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Su-Jung Chen,
Tze-Fan Chao,
Yenn-Jiang Lin,
Li-Wei Lo,
Yu-Feng Hu,
Ta-Chuan Tuan,
Tsui-Lieh Hsu,
Wen-Chung Yu,
Hsin-Bang Leu,
Shih-Lin Chang, Shih-Ann Chen
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ABSTRACT: Many cardiac diseases demonstrate seasonal variations in the incidence and mortality. This study was designed to investigate whether the mortality of infective endocarditis (IE) was higher in cool seasons and to evaluate the effects of cool climate for IE. We enrolled 100 IE patients with vegetations in our hospital. The temperatures of the IE episodes were defined as the monthly average temperatures of the admission days. The average temperatures in the cool (fall/winter) and warm seasons (spring/summer) were 19.2°C and 27.6°C, respectively. In addition, patients admitted with the diagnosis of IE were identified from the National Health Insurance Research Database (NHIRD) and the in-hospital mortality rates in cool and warm seasons were compared to validate the findings derived from the data of our hospital. The mortality rate for IE was significantly higher in fall/winter than in spring/summer which presents consistently in the patient population of our hospital (32.7% versus 12.5%, p = 0.017) and from NHIRD (10.4% versus 4.6%, p = 0.019). IE episodes which occurred during cool seasons presented with a higher rate of heart failure (44.2% versus 22.9%, p = 0.025) and D-dimer level (5.5 ± 3.8 versus 2.4 ± 1.8 μg/ml, p = 0.017) at admission than that of warm seasons. These results may reflect the impact of temperatures during the pre-hospitalized period on the disease process. In the multivariate analysis, Staphylococcal infection, left ventricular hypertrophy, left ventricular systolic dysfunction and temperature were the independent predictors of mortalities in IE patients.
International Journal of Bioclimatology Biometeorology 03/2012; 56(5):973-81. · 2.25 Impact Factor
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Tze-Fan Chao,
Kibos Ambrose,
Hsuan-Ming Tsao,
Yenn-Jiang Lin,
Shih-Lin Chang,
Li-Wei Lo,
Yu-Feng Hu,
Ta-Chuan Tuan,
Kazuyoshi Suenari,
Cheng-Hung Li,
Beny Hartono,
Hung-Yu Chang,
Tsu-Juey Wu, Shih-Ann Chen
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ABSTRACT: Catheter ablation of paroxysmal atrial fibrillation has been performed for more than 10 years. However, data about the long-term results were limited.
To evaluate the long-tem efficacy following paroxysmal atrial fibrillation ablation and to investigate whether there were different patterns of recurrences in patients with different CHADS(2) scores.
A total of 238 patients with paroxysmal atrial fibrillation who received a catheter ablation from 2004 to 2007 were enrolled. Free of recurrence was defined as the absence of atrial arrhythmias without using any antiarrhythmic agents after ablation.
There were 121 patients (50.8%) suffering from recurrences after the first ablation procedure during a median follow-up period of 5 years. The CHADS(2) score and left atrial diameter were significant predictors of recurrences in the multivariate analysis. Different patterns of recurrence were observed in different groups of patients categorized on the base of CHADS(2) score. Among patients with a CHADS(2) score of ≥3 without recurrences at 2 years postablation, 63.6% experienced episodes of arrhythmias during the subsequent follow-up period. In contrast, in patients with a CHADS(2) score of 0 without recurrences at 2 years postablation, the future recurrence rate was only 2.7%.
After a successful ablation, recurrences may continue to occur without reaching a plateau during the long-term follow-up, especially in patients with a high CHADS(2) score. The optimal follow-up strategy may differ and should be individualized for patients with different scores.
Heart rhythm: the official journal of the Heart Rhythm Society 03/2012; 9(8):1185-91. · 4.56 Impact Factor
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Hugh Calkins,
Karl Heinz Kuck,
Riccardo Cappato,
Josep Brugada,
A John Camm, Shih-Ann Chen,
Harry J G Crijns,
Ralph J Damiano,
D Wyn Davies,
John DiMarco, [......],
Stanley Nattel,
Douglas L Packer,
Carlo Pappone,
Eric Prystowsky,
Antonio Raviele,
Vivek Reddy,
Jeremy N Ruskin,
Richard J Shemin,
Hsuan-Ming Tsao,
David Wilber
Heart rhythm: the official journal of the Heart Rhythm Society 03/2012; 9(4):632-696.e21. · 4.56 Impact Factor
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Hugh Calkins,
Karl Heinz Kuck,
Riccardo Cappato,
Josep Brugada,
A John Camm, Shih-Ann Chen,
Harry J G Crijns,
Ralph J Damiano,
D Wyn Davies,
John DiMarco, [......],
Stanley Nattel,
Douglas L Packer,
Carlo Pappone,
Eric Prystowsky,
Antonio Raviele,
Vivek Reddy,
Jeremy N Ruskin,
Richard J Shemin,
Hsuan-Ming Tsao,
David Wilber
Europace 03/2012; 14(4):528-606. · 1.98 Impact Factor
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Hugh Calkins,
Karl Heinz Kuck,
Riccardo Cappato,
Josep Brugada,
A John Camm, Shih-Ann Chen,
Harry J G Crijns,
Ralph J Damiano,
D Wyn Davies,
John DiMarco, [......],
Stanley Nattel,
Douglas L Packer,
Carlo Pappone,
Eric Prystowsky,
Antonio Raviele,
Vivek Reddy,
Jeremy N Ruskin,
Richard J Shemin,
Hsuan-Ming Tsao,
David Wilber
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ABSTRACT: This is a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation, developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology and the European Cardiac Arrhythmia Society (ECAS), and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). This is endorsed by the governing bodies of the ACC Foundation, the AHA, the ECAS, the EHRA, the STS, the APHRS, and the HRS.
Journal of Interventional Cardiac Electrophysiology 03/2012; 33(2):171-257. · 1.17 Impact Factor
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Cheng-Hung Li,
Yenn-Jiang Lin,
Jin-Long Huang,
Tsu-Juey Wu,
Chen-Chuan Cheng,
Wei-Shiang Lin,
Ta-Chuan Tuan,
Shih-Lin Chang,
Li-Wei Lo,
Yu-Feng Hu,
Tze-Fan Chao,
Fa-Po Chung,
Chin-Feng Tsai,
Hsuan-Ming Tsao, Shih-Ann Chen
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ABSTRACT: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a major cause of sudden cardiac death due to tachyarrhythmias. The purpose of this study was to investigate the long-term prognosis in patients with ARVC and the incidence of rapid ventricular arrhythmias during follow-up.
Thirty ARVC patients (19 male, 63.3%, mean age 48 ± 15 years) fulfilling modified Task Force criteria 2010 were included. Of them, 13 patients (43.3%) received implantable cardioverter-defibrillator (ICD) implantation. Rapid ventricular arrhythmia was defined as electrical storm or the occurrence of ventricular tachycardia (VT) or ventricular fibrillation (VF) with a cycle length of 240 ms or less that necessitate shock delivery to 2 or more times within a 24-hour period.
With a mean follow-up of 68 ± 10 months, 6 patients (20%) with ICD implantation had recurrent rapid VT/VF. One (3.3%) of them died of multiple shocks and SCD, and 5 (16.7%) had multiple ICD therapies due to VT/VF and electrical storm. The interval between the diagnosis of ARVC and occurrence of rapid VT/VF was 13.4 ± 4.9 months. Most (5/6, 83.3%) events of recurrent rapid VT/VF occurred within 2 years. Ablated patients who did not receive an ICD implant were totally free of rapid VT/VF.
For patients with ARVC, long-term prognosis is favorable. During a long-term follow-up, patients meeting the criteria for ICD implantation have a higher rate of rapid and potentially life-threatening arrhythmias. However, early and clustered recurrence of rapid VT/VF in patients with an ICD is common, whereas late occurrence of rapid VT/VF is very rare.
Journal of Cardiovascular Electrophysiology 02/2012; 23(7):750-6. · 3.06 Impact Factor
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Yu-Feng Hu,
Hung-I Yeh,
Hsuan-Ming Tsao,
Ching-Tai Tai,
Yenn-Jiang Lin,
Shih-Lin Chang,
Li-Wei Lo,
Ta-Chuan Tuan,
Kazuyoshi Suenari,
Cheng-Hung Li,
Tze-Fan Chao, Shih-Ann Chen
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ABSTRACT: Heat shock protein (HSP) 27 is related to the pathogenesis of AF. However, the clinical relationship between HSP27 and AF is unclear. The present study was conducted to determine the clinical relationship between HSP27 and atrial fibrillation (AF).
A case-control study was conducted (AF, n=114; control, n=100). Serum HSP27 (HSP27S) levels were measured by ELISA, and its correlations with electrophysiological characteristics and catheter ablation outcomes were investigated. The patients with AF had a larger left atrial diameter (LAD), waist circumference, and body mass index, and a lower baseline HSP27S level, than controls. After logistic multivariate analysis, low baseline HSP27S was independently associated with AF. In patients with AF, those with paroxysmal AF (PAF) had higher baseline HSP27S levels compared with those without PAF. In patients with PAF, lower baseline HSP27S was associated with larger LAD, whereas baseline HSP27S was not correlated with LAD in controls. In PAF, low baseline HSP27S (≤3.85 ng/mL) was associated with low atrial voltage and nonpulmonary vein ectopies. In non-PAF, the mean fractionated interval had a good correlation with baseline HSP27S. After catheter ablation, a high baseline HSP27S level could predict sinus rhythm maintenance in the patients with PAF. Baseline HSP27S was also correlated with interleukin 10 and tumor necrosis factor-α levels. Analysis of buffy coat mRNA levels showed the same correlations.
The HSP27S levels were correlated with LAD, left atrial voltage, and fractionated intervals, and predicted AF recurrence after catheter ablation. The mechanisms could be related to inflammation.
Circulation Arrhythmia and Electrophysiology 02/2012; 5(2):334-40. · 6.46 Impact Factor
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ABSTRACT: The detail of biatrial activation during sustained atrial fibrillation (AF) has not been investigated until now.
Five dogs with right ventricular pacing-induced congestive heart failure (CHF) and five normal dogs were included. Biatrial endocardiac mapping was performed using noncontact mapping system.
Noncontact mapping of the right atrium (RA) showed CHF dogs had a higher frequency of focal discharge from Bachmann's bundle, sinoatrial region, and crista terminalis. CHF dogs also had a higher frequency of wave break, wave fusion, and reentry. CHF dogs had greater effective refractory period (ERP) dispersion. Noncontact mapping of the left atrium (LA) showed CHF dogs had more frequent focal discharge from left superior pulmonary vein (PV), right superior PV, and left atrial appendage. CHF dogs had a higher frequency of wave break, wave fusion, and reentry. CHF dogs had greater ERP dispersion. Comparison between RA and LA showed LA had a higher frequency of focal discharge, wave break, wave fusion, and leading circle reentry than the RA. LA also had greater ERP dispersion than RA.
CHF dogs had a higher frequency of focal discharge and reentry, suggesting that CHF provided an arrhythmogenic substrate. LA had a higher frequency of focal discharge and reentry, suggesting that LA is more important to maintain AF.
Pacing and Clinical Electrophysiology 02/2012; 35(2):188-95. · 1.35 Impact Factor
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ABSTRACT: Long QT syndrome (LQTS) is associated with a high incidence of atrial fibrillation (AF), but the underlying mechanisms are unclear. Pulmonary veins (PVs) play a critical role in AF genesis. Type 3 LQTS increases late sodium current (I(Na,L) ), which may increase PV arrhythmogenesis and AF. Therefore, this study examines PV arrhythmogenesis in anemonia sulcata toxin II (ATX-II)-induced type 3 LQTS and evaluates whether the I(Na,L) inhibitor ranolazine can suppress PV arrhythmogenesis.
Conventional microelectrodes were used to record the action potentials (AP) and contractility in isolated rabbit PV specimens before and after ATX-II administration with or without ranolazine.
Anemonia sulcata toxin II (100 nM) increased the PV spontaneous rates from 2·0 ± 0·1 to 2·9 ± 0·2 Hz (n = 7), induced PV burst firing (100%) with the genesis of early afterdepolarization (EAD) (86%) and prolonged the AP duration. Ranolazine (0·1, 1 and 10 μM) dose dependently reduced the PV spontaneous rates from 2·5 ± 0·2 to 2·3 ± 0·2 Hz, 1·9 ± 0·2 and 1·5 ± 0·3 Hz (P < 0·05) and decreased the diastolic tension by 40 ± 19%, 87 ± 26% and 113 ± 28%. In the presence of ranolazine (10 μM), ATX-II (100 nM) further increased the AP duration. However, ATX-II neither increased the PV spontaneous rates (1·6 ± 0·1 vs. 1·7 ± 0·2 Hz, n = 7) nor induced PV burst firing or EAD. Moreover, ranolazine (10 μM) reduced ATX-II-induced PV acceleration and EAD.
The I(Na,L) enhancer ATX-II can increase PV arrhythmogenesis, which can be attenuated or blocked by ranolazine. This suggests that AF may be related to type 3 LQTS through increased I(Na,L) .
European Journal of Clinical Investigation 02/2012; 42(8):823-31. · 3.02 Impact Factor
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ABSTRACT: The burden of atrial fibrillation (AF) and the lack of data on AF and its management in the Asia Pacific highlight the need for a comprehensive prospective study of AF management in this region. To address this need, the REgistry on Cardiac rhythm disORDers (RecordAF-Asia Pacific [AP]) has been initiated to assess the management of AF in 8 countries across the Asia Pacific. RecordAF-AP is a prospective, observational survey of the management of recently diagnosed AF with 1 year of follow-up. Eligible patients with AF, treated or not, were included in the registry; with data recorded prospectively during the follow-up visits at 6 and 12 months. A total of 2,721 patients with AF were recruited, of whom 2,629 were eligible for evaluation (intent-to-treat population). At study inclusion, rhythm- and rate-control strategies were applied to 37% (n = 959) and 62% (n = 1,610) of the patients, respectively. At baseline, the rhythm-control patients were mainly prescribed class III agents (49%), class Ic agents (39%), or β blockers (except for sotalol; 35%). The rate-control patients were mainly prescribed β blockers (except for sotalol; 57%) or cardiac glycosides (32%). Patients receiving rate-control strategies were more likely to have a history of heart failure or valvular heart disease and persistent AF. In contrast, those receiving rhythm-control strategies were more likely to have recently diagnosed or paroxysmal AF. In conclusion, RecordAF-AP will provide much needed insight into the real-life management of patients with AF in the Asia Pacific region.
The American journal of cardiology 11/2011; 109(3):378-82. · 3.58 Impact Factor
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Stuart J Connolly,
A John Camm,
Jonathan L Halperin,
Campbell Joyner,
Marco Alings,
John Amerena,
Dan Atar,
Álvaro Avezum,
Per Blomström,
Martin Borggrefe, [......],
Denis Xavier,
Jun Zhu,
Jun-Ren Zhu,
Lydie Baret-Cormel,
Estelle Weinling,
Christoph Staiger,
Salim Yusuf,
Susan Chrolavicius,
Rizwan Afzal,
Stefan H Hohnloser
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ABSTRACT: Dronedarone restores sinus rhythm and reduces hospitalization or death in intermittent atrial fibrillation. It also lowers heart rate and blood pressure and has antiadrenergic and potential ventricular antiarrhythmic effects. We hypothesized that dronedarone would reduce major vascular events in high-risk permanent atrial fibrillation.
We assigned patients who were at least 65 years of age with at least a 6-month history of permanent atrial fibrillation and risk factors for major vascular events to receive dronedarone or placebo. The first coprimary outcome was stroke, myocardial infarction, systemic embolism, or death from cardiovascular causes. The second coprimary outcome was unplanned hospitalization for a cardiovascular cause or death.
After the enrollment of 3236 patients, the study was stopped for safety reasons. The first coprimary outcome occurred in 43 patients receiving dronedarone and 19 receiving placebo (hazard ratio, 2.29; 95% confidence interval [CI], 1.34 to 3.94; P=0.002). There were 21 deaths from cardiovascular causes in the dronedarone group and 10 in the placebo group (hazard ratio, 2.11; 95% CI, 1.00 to 4.49; P=0.046), including death from arrhythmia in 13 patients and 4 patients, respectively (hazard ratio, 3.26; 95% CI, 1.06 to 10.00; P=0.03). Stroke occurred in 23 patients in the dronedarone group and 10 in the placebo group (hazard ratio, 2.32; 95% CI, 1.11 to 4.88; P=0.02). Hospitalization for heart failure occurred in 43 patients in the dronedarone group and 24 in the placebo group (hazard ratio, 1.81; 95% CI, 1.10 to 2.99; P=0.02).
Dronedarone increased rates of heart failure, stroke, and death from cardiovascular causes in patients with permanent atrial fibrillation who were at risk for major vascular events. Our data show that this drug should not be used in such patients. (Funded by Sanofi-Aventis; PALLAS ClinicalTrials.gov number, NCT01151137.).
New England Journal of Medicine 11/2011; 365(24):2268-76. · 53.30 Impact Factor
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ABSTRACT: The literature suggests that the prevalence of atrial fibrillation (AF) may be lower in Asian countries than in Western countries. Nevertheless, AF remains a significant public health problem in the region. The burden of AF, the experiences of previous trials and the lack of data on AF and its management in Asia Pacific highlight the need for a comprehensive prospective study of AF management.
The REgistry on Cardiac rhythm disORDers assessing the control of Atrial Fibrillation Asia Pacific (RecordAF-AP) is a prospective, observational survey of the management of recently diagnosed AF patients with 1-year follow-up in 8 countries across Asia Pacific. Eligible patients presenting with AF, treated or not, will be included in the registry and data will be recorded prospectively during follow-up visits at 6 and 12 months.
RecordAF-AP will recruit more than 3000 patients. Study recruitment commenced in April 2009 and the final results anticipated at the end of 2011.
RecordAF-AP will assess the real-life management of AF patients in Asia Pacific, including a comparison of clinical outcomes in rhythm versus rate control strategies, providing much needed insight into the costs, treatment choices and clinical outcomes of AF patients in this region.
Clinical Medicine Insights. Cardiology. 01/2011; 5:1-6.
