Ablation of persistent atrial fibrillation is still a challenge for the ablationist. Extensive ablation is required under some conditions and could lead to some unintended complications. Here we report a case of atrium-atrioventricular node block complicating multiple catheter ablation procedures for persistent atrial fibrillation. After extensive ablation, including circumferential pulmonary vein ablation, linear ablation at the left atrial roof, mitral isthmus, atrial septum, cavotricuspid isthmus, and complex fractionated atrial electrogram ablation, conduction obstacle was found, and sinus impulse could not travel from the right atrium, atrial septum and left atrium to atrioventricular node. The case indicated that intensive ablation at some key sites, especially the interatrial septum, should be careful during ablation of atrial fibrillation.
Aged ; Atrial Fibrillation ; therapy ; Atrioventricular Block ; diagnosis ; etiology ; Atrioventricular Node ; pathology ; Catheter Ablation ; adverse effects ; Humans ; Male

OBJECTIVETo investigate the effects of histone deacetylase 2 (HDAC2) expression on cell proliferation, apoptosis and migration of laryngeal squamous cell carcinoma (LSCC) Hep-2 cells.

METHODSHDAC2 siRNA and control siRNA were transfected into LSCC Hep-2 cells by lipofectamine 2000, and cells were divided into three experimental groups: untreated group, control siRNA group and HDAC2 siRNA transfection group. Western blotting was utilized to detect the expression of HDAC2 protein in Hep-2 cells. Cell proliferation and apoptosis were investigated by CCK-8 kit and flow cytometry, respectively. Boyden chamber was used to study cell migration. Expressions of cell apoptosis and cell migration related proteins were detected by Western blotting.

RESULTSHDAC2 siRNA significantly down-regulated the expression of HDAC2 protein in LSCC Hep-2 cells. Down-regulation of HDAC2 expression coincided with an inhibition of cell proliferation and migration along with an induced cell apoptosis of Hep-2 cells. Moreover, down-regulation of HDAC2 expression significantly increased the expressions of caspase-3 and caspase-9 proteins but decreased the expressions of matrix metalloproteinases (MMP)-2 and MMP-9 proteins.

CONCLUSIONSHDAC2 may play a pivotal role in the initiation and development of LSCC. Down-regulation of HDAC2 expression mediates cell apoptosis. Cell migration inhibition may be tightly associated with overexpression of caspase-3 and caspase-9 along with down-regulation of MMP-2 and MMP-9 expressions.

Apoptosis ; Carcinoma, Squamous Cell ; metabolism ; pathology ; Caspase 3 ; metabolism ; Caspase 9 ; metabolism ; Cell Line, Tumor ; Cell Movement ; Cell Proliferation ; Down-Regulation ; Histone Deacetylase 2 ; genetics ; metabolism ; Humans ; Laryngeal Neoplasms ; metabolism ; pathology ; Matrix Metalloproteinase 2 ; metabolism ; Matrix Metalloproteinase 9 ; metabolism ; RNA Interference ; RNA, Small Interfering ; genetics ; Transfection

Dextrocardia is a rare anomaly where the heart is located on the right side of the chest instead of the normal left side. Ablation of atrial fibrillation (AF) with such an inverted anatomy may be challenging for the manipulation of the catheters. Here we report a case of dextrocardia who underwent ablation for persistent AF guided by image integration system.
Atrial Fibrillation ; therapy ; Catheter Ablation ; methods ; Dextrocardia ; therapy ; Humans ; Male ; Middle Aged

Dextrocardia is a rare anomaly where the heart is located on the right side of the chest instead of the normal left side.Ablation of atrial fibrillation (AF) with such an inverted anatomy may be challenging for the manipulation of the catheters.Here we report a case of dextrocardia who underwent ablation for persistent AF guided by image integration system.

OBJECTIVETo study the effect and indications of intracranial pressure (ICP) monitoring for frontal lobe contusion patients.

METHODSDuring January 2005-December 2008, 34 cases of frontal lobe contusion received ICP monitoring in our department (monitoring group). Different treatment protocols were adopted according to the results of ICP. Meanwhile 46 cases of same type of head-injured patients who did not undergo ICP monitoring served as control group.

RESULTSWe found that ICP elevated dramatically within 24 hours after head injury if the contusions were located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or dispersed in bilateral lobe. After half a year follow-up and on the basis of Glasgow Coma Scale assessment, the monitoring group showed better outcome than the control group with good recovery in 24 cases (70.6%) , moderate disability in 7 cases (20.6%), severe disability in 2 (5.88%) and death in 1 (2.94%). The outcome of control group displayed good condition in 25 cases (54.3%), moderate disabilities in 8 (17.4%), severe disability in 7 (15.2%), and death in 6 (13.0%).

CONCLUSIONSFrontal lobe contusions are vulnerable and complex head injuries, especially when the contusions are located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or diffused in bilateral lobes. These patients should undergo ICP monitoring regardless of their consciousness status. If ICP elevates over 25 mm Hg, the craniotomy is mandatory and will markedly reduce the mortality and disability of these patients.

Adolescent ; Adult ; Aged ; Contusions ; physiopathology ; Craniocerebral Trauma ; physiopathology ; Female ; Frontal Lobe ; injuries ; Glasgow Coma Scale ; Humans ; Intracranial Pressure ; Male ; Middle Aged

BACKGROUNDThe optimal endpoint for catheter ablation of persistent atrial fibrillation (AF) remains ambiguous. This study investigated the impact of AF termination as a procedural endpoint and the termination mode on long-term clinical outcome.

METHODSTwo hundred and ninety-three patients who underwent stepwise ablation for persistent AF were categorized into the AF termination by ablation group and into the electrical cardioversion (CV) group. Subgroups were also analyzed based on different termination modes. Follow-up assessment included early recurrence and sinus rhythm (SR) maintenance.

RESULTSDuring initial ablation, 33 patients (11.3%) were directly converted to SR, 166 patients (56.7%) were converted to atrial tachycardia (AT) that subsequently restored SR with further ablation in 98 patients (33.4%), and a total of 162 patients (55.3%) underwent cardioversion due to persistent atrial arrhythmias. Comparison between termination by ablation and termination by cardioversion in patients exhibiting AF or AT revealed that no significant difference was observed in early recurrence (38.2% vs. 43.8%, P = 0.328) and SR maintenance (67.2% vs. 59.8%, P = 0.198) during the (23 ± 7) months follow-up. Even after repeat ablation, the SR maintenance continued to exhibit no statistical difference in above two groups (72.5% vs. 70.4%, P = 0.686). Further analysis of subgroups, however, demonstrated that patients with AF terminated directly to SR experienced better clinical outcomes than other subgroups (P < 0.05). Furthermore, atrial arrhythmias present during ablation have been implicated in prediction of recurrence mode: AF or AT (P < 0.05).

CONCLUSIONSTermination as a procedural endpoint is not associated with favorable long-term SR maintenance in persistent AF. AF methods that convert arrhythmia directly to SR have, however, been linked with improved clinical outcomes, although conversions to AT may not be correlated. Atrial arrhythmias observed during the ablation may be used to predict the recurrence mode.

Adult ; Aged ; Atrial Fibrillation ; physiopathology ; therapy ; Catheter Ablation ; methods ; Electrophysiologic Techniques, Cardiac ; Female ; Humans ; Male ; Middle Aged

Catheter Ablation ; methods ; Heart Atria ; surgery ; Heart Defects, Congenital ; surgery ; Humans ; Postoperative Complications ; prevention & control ; Tachycardia, Supraventricular ; prevention & control

BACKGROUNDIt is unclear whether a history of paroxysmal atrial fibrillation (PAF) would impact the effect of catheter ablation on persistent atrial fibrillation (AF). This study aimed to compare the effect of catheter ablation on persistent AF with and without a history of PAF.

METHODSOne hundred and eighty-three patients underwent catheter ablation of persistent AF lasting for > 1 month and were reviewed. Patients were divided into two groups according to whether they had a history of PAF or not. Group I consisted of persistent AF patients with a history of PAF, and group II consisted of persistent AF patients without such a history. All patients received catheter ablation focused on pulmonary vein isolation and were observed for arrhythmia recurrences, which were defined as documented episodes of AF or atrial tachycardia after a blanking period of 3 months.

RESULTSOne hundred and three patients (60.9%) in group I and sixty-six patients (39.1%) in group II were successfully followed and included in analysis. There were no significant differences in clinical and echocardiographic characteristics between both groups except for a younger age and more male patients in group II. After (15.5 ± 10.7) months of follow-up, 59 (57.3%) patients in group I and 49 (74.2%) patients in group II maintained sinus rhythm free of anti-arrhythmia drugs (P = 0.025). Multivariate analyses found left atrial anteroposterior diameter (P = 0.006) and persistent AF with a history of PAF (OR 1.792, 95%CI 1.019 - 3.152; P = 0.043) as the only independent statistical predictors of arrhythmia recurrences.

CONCLUSIONThe arrhythmia recurrence rate of catheter ablation based on pulmonary vein isolation in persistent AF with a history of PAF was higher than those without a history of PAF.

Adult ; Aged ; Atrial Fibrillation ; surgery ; Catheter Ablation ; Female ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Pulmonary Veins ; surgery ; Recurrence

BACKGROUNDExtensive atrial fibrillation (AF) ablation is associated with an increased success rate of catheter ablation in chronic AF patients and an increased rate of atrial tachycardia (AT) during the procedure. The mechanism of these ATs varies in previous studies. Our study aimed to report the mechanism of organized AT occurring during the stepwise ablation procedure of chronic AF.

METHODSA prospective cohort of 86 consecutive patients who underwent an ablation procedure for chronic atrial fibrillation (CAF) was investigated. The stepwise procedure was performed in the following order: circumferential pulmonary vein ablation, complex fractionated atrial electrograms ablation, mapping and ablation of AT. The endpoint was noninducibility of AF/AT after sinus rhythm (SR) was restored or the procedure time was beyond 6 hours.

RESULTSSixty-nine (80%) of patients converted to SR via AT. A total of 179 sustained ATs were observed in 69 patients during the procedure. There were 81% (n = 145) macroreentrant ATs which included 65 perimitral circuits, 48 peritricuspid tachycardia and 32 roof dependent circuits, 12% (n = 21) localized reentrant and 7% (n = 13) focal ATs. Thirty (15%) patients experienced significant left atrium (LA) and LA appendage (LAA) conduction delay or dissociation in the procedure or during the follow-up period.

CONCLUSIONSMost CAF patients converted to SR via ablation of organized AT occurring during the stepwise procedure. The mechanism of most of these ATs was macro-reentry.

Aged ; Atrial Fibrillation ; surgery ; Catheter Ablation ; methods ; Electrophysiology ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Tachycardia, Ectopic Atrial ; surgery ; Treatment Outcome

Background The optimal endpoint for catheter ablation of persistent atrial fibrillation (AF) remains ambiguous.This study investigated the impact of AF termination as a procedural endpoint and the termination mode on long-term clinical outcome.Methods Two hundred and ninety-three patients who underwent stepwise ablation for persistent AF were categorized into the AF termination by ablation group and into the electrical cardioversion (CV) group.Subgroups were also analyzed based on different termination modes.Follow-up assessment included early recurrence and sinus rhythm (SR) maintenance.Results During initial ablation,33 patients (11.3％) were directly converted to SR,166 patients (56.7％) were converted to atrial tachycardia (AT) that subsequently restored SR with further ablation in 98 patients (33.4％),and a total of 162 patients (55.3％) underwent cardioversion due to persistent atrial arrhythmias.Comparison between termination by ablation and termination by cardioversion in patients exhibiting AF or AT revealed that no significant difference was observed in early recurrence (38.2％ vs.43.8％,P=0.328) and SR maintenance (67.2％ vs.59.8％,P=0.198) during the (23±7) months follow-up.Even after repeat ablation,the SR maintenance continued to exhibit no statistical difference in above two groups (72.5％ vs.70.4％,P=0.686).Further analysis of subgroups,however,demonstrated that patients with AF terminated directly to SR experienced better clinical outcomes than other subgroups (P ＜0.05).Furthermore,atrial arrhythmias present during ablation have been implicated in prediction of recurrence mode:AF or AT (P ＜0.05).Conclusions Termination as a procedural endpoint is not associated with favorable long-term SR maintenance in persistent AF.AF methods that convert arrhythmia directly to SR have,however,been linked with improved clinical outcomes,although conversions to AT may not be correlated.Atrial arrhythmias observed during the ablation may be used to predict the recurrence mode.