Ta-Chuan Tuan

Taipei Veterans General Hospital, T’ai-pei, Taipei, Taiwan

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Publications (93)378.18 Total impact

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    ABSTRACT: Atrial fibrillation (AF) is associated with cognitive decline and may contribute to an increased risk of dementia. The goal of the present study was to investigate whether statin use prevented non-vascular dementia in subjects with AF. Data from the National Health Insurance Research Database of Taiwan were used in this study. The study group comprised 51,253 AF subjects aged ≥60years who had received statin treatment. For each study patient, four age- and sex-matched AF subjects without statin exposure were selected as the control group (n=205,012). The risk of non-vascular dementia was compared between the statin and control groups. During the follow-up period, 17,201 patients experienced non-vascular dementia. The annual incidence of non-vascular dementia was lower in the statin group than in the control group (1.89% vs. 2.20%; p<0.001). Statin use exhibited a protective effect on the occurrence of non-vascular dementia, with an adjusted hazard ratio (HR) of 0.832 (95% confidence interval=0.801-0.864). Among statin types, the use of rosuvastatin was associated with the largest risk reduction (adjusted HR=0.661). Statin exposure duration was related inversely to the risk of non-vascular dementia. In this large-scale nationwide cohort study, statin use was associated with a lower risk of non-vascular dementia in AF. Use of more potent statin and longer exposure time may be associated with greater benefits. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International journal of cardiology 10/2015; 196. DOI:10.1016/j.ijcard.2015.05.159 · 6.18 Impact Factor
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    ABSTRACT: Orthostatic hypotension (OH) is a common condition encountered in the elderly. The present study aimed to examine the relationship between OH and adverse events in Asians. We used the "National Health Insurance Research Database" in Taiwan. A total of 1226 patients with OH and without previous history of ischemic stroke and myocardial infarction were identified as the study group. For each study patient, ten age-, sex- and comorbidity-matched subjects without OH were selected to constitute the control group (n=12,260). The clinical endpoints were ischemic stroke, myocardial infarction and all-cause mortality. The mean age of the study population was 54.8±19.0years and males accounted for 47% of the patients. During the follow-up of 4.5±2.9years, 704 (5.2%) patients developed ischemic stroke, 190 (1.4%) patients developed myocardial infarction, and 733 (5.4%) patients died. In the multivariable Cox regression analyses which were adjusted for age, gender and differences in medication usages, OH was significantly associated with an increased risk of ischemic stroke (hazard ratio [HR]=1.40, 95% confidence interval (CI)=1.09-1.81, p=0.009), all-cause mortality (HR=1.35; 95% CI=1.05-1.73, p=0.018) and adverse events (ischemic stroke, myocardial infarction or mortality) (HR=1.41; 95% CI=1.18-1.68, p<0.001). OH is an independent factor associated with ischemic stroke and mortality in Asians. Whether aggressive managements for stroke prevention could improve the outcome for OH patients deserves further study. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Cardiology 05/2015; 195. DOI:10.1016/j.ijcard.2015.05.060 · 6.18 Impact Factor
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    ABSTRACT: Ventricular arrhythmia (VA) can occur during propafenone therapy in atrial fibrillation (AF) patients with structurally normal heart. This study was designed to evaluate the incidence and characteristics of propafenone associated VAs in AF patients with structurally normal heart. First, we studied and compared the risk of new-onset VAs between AF patients with structurally normal heart taking and not taking propafenone in a nationwide longitudinal cohort in Taiwan (n = 127197, since 2000). Then, we investigated the association between propafenone and VA in AF patients with structurally normal heart in a single-center database (n = 396). In the nationwide cohort, 102 patients (0.008% per patient-year) developed ventricular tachycardia (VT)/ ventricular fibrillation (VF) during a follow-up period of 9.8 ± 3.5 years. After multivariate Cox regression analysis, propafenone treatment was a significant risk factor for new-onset VT/VF with a hazard ratio (HR) of 3.59 (95% confidence interval (CI)= 1.30-9.89, p value = 0.0136). Propafenone treatment offered protection against ischemic stroke with HR 0.649 (95% CI =0.55-0.77, p value <0.001).In the single center study using ECG and medical records, presence of inferior J wave, wider QRS, and old age were independent risk factors for VA after adjustment of clinical, biochemical and echocardiographic variables. Albeit low incidence, propafenone therapy for AF was associated new-onset VA in the nationwide longitudinal cohort study in Taiwan. Old age, presence of inferior lead J wave, and wider QRS in ECG were significant risk factors in our single center study. Copyright © 2015. Published by Elsevier Inc.
    Heart rhythm: the official journal of the Heart Rhythm Society 04/2015; DOI:10.1016/j.hrthm.2015.04.018 · 4.92 Impact Factor
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    ABSTRACT: Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an inherited genetic disease caused by defective desmosomal proteins, and it has typical histopathological features characterized by predominantly progressive fibro-fatty infiltration of the right ventricle. Clinical presentations of ARVD/C vary from syncope, progressive heart failure (HF), ventricular tachyarrhythmias, and sudden cardiac death (SCD). The 2010 modified Task Force criteria were established to facilitate the recognition and diagnosis of ARVD/C. An implantable cardiac defibrillator (ICD) remains to be the cornerstone in prevention of SCD in patients fulfilling the diagnosis of definite ARVD/C, especially among ARVD/C patients with syncope, hemodynamically unstable ventricular tachycardia (VT), ventricular fibrillation, and aborted SCD. Further risk stratification is clinically valuable in the management of patients with borderline or possible ARVD/C and mutation carriers of family members. However, given the entity of heterogeneous penetrance and non-uniform phenotypes, the standardization of clinical practice guidelines for at-risk individuals will be the next frontier to breakthrough.
    Journal of Cardiology 03/2015; 65(6). DOI:10.1016/j.jjcc.2014.12.023 · 2.57 Impact Factor
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    ABSTRACT: Although the CHA2DS2-VASc (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) score is recommended by both American and European guidelines for stroke risk stratification in atrial fibrillation (AF), the treatment recommendations for a CHA2DS2-VASc score of 1 are less clear. This study aimed to investigate the risk of ischemic stroke in patients with a single additional stroke risk factor (i.e., CHA2DS2-VASc score = 1 [males] or 2 [females]) and the impact of different component risk factors. We used the National Health Insurance Research Database in Taiwan. Among 186,570 AF patients not on antiplatelet or anticoagulant therapy, we evaluated males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2. The clinical endpoint was the occurrence of ischemic stroke. Among 12,935 male AF patients with a CHA2DS2-VASc score of 1, 1,858 patients (14.4%) experienced ischemic stroke during follow-up (5.2 ± 4.3 years), with an annual stroke rate of 2.75%. Ischemic stroke risk ranged from 1.96%/year for men with vascular disease to 3.50%/year for those 65 to 74 years of age. For 7,900 females with AF and a CHA2DS2-VASc score of 2, 14.9% experienced ischemic stroke for an annual stroke rate of 2.55%. Ischemic stroke risk increased from 1.91%/year for women with hypertension to 3.34%/year for those 65 to 74 years of age. Not all risk factors in CHA2DS2-VASc score carry an equal risk, with age 65 to 74 years associated with the highest stroke rate. Oral anticoagulation should be considered for AF patients with 1 additional stroke risk factor given their high risk of ischemic stroke. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    Journal of the American College of Cardiology 02/2015; 65(7):635-642. DOI:10.1016/j.jacc.2014.11.046 · 15.34 Impact Factor
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    ABSTRACT: Atrial fibrillation (AF) is prevalent in end-stage renal disease (ESRD) patients and negatively impacts patient outcomes. We explored the incidence and risk factors for new-onset AF among patients with ESRD undergoing renal replacement therapy, without a prior history of AF, retrieved from Taiwan's National Health Insurance Research Database (NHIRD). For each of 134,901 patients with ESRD, one age- and gender-matched control and one similarly matched patient with chronic kidney disease (CKD), a total of 404,703 patients, were selected from the NHIRD. The study endpoint was the occurrence of new-onset AF and patients were followed an average of 5.1 years. The incidence rates of AF were 12.1, 7.3, and 5.0 per 1000 person-years for ESRD, CKD, and control patients, respectively. Among patients with ESRD, age, hypertension, heart failure, coronary artery disease, peripheral arterial occlusive disease, and chronic obstructive pulmonary disease were significant risk factors for new-onset AF. Thus, patients with ESRD had a significantly higher risk of new-onset AF. The presence of multiple risk factors was associated with a higher possibility of AF occurrence.Kidney International advance online publication, 14 January 2015; doi:10.1038/ki.2014.393.
    Kidney International 01/2015; 87(6). DOI:10.1038/ki.2014.393 · 8.52 Impact Factor
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    ABSTRACT: Multiform premature ventricular complexes (PVCs) are common electrocardiographic abnormalities in patients with structurally normal hearts. However, the prognostic value of these complexes remains unclear. This study aimed to clarify the role of PVC polymorphism in predicting adverse outcomes. We examined the database for 24-hour electrocardiography monitoring between January 1, 2002 and December 31, 2004. We analyzed 3351 individuals with apparently normal hearts. Kaplan-Meier curves and multivariate Cox proportional hazards models were employed to estimate the effect of multiform PVC and uniform PVC on the number of incident adverse events. Average follow-up time was 10±1years. Patients with multiform PVC were older and had a higher prevalence of comorbidities. In multivariate analysis, patients with multiform PVC had an increased incidence of mortality (hazard ratio [HR]: 1.642, 95% confidence interval [CI]: 1.327-2.031), hospitalization (HR: 1.196, 95% CI: 1.059-1.350), cardiovascular hospitalization (HR: 1.289, 95% CI: 1.030-1.613), new-onset heart failure (HF; HR: 1.456, 95% CI: 1.062-1.997), transient ischemic accident (HR: 1.411, 95% CI 1.063-1.873), and new-onset atrial fibrillation (AF; HR: 1.546, 95% CI: 1.058-2.258) compared to the group without PVC. Patients with multiform PVC had a higher rate of mortality (HR: 1.231, 95% CI: 1.033-1.468) and all cause-hospitalization (HR: 1.147, 95% CI: 1.025-1.283) compared with patients with uniform PVC. The presence of multiform PVC was associated with a higher incidence of mortality, hospitalization, transient ischemic attack, new-onset AF, and new-onset HF independent of other clinical risk factors. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    International Journal of Cardiology 11/2014; 180C:80-85. DOI:10.1016/j.ijcard.2014.11.110 · 6.18 Impact Factor
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    ABSTRACT: A new scoring system, the anticoagulation and risk factors in atrial fibrillation (ATRIA) score, was proposed for risk stratification in patients with atrial fibrillation (AF). Whether the ATRIA scheme can adequately identify patients who are at low risk of ischemic stroke remains unknown.
    Journal of the American College of Cardiology 10/2014; 64(16):1658-65. DOI:10.1016/j.jacc.2014.06.1203 · 15.34 Impact Factor
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    ABSTRACT: Background The implantation of permanent pacemaker (PPM) is life-saving for patients with life-threatening bradycardia. However, the effectiveness and prognosis of PPM implantations for extremely old patients (> 90 years old) have not been investigated before. Methods From 2001-2012, a total of 108 patients older than 90 years were identified from 2,630 consecutive patients receiving PPM implantations in our hospital as the study group. For each study patient, four age-, gender- and comorbidity-matched subjects who did not have the diagnoses of bradyarrhythmias indicated for PPM implantations were selected from the “Taiwan National Health Research Database” to constitute the control group (n = 432). The study endpoint was all-cause mortality. Results The median age of the study population was 91 (inter-quartile range = 90-93) years. Among the PPM group, 45 patients died during the follow-up with an annual mortality rate of 18.7%. The risk of mortality did not differ significantly between the study and control groups with a hazard ratio of 1.020 (95% confidence interval = 0.724-1.437, p value = 0.912) after the adjustment for age and gender. Procedure-related complications occurred in 7.4% of the patients receiving PPM implants, and pocket hematoma was the most common one. The pre-implantation history of heart failure and cerebrovascular accident, rather than age, were significant predictors of mortality among PPM recipients. Conclusions Nonagenarians with severe bradyarrhythmias could retain the same life expectancies as those without bradyarrhythmias through PPM implantations. Extremely old age (> 90 years) should not be a barrier for PPM implants when indications were present.
    The Canadian journal of cardiology 10/2014; 30(10). DOI:10.1016/j.cjca.2014.04.010 · 3.94 Impact Factor
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    ABSTRACT: Background Digoxin and related cardiac glycoside have been used for almost 100 years in atrial fibrillation (AF). However, recent 2 analyses of the “AFFIRM” trial showed non-consistent results about the risk of mortality associated with digoxin use. The goal of the present study is to investigate the relationship between digoxin and the risk of ischemic stroke and mortality in Asians. Methods This study used the “National Health Insurance Research Database” in Taiwan. A total of 4,781 AF patients who did not receive any antithrombotic therapy were selected as the study population. Among the study population, 829 subjects (17.3%) received the digoxin treatment. The risks of ischemic stroke and mortality of patients with or without digoxin use were compared. Results The use of digoxin was associated with an increased risk of clinical events with an adjusted hazard ratio of 1.41 (95% CI =1.17-1.70) for ischemic stroke and 1.21 (95% CI =1.01-1.44) for all-cause mortality. In the subgroup analysis based on the coexistence with heart failure or not, digoxin was a risk factor of adverse events for patients without heart failure, but not for those with heart failure (interaction p<0.001 for either endpoint). Among AF patients without heart failure, the use of beta-blockers was associated with better survival with an adjusted hazard ratio of 0.48 (95% CI = 0.34-0.68). Conclusions Digoxin should be avoided for AF patients without heart failure since it was associated with an increased risk of clinical events. Beta-blockers may be a better choice for controlling ventricular rate.
    The Canadian journal of cardiology 10/2014; 30(10). DOI:10.1016/j.cjca.2014.05.009 · 3.94 Impact Factor
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    ABSTRACT: BACKGROUND The risk of acute myocardial infarction (AMI) in patients with atrial fibrillation (AF) with a CHA(2)DS(2)-VASc score of 0 (for men) or 1 (for women) has not been previously investigated. OBJECTIVE The objective of the present study was to compare the risk of AMI in AF and non-AF subjects with a Low (0 or 1) CHA(2)DS(2)VASc score. METHODS By using the National Health Insurance Research Database in Taiwan, we identified 7254 men with AF (with a CHA(2)DS(2)VASc score of 0) and 4860 women with AF (with a CHA(2)DS(2)-VASc score of 1). For each study patient, 1 age-, sex-, and CHA(2)DS(2)-VASc score-matched subject without AF was randomly selected to constitute the control group (n = 12,114). The clinical end point was the occurrence of AMI. RESULTS During a mean follow-up period of 5.7 L- 3.6 years, 258 patients (1.1%) suffered an AMI, with an annual incidence of 0.29% and 0.100/0 for patients with and without AF. AF was an independent risk factor of AMI, with an adjusted hazard ratio (HR) of 2.93 (95% confidence interval 2.21-3.87; P <.001). The risk of AMI was higher in men with AF than in women with AF, with a hazard ratio of 2.24 (95% confidence interval 1.61-3.11; P <.001) after adjustment for age and other comorbidities. CONCLUSION In patients with a CHA(2)DS(2)-VASc score of 0 or 1, AF was an independent risk factor of AMI. The risk of AMI was higher in men with AF than in women with AF. Cardiovascular risk prevention should be performed as part of the holistic management of AF to minimize the risks of AMI associated with AF.
    Heart rhythm: the official journal of the Heart Rhythm Society 08/2014; 11(11). DOI:10.1016/j.hrthm.2014.08.003 · 4.92 Impact Factor
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    ABSTRACT: Endocardial Unipolar Peak-Negative Voltage Predicts Abnormal Epicardial Substrates. Introduction: The characteristics of endocardial electrograms needed to detect the overlying abnormal epicardial substrates in arrhythmogenic right ventricular cardiomyopathy with epicardial ventricular tachycardia (VT) remain unclear. This study investigated which of the endocardial electrogram characteristics could predict the overlying abnormal epicardial substrates. Methods and Results: In 20 consecutive patients (median age: 46 years, 11 men) undergoing epicardial VT ablation, detailed endocardial and epicardial mappings were obtained by using the CARTO 3 system. The endocardial electrographic characteristics (unipolar peak-to-peak voltage, unipolar peak-negative-voltage, bipolar voltage, and bipolar electrogram duration) of the opposite endocardium and epicardium in RV were retrospectively investigated (N = 1,697 paired points, 84 +/- 60 pairs/patient). Endocardial predictors of the presence of epicardial dense scar (<0.5 mV), low voltage zones (LVZ; <= 1.5 mV), and ablation targets (by using activation mapping, entrainment mapping, and pace mapping) were analyzed. Results: In the multivariable analysis, (1) unipolar peak-negative voltage independently predicted the presence of epicardial LVZ, epicardial dense scar, and ablation targets; (2) bipolar voltage could not predict epicardial lesions; and (3) bipolar electrogram duration predicted epicardial LVZ, but not dense scar or ablation targets. The endocardial unipolar peak-negative voltage of <1.66 mV (89% sensitivity and 53% specificity) was the optimal cutoff point for predicting epicardial dense scar. Conclusions: In patients with RV epicardial VT, the presence of unipolar peak-negative voltage of <1.66 mV in the endocardium predicted the presence of epicardial dense scar (<0.5 mV) and potential ablation targets in the overlying epicardium.
    Journal of Cardiovascular Electrophysiology 07/2014; 25(12). DOI:10.1111/jce.12495 · 2.88 Impact Factor
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    ABSTRACT: Background:Although the link between sleep-disordered breathing (SDB) and atrial fibrillation (AF) has been reported, a population-based longitudinal cohort study was lacking. The goal of the present study was to investigate the AF risk carried by SDB, using the National Health Insurance Research Database in Taiwan.Methods and Results:From 2000 to 2001, a total of 579,521 patients who had no history of cardiac arrhythmias or significant comorbidities were identified. Among them, 4,082 subjects with the diagnosis of SDB were selected as the study group, and the remaining 575,439 subjects constituted the control group. The study endpoint was the occurrence of new-onset AF. During a follow-up of 9.2±2.0 years, there were 4,023 patients (0.7%) experiencing new-onset AF. The occurrence rate of AF was higher in patients with SDB compared to those without it (1.3% vs. 0.7%, P<0.001). The AF incidences were 1.38 and 0.76 per 1,000 person-years for patients with and without SDB, respectively. After anadjustment for age and sex, SDB was a significant risk factor of AF with a hazard ratio of 1.536. The AF risk increased with increasing clinical severity of SDB, represented by the requirement of continuous positive airway pressure use.Conclusions:SDB itself, without the coexistence of other systemic diseases, was a risk factor of AF.
    Circulation Journal 07/2014; 78(9). DOI:10.1253/circj.CJ-14-0222 · 3.69 Impact Factor
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    ABSTRACT: BACKGROUND Renal dysfunction is a significant risk factor for ischemic stroke in atrial fibrillation (AF). However, the incidence of ischemic stroke and how to predict its occurrence among AF patients with end-stage renal disease (ESRD) are unclear. OBJECTIVE The purpose of this study was to compare the CHADS2 and CHA2DS2-VASc scores for stroke risk stratification in AF patients with ESRD. METHODS A total of 10,999 AF patients with ESRD undergoing renal replacement therapy who were not receiving oral anticoagulants or antiplatelet agents were identified from Taiwan's National Health Insurance Research Database. The study endpoint was occurrence of ischemic stroke. RESULTS The median (interquartile) CHADS2 and CHA2DS2-VASc scores for the study cohort were 3 (2-5) and 5 (4-7), respectively. During follow-up, 1217 patients (11.7%) experienced ischemic stroke, with an incidence rate of 6.9 per 100 person-years. In Cox regression models, the CHADS2 and CHA2DS2-VASc scores both were significant predictors of ischemic stroke. C-indexes for CHADS2 and CHA2DS2-VASc were 0.608 and 0.682, respectively (P <.001). CHA2DS2-VASc improved the net reclassification index by 4.8% compared with CHADS2 (P <.0001). Among 1409 patients with a CHADS2 score of 0 or 1, the CHA2DS2-VASc score ranged from 1 to 4, with event rates ranging from 2.1 to 4.7 per 100 person-years. CONCLUSION The CHA2DS2-VASc score was useful in predicting ischemic stroke in AF patients with ESRD undergoing dialysis and was superior to the CHADS2 score. The net clinical benefit balancing stroke reduction against major bleeding with anticoagulation in these high-risk patients remains to be defined.
    Heart rhythm: the official journal of the Heart Rhythm Society 06/2014; 11(10). DOI:10.1016/j.hrthm.2014.06.021 · 4.92 Impact Factor
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    ABSTRACT: BACKGROUND Radiofrequency catheter ablation (RFCA) is an effective therapeutic strategy in eliminating drug-refractory idiopathic right ventricular outflow tract ventricular arrhythmias (RVOT VAs). It remains unclear what factors affect early and late VA recurrences after ablation. OBJECTIVE The aim of our study was to elucidate the differences between early and late recurrences after acute successful RFCA of RVOT VAs in a Long-term follow-up. METHODS A total of 220 patients with acute successful RFCA of RVOT VAs were enrolled. Detailed clinical characteristics and assessments by noninvasive and invasive electrophysiology study were explored to predict the overall, early ( <1 year), and late VA ( > 1 year) recurrences. RESULTS During a mean follow-up of 34.15 33.74 months, 45 of 220 patients (20.5%) documented recurrence of RVOT VAs after the initial RFCA. Of these patients, 26 patients (57.8%) with recurrent VAs showed similar morphology, and 19 (42.2%) were different. Patients with recurrent VAs were associated with a higher incidence of hypertension, higher systolic blood pressure, identification of foci by pace mapping alone, shorter earliest activation time, more radiofrequency pulses required, and VA originating from the anterior free wall. Multivariate analysis demonstrated that mapping strategy and shorter earliest activation time preceding VA were associated with early recurrences (hazard ratio [HR] 2.26; 95% confidence interval [CI] 1.49-3.42; P <.001; and HR 0.91; 95% CI 0.85-0.98; P =.008, respectively), whereas hypertension was associated with late recurrence (HR 3.48; 95% CI 1.34-9.07; P =.001). CONCLUSION RFCA is an effective strategy in the elimination of RVOT VAs. However, early and late recurrences occur commonly. Patients with early and late VA recurrences demonstrated nonuniform patterns
    Heart rhythm: the official journal of the Heart Rhythm Society 06/2014; 11(10). DOI:10.1016/j.hrthm.2014.06.011 · 4.92 Impact Factor
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    ABSTRACT: Signal averaged electrocardiogram (SAECG) is a specific and non-invasive tool useful for arrhythmogenic right ventricular cardiomyopathy (ARVC) diagnosis. However, its role in risk stratification of patients with ARVC remains largely undefined. Sixty-four patients fulfilling Task Force ARVC criteria (mean age: 47±14years-old, 56% male, 50% definite ARVC) were enrolled. The baseline demographic, electrocardiographic, structural, and electrophysiological characteristics were collected. Patients with SAECG fulfilling all 3 Task Force criteria (3+ SAECG) were categorized into group 1, and those fulfilled 2 or less criterion were categorized into group 2. The study endpoints were unstable ventricular arrhythmia (VA), device detectable sustained fast VA (cycle lengths <240ms) and cardiovascular death. During a mean follow-up of 21±20months, 15 primary endpoints including 12 unstable VAs and 3 device-detected fast VAs were met. One patient died of electrical storm, and one patient underwent heart transplantation. The presence of 3+ SAECG predicted malignant events in all patients with definite and non-definite ARVC (p<0.01, OR=30.5, 95% CI=2.5-373.7) and in patients with definite ARVC alone (p=0.03, OR=11.1, 95% CI=1.3-93.9). Patients diagnosed with non-definite ARVC without 3+ SAECG were free from malignant events. SAECG fulfilling all 3 Task Force criteria was an independent risk predictor of malignant events in ARVC patients. SAECG may play a valuable role in ARVC risk stratification.
    International journal of cardiology 04/2014; 174(3). DOI:10.1016/j.ijcard.2014.04.169 · 6.18 Impact Factor
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    ABSTRACT: Background A new risk model, the R2CHADS2 score, was proposed to be a powerful scoring scheme in predicting stroke or systemic embolism in atrial fibrillation (AF). The goal of the present study is to validate the usefulness of R2CHADS2 score among AF patients after catheter ablations. We also aimed to compare the accuracies of the CHA2DS2-VASc and R2CHADS2 scores for risk stratifications of thromboembolic (TE) events after ablation procedures. Methods We enrolled a total of 526 patients with AF who underwent catheter ablation. The clinical endpoint was the occurrence of TE events (ischemic stroke, transient ischemic attack, or other systemic embolisms) during the post-ablation follow-up. Results During a follow-up of 37.5+21.3 months, 14 patients (2.7%) experienced TE events. The R2CHADS2 score was an independent predictor of TE events in the multivariate analysis. Patients with a R2CHADS2 score of > 2 had a higher event rate compared to those with a score of 0 or 1 (0.5% versus 7.7%). The areas under the ROC curves of CHA2DS2-VASc and R2CHADS2 scores in predicting TE events were 0.832 and 0.872, respectively. The difference between these 2 curves did not reach statistical significance (p value = 0.338). In addition, the R2CHADS2 score did not improve net stroke risk reclassification over the CHA2DS2-VASc score (net reclassification improvement = -0.9%, p value = 0.948). Conclusions The R2CHADS2 and CHA2DS2-VASc scores could be used to predict TE events for AF patients receiving catheter ablations. The predictive accuracies of both scores were similar in this relatively small-sized cohort undergoing ablation.
    The Canadian journal of cardiology 04/2014; DOI:10.1016/j.cjca.2014.01.005 · 3.94 Impact Factor
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    ABSTRACT: Background Radiofrequency catheter ablation (RFCA) is an effective therapeutic strategy in eliminating drug-refractory idiopathic right ventricular outflow tract ventricular arrhythmias (RVOT VAs). It remains unclear what factors influence early and late VA recurrences after ablation. Objectives The aim of our study was to elucidate the differences between early and late recurrences after acute successful RFCA of RVOT VAs in a long-term follow-up. Methods A total of 220 patients with acute successful RFCA of RVOT VAs were enrolled. Detailed clinical characteristics and assessments by non-invasive and invasive electrophysiological studies were explored to predict the overall, early (≤ 1 year), and late VA recurrences (>1 year). Results During a mean follow-up of 34.15±33.74 months, 45 of the 220 patients (20.5%) documented recurrence of RVOT VAs after initial RFCA. Of them, 26 (57.8%) recurrent VA showed similar morphology, and 19 (42.2%) were different. Patients with recurrent VAs were associated with higher incidence of hypertension, higher systolic BP, identification of foci by pacemapping alone, shorter earliest activation time, more RF pulses required, and VA originating from anterior free wall. Multivariate analysis demonstrated that mapping strategy and shorter earliest activation time preceding VA were associated with early recurrences (P<0.001, HR:2.26, 95% CI: 1.49~3.42; P=0.008, HR:0.91, 95% CI: 0.85~0.98, respectively), whereas hypertension was associated with late recurrence (P=0.001, HR:3.48, 95% CI: 1.34~9.07). Conclusion RFCA is an effective strategy in elimination of RVOT VAs. However, early and late recurrences occur commonly. Patients with early and late VA recurrences demonstrated non-uniform patterns of clinical characteristics and electrophysiological properties.
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    ABSTRACT: Background Renal dysfunction is a significant risk factor of ischemic stroke in atrial fibrillation (AF). However, the incidence of ischemic stroke and how to predict its occurrence amongst AF patients with end-stage renal disease (ESRD) are unclear. Objective The goal of the present study was to compare the CHADS2 and CHA2DS2-VASc scores for stroke risk stratification in AF patients with ESRD. Methods A total of 10,999 AF patients with ESRD undergoing renal replacement therapy who were not receiving oral anticoagulants or antiplatelet agents were identified from Taiwan’s National Health Insurance Research Database. The study endpoint was occurrence of ischemic stroke. Results The median (IQR) CHADS2 and CHA2DS2-VASc scores for the study cohort were 3 (2-5) and 5 (4-7), respectively. During the follow-up, 1,217 patients (11.7%) experienced ischemic stroke, with an incidence rate of 6.9 per 100 person-years. In Cox regression models, the CHADS2 and CHA2DS2-VASc scores were both significant predictors of ischemic stroke. C-indexes for CHADS2 and CHA2DS2-VASc were 0.608 and 0.682, respectively (p<0.001). CHA2DS2-VASc improved the net reclassification index by 4.8% compared with CHADS2 (p<0.0001). Among 1,409 patients with a CHADS2 score of 0 or 1, the CHA2DS2-VASc score ranged from 1 to 4, with event rates ranging from 2.1 to 4.7 per 100 person-years. Conclusions The CHA2DS2-VASc score was useful in predicting ischemic stroke in AF patients with ESRD undergoing dialysis, and was superior to CHADS2. The net clinical benefit balancing stroke reduction against major bleeding with anticoagulation in these high risk patients remains to be defined.
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    ABSTRACT: It is unclear whether atrial fibrillation (AF) adversely influences the clinical course of patients with hepatocellular carcinoma (HCC). During the period from January 1, 2001 to December 31, 2010, 476 patients (mean ± SD age 60.3 ± 12.9 years) diagnosed with HCC were retrospectively enrolled in our study. The HCC stage, treatment, baseline characteristics, underlying cardiovascular diseases, and corresponding drug treatment were systematically reviewed. The primary endpoint was death from any cause. AF was associated with a significantly reduced survival time in patients with HCC (AF vs. non-AF patients mean ± SD survival time 470.1 ± 89.6 days vs. 1161.2 ± 32.6 days, log-rank p < 0.001; probability of survival 0.20, 95% confidence interval 0.10-0.38, p < 0.001). After adjustment for gender and age, AF was still associated with poorer survival times (hazard ratio 4.131, 95% confidence interval 2.134-5.733, p < 0.001). The causes of death among 22 patients with both HCC and AF included 11 cases of hepatic failure, four cases of ruptured tumor, and two cases of bleeding from esophageal varices. None of these patients with AF used warfarin. Seven bleeding events related to HCC were noted, but none of these patients developed a major thromboembolism. The mean ± SD follow-up period was 645 ± 468 days. Patients with HCC had a significantly reduced survival time with the comorbidity of AF. Tumor rupture was relatively common among patients with both HCC and AF. The anticoagulation treatment of AF in patients with HCC deviated from the current guidelines without an increase in thromboembolic events.
    Journal of the Chinese Medical Association 12/2013; DOI:10.1016/j.jcma.2013.11.004 · 0.89 Impact Factor

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1k Citations
378.18 Total Impact Points

Institutions

  • 2005–2015
    • Taipei Veterans General Hospital
      • Cardiology Division
      T’ai-pei, Taipei, Taiwan
  • 2003–2015
    • National Yang Ming University
      • • School of Medicine
      • • Institute of Clinical Medicine
      T’ai-pei, Taipei, Taiwan
  • 2009
    • University of the Ryukyus
      • Faculty of Medicine
      Okinawa, Okinawa, Japan