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Background: Lambl's excrescences (LEs) are excrescences with an extremely low incidence, mainly ultrasound diagnosed. Increasingly, LEs are detected by transesophageal echocardiography before catheter ablation, which raises safety concerns on whether LEs were associated with an embolism event during or after ablation, but clinical data are still lacking., Methods and Results: We consecutively recruited 8081 patients with atrial fibrillation who underwent radiofrequency catheter ablation in Beijing Anzhen Hospital from Jan 1, 2017 to Dec 31, 2019. Total 21 patients (0.3%) were diagnosed as LEs with an average age of 70.8 ± 8.9 years, and 38.1% were male. Persistent atrial fibrillation (PeAF) and paroxysmal atrial fibrillation (PAF) accounted for 57.1% (12 cases) and 42.9% (nine cases), respectively. LEs were mostly frequently observed on the aortic valve (18 cases, 75%) and mitral valve (six cases, 25%). Precisely, the noncoronary cusp is ranked first in terms of the LEs presence (seven cases, 29.2%), followed by the right coronary cusp (six cases, 25.0%), the left coronary cusp (five cases, 20.8%), the anterior mitral valve (four cases, 16.7%), and the posterior mitral valve (two cases, 8.3%). During the ablation for LEs patients, the average procedure time was 96.0 ± 22.4 min; the average fluoroscopy time was 4.2 ± 0.8 min; the average total ablation time was 20.6 ± 5.6 min; and the mean hospital stay was 3.3 ± 0.6 days. No patients suffered from serious complications during the procedure. Furthermore, no cardiovascular event was observed during a follow-up of 19.1 ± 11.8 months., Conclusions: There was no clear association between LEs with intraoperative embolism events or cardiovascular events during the follow-up period., (© 2022 Wiley Periodicals LLC.)

Background: Catheter ablation of perimitral atrial tachycardia (PMAT) is challenging. Epicardial conduction of the Marshall bundle (MB) across the mitral isthmus (MI) remains an important cause of recurrent tachycardia. The role of ethanol infusion into the vein of Marshall (EI-VOM) for PMAT has not been fully elucidated., Methods: The study enrolled 28 consecutive patients with recurrent PMAT after atrial fibrillation (AF) ablation. Conventional PMAT (group 1, n = 15) and MB-related PMAT (group 2, n = 13) were diagnosed by detailed activation mapping and entrainment mapping. VOM venography and EI-VOM were first performed, and additional ablation was performed if necessary., Results: The VOM was accessible in 24 (85.7%) patients (12 [80%] in group 1 and 12 [92.3%] in group 2). Patients with MB-related PMAT were more responsive to EI-VOM (as shown by PMAT termination or tachycardia cycle length prolongation) (92.4% vs 53.3%, P = .038). In the 16 patients requiring additional ablation after EI-VOM, all residual MI conduction gaps were located on the annular side of the MI. At the end of the procedure, MI bidirectional block was achieved in 14 (93.3%) patients in group 1 and in 12 (92.3%) patients in group 2 (P = 1.000). After a mean follow-up of 7.5 ± 3.1 months, three (10.7%) patients had recurrent AT., Conclusions: EI-VOM is feasible and effective in the treatment of PMAT after AF ablation, especially in patients with MB-related PMAT., (© 2020 Wiley Periodicals LLC.)

Introduction: Radiofrequency catheter ablation (RFCA) is widely used to treat atrial fibrillation (AF) in China., Objective: We aimed to determine the long-term cost effectiveness of RFCA versus antiarrhythmic drugs (AADs) in treating AF from the perspective of third-party payers., Methods: The model was structured as a 12-month decision tree leading to a Markov model that simulated the follow-up treatment outcomes and costs with time horizons of 8, 15, and 20 years. Comparators were standard-of-care AADs. Clinical parameters captured normal sinus rhythm, AF, stroke, post-stroke, intracranial hemorrhage (ICH), gastrointestinal bleeding, post-ICH, and death. The risk of operative death, procedural complications, and adverse drug toxicity were also considered. The model output was quality-adjusted life-years (QALYs) and incremental cost per QALY gained., Results: RFCA incurred more costs than the AADs but resulted in more QALYs gained than did AADs. The incremental cost per QALY gained with RFCA versus AADs was ¥66,764, ¥36,280, and ¥29,359 at 8, 15, and 20 years, respectively. The sensitivity analyses showed that the results were most sensitive to the changes in RFCA cost and CHADS 2 score (clinical prediction rule for assessing the risk of stroke in patients with non-rheumatic AF)., Conclusion: Compared with AADs, RFCA significantly improves clinical outcomes and QALYs among patients with paroxysmal or persistent AF. From the Chinese payer's perspective, RFCA is a cost-effective therapy over long-term horizons.

Background: Studies have demonstrated that catheter ablation of atrial fibrillation is associated with better rhythm control than drug therapy. The present study aimed to assess the clinical outcomes and health-related quality of life of ablation therapy in a real world setting., Methods: A prospective, non-randomized, single center study in a real-world clinical setting in China was conducted. Patients were followed up at 3, 6, and 9 months after baseline encounter. Propensity score matched patients receiving ablation or anti-arrhythmic drug therapy were compared. Incidence rate of atrial fibrillation recurrence and quality of life outcomes were measured and analyzed using log-rank test, multivariate logistic regression and mixed-effects linear regression respectively., Results: In this study, 151 atrial fibrillation patients treated by ablation therapy and 318 patients treated by anti-arrhythmic drugs were enrolled. During follow up, 82.0% in the ablation arm and 22.4% in the drug arm had no documented atrial fibrillation recurrence [HR for atrial fibrillation recurrence 0.07 (95%CI: 0.02-0.21, p < 0.0001)] among paroxysmal atrial fibrillation patients. The corresponding no recurrent rate were 66.7% and 18.5% [0.21 (0.05-0.95, p = 0.04)] respectively among persistent atrial fibrillation patients. Improvement in Short Form-36 physical component scores, Short Form-36 mental component scores and total Atrial Fibrillation Effect on Quality-of-life scores were 16.33 (14.05-18.61, p < 0.001), 8.10 (6.11-10.09, p < 0.001) and 18.28 (16.11-20.45, p < 0.001) respectively among paroxysmal AF patients and 6.32 (3.15-9.49, p < 0.001), 3.99 (1.82-6.16, p < 0.001) and 13.97 (10.89-17.05, p < 0.001) respectively among persistent AF patients. Improvements in total Atrial Fibrillation Effect on Quality-of-life score were also significant in ablation arm while no significant improvement of total Atrial Fibrillation Effect on Quality-of-life score in the drug arm., Conclusion: Compared with drug therapy, catheter ablation is associated with significant lower AF recurrence and improved overall quality of life., Trial Registration: The present study has been registered on clinicaltrials.gov. The ClinicalTrials.gov ID is NCT01878981 . The registration date is May 29, 2013.

Objective: To evaluate the efficacy of catheter ablation in Chinese hypertrophic cardiomyopathy (HCM) patients with atrial fibrillation (AF), and to determine the risk factors of AF recurrence., Methods: This study enrolled 40 HCM patients with AF who underwent primary AF ablation at Beijing Anzhen Hospital from June 2005 to June 2013. Ablation strategy included bilateral pulmonary vein isolation (PVI) for paroxysmal AF (n = 27) and PVI plus left atrial roof, mitral isthmus and tricuspid isthmus linear ablations for persistent AF (n = 13). AF recurrence was followed-up by means of electrocardiography or Holter monitoring. Risk factors associated with AF recurrence were determined by a Cox regression model and the predictive power was evaluated by receiver operating characteristic (ROC) curve., Results: After (34 ± 18) months follow-up, 30% (12/40) cases remained in sinus rhythm off antiarrhythmic drug, most AF recurrence (18/28, 64.3%) occurred within 1 year post ablation. Multivariate Cox regression demonstrated that left atrial dimension (LAD, HR = 1.124, 95% CI 1.051-1.202, P = 0.001) and female gender (HR = 3.304, 95% CI 1.397-7.817, P = 0.007) were independent risk factors of AF recurrence. The cut-off value of LAD at 43.5 mm predicted AF recurrence with sensitivity of 93.5% and specificity of 60.0%. Every 1 mm enlargement in LAD was associated with an increased risk of arrhythmia recurrence (HR = 1.095, 95% CI 1.031-1.163, P = 0.003)., Conclusions: AF ablation in Chinese HCM patients is safe and feasible. However, sinus rhythm maintenance rate is low at long-time follow-up. Most of the recurrent AF occurs within 1 year post AF ablation procedure. Left atrial diameter and female gender are independent risk factors of AF recurrence.

Background: Studies have demonstrated that catheter ablation of atrial fibrillation is associated with better rhythm control than drug therapy. The present study aimed to assess the clinical outcomes and health-related quality of life of ablation therapy in a real world setting.Methods: A prospective, non-randomized, single center study in a real-world clinical setting in China was conducted. Patients were followed up at 3, 6, and 9 months after baseline encounter. Propensity score matched patients receiving ablation or anti-arrhythmic drug therapy were compared. Incidence rate of atrial fibrillation recurrence and quality of life outcomes were measured and analyzed using log-rank test, multivariate logistic regression and mixed-effects linear regression respectively.Results: In this study, 151 atrial fibrillation patients treated by ablation therapy and 318 patients treated by anti-arrhythmic drugs were enrolled. During follow up, 82.0% in the ablation arm and 22.4% in the drug arm had no documented atrial fibrillation recurrence [HR for atrial fibrillation recurrence 0.07 (95%CI: 0.02-0.21, p < 0.0001)] among paroxysmal atrial fibrillation patients. The corresponding no recurrent rate were 66.7% and 18.5% [0.21 (0.05-0.95, p = 0.04)] respectively among persistent atrial fibrillation patients. Improvement in Short Form-36 physical component scores, Short Form-36 mental component scores and total Atrial Fibrillation Effect on Quality-of-life scores were 16.33 (14.05-18.61, p < 0.001), 8.10 (6.11-10.09, p < 0.001) and 18.28 (16.11-20.45, p < 0.001) respectively among paroxysmal AF patients and 6.32 (3.15-9.49, p < 0.001), 3.99 (1.82-6.16, p < 0.001) and 13.97 (10.89-17.05, p < 0.001) respectively among persistent AF patients. Improvements in total Atrial Fibrillation Effect on Quality-of-life score were also significant in ablation arm while no significant improvement of total Atrial Fibrillation Effect on Quality-of-life score in the drug arm.Conclusion: Compared with drug therapy, catheter ablation is associated with significant lower AF recurrence and improved overall quality of life.Trial Registration: The present study has been registered on clinicaltrials.gov. The ClinicalTrials.gov ID is NCT01878981 . The registration date is May 29, 2013. [ABSTRACT FROM AUTHOR]