su-Jung Chen,
Kang-Ling Wang,
Yenn-Jiang Lin,
Shih-Lin Chang,
Li-Wei Lo, Yu-Feng Hu,
Ta-Chuan Tuan,
Tsu-Juey Wu,
Tzeng-Ji Chen,
Hsuan-Ming Tsao,
Shih-Ann Chen
[show abstract]
[hide abstract]
ABSTRACT: Atrial fibrillation (AF) is an independent risk factor for stroke. Recent studies have demonstrated that the CHA(2)DS(2)-VASc scheme is useful for selecting patients who are truly at low risk. The goal of the present study was to compare the risk of ischemic stroke among AF patients with a CHA(2)DS(2)-VASc score of 0 (male) or 1 (female) with those without AF.
The study enrolled 509 males (CHA(2)DS(2)-VASc score=0) and 320 females (CHA(2)DS(2)-VASc score=1) with AF who did not receive any antithrombotic therapy. Patients were selected from the National Health Insurance Research Database in Taiwan. For each study patient, 10 age-matched and sex-matched subjects without AF and without any comorbidity from the CHA(2)DS(2)-VASc scheme were selected as controls. The clinical end point was the occurrence of ischemic stroke.
During a follow-up of 57.4±35.7 months, 128 patients (1.4%) experienced ischemic stroke. The event rate did not differ between groups with and without AF for male patients (1.6% vs 1.6%; P=0.920). In contrast, AF was a significant risk factor for ischemic stroke among females (hazard ratio, 7.77), with event rates of 4.4% and 0.7% for female patients with and without AF (P<0.001).
AF males with a CHA(2)DS(2)-VASc score of 0 were at true low risk for stroke, which was similar to that of non-AF patients. However, AF females with a score of 1 were still at higher risk for ischemic events than non-AF patients.
Stroke 08/2012; 43(10):2551-5. · 5.73 Impact Factor
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Yenn-Jiang Lin,
Kazuyoshi Suenari,
Men-Tzung Lo,
Chen Lin,
Wan-Hsin Hsieh,
Shih-Lin Chang,
Li-Wei Lo, Yu-Feng Hu,
Chen-Chuan Cheng,
Yasuki Kihara,
Tze-Fan Chao,
Beny Hartono,
Tsu-Juey Wu,
Wei-Shiang Lin,
Ke-Hsin Hsu,
Ambrose S Kibos,
Norden E Huang,
Shih-Ann Chen
[show abstract]
[hide abstract]
ABSTRACT: Background- The characteristics of atrial electrograms associated with atrial fibrillation (AF) termination are controversial. We investigated the electrogram characteristics that indicate procedural AF termination during continuous complex fractionated electrogram ablation. Methods and Results- Fifty-two consecutive patients with persistent AF (47 men; aged 54±9 years), who underwent electrogram-based catheter ablation in the left atrium and coronary sinus after pulmonary vein isolation, were enrolled. The intracardiac bipolar atrial electrogram recordings were characterized by (1) fractionation interval (FI) analysis (>6 seconds), (2) kurtosis (shape of the FI histogram), and (3) skewness (asymmetry of the FI histogram). Sites showing complex, fractionated electrograms (mean FI ≤60 ms) were targeted, and AF was terminated in 20 patients (38%) after the pulmonary vein isolation. The conventional complex fractionated electrogram sites (mean ≤120 ms) in patients with AF termination exhibited higher median kurtosis (2.69 [interquartile range, 2.03-3.46] versus 2.35 [interquartile range, 1.79-2.48]; P=0.024) and higher complex fractionated electrogram-mean interval (102.7±19.8 versus 87.7±15.0; P=0.008) than patients without AF termination. Furthermore, AF termination sites had higher median kurtosis than targeted sites without AF termination (5.13 [interquartile range, 3.51-6.47] versus 4.18 [interquartile range, 2.91-5.34]; P<0.01) in patients with procedural termination. In addition, patients with AF termination had a higher sinus rhythm maintenance rate after a single procedure than patients without AF termination (log-rank test, P=0.007). Conclusions- A kurtosis analysis using the FI histogram may be a useful tool in identifying the critical substrate for persistent AF and potential responders to catheter ablation.
Circulation Arrhythmia and Electrophysiology 07/2012; 5(5):949-956. · 6.46 Impact Factor
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Wen-Chin Tsai,
Ji-Hung Wang,
Yenn-Jiang Lin,
Hsuan-Ming Tsao,
Shih-Lin Chang,
Li-Wei Lo, Yu-Feng Hu,
Chien-Jung Chang,
Wei-Hua Tang,
Shih-Yu Huang,
Kazuyoshi Suenari,
Ta-Chun Tuan,
Shih-Ann Chen
[show abstract]
[hide abstract]
ABSTRACT: The different settings of the automatic algorithm in the Carto system (Carto XP, Biosense Webster, Diamond Bar, CA, USA) used for detecting complex fractionated electrograms (CFEs) during atrial fibrillation (AF) may influence the identification of the fragmented electrograms.
We aimed to evaluate the impact of the different parameters on the detection of CFEs and the efficacy of the substrate modification after pulmonary vein isolation (PVI).
A total of 1,159 electrograms were analyzed from 11 consecutive patients (age = 56 ± 12 years). The effect of the different algorithm factors, such as the high-voltage thresholds (0.12, 0.25, 0.5, 20 mV), detection algorithms (average complex interval [ACI] vs interval confidence level), and recording duration (2.5 seconds vs 5 seconds), on the disparities of the CFEs was investigated.
The proportion of the different grades of CFEs depended on the detection algorithm and recording duration. The high-voltage threshold would not affect the consistency of the CFEs irrespective of the different settings of the detection algorithm or recording duration. High-grade CFEs were most consistent with an ACI algorithm and recording duration of 5 seconds (Cronbach's alpha = 0.952). Ablation consisting of a PVI and high-grade CFE sites converted AF directly to sinus rhythm in eight of 11 patients or into atrial tachycardia in one of 11.
The distribution and consistency of the CFE detection depended on the detection algorithm and recording duration, but not on the high-voltage threshold. Under the ACI algorithm and a recording duration of 5 seconds, high-grade CFE sites remained highest consistency.
Pacing and Clinical Electrophysiology 07/2012; 35(8):980-9. · 1.35 Impact Factor
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ABSTRACT: AIMS: It remains unclear as to whether regional atrial substrates of certain areas of the atrium in patients with atrial fibrillation (AF) can be related to sinoatrial node dysfunction. We investigated the relationship between the biatrial substrate characteristics and sinus node function in these patients.METHODS AND RESULTS: The study enrolled 34 patients (aged 57 ± 11 years old; 20 males) who underwent catheter ablation for symptomatic paroxysmal AF. Sinus node dysfunction was defined as having corrected sinus node recovery time longer than 550 ms. Atrial substrate analyses of both atria and atrial conductive properties were investigated in patients with (Group 1) and without sinus node dysfunction (Group 2). The mean global bipolar voltage of both atria and the atrial refractory period were similar between the two groups. Regional analysis showed that the mean bipolar voltage for patients in Group 1 was lower than in Group 2 (1.0 ± 0.3 vs. 2.1 ± 0.7 mV, P < 0.001) only in the sinus node region, while the electrophysiological properties were similar for both groups in other anatomic regions of both atria. The right atrial total activation time was significantly longer (97 ± 9 vs. 89 ± 10 ms, P = 0.023) and the conduction velocity along the crista terminalis was significantly slower (1.0 ± 0.2 vs. 1.2 ± 0.3 m/s, P = 0.019) in Group 1 patients than in Group 2 patients.CONCLUSION: In patients with AF, regional atrial remodelling near the sinus node area was associated with sinus node dysfunction.
Europace 07/2012; · 1.98 Impact Factor
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Tze-Fan Chao,
Hsuan-Ming Tsao,
Kibos Ambrose,
Yenn-Jiang Lin,
Wei-Shiang Lin,
Shih-Lin Chang,
Li-Wei Lo, Yu-Feng Hu,
Ta-Chuan Tuan,
Kazuyoshi Suenari,
Cheng-Hung Li,
Beny Hartono,
Hung-Yu Chang,
Fa-Po Chung,
Dicky A Hanafy,
Wen-Yu Lin,
Shih-Ann Chen
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ABSTRACT: BACKGROUND: Renal dysfunction is recognized as an important risk factor for thromboembolic (TE) events in patients with atrial fibrillation (AF) under medical treatment. OBJECTIVE: To investigate whether renal dysfunction is a useful predictor of TE events among patients receiving AF ablation. We also aimed to determine whether the diagnostic accuracy of the CHA(2)DS(2)-VASc score in predicting TE events could be improved by adding renal dysfunction into the scoring system. METHODS: We enrolled a total of 547 patients with AF who underwent catheter ablation. Renal dysfunction was defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m(2). The clinical end point was the occurrence of TE events (ischemic stroke, transient ischemic attack, or other systemic embolisms) during follow-up after catheter ablation. RESULTS: During a follow-up of 38.9 ± 22.5 months, 16 patients (2.9%) experienced TE events. Both the CHA(2)DS(2)-VASc score and renal dysfunction were independent predictors of TE events in the multivariate analysis. Among patients with a CHA(2)DS(2)-VASc score of 0 or 1, renal dysfunction can further stratify them into 2 groups with different event rates (4.3% vs 0.3%; P = .046). A new scoring system derived by assigning 1 more point representing renal dysfunction to the CHA(2)DS(2)-VASc score could improve its predictive accuracy; the area under the receiver operating characteristic curve increased from 0.84 to 0.88 (P = .043). CONCLUSIONS: Renal dysfunction was a significant risk factor for TE events after catheter ablation of AF and may improve the diagnostic accuracy of the CHA(2)DS(2)-VASc score.
Heart rhythm: the official journal of the Heart Rhythm Society 06/2012; · 4.56 Impact Factor
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ABSTRACT: We report a case with dextrocardia, corrected transposition of the great arteries. He also had an atrial septum defect (ASD) with patch repair. Activation map showed a centrifugal activation from a focal origin on the systemic lower left atrial ASD patch. Ablation of the origin can terminate the atrial tachycardia. (PACE 2012; 35:e306-e308).
Pacing and Clinical Electrophysiology 06/2012; 35(10):e306-8. · 1.35 Impact Factor
